Despite declines in adolescent illicit drug use, overdose deaths continue to rise due to fentanyl

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Fentanyl overdoses in Cobb County have been in the news periodically for more than a year. In August of 2022, a county news release stated that Cobb had seen a spike in ODs from that synthetic opioid, particularly in zip code 30127, which includes Powder Springs, the southern portion of west Cobb, and part of southeast Paulding County.

At a town hall organized by Cobb District Attorney Flynn Broady last month, Kevin Baldwin, a senior researcher at Applied Research Service said that as little as two milligrams of fentanyl, the equivalent of four or five grains of salt, can kill someone.

“Fentanyl is now being used to adulterate practically every other drug of abuse,” Baldwin said.

The good news though, according to a press release issued Wednesday by the National Institutes of Health, is that reported drug use among adolescents continued to hold below pre-pandemic levels in 2023.

The press release stated:

The percentage of adolescents reporting they used any illicit substances in 2023 continued to hold steady below the pre-pandemic levels reported in 2020, with 10.9% of eighth graders, 19.8% of 10th graders, and 31.2% of 12th graders reporting any illicit drug use in the past year, according to the latest results(link is external) from the Monitoring the Future survey(link is external).

The press release went on to contrast that with the number of deaths which have risen:

The 2023 data continue to document stable or declining trends in the use of illicit drugs among young people over many years. However, importantly, other research has reported a dramatic rise in overdose deaths among teens between 2010 to 2021(link is external), which remained elevated well into 2022 according to a NIDA analysis of CDC and Census data. This increase is largely attributed to illicit fentanyl, a potent synthetic drug, contaminating the supply of counterfeit pills made to resemble prescription medications. Taken together, these data suggest that while drug use is not becoming more common among young people, it is becoming more dangerous.

What is fentanyl and why is it so dangerous?

According to an article by medical toxicologist Kavita Babu entitled “What is fentanyl and why is it behind the deadly surge in US drug overdoses? A medical toxicologist explains” first published in The Conversation and later republished in the Cobb County Courier:

Fentanyl is a synthetic opioid that was originally developed as an analgesic – or painkiller – for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency.

For example, carfentanil, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, acetylfentanyl, is approximately three times less potent than fentanyl, but has still led to clusters of overdoses in several states.

The reason it is so dangerous is that it’s become the dominant adulterant for illicit drugs, and because it’s 50 times more powerful on average than heroin, a small miscalculation is dosage can make the drug deadly.