Addressing the Appeal and Accessibility of Fentanyl Among Adolescents Through Harm Reduction Approaches

Imagine getting the phone call that everyone dreads, a loved one has passed away. For parents, such news is a nightmare, especially when the cause is fentanyl poisoning. At that moment, any parent is likely to feel extreme confusion coupled with crippling worry and grief. The truth is, no parent should outlive their children or lose a child to drug poisoning or overdose. With an increase in fentanyl-related deaths among adolescents in recent years, questions about its appeal and accessibility is warranted.

Understanding Fentanyl

Throughout the years, fentanyl has been utilized in medical settings to address severe pain, such as pain caused by cancer (NIDA, 2021). In its therapeutic form, fentanyl is 50 to 100 times more potent than morphine, but unlike morphine, when prescribed, it tends to be given as a patch, shot, or lozenge (Han et al., 2019). In its illegal form, fentanyl is available in pill and powder forms but can also be put in eye droppers, nose sprays, and dropped onto blotted paper (Ramos-Matos et al., 2023). With all these options, fentanyl has become a major concern, especially for adolescents. In fact, fentanyl has accounted for a significant portion of adolescent opioid deaths in recent years (Peavy & Banta-Green, 2021).

Factors Driving Adolescent’s Attraction to Fentanyl

The allure of fentanyl among adolescents lies in its analgesic properties and perceived benefits. It may be that adolescents do not have the capacity to anticipate the possibility of fentanyl poisoning and underestimate its effects (Cook-Santher et al., 2021). However, other research suggests that many adolescents who use fentanyl and experience adverse effects do so accidentally. This is because many of the drugs that adolescents take illegally can unknowingly be laced with or contain fentanyl (Fischer, 2022). This was the case for three adolescents, Griffin Hoffmann (Portland, OR), Sienna Vaughn (Plano, TX), and Laird Ramirez (North Carolina). All three teens had purchased what they thought were prescription pain pills from friends or using the internet, but the pills turned out to be counterfeit and had been laced with fentanyl (Nadworny & Gaines, 2023). All three had been involved in sports and had bright futures ahead of them. In search of pain remedies and relaxation, these teens lost their lives; their stories are a few of many fentanyl poisonings across the nation.

The Urgent Need for Harm Reduction

With adolescents increasingly accessing opioids like fentanyl, urgent action is imperative. Adopting harm reduction approaches has emerged as a promising solution. Research has shown that harm reduction strategies can be effective in preventing overdose and poisoning, including those that occur among adolescents (Volkow, 2021). This is because they aim to reduce negative consequences for adolescents who use substances (Kimmell et al., 2021). Research indicates that such strategies effectively prevent overdoses and poisoning, especially among adolescents who may be reluctant to seek help due to stigma and fear of repercussions (Leitz et al., 2023). According to Kimmell et al. (2022), implementing harm reduction strategies in locations frequented by adolescents can be impactful. In addition, including harm reduction strategies within the classroom can be helpful for younger students (Fischer, 2022).

Implementing Diverse Harm Reduction Strategies

Harm reduction strategies must be implemented in various settings frequented by adolescents, such as community pharmacies, festivals, concerts, and educational institutions (SAMHSA, 2023). These strategies can vary depending on population needs and should aim to meet substance users where they are. By incorporating various methods, including abstinence (which has been associated with stigma), harm reduction can help to manage use and address associated conditions (Cook-Santher et al., 2021). Other unconventional strategies have included peer-led naloxone training, using the drug slowly and in less quantity to identify the level of tolerance, paying attention to the body’s responses (heart rate, etc.), using testing strips to identify the presence of fentanyl, and avoiding injecting any drug (Kimmell et al., 2022). These approaches offer practical solutions to mitigate harm and prevent tragedies.

The Importance of Open Dialogue

For many, talking about fentanyl use can be uncomfortable and challenging. It may seem easier to avoid the issue altogether, but current numbers tell us otherwise. If we do not take immediate action and become open to having hard conversations as well as providing vital education to our children, there may be no end in sight to our present fentanyl (and opioid) crisis. By employing harm reduction strategies that address the appeal and accessibility of fentanyl, we could potentially prevent many parents from receiving devastating phone calls.

‍‍**Please note: This post is for educational purposes only. This post does not constitute medical advice and is not intended as a substitute for professional medical advice, diagnosis, or treatment, and readers are advised to consult with a qualified healthcare professional for any medical concerns or conditions. The views expressed may not reflect those of all healthcare professionals

References

Cook-Sather, S., Urban, E., Romano, V., & Romano, M. (2021). When fentanyl finds an outlier: Talking with teenagers about the danger. Pediatrics, 148(4). When Fentanyl Finds an Outlier: Talking With Teenagers About the Danger | Pediatrics | American Academy of Pediatrics (aap.org)

Fischer, N.R. (2022). School based harm reduction with adolescents: A pilot study. Substance Abuse Treatment, Prevention and Policy, 17(79). School-based harm reduction with adolescents: a pilot study | Substance Abuse Treatment, Prevention, and Policy | Full Text (biomedcentral.com)

Han, Y., Yan, W., Zheng, Y., Khan, M. Z., Yuan, K., & Lu, L. (2019). The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies. Translational Psychiatry, 9(1), 282. https://doi.org/10.1038/s41398-019-0625-0

Kimmel, S. D., Gaeta, J. M., Hadland, S. E., Hallett, E., & Marshall, B. D. L. (2021). Principles of harm reduction for young people who use drugs. Pediatrics, 147(Suppl 2), S240–S248. https://doi.org/10.1542/peds.2020-023523G

Leitz, S. J., Bagley, S. M., Cook, A. J., Jones, C., Lawrence, D., & Pearce, P. (2023). Strategies to reduce harm: An expert panel discussion on the fentanyl crisis. The Permanente Journal, 27(1), 3–15. https://doi.org/10.7812/TPP/22.176

Nadworny, E., & Gaines, L. (2023). As More Teens Overdose on Fentanyl, Schools Face A Drug Crisis Unlike Any Other. As teen fentanyl deaths rise, schools grapple with their role : NPR

NIDA. (2021). What is Fentanyl? Fentanyl DrugFacts | National Institute on Drug Abuse (NIDA) (nih.gov)

Peavy, K.M., & Banta-Green, C. (2021). Understanding and Supporting Adolescents with an Opioid Use Disorder. Seattle, WA: Addictions, Drug & Alcohol Institute, University of Washington. http://adai.uw.edu/pubs/pdf/2021AdolescentsOUD.pdf

Ramos-Matos,C.F., Bistas,K.G., & Lopez-Ojeda,W.(2023). Fentanyl. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459275/

SAMHSA. (2023). Harm Reduction. Harm Reduction | SAMHSA

Volkow N. D. (2021). The epidemic of fentanyl misuse and overdoses: challenges and strategies. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 20(2), 195–196. https://doi.org/10.1002/wps.20846