How policymakers can help prevent accidental fentanyl poisonings from endangering our children 

Too often, when people think about the fentanyl and opioid crisis facing many communities, they view it strictly as a drug problem and view the victims primarily as chronic drug users. Sadly, however, this crisis in our country has shifted and now includes too many children and other innocent people. These individuals are becoming victims of accidental fentanyl poisoning, and it’s time for policymakers to adjust strategies to combat this growing issue. 

In just 10 days last month, authorities in Portland, Ore., reported fentanyl overdoses in three toddlers—two 1-year-olds and one 3-year-old. Similar reports this year involved a 1-year-old in Lexington, Ky., a 2-year-old in Baltimore, and a 2-year-old in Albuquerque.  

These senseless tragedies beg the question—how do we stop this drug from endangering our children?  

First, policymakers must understand that the rise of synthetic opioids and illicitly manufactured fentanyl is a key factor in the third wave of the ongoing opioid crisis. The first wave began in the late 1990s with a rise in prescription opioid overdose deaths, followed by a second wave from heroin overdose deaths. Synthetic opioid overdose deaths began increasing in the U.S. in 2013 and increased more than 20-fold over eight years, ultimately accounting for two-thirds of the 106,699 drug overdose deaths in the U.S. in 2021. 

Fentanyl is about 50 times more potent than heroin, and just two milligrams (about the size of the tip of a pencil) can be deadly. Illicitly manufactured fentanyl and similar compounds are produced outside of pharmaceutical settings, and small changes to the chemical structure of fentanyl can increase the drug’s potency significantly. Some modifications make fentanyl 100 times stronger and even more deadly. 

Second, policymakers should recognize that the most recent phase of the opioid epidemic involves people who are unknowingly exposed to fentanyl. This change is now causing accidental poisonings and is affecting new groups of people every day. 

Since 2021, adolescent drug overdose deaths have increased, even though drug use among that age group has declined, and 77 percent of those adolescent overdose deaths involved deadly fentanyl. Deaths from fentanyl poisonings are also being reported in adolescents without a history of drug use, treatment, or poor mental health.  

Ramifications of the COVID-19 pandemic, including social isolation, mental illness, suicidal ideation, and changes to the illicit drug market, likely contributed to this large rise. Social media also plays a significant role, and the DEA now warns of the high risk of counterfeit pills that are largely marketed to children and teenagers on apps such as Snapchat. 

The accidental ingestion of fentanyl by infants and young children exemplifies the risk to the general population. Recent research found that 40 infants and 93 children ages 1 to 4 died from accidental fentanyl poisoning in the U.S. in 2021—a nearly sixfold increase among children younger than 5 years since 2018. 

And third, lawmakers must now prioritize targeted policy solutions that reduce the supply of illicit opioids more than ever. These solutions must also increase access to life-saving efforts for victims of fentanyl poisoning.  

The initial step in combating this scourge is to permanently classify all fentanyl related substances as Schedule I substances. The DEA temporarily did this in 2018, and as a result, saw a decrease in new kinds of fentanyl analogues in the country. The HALT Fentanyl Act, which passed the U.S. House on May 25, 2023, with bipartisan support, would implement permanent scheduling.  

[An additional step is to create accountability for social media companies. The Cooper Davis Act, named after a 16-year-old Kansan who died from fentanyl poisoning from a counterfeit Percocet tablet he purchased on Snapchat, would require companies to report all illicit drug activity occurring on their platforms to law enforcement.] 

Next, lawmakers need to increase access to the life-saving opioid reversal agent naloxone. The Food and Drug Administration recently approved Narcan nasal spray for over-the-counter sale at pharmacies. The impact of this decision on cost and coverage should be closely monitored, and the agency should review all other over-the-counter naloxone drug applications quickly to create competition. Policymakers should also consider making this life-saving product readily available in high-traffic public spaces, including schools and colleges, airports, shopping malls and grocery stores. Nine in 10 voters support this policy, according to a March 2023 national survey by Scott Rasmussen.  

Nationwide education efforts are also of paramount importance. The DEA has launched the “One Pill Can Kill” campaign to educate the public on the dangers of fentanyl, especially in pills made to look like real prescription drugs. State and local efforts can reinforce this message in communities in partnership with advocacy organizations.   

Finally, co-prescribing naloxone with opioid prescriptions is a commonsense strategy to help prevent accidental fentanyl poisonings due to incorrect or inadvertent use. Twenty states already have some requirements on naloxone co-prescribing.  

These public health solutions must occur in tandem with a comprehensive plan to combat deadly fentanyl in our country, including getting tough on China, securing the border, and enacting stricter penalties. Together, we can implement an America First approach and save a generation of Americans from deadly fentanyl poisonings.  

Roger Marshall, M.D., serves the state of Kansas and practiced medicine for more than 25 years and served in the Army Reserves for seven years. He currently serves on the Senate Committee on Health, Education, Labor, and Pensions. Dr. Heidi Overton, M.D., Ph.D., serves as AFPI’s chief policy officer and director of the Center for a Healthy America. Dr. Overton previously served as a White House Fellow in the Domestic Policy Council. She is board certified in Public Health and General Preventive Medicine and obtained her Ph.D. in Clinical Investigation from the Johns Hopkins University Bloomberg School of Public Health.