NASHVILLE, Tenn. (WKRN) — One pill can be much more deadly than it used to be, and the impact is becoming apparent to officials as the death toll among adolescents continues to climb.

The recent death of a Nashville girl who was not even two years old yet is among the “alarming” trend of adolescents dying from drug overdoses, with one common culprit: fentanyl.

According to the latest nationwide data from the Centers for Disease Control and Prevention (CDC), overdose deaths among adolescents ages 10 to 19 increased 109% from 2019 to 2021, while adolescent deaths involving illicit fentanyl increased 182%.

While still a small portion of overall overdoses, the data has been striking to Tommy Farmer, the director of the Tennessee Dangerous Drugs Task Force, who said typically drug overdoses are seen trending up in the 18 to 23 or 26 to 39 age groups, not among younger children.

“That is not generally seen because at younger adolescent ages you may see experimental drug use, but that may tend to be more restricted to something like alcohol, or first-time marijuana,” Farmer said. “It’s generally not going into something like this, strong opioids.”

Law enforcement only represents a portion of first responders dispatched to overdose calls and organizations recording data. However, preliminary data collected by the Tennessee Bureau of Investigation (TBI) mirrors national statistics, capturing a “good comparative figure,” Farmer said.

Overall, nonfatal overdoses among children 17 years old and under increased about 163% from 2020 to 2022 in Tennessee.

When law enforcement is dispatched to the scene and equipped with Narcan, Farmer said that saves the person’s life “better than 78% of the time.”

Fatal overdoses among adolescents increased 100% just from 2021 to 2022, with two reported in 2020, three in 2021 and six in 2022, according to TBI data.

“Not only are we seeing trending increases to fatal overdoses and nonfatal overdoses at younger age groups, but we’re also seeing the suicide rates that are also increasing,” Farmer said. “There are a number of trends that I think we’re taking a look at right now.”

‘Fentanyl is in everything now’

The reason why kids are overdosing at higher rates is more complex than a single answer. Tabatha Curtis, the statewide coordinator for the Tennessee Alliance for Drug Endangered Children, points to societal changes and the increased accessibility of more potent drugs.

“Kids experiment with alcohol or they experiment with marijuana,” Curtis said. “They don’t have an option in 2023 or 2022 of just experimenting with a drug because one pill could kill. Using this one substance not knowing whether it’s something from a parent’s medicine cabinet or where they may have gotten that drug off the street.”

Fentanyl is a synthetic opioid that is 50 to 100 times stronger than morphine. It was originally derived for use as a pain management treatment for cancer patients, according to the Drug Enforcement Administration (DEA).

However, because of its powerful opioid properties, fentanyl has been diverted for abuse, being added to drugs like heroin, cocaine or other opioids in the form of fake prescription pills.

Counterfeit pills were present in nearly 25% of adolescent deaths in the U.S. in recent years, according to the CDC.

“Fentanyl is in everything now,” Farmer said. “We’re seeing those from the crime lab, the number of heroin seizures, even considering looking for heroin, your greater struggle is going to be finding heroin that doesn’t have fentanyl in it, or even finding cocaine that doesn’t have fentanyl.”

Many users believe they are purchasing one drug, when actually it is laced with a large amount of fentanyl— often resulting in an accidental death. Farmer said the amount of fentanyl in one pill can vary widely due to the process by which drug dealers manufacture counterfeit pills.

To the casual eye, it can be extremely difficult to tell counterfeit and legitimate oxycodone pills apart.

At the TBI’s crime lab, Farmer said the majority of oxycodone pills tested are fake.

“You’ve got to remember when you’re talking about teens, these are developing systems, and generally they’re going to be opioid naïve,” Farmer said. “They’re not going to have a tolerance for these very strong drugs.”

It only takes a small amount of fentanyl to be deadly, with about 2 mg considered a lethal dose. According to the DEA, a recent study found 42% of pills tested for fentanyl contained at least 2 mg of the highly potent drug.

“I can take something the size of a sugar pack and have more potency than a pound of heroin, that’s pretty earth shattering,” Farmer said.

While the Metro Public Health Department could not provide data specifically on adolescent overdoses, in 2022, fentanyl was detected in 79% of overdose-related toxicology reports and has been a main driver in increased drug overdoses in Davidson County.

Officials say kids are using stronger drugs at an earlier age

Curtis, who has been working in substance abuse prevention for years, said the increased potency of drugs has been accompanied by an earlier onset of drug use.

“We talk about teenage use, but from my experience in working with our drug endangered children response communities and hearing from them, the age of onset now, they’re getting 9, 10-year-olds in juvenile court who are experimenting or using substances in some form or fashion,” she said.

Over the past decade, Curtis said substance abuse coalitions aimed at preventing drug usage among adolescents have had to shift their focus from tobacco, alcohol and marijuana to stronger drugs like opioids.

Not only has there been a societal shift where usage of those types of drugs has become more common, but Curtis and Farmer agreed part of the problem is kids are being targeted online, and it’s never been easier for them to access drugs.

“From tobacco to drug dealers, sure they’re going to target children. What we call someone suffering from addiction, they consider them a very loyal customer,” Farmer said. “You get them earlier, you get them addicted. That play book has already been played and it has continued to be, and it’s successful.”

Metro Public Health Department Program Director Sheldon Walker said he believes social media has played an “enormous role in where we’re at today with fentanyl.”

“With the age we’re in now — the touch me age is what I like to call it — you can click anything and see what’s going on. So, really with the algorithms, when it comes to social media, if you click on one thing and it gets in your algorithm, it will keep popping up,” Walker said. “It leaves an impression, especially with kids, just to try it.”

Farmer said kids are also using social media to discretely purchase drugs, which can be delivered directly to their homes. According to the DEA, emojis used to symbolize drugs have become so prevalent, prosecutors are now using them in their affidavits as known drug language.

“Sometimes we feel like we’re swimming upstream. There’s so much of it coming in,” Farmer said. “It even makes it that much harder when you’ve got something that can be delivered to the house in small quantities that are not suspicious via the mail.”

In addition to increased access, kids are potentially becoming more vulnerable to overdosing because of a rise in mental health issues, which can often be linked to substance abuse.

According to the CDC, about 41% of kids who died of overdoses in recent years had evidence of mental health conditions or treatment. Curtis said many juveniles are now being referred to mental health services.

“Just with mental illness in general, being depressed, not having any hope, it all ties into people trying different things and basically not being in love with themselves because they feel like life doesn’t matter,” Walker said. “So, what do you do? You try to suppress your feelings and emotions.”

How family, friends can help prevent overdoses

A history of addiction in their family can also have a “tremendous impact” on kids, which Farmer said makes them much more susceptible to substance abuse, even when using legal substances like pain medication.

Curtis said its important parents and other family members keep an open dialogue with their children, also watching for signs of depression or other changes in behavior such as lower performance in school or a sudden change in friends or appearance.

“Sometimes we have to have those hard conversations with our family members or our friends,” Curtis said. “But I can assure you any parent that has a child who is experiencing substance use disorders or if their child is experimenting, they would much rather have someone come to them and have those hard conversations than come to them when they’re standing before a casket.” 

Farmer said parents should also be monitoring their kid’s internet usage, whether that means limiting their access to devices or putting parental controls on those devices. Walker added that constant awareness is vital.

“The way we do it here at the health department is education,” Walker said. “What does education look like? It looks like being aware of exactly what this drug does to you, how accessible it is, and when they want to get help, making sure they have the necessary resources.”

The Metro Public Health Department is trying to get ahead of the epidemic by creating coalitions to see how they can best help different communities seeing large amounts of overdoses.

Anyone who would like to give their input or learn more is encouraged to reach out to Walker at sheldon.walker@nashville.gov.

“Hope is available. Help is available,” Walker said. “We just have to do a better job — and when I say we, Nashville, Tennessee, everybody collectively — of making sure that everybody has the resources right next to them, in their phone, if they encounter somebody that is having issues, that they know directly where to go.”

If you suspect a child is drug-endangered, contact 1-877-866-6384, or to report suspected child abuse and neglect, contact the Tennessee Department of Children’s Services at 1-877-237-0004. In case of an emergency or life-threatening situation, call 911.