Majority of Youth Overdose Deaths from 2018 to 2022 Were Driven by Fentanyl Alone

Study Reveals Changing Nature of U.S. Drug Supply

NEW YORK, May 20, 2025 /PRNewswire/ -- Fatal drug overdoses among youth aged 15 to 24 in the United States involving synthetic opioids alone—not mixed with other substances—soared by 168 percent over the five-year time period of 2018 to 2022, a new study shows. Published online today in the journal Pediatrics, the work also found that youth overdose rates and drug combinations varied significantly across age, sex and race/ethnicity.

Led by NYU Grossman School of Medicine, the new study is the first, say investigators, to identify which specific combinations of drugs drove synthetic opioid-involved fatal overdoses among young people across sociodemographic groups over time.

Overdoses that involved synthetic opioids alone—predominantly fentanyl—had the highest rates of fatalities when compared to overdoses involving other drug combinations examined by the researchers. This was regardless of age, sex and race/ethnicity.

"Before we looked at the data, we thought we would find that the majority of fatal youth overdoses involved fentanyl combined with other substances, such as prescription opioids or cocaine," said Noa Krawczyk, PhD, assistant professor in the Department of Population Health, and senior author of the study. "Instead, we found the opposite—that most deaths were caused by fentanyl alone. Our analysis sheds light on the changing nature and risks of the drug supply and how they impact key demographic groups. Some may think they are taking one substance but are actually exposed to another."

According to Krawczyk, who is also associate director of the Center for Opioid Epidemiology and Policy at NYU Langone, their findings underscore the need to tailor overdose prevention strategies that include harm reduction services specifically to youth to prevent death and suffering among this under-studied population.  

How the Study was Conducted

Analyzing data from the National Center for Health Statistics, the researchers characterized trends in overdose death involving synthetic opioids (predominantly fentanyl) alone, as well as in combination with five common other drugs (benzodiazepines, heroin, prescription opioids, cocaine, and other stimulants) among youth aged 15-24 across age, sex and race/ethnicity over five years (from 2018 to 2022).

The investigators found that during the five-year study period, overdoses involving synthetic opioids alone increased by 168 percent—the highest rates of fatalities compared to those that included a combination of the examined drugs, regardless of age, sex and race/ethnicity.

After deaths due to synthetic opioids/fentanyl alone, the next highest rates of fatal overdoses involved fentanyl combined with cocaine or another stimulant; however, rates differed by age, sex, race/ethnicity and over time. In 2018, White non-Hispanic youth had the highest rates of overdoses involving synthetic opioids/fentanyl alone. By 2022, rates of overdose deaths involving only fentanyl among Black American, American Indian and Alaska Native, and Hispanic youth exceeded White non-Hispanic youth. When it came to the impact of sex and age, fatal overdoses across all groups were highest among males, as well as all youth aged 20 to 24.

According to the research team, understanding the landscape of overdose patterns provides needed context in terms of how to best inform specific public health interventions that can prevent more deaths.

Megan Miller, a research coordinator at the NYU Center for Opioid Epidemiology and Policy and lead author of the study, emphasized that "there are a variety of ways to engage youth and reduce their risk of overdose. Schools, places of employment, homeless shelters, child welfare services, and juvenile justice settings are all possible touchpoints to offer education and harm reduction tools such as naloxone and fentanyl test strips. Our findings highlight the need to tailor these strategies to different youth groups based on the types of drugs they are using to help prevent further overdose deaths."

Limitations to the study findings, according to the investigators, include possible misclassification in mortality coding practices, as well as limited sociodemographic information. For example, youth who identify as LGBTQ+ tend to have a higher risk of overdose, yet that information was not available. Due to small sample sizes, the data did not examine youth who may identify as more than one race or ethnicity.

In addition to Krawczyk and Miller, study co-authors from NYU Grossman School of Medicine include Katherine Wheeler-Martin, MPH, Amanda M. Bunting, PhD, and Magdalena Cerdá, DrPH.

Funding for the study was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number K01DA055758. Dr. Bunting was supported by the National Institute on Drug Abuse under Award Number K01DA053435. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About NYU Langone Health
NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone No. 1 out of 115 comprehensive academic medical centers across the nation for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across seven inpatient locations, its Perlmutter Cancer Center, and more than 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise.

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SOURCE NYU Langone