The Fentanyl Crisis in Schools: Awareness, Education Part of Prevention Efforts

school drowning in fentanyl pills

By Jaimie Seaton

Imagine if an entire classroom of students died—every single week.

It’s hard to overstate the horror. And, unfortunately, we don’t have to imagine it. An average of 22 adolescents (14 to 18 years old) died from drug overdoses in the U.S. each week in 2022. That makes drug overdoses and poisonings the third leading cause of pediatric deaths in the nation (behind gun injuries and motor vehicle accidents). And most of these deaths can be attributed to illicit fentanyl.

Fentanyl is now involved in at least 75% of adolescent overdose deaths. Worth noting is that 84% of these deaths are categorized as unintentional. That’s because fentanyl is often added to other illicit drugs, which makes them cheaper, more powerful, more addictive—and extremely dangerous.


Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health, characterizes the current opioid overdose crisis as the worst in U.S. history and among the gravest crises facing the nation. “Overdose rates are increasing across race/ethnicity and sex categories, and in all age groups, including among young people,” Volkow says.

While the deadly drug fueling this crisis doesn’t discriminate—it crosses all demographics and impacts every corner of this country—some regions and groups are hurting more than others. The New England Journal of Medicine found that from 2020 to 2022, Arizona, Colorado and Washington state had adolescent mortality rates nearly twice the national average, or higher.

According to NIDA, overdose death rates involving opioids like fentanyl are highest among American Indian and Alaska Native people, closely followed by non-Hispanic Black people. Between 2015 and 2021, rates of overdoses involving opioids increased fivefold among Black people and twofold among white people (in absolute numbers, white people still experience the most deaths).

The statistics are sobering, but fighting the crisis is not impossible. Across the country, school social workers, school nurses, youth counselors, government agencies and teens themselves are working to reduce the number of fentanyl-related deaths and drug use in general among children and adolescents. They’re focused on saving lives through education and prevention measures and lifesaving overdose treatment.

Know Thine Enemy

There are two types of fentanyl: pharmaceutical and illegally made. Both are a synthetic drug akin to heroin and morphine but 50 to 100 times more powerful. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery, and for advanced-stage cancer. The U.S. Drug Enforcement Administration (DEA) classifies fentanyl as a Schedule II prescription drug, meaning it has a high potential for abuse.

For more than a decade, illicit fentanyl has been mixed with drugs such as heroin, methamphetamine and cocaine to increase their potency, but it’s now become the dominant ingredient in counterfeit prescription drugs as well. It’s also found in marijuana, eye drops and nasal sprays or dropped onto paper or small candies. In recent years, fentanyl pills in various shapes and bright colors have hit the market, designed to attract younger customers.

Tragically, the majority of illicit drug users don’t even know they’re taking fentanyl—often with deadly consequences. Depending on a person’s body size, tolerance and past usage, just 2 milligrams of fentanyl (equal to 10 to 15 grains of table salt) can be lethal.

In 2021, four out of 10 fentanyl-laced fake prescription pills tested by the DEA contained a potentially lethal dose. The next year, that number rose to six out of 10. This could explain why the rate of overdose deaths rose sharply even as illicit drug use by adolescents decreased between 2020 and 2023.

“The problem with fentanyl and young people is the fact that people think they have a pill that is Xanax or an anti-anxiety medication or a prescription opioid like oxycodone or an amphetamine like Adderall, and in fact, it’s fentanyl,” says Capt. Christopher Jones, director of the Center for Substance Abuse Prevention at the Substance Abuse and Mental Health Services Administration (SAMHSA).

“One key part (of addressing the issue) is raising awareness that if somebody gives you a pill that looks like something you’ve seen from a pharmacy before, more than likely it’s not what you think. And in many cases it’s pressed fentanyl in that fake pill,” Jones says. He adds that while overdose deaths among young people have increased over the last several years, they’ve decreased among some adult populations over the same period, which reflects the toxic illicit drug supply, in particular fake pills among young people.

Changing Times

lockers full of pills

Kim Downs, LCSW, has been a social worker in schools for 26 years. She’s worked with students of all ages and is currently at Lillian Schumacher Elementary in Missouri. She’s also on the youth drug prevention committee for the school district. Downs says when she began her career in schools, fentanyl wasn’t part of the conversation.

“The conversation has definitely changed. Fentanyl has become a new conversation in the last five years. The kids that have died or been affected by [fentanyl] in this area have primarily been seeking Xanax, and the source of those has typically been Snapchat,” Downs says, adding that she’s seeing drug use in both middle and high school. She says drug use in middle school is not the norm, but it’s also not unprecedented.

Not only is fentanyl found in more illegal substances than it used to be, but fentanyl-laced drugs are increasingly marketed to kids through social media, which is also attracting younger kids.

“It’s big and something we need to talk about,” says Makeba Royall, LCSW, senior practice associate, behavioral health, at NASW. She recounts one ninth-grade boy in her area who overdosed while with some friends in the school bathroom.

The boy might be alive today if someone at the school had found them in time and administered naloxone. Though still somewhat controversial, schools, community centers and other public spaces are increasingly stocking naloxone (sold under the brand name Narcan), which can reverse a fentanyl—or other opioid—overdose if given in time; and fentanyl test strips, which are used to detect the presence of fentanyl in other drugs.

Lynn Nelson, president-elect of the National Association of School Nurses, says schools need to be thought of as part of a community. “Yes, Narcan should be in schools, absolutely, everybody should know where to grab it, but it should be everywhere in the community as well.”

Prevention Strategies

life preserver in a sea of pills

One challenge with changing teen behavior is that the brain’s frontal lobe, which controls decision-making and risk-taking, isn’t fully developed until the mid-twenties, so warnings often fall on deaf ears. As fentanyl overdoses have increased around the country, stakeholders are stepping up their prevention strategies, which have come a long way from the unsuccessful “Just Say No” campaign of the 1980s. While there are those who believe preaching abstinence is still the best approach, the prevailing wisdom is that it’s better to tackle the root causes of drug use among teens, while educating them about the severe dangers of fentanyl (and other drugs) and preparing them to stay safe.

According to SAMHSA’s Jones, there is a prevention science built on evidence-based programs, policies and practices. Focusing on the root drivers or the spectrum of risk and protective factors can drive down substance use, he says. The programs aren’t specific to a particular drug. Instead, they look at the underlying contributors, such as adverse childhood experiences and trauma.

“How are we helping kids feel supported, feel safe, make healthy decisions?” Jones asks. “And then for kids who need a higher level of support, how are we identifying those kids and how are we connecting them to those that care?”

A 2022 study found that 41% of adolescents who died of an overdose between July 2019 and December 2021 had a known mental health problem or history of receiving mental health care, while only 11% had a history of receiving substance-use treatment. However, mental health issues are not the only underlying factor.

Jones says it’s important to look at the social determinants of health and how to reduce stress in the home, which can increase the risk of substance use. He cited a recent study that found there were reduced rates of substance use and substance-use disorder among adults in the home in states with more generous supplemental nutrition assistance programs (SNAP). (When parents use opioids, there’s a greater risk of children being substance abusers.)

“To me, that’s prevention science right at work. What are we doing to support kids, and how are we also supporting families and healthy relationships? But then, how are we looking at a bigger picture as well?” Jones asks.

He says school social workers play an important role, especially in the school/community/family dynamic, to help address and uncover issues that are contributing to risk.

April Ferguson, LCSW-C, a senior practice associate at NASW with expertise on children and adolescents, says school social workers often are only called in when there’s a crisis.

“Schools don’t always know what to do with the school social worker. I think it’s not always clear that social workers can address substance use. We can provide psychoeducation, we can address recidivism, we can offer mental health services, we can do assessments,” Ferguson says, adding that she’s hearing similar sentiments from school social workers around the country. A widely held view is that schools need to address the underlying issues leading to drug use among teens, and social workers need to be part of prevention efforts.

“We’re on the back end of a problem versus we could have been in the front, coming up with solutions to avoid problems,” Ferguson says.

The Holistic Approach

broom wiping pills 2

Peter Karys, LCSW, CPP, CASAC, is the director of youth counseling and support at The Lesbian, Gay, Bisexual & Transgender Community Center in New York City. The center has an after-school program for LGBTQ+ teens that provides activities and a range of substance-use services, including counseling.

Karys, who has worked with teens for 15 years, says a big part of their program is providing a safe affirming space for LGBTQ+ youth to make friends and find community and support.

“We know that there’s a higher prevalence of use among youth in our community, often because of isolation, family rejection or bullying, harassment, or not having access to affirming care, like affirming mental health care or medical care,” Karys says.

Substance use often is a coping mechanism because LGBTQ+ youth don’t feel like they have other tools or resources or support networks available, Karys says. (Of course, this can apply to youth across the board.) Part of the center’s prevention efforts are aimed at kids who are just being exposed to drugs but aren’t serious users.

With the recovery and treatment program for the serious users, Karys says they take a holistic approach. Rather than telling the person to stop using, they look at the factors leading to their substance use and what the teen is getting out of it. “It’s serving a purpose and we can’t just take it away without giving them the skills or the tools they need. We’re never trying to shame anyone for what they’re doing, because we’re realizing it’s a survival strategy. ... We generally find that (approach is) more successful in terms of outcomes and youth being engaged and motivated.”

Engagement also is favored by the teens themselves, many of whom have joined the fight against fentanyl overdoses among their peers.

In 2020, Avery Kalafatas founded Project1Life, a nonprofit dedicated to spreading awareness (from teens and young adults to their peers) about the dangers of prescription drug abuse and fentanyl after her 18-year-old cousin, Aiden, died from a counterfeit fentanyl-laced Percocet.

Kalafatas,18, says she was blindsided by Aiden’s death because he was in recovery for substance addiction and in a stable place, which she says speaks to “how quickly a hot decision of the teenage brain can have horrible outcomes in the modern drug world.” As she began to talk about Aiden’s death, Kalafatas said everyone she met had a connection to a fentanyl overdose story.

“Yet there was really no understanding, especially among my peers, of just how dangerous the fentanyl crisis is,” Kalafatas says. She adds that an autopsy discovered enough fentanyl in Aiden’s system to kill an elephant, though he didn’t even know he was ingesting it.

“That’s the case among a lot of young people and teens that are unfortunately dying. I call it a poisoning rather than an overdose, which is a key distinction in my mind,” Kalafatas says.

Project1Life currently has 235 teen ambassadors in high schools across the country, and Kalafatas says she views their work as a supplement to school and other authority education. She notes that messages coming from young people who are interacting with social media and drugs in the same way as their audience are a lot more meaningful and powerful than messages from authority figures.

The ambassadors talk to their peers in a nonjudgmental way, teaching them about Narcan and why they should carry it, even if they don’t use drugs. They cover a wide range of issues that they determine are relevant, and they relay back to the organization the key questions they’re getting from students.

“Obviously, if I could snap my fingers and have no one in the world ever do drugs, I totally would, but that’s not possible,” Kalafatas says. “So (messaging) has to come from a place of accepting that (drug use is) going to happen and we need to educate kids to keep them and their peers safe.”

When she first began her work, Kalafatas says awareness of fentanyl among teens was terrifyingly low. Now a freshman in college, she says the situation has improved, but there is still a huge need to educate teens on just how deadly fentanyl is.

“I think the most dangerous narrative that unfortunately is held by a lot of adults, especially parents, is that tragedies like this, what happened to Aiden, only happen in specific environments and in specific places … when in reality everyone is vulnerable to addiction, drug use, and resulting fentanyl poisoning.

Jaimie Seaton is a New England-based journalist with 30 years of experience. Her work appears in multiple publications, including Scientific American and Smithsonian Magazine.


The Overdose Crisis Among U.S. Adolescents
CDC Fentanyl Facts
Teen drug use
Unintentional Drug Overdose Death Rates
High school overdose deaths in 2022
DEA-Fentanyl pills
DEA-Drug Trafficking Threat 
DEA One Pill Can Kill Public Awareness Campaign
Trends in Drug Overdose Deaths Among U.S. Adolescents, January 2010 to June 2021
Study Shows How Nation's Fentanyl Crisis Affects Kids
Washington teens advocate for Narcan in every school
The Lesbian, Gay, Bisexual and Transgender Community Center

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Recognizing the signs of opioid overdose can save a life. Here are some things to look for:

  • Small, constricted “pinpoint pupils”
  • Falling asleep or losing consciousness
  • Slow, weak or no breathing
  • Choking or gurgling sounds
  • Limp body
  • Cold and/or clammy skin
  • Discolored skin (especially in lips and nails)

—Centers for Disease Control and Prevention