Within 30 blocks of his home in Seattle’s Ballard neighborhood, substance use disorder counselor Johnny Ohta knows at least 25 teens and young adults addicted to little blue pills.
Youths might think the drugs, stamped with “M” and “30” to resemble oxycodone pills, look innocent enough. But they’re counterfeit — laced with the synthetic opioid fentanyl, a drug approximately 100 times as powerful as other opioids and one linked to an alarming rise in overdose deaths.
At the same time, Ohta has seen a hopeful shift in youths’ approach to other substances like tobacco and marijuana; smoking tobacco is taboo in many younger circles, he said, and the novelty of using marijuana tempered after recreational use became legal in 2012.
Two new pieces of research now help confirm the duality Ohta and many others are witnessing locally: Overall, teen drug use has dropped to a relative historic low, according to the state’s latest Healthy Youth Survey and national data. But the drug supply is becoming more dangerous. And teen overdose deaths, which have been flat for the last decade, are now increasing rapidly, suggests a national study published Tuesday in The Journal of the American Medical Association.
“Both things are happening at once,” said Ohta, who works for youth treatment center Ryther and has worked with youths for more than 25 years. “Something is happening with young people and drug use that is positive, and I think it’s extremely important to highlight. … And then you have another thing going on that’s severely detrimental and causing death and harm to a lot of young people and families.”
Teen overdose deaths nationally remained stable from 2010 to 2019, but suddenly doubled from 2019 to 2020 — and increased by another 20% the following year, according to the new JAMA study. Simultaneously, teenagers’ recent use of any drugs dropped significantly for the first time in a decade from about 18% in 2020 to about 11% in 2021. Although Washington data on youth fentanyl use isn’t available, the new JAMA study helps fill in details about trends over which Ohta and others on the ground have been sounding an alarm.
The study includes Centers for Disease Control and Prevention data on overdose deaths among 14-to-18-year-olds. In addition to the overall increase, it found that Native, Latino and Hispanic youths are overdosing at higher rates than their peers.
The findings linked to Latino and Hispanic teens are somewhat surprising, says Joseph Friedman, lead researcher on the JAMA study and a substance use researcher at the University of California, Los Angeles. Adults in this demographic group tend to have lower overdose death rates relative to other adults.
The finding might be partially explained by the prevalence of fentanyl pills on the West Coast compared to other regions, he said, and the fact that Western states have a higher proportion of Latino and Hispanic youths than many other corners of the U.S.
The West Coast is the “epicenter of this,” Friedman said: The youth overdose death rate here is 1.68 times the national average.
“The game-changer”
Overdose deaths among the general population have been on the rise for the past decade. But until now, young people were largely insulated from any increase. The new jump in overdose deaths among youths is particularly worrisome, and the relative increase among those ages 14-18 is now the highest of any age group, Friedman said. The data fit with December findings suggesting the rate of fentanyl and other synthetic opioid-related overdose deaths in Washingtonians under 30 has increased dramatically since 2018.
“This is very much a historic, unprecedented shift and [is] very concerning,” Friedman said. “I’m particularly concerned because we’ve seen this with other subgroups of the population, where once overdose rates start to increase exponentially, they tend to keep increasing exponentially for a long time.”
The sudden increase in young people is likely tied to illicit fentanyl pills — called “blues” — that are flooding the drug market, Friedman said. For teenagers, he and other experts said, experimenting with a pill is an easier sell than injecting or smoking a drug on foil — methods that, culturally, seem like a deeper descent into serious drug use.
“All the images we’ve been fed are not the image of taking a pill or taking a hit off a little pill,” Ohta said. “That’s really what’s the game-changer.”
Stark decline
Young people in Washington began reporting less-frequent use of drugs like alcohol and tobacco at least a decade ago.
The Healthy Youth Survey — a statewide survey of more than 208,000 Washington students that’s published every two years or so — suggests this downward trend accelerated during the pandemic, including among youths who could be more prone to using drugs, such as those who miss school, are low-income, or are homeless or forced out of housing because of their family’s finances.
The data suggests that between 2018 and 2021, recent use of marijuana and alcohol declined from 18% to 7% and 8%, respectively, and cigarette use declined from 5% to 2%. The data refers to high school sophomores’ drug use, which researchers use as an indicator of teen drug use more generally.
“It is a pretty notable trend,” said Maayan Simckes, principal investigator for the state study and an epidemiologist at the Washington State Department of Health. “Unfortunately, with one year of data during the pandemic, we just don’t know enough yet” about what is driving the drop or whether it will persist.
In general, experts say the long-term decline in teen drug use could be explained by shifts in cultural attitudes about drugs, and personal experience or education about addiction and the opioid crisis. New state laws, such as the 2020 move that made it illegal to sell tobacco and vaping products to anyone under 21, could also play a role, Simckes said.
Pandemic-specific factors, like school closures, likely contributed to the even starker decline over the past few years.
“It’s about supply and demand — and access, in many ways, was more difficult,” during the pandemic, said Caleb Banta-Green, a principal research scientist at the University of Washington School of Medicine’s Addictions, Drug & Alcohol Institute. “Youth were in the home. They were supervised” in many households, and were cut off from typical social activities like sports, after-school clubs and parties.
State officials who oversee the survey say they’re still analyzing the data to understand what factors influenced drug use during the pandemic. But the results do suggest that over the past decade, youths’ perception of the availability of substances has declined.
Dueling trends
The Healthy Youth Survey has limitations: It doesn’t ask youths specifically about fentanyl, and it only captures the experiences of youths who are in school.
Of the youths Ohta knows who use fentanyl, “they’re not in school,” he said, so they’re not taking the survey.
Ohta has a visible presence in King County. He’s known for riding his bike across the county to deliver drug counseling services to youths who sleep outside and other teens in crisis; his commitment to his work was detailed in a 2019 profile in Crosscut. These days, he travels with a physician who can prescribe the medications suboxone or buprenorphine, which are used to treat opioid use disorder.
His lens has narrowed to a specific population: those ages 14-24 who are addicted to fentanyl. He’s witnessing a particularly troubling phenomena among these youths and young adults: They’re falling into addiction much more rapidly — within a few weeks’ or months’ time — than is typical among folks who become addicted to fentanyl.
“It’s the severity of addiction and the rapid onset that’s happening to a lot more young people that did not happen two years ago,” he said.
