Teens and young adults experimenting with drugs is not a new phenomenon or concern. However, because of the growing prominence of fentanyl-laced drugs and fake prescription pills, the chances of a fatal overdose have reached an all-time high. Now, one pill, one dose, one experiment is enough to be their last. One pill can kill.

Fentanyl’s Fatality

Fentanyl is a highly addictive synthetic opioid 50 times more potent than heroin and 100 times more potent than morphine. When prescribed and given under careful medical supervision, it is used to treat pain. Because of its high potency, however, it is being added to many “street drugs” such as heroin, meth, and cocaine to increase their effects.

Fentanyl is powerful and its use can cause confusion, drowsiness, dizziness, nausea, vomiting, changes in pupil size, cold and clammy skin, coma, and respiratory failure, leading to death. Two milligrams of fentanyl – small enough to fit on the tip of a pencil – is a fatal dose. 

Fentanyl is particularly dangerous for someone with a low tolerance to opioids. Because of this, any drug that is at risk for containing fentanyl (i.e., was not obtained through a legitimate, personal prescription from a medical professional), can be lethal.

Fentanyl-laced fake prescription pills are also a growing concern for this reason. According to the Drug Enforcement Administration (DEA), criminal drug networks are mass producing fake prescription pills containing fentanyl that are made to look nearly identical to real prescriptions, including oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), alprazolam (Xanax), and stimulants like amphetamines (Adderall, Ritalin).

Fentanyl-laced drugs and fake pills are not restricted to one geographical area, nor do they discriminate between rural, urban, and suburban areas – fentanyl is a growing danger everywhere. In 2021, the DEA seized more than 20.4 million fake prescription pills. In 2022, in just over three months, they seized 10.2 million fake pills throughout all 50 states. 

Although there are slight visual differences between manufactured and legitimate pills, there is no way to know if a drug or pill has been laced with fentanyl without testing them. Many users are not aware they are using fentanyl and may not be until it’s too late. According to the Centers for Disease Control and Prevention (CDC), between January 2021 and January 2022, 107,375 Americans died by drug overdose and drug poisoning, with 67% involving synthetic opioids like fentanyl.

The New Landscape of Drug Experimentation

For previous generations, experimenting with drugs was a gradual process. Substances were generally less accessible and less potent compared to today’s drug landscape, leaving individuals with more time between doses to reflect and decide whether to stop or continue using, or even try something stronger.

However, the growing prominence of undetectable fentanyl-laced drugs has stripped many teens and young adults of this reflection time. While some fentanyl-involved overdoses occur due to already potent street drugs being laced, some are caused by fake prescription pills – pills that teens may have taken believing they were legitimate and would have their intended effect.

Most misused prescription drugs fall under three categories: opioids (medications used to relieve pain), depressants (medications that slow brain activity, relieve anxiety, or help someone sleep), and stimulants (medications that increase attention and alertness). According to the CDC’s 2015 Youth Risk Behavior Survey, 16.8% of high school students took a prescription drug without a doctor’s prescription one or more times during their life.

Teens seeking out prescription drugs may intend to use them to get high or maintain an addiction. However, as the National Institute on Drug Abuse points out, teens are also seeking out drugs to help relieve pain or even to get better grades, taking stimulants to study for a stressful exam or staying up to write a paper.

Stimulants like Adderall have become increasingly popular among students to help power through all-nighters or important test periods. As a result, teens don’t necessarily seek out their own long-term prescriptions to help with daily performance, but rather find a friend with a prescription (or an easy hookup) to provide a few pills to get them through finals.

Not only has the potency of drugs changed throughout generations, but the methods and ease of selling and distributing drugs have, too. Social media and the ever-changing apps teens and young adults use are a prime platform for drug dealers, whether they are traffickers marketing “prescription pills” to area sellers or your child’s well-intentioned friend trying to make a quick buck on stressed students looking for stimulants.

Illegitimate online pharmacies have grown increasingly popular as a method for drug traffickers to sell “prescription drugs” without the need for a prescription or doctor’s approval. However, even more steadily popular is the use of social media to sell drugs, especially between young adults (who may not know their supply is laced with fentanyl) and their friends or acquaintances.

The 2016 National Survey on Drug Use and Health found that, of the 11.5 million people 12 years and older surveyed who had misused prescription pain relievers, 40.4% got them from a friend or relative for free. Only 6% of respondents bought pain relievers from a drug dealer or stranger.

YouTube, Instagram, and Snapchat are the most popular online platforms among teens according to the 2018 Teens, Social Media & Technology Overview. Snapchat is an especially concerning platform as messages and pictures between users disappear after a time limit established by the user.

For example, someone may post a story (visible to all their followers) advertising a picture of a drug with its available doses and price. Interested buyers can reply with a message requesting to purchase and determining pickup and payment details. Then, all the evidence scrubs itself, as individual messages have a limit of 10 seconds to view before auto-deleting, and whole conversations between users auto-delete after 24 hours.

What Parents Need to Know About Opioids and Fentanyl

Warning signs of possible drug use, in general, include bloodshot eyes, pinpoint pupils, constant scratching, and burns on fingers or lips from smoking. Problems at school may also be an indication of drug use, including poor academic performance, missing classes or skipping school, decreased interest in school or extracurricular activities, and complaints from teachers or classmates.

Changes in behavior can be especially indicative of drug use, including changing friends or social circles, isolation from family or friends, excessive demand for privacy, lack of respect for authority, and money issues. Suddenly requesting money without good reason, stealing money from the home, and stealing valuable objects to sell for cash are all also warning signs of potential drug use.

In addition to checking credit card and bank statements for suspicious purchases that may indicate online drug purchases (such as through an illegal online “pharmacy”), parents should also familiarize themselves with the sites and apps children use, what happens on there, and how teens talk to each other.

Unfortunately, some sensational myths about fentanyl frequently circulate, distracting from the very real dangers it possesses and, in some cases, adding to the crisis. Incidental exposure to fentanyl, such as casual tactile and respiratory contact with its powder form, has been reported to cause shortness of breath, heart palpitations, and fainting, as is shown in many now-viral videos of police officers collapsing after being in casual contact with the drug.

However, an analysis of this misinformation and similar reports points out that not only are these symptoms not consistent with opioid toxicity, but the spread of these myths may delay intervention for true overdoses. For example, first responders addressing a fentanyl overdose may be hesitant to act, believing that casual contact with the user could harm or kill them.

There is also a myth perpetuated annually that children’s Halloween candy may contain fun, rainbow-colored, or character-featuring drugs to promote addiction among younger demographics. Manufactured, fentanyl-laced drugs are a real and serious issue; however, these drugs are being marketed and sold for a profit, not distributed for free among children’s candy. 

Checking children’s Halloween candy to ensure wrappers have not been tampered with is always recommended, but considering this the main distribution of fentanyl and other dangerous drugs distracts from the actual threats that are present.

It’s important to have transparent conversations with teens and young adults about the dangers of fentanyl. Though abstinence from drugs is undeniably preferable, it is also unrealistic. Parents are encouraged to have transparent conversations with their children about the risks of fentanyl and drugs that could be unknowingly laced with fentanyl, and what to do in case of trouble.

The DEA recommends that parents:

  • Encourage open and honest communication about drug experimentation.
  • Explain what fentanyl is and why it is dangerous.
  • Stress not to take any pills that were not prescribed by a doctor.
  • Underscore that no pill purchased on social media is safe.
  • Ensure children know that fentanyl has been found in most illegal (“street”) drugs, as well as fake prescription pills, and what fake pills look like.
  • Create an “exit plan” to help children know what to do if they are pressured to take a pill or use drugs.

Additionally, parents should know how to recognize the signs of an overdose and what to do in the event of one. Signs of an opioid overdose include:

  • Small, constricted, pinpoint pupils.
  • Falling asleep or losing consciousness.
  •  Slow, weak, or no breathing.
  • Choking or gurgling sounds.
  • Limp body.
  • Cold and clammy skin.
  • Discolored skin (especially in lips and nails).

It can be difficult to determine whether a person is high or experiencing an overdose. If you aren’t sure, treat it like an overdose, as this could save a life:

  • Call 911 immediately. Most states have laws that may protect a person who is overdosing or the person who called for help from legal trouble.
  • Administer naloxone, if available. Naloxone is a medication that can reverse the effects of opioid overdose and save lives. It is available in all 50 states and can be purchased from a local pharmacy without a prescription in most states.
  • Try to keep the person awake and breathing.
  • Lay the person on their side to prevent choking.
  • Stay with the person until emergency assistance arrives.

Learn more about how one pill can kill and the steps being taken to stop opioid misuse in Missouri.

For additional information on this topic:

accessHealth News – Fentanyl Test Strips are an Important Harm Reduction Tool

accessHealth News – Harm Reduction Strategies and Resources are Crucial in Preventing Fentanyl Overdoses

accessHealth News – New Narcan Vending Machine Combats Opioid Crisis in Butler County

CDC – Fentanyl Facts

DEA – One Pill Can Kill

DEA – Fentanyl Awareness

DEA – What Every Parent and Caregiver Needs to Know about Fake Pills

DEA – Prescription for Disaster: How Teens Misuse Medicine

Time2Act – Stop Opioid Use in Missouri