A new study in The American Journal of Drug and Alcohol Abuse by NDEWS Co-Directors Drs. Palamar and Cottler, along with NDEWS colleague, Dr. Black, analyzed 3,009 nonfatal fentanyl exposures among U.S. children and adolescents (ages 0–19) reported to poison centers from 2015 to 2023. Cases increased 1,194.2% overall, with a 924.3% rise among children (0–12) and a 1,506.3% rise among teens (13–19). Among children, 81.7% of exposures were unintentional, primarily through ingestion (76.9%), while 65.7% of teen cases involved misuse or abuse, with 54.1% ingesting fentanyl and 33.8% inhaling it. Over 41% of exposures resulted in life-threatening effects, and ingestion-related exposures rose from 44.1% in 2015 to 67.9% in 2023. With fentanyl-laced counterfeit pills now comprising nearly half of seized fentanyl, the authors stress the urgent need for prevention, harm reduction, and expanded naloxone access, particularly for youth.

Read the latest NDEWS-related publication here.

Media coverage:
- Major increase in nonfatal fentanyl exposure among U.S. children over the past decade, study finds - CBS News
- Alarming rise in fentanyl poisoning among US children revealed - Newsweek
- News flash: Increased numbers of children poisoned by fentanyl - Psychology Today
- More Children Accidentally Poisoned By Fentanyl - US News & World Report

According to the recently published paper by NDEWS Co-Directors Drs. Palamar and Cottler, there has been a 1,194.2% increase in nonfatal pediatric fentanyl exposures reported to poison centers, rising from just 69 cases in 2015 to 893 in 2023.Since the paper's data covers 2015-2023, we wanted to see if recent EMS data mirrored such trends in the US nationally across all ages.

In this week’s report, NDEWS highlights observations from biospatial.io detailing the monthly trends in EMS encounters in the US for nonfatal fentanyl-related overdoses from 2023 to 2025. During this timeframe, 147,282 EMS encounters in response to nonfatal fentanyl-related overdoses occurred. 

The data in the report shows that between January 2023 to June 2023, EMS encounters for nonfatal fentanyl-related overdoses significantly increased and then significantly decreased through February 2025.

To view the entire Special Report from our Weekly Briefing, click here.

Click here to learn more about NDEWS Hotspot Alerts

Search Methodology
Two targeted searches on Reddit were conducted to analyze discussions about nonfatal pediatric fentanyl exposure.

Youth and Fentanyl Search: Identified posts mentioning fentanyl in connection with young people by searching for terms related to children, teens, students, schools, and family relationships alongside fentanyl references.

Fentanyl Poisoning Search: Collected posts discussing fentanyl poisonings by searching for mentions of overdoses, accidental exposures, medical interventions (like Narcan), and contaminated substances. Only posts that mentioned poisonings in conjunction with discussions about youth were considered for the discussion write-up.

This approach allowed for systematic identification of relevant content while capturing the intersection between youth involvement and poisoning incidents.

What is Pediatric Fentanyl Exposure? Pediatric fentanyl poisoning refers to toxic exposure to fentanyl among children, adolescents, and young adults under 19 years of age. These exposures can occur through various pathways: intentional misuse, unintentional exposure (particularly in younger children), or consumption of counterfeit medications.

What was found? According to the recently published paper by NDEWS Co-Directors Drs. Palamar and Cottler, there has been a 1,194.2% increase in nonfatal pediatric fentanyl exposures reported to poison centers, rising from just 69 cases in 2015 to 893 in 2023. Although the paper's data were from 2015 to 2023, we wanted to see more recent discussion on Reddit. Our analysis of Reddit discussions indicates a decrease in mentions combining terms related to "fentanyl" with terms related to adolescents or poisoning over the past few months.

How is it being discussed? Reddit discussions on youth fentanyl exposure highlight two main pathways: adolescents through counterfeit prescription pills (especially "M30s") and contaminated recreational substances (MDMA, cocaine, cannabis), and younger children through environmental exposure in homes where adults ingest substances. Comments emphasize that adolescents typically lack experience in recognizing overdose signs, and doses that might not severely affect opioid-tolerant adults can be fatal for youth.

Reddit users who claim to be parents express concerns about accidental exposures. Discussions frequently mention harm reduction strategies for youth including fentanyl test strips and naloxone availability. The educational impact of exposure (disrupted academics, abandoned goals) and family trauma resulting from overdose incidents are recurring themes in these conversations.

Click here to read more about NDEWS Online Monitoring.

Submit any information concerning decreases in nonfatal fentanyl-related overdoses in your area here.

Is there any other information NDEWS should know about related to substance use, overdoses (fatal or nonfatal) or other drug-related trends in your area, including trends associated with polysubstance or co-use. Share it via our submission form here!

The latest issue of Substance Use Trends in Canada from the Canadian Community Epidemiology Network on Drug Use (CCENDU) highlights the growing presence of fentanyl analogues in Canada’s drug supply. In Ontario, analogues appeared in 77% of fentanyl samples, while Quebec reported them in 65% of opioid-related deaths. Alberta found carfentanil in 14% of Edmonton overdoses, and B.C. detected more fluorofentanyl than fentanyl in late 2024. 

Read the latest CCENDU's newsletter here.

To read more about CCENDU alerts and bulletins, click here

A recent Cayman Chemical report by Bassman et al. explores how the body processes Δ10-THC, a lesser-known THC variant found in some cannabis products. Using human liver enzymes, researchers identified key breakdown products, including 11-hydroxy-Δ10-THC, which is similar to the active form of traditional THC. Several liver enzymes, especially CYP2C9 and CYP3A4, play a major role in this process. As Δ10-THC appears in more vape and edible products, understanding its metabolism is essential for drug testing and public health monitoring.

Read more here.

Additionally,  see the newest version of Cayman Chemical's free GC-MS spectral database here, the latest update includes 42 new compounds, totaling 2,625 compounds in their searchable GC-MS spectral database

A Vancouver Sun media article highlights the widespread presence of BTMPS, a toxic industrial chemical, in U.S. fentanyl supplies, while Canadian authorities have not detected it domestically. The DEA first identified BTMPS in Phoenix in June 2024, and it has since spread nationwide, likely due to Sinaloa cartel production errors. A UCLA-led JAMA study found BTMPS in fentanyl across multiple U.S. locations, raising concerns about cardiotoxicity and sudden death risks. 

Read more here.

See previous NDEWS issues for more information about BTMPS:
Issue 219 | Issue 217

An NPR article reports that U.S. fentanyl-related overdose deaths have dropped by 30.6% in the past year, with declines in all 50 states. A University of North Carolina analysis found deaths began decreasing earlier than previously believed, suggesting a sustained trend. Factors contributing to this decline include increased naloxone access, more people smoking fentanyl instead of injecting, and lower fentanyl potency. However, experts warn that street drugs remain dangerous, with xylazine and medetomidine causing severe health complications.

Read more here.

📅 Date: Thursday, March 20, 2025

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📅 Date: Thursday, April 10, 2025

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📅 Dates: May 29 - May 30, 2025

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

     • NDEWS Hotspot Alerts using substance-related EMS data
     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
     • Previous issues of the NDEWS Weekly Briefings

The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (PI: Cottler, Co-Is: Goldberger, Nixon, Striley), New York University (Deputy Director: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.