Youth Drug Use Not Increasing, But Far More Dangerous and Deadly

Youth crowd

Every year, researchers from the University of Michigan complete more than 20,000 surveys among American high school students to find out their rates of drug and alcohol use. This survey, called the Monitoring the Future Survey, has been collecting these data since 1975. It provides us with an accurate picture of the increases and decreases in adolescent drug and alcohol use. The most recent survey showed us that drug and alcohol use has recently dropped—but then why are more youth dying from drug overdoses?

During the years of the pandemic shutdown, drug and alcohol use by teens has dropped. As the pandemic waned, the numbers of youth using drugs or alcohol have not risen to pre-pandemic levels. This sounds like good news, but that’s only until you dig a little deeper.

While fewer youth are using drugs, the number dying of drug overdoses has more than doubled.

Our Tragic Loss of Young Lives 2015–2022

The Centers for Disease Control and Prevention has provided numbers documenting our tragic and heartbreaking situation. The calculations below are taken from the CDC’s statistical information on Americans dying from drug overdoses.

NIDA Chart, Unintentional deaths
Image courtesy of
  • This chart shows the increase in the number of teens aged 15 to 19 we lost per 100,000 of this population.
  • From the first quarter of 2015 to the third quarter of 2022 (the latest figures on this graph), the loss of young lives increased 2.5-fold.
  • As is true for almost every statistic related to drug or alcohol use, young men fared the worst. From the first quarter of 2015 to the third quarter of 2022, losses among teenage males increased 2.3-fold. Of every 100,000 male teens aged 15 to 19, we lost more than two young men in 2022 while in 2015, we lost fewer than one.
  • In an even more shocking contrast, from the first quarter of 2019 to the second quarter of 2021, the loss of young men in this age group increased 3.3-fold.

Trying to Understand the Trends

Analysts have studied the situation to determine why these two trends seem to be so contradictory: If the number of teens using drugs dropped, why are so many more dying?

Their conclusion? A major reason is the vast quantities of illicitly manufactured fentanyl being trafficked into our cities and towns.

Fentanyl has long been an important pharmaceutical drug used in surgical anesthetics and pain formulas for cancer patients or the terminally ill. Prior to 2013, about the only fentanyl being trafficked to drug users was filched from hospitals or pharmacies. Then in 2013, America’s illicit drug market changed, and fentanyl cooked up in illicit overseas labs began to be trafficked on our shores.

Over the next eight years, our overdose losses climbed to unprecedented heights, topping 100,000 deaths in a twelve-month period for the first time in April 2021.

The Next Fentanyl Phase: Counterfeit Prescription Drugs

After fentanyl powder had been trafficked into the U.S. for a few years, some traffickers hit on the idea of pressing fentanyl into counterfeit pills. After all, many people contacting drug dealers were buying pills instead of heroin because they thought pills were safer to abuse.

Some of those who thought pills were safer to abuse were young people. Teens. The result is shown in the chart above.

Every Year, More of Those Counterfeit Pills Contain Fentanyl

Youth gets pills from a dealer

According to the Drug Enforcement Administration, every year, a higher proportion of these counterfeit pills are loaded with fentanyl.

  • In 2021, four out of ten counterfeit pills contained fentanyl.
  • By 2022, six out of ten pills contained fentanyl.
  • By 2023, it was seven pills out of ten.

That means for every ten people who buy counterfeit pills from a drug dealer (not realizing they are fake), seven of them might inadvertently buy a fatal dose of fentanyl. After all, it only takes two milligrams of fentanyl (equivalent to a few grains of salt) to kill a person who is not accustomed to using an opioid like heroin, Oxycontin, or Vicodin.

The number of pills and quantity of powdered fentanyl seized by the DEA each year keep increasing too.

  • 2019: 2.6 million counterfeit pills laced with fentanyl were seized.
  • 2021: 20.4 million counterfeit pills containing fentanyl were seized.
  • 2022: More than 50.6 million fake pills containing fentanyl along with 10,000 pounds of fentanyl powder were seized.
  • 2023: More than 78.4 million pills laced with fentanyl were seized.
  • Also seized in 2023 were nearly 12,000 pounds of fentanyl powder, ready to be pressed into more counterfeit prescription drugs or into what is purported to be ecstasy pills.
  • In addition, the Customs and Border Patrol reported seizing 27,000 pounds of fentanyl at our borders. Fentanyl powder is also often mixed into cocaine, methamphetamine, and heroin before its sale on the street.

Why Fentanyl?

Fentanyl is cheap and synthetic. Drug cartels don’t need poppy fields to grow the makings of morphine or heroin. They don’t need coca fields to get the leaves to process into cocaine. They only need precursor chemicals from overseas pharmaceutical or chemical companies. They can then cook up large batches of fentanyl in this hemisphere and traffic that powder into the U.S.A.

Or, with pill presses and some coloring material, drug traffickers can press this powder into pills that look like Oxycontin, Percocet, Vicodin, Adderall, Xanax, generic oxycodone, or other medications.

How Many of These Pills Are Actually Trafficked Into Our Country?

Fentanyl pills seizure
Large Fentanyl Pill Seizure. Image courtesy of

It’s hard to find estimates for how many drugs being trafficked into America are seized by law enforcement personnel. In Congressional testimonies, you will sometimes see an estimate of 10 percent. In other words, about 10 percent of the quantity of illicit drugs being sent into America are found and seized, allowing 90% to reach our streets. Apply this ratio to the 78.4 million pills seized in 2023, and you realize that nearly 800 million pills may have been trafficked into America that year.

If it only takes 2 milligrams of pure fentanyl to kill a person new to opioids, then you can get an idea of the deadliness of these shipments.

Our teens are not, by and large, very experienced drug users. It would be easy for them to assume that an authentic-looking pill is a safer drug to abuse than a bag of heroin. The rapidly increasing loss of life among these teens shows that this assumption is both false and life-threatening.

This vast increase of dangerous pills on the market necessitates much greater vigilance on the part of parents, teachers, coaches, and others who work with youth. It’s vital to educate youth that any pill that wasn’t prescribed by a physician and dispensed by a pharmacist could easily be deadly, including pills obtained from a friend or acquaintance who also might not know where they came from. In this age of fentanyl, the only safety is in sobriety.


  • “Unintentional Drug Overdose Death Rates Among US Youth Aged 15-19.” National Institute on Drug Abuse, 2023. NIDA
  • “Drug Overdose Deaths Among Persons Aged 10–19 Years—United States, July 2019–December 2021.” Centers for Disease Control and Prevention, 2022. CDC
  • “Provisional Drug Overdose Death Counts.” Centers for Disease Control and Prevention, 2024. CDC
  • “DEA Laboratory Testing Reveals that 6 out of 10 Fentanyl-Laced Fake Prescription Pills Now Contain a Potentially Lethal Dose of Fentanyl.” Drug Enforcement Administration, 2022. DEA
  • Drug Enforcement Administration home page. Drug Enforcement Administration, 2021. DEA
  • “Counterfeit Pills Fact Sheet.” Drug Enforcement Administration, 2021. DEA
  • “Drug Enforcement Administration Announces the Seizure of Over 379 Million Deadly Doses of Fentanyl in 2022.” Drug Enforcement Administration, 2022. DEA
  • “Drug Seizure Statistics.” Customs and Border Patrol, 2024. CBP
  • “Legalization and Illicit Drugs,” page 86. Office of Justice Programs, 1988. OJP


Karen Hadley

For more than a decade, Karen has been researching and writing about drug trafficking, drug abuse, addiction and recovery. She has also studied and written about policy issues related to drug treatment.