The following was written by Gabriel Spitzer for Public Health Insider, the official blog of Public Health — Seattle & King County:

With the first months of school now behind us and young people more used to re-engaging with their peers, it’s a good time to have an open and honest conversation with our kids about fentanyl.

This powerful synthetic drug has changed the landscape of drug use in our region. In 2015, just three people died from a fentanyl-related overdose in King County. In 2021, that number is expected to reach 350 or more people.

Especially alarming, there has been a significant increase in overdose deaths among young people. These deaths used to be rare in King County: Between 2008-2018, an average of 4 people aged 19 or younger died each year from overdose. This year, so far, there have been 21.

WHY FENTANYL IS UNFORGIVING

The current drug supply is especially dangerous, in part because such a small amount of fentanyl can be lethal. Fentanyl is estimated to be 50 times more powerful than heroin, and even one pill or dose is enough to end a young person’s life.

Brad Finegood, King County Strategic Advisor, explained in a recent podcast how the availability of opioids in pill form has led some young people to experiment more readily with them.

“It has lowered the initial threshold for taking opioids for the first time. Previously you would have needed to smoke heroin or use a needle to use heroin, and that’s a huge threshold jump in order to get to that point with experimental use. We also know that experimentation is somewhat normal for youth, and if they feel comfortable experimenting with pills, then this becomes a really dangerous mixture,” Finegood said on the podcast Countering the Opioid Crisis: Time to Act, produced by the National Academy of Medicine and the Aspen Institute.

Add another ingredient to that mixture: Young people’s developing brains are wired to make spontaneous decisions and youth may not have enough information to assess the real risks of their behavior. And fentanyl is unforgiving.

That’s why they need love, support, and good information from parents and other trusted adults. Public Health and Department of Community and Human Services have launched a campaign called Laced and Lethal, aimed at informing kids and adults of the dangers of fentanyl-laced pills, powders, and other drugs.

Laced and Lethal includes downloadable resources for teens and a discussion guide for adults on how to talk with young people about the risks.

TALKING WITH TEENS: EXPLAIN THE REALITY

An effective conversation with youth about fentanyl will focus on listening and facts, not judgment. We know that youth want the adults in their lives to trust them with information and support them in making decisions. Simply telling kids “don’t do drugs” may cause those most at risk to just tune out.

Listen first: Ask your teen non-judgmental questions. Is fentanyl something that you’ve heard about on the news, or at school? What have you heard? Do you think the risks are exaggerated? Where do you think teens your age are likely to start using pills and why? Even if teens seem to tune you out, continue to provide non-judgmental support and frequent conversations. Research tells us that parents and supportive influential adults can and do make a difference in whether a youth will engage in at-risk behaviors.

It’s also an opportunity to provide factual information to teens. Teens need to know that fentanyl-laced drugs are widespread, and that the first dose can be deadly.

Fentanyl-laced pills look identical to pills prescribed by doctors. In King County, fentanyl is most commonly seen in blue, greenish, or pale-colored counterfeit pills, often marked as “M30.” They are often called blues, M-30s, percs (because legitimate pills with the same markings are named Percocet), or other names. The fentanyl in these drugs is often produced on the illicit market. It is not medical grade, and it is not regulated for safety.

BE CLEAR ABOUT THE RISK

An amount of fentanyl the size of two grains of salt is enough to cause a fatal overdose. It’s tasteless, odorless, and impossible to see: There’s no way to know by looking at a pill or powder whether it contains a potentially lethal amount of fentanyl.

It’s helpful for teens to know that the person selling or sharing the drugs may not even know the pills contain fentanyl. The danger is not limited to drugs bought from a stranger on the street or online. Adults should dispel the myth that drugs from “trusted sources,” including friends or known dealers, are safe. They are not. Pills and powders from any source (besides a medical provider or pharmacy) should be assumed to contain this deadly ingredient, making every dose a risk.

HELP THEM FIND NALOXONE

Tell your teens that overdose deaths are preventable. One of our most powerful, life-saving tools is naloxone, also known as Narcan. Naloxone is a medication that can reverse an opioid overdose (like fentanyl) almost immediately. It can be administered either through a nasal spray or an injection.

Young people may not know about naloxone, or, if they do, they may not carry it or know where to get it. Naloxone is widely available and legal for all ages.

• Youth and adults can confidentially order free naloxone for delivery online. Find a link to order at LacedAndLethal.com.
• Local providers such as pharmacies offer naloxone without a prescription. Find a list of providers offering free naloxone at StopOverdose.org.

Note that youth and adults who seek help for someone experiencing an overdose are legally protected from prosecution of drug possession by Washington state’s Good Samaritan law.

STRESS THE IMPORTANCE OF LOOKING OUT FOR ONE ANOTHER

The Laced and Lethal discussion guide for talking to teens suggests emphasizing the need for young people to take care of each other.

When someone is overdosing, they can’t give themselves naloxone. By carrying naloxone at all times, letting others know they have it, and accompanying friends who may be using, teens can decrease the chances of a friend dying from overdose.

OUR YOUTH NEED COMPASSION RIGHT NOW

Since the COVID-19 pandemic began, this has been an extremely challenging time for many young people. Kids and teens may be vulnerable in ways that aren’t obvious or visible.

“It’s a recipe for disaster,” Brad Finegood said on the Time to Act Podcast. “All of these impacts on top of each other, the social isolation and depression that have come with the COVID pandemic, have just wreaked havoc on our youth — in a really quiet manner, but one that’s real. And we’re really seeing it in the outcomes of overdoses.”

Finegood emphasizes that reducing stigma around drug use, including having open, non-judgmental conversations about it with our teens, is crucial to preventing more harm and more deaths. “If we can really start to change the culture of the way that we see people who have complex behavioral health conditions and may be using substances … we’ll be able to go far.”

TOOLKIT AND RESOURCES

• For more information on the risks related to fentanyl, our toolkit for community organizations provides information and campaign materials.

• CDC resources on mental health for youth during the pandemic

• Recent trends in fentanyl-related overdoses post from July