Drug deaths plummet among young Americans as fentanyl carnage eases

PHILADELPHIA — When Justin Carlyle, 23, began experimenting with drugs a decade ago, he found himself part of a generation of young Americans caught in the devastating wave of harm caused by fentanyl addiction and overdose.

“I use fentanyl, cocaine, crack cocaine, yeah, all of it,” Carlyle said, speaking to NPR on the streets of Kensington, a working class neighborhood in Philadelphia where dealers sell drugs openly. “I was real young. I was 13 or 14 when I tried cocaine, crack cocaine, for the first time.”

As an elevated train rumbled overhead, Carlyle described turning to fentanyl, xylazine and other increasingly toxic street drugs. “I’ve had three overdoses, and two of the times I was definitely Narcaned,” he said, referring to a medication, also known as naloxone, that reverses potentially fatal opioid overdoses.

Carlyle’s teens and early 20s have been wracked by severe drug use, but the fact that he’s still alive means he’s part of a hopeful new national trend.

“What we’re seeing is a massive reduction in [fatal] overdose risk, among Gen Z in particular,” said Nabarun Dasgupta, an addiction researcher at the University of North Carolina. “Ages 20 to 29 lowered the risk by 47%, cut it right in half.”

This stunning drop in drug deaths among people in the U.S. is being tracked in data compiled by the Centers for Disease Control and Prevention and other federal agencies.

The latest available records found fentanyl and other drugs killed more than 31,000 people (see chart) under the age of 35 in 2021. By last year, that number had plummeted to roughly 16,690 fatal overdoses, according to provisional CDC data.

The life-saving shift is welcome news for parents like Jon Epstein, who lost his son Cal to fentanyl in 2020. “What has happened with the 20- to 29-year-olds? They beat fentanyl,” said Epstein, who works with a national drug awareness group focused on young people called Song for Charlie.

For America’s young, a decade of unprecedented carnage

To understand the significance of this promising trend, it’s important to recall the terror and devastation wrought by fentanyl among families and communities in the U.S.

Beginning around 2014, U.S. officials say Mexican drug cartels began smuggling large quantities of fentanyl into American communities, often disguising the street drug as counterfeit prescription pills resembling OxyContin or Percocet.

Over the past decade, drug overdoses among young people surged, killing more than 230,000 people under the age of 35. For many families and whole communities, the losses felt catastrophic.

“We went to check on [Cal] and he was unresponsive,” Jon Epstein recalled. “We made it to the hospital, but he didn’t make it home. It was a bolt out of the blue.”

Cal Epstein was 18, a college student. According to the family, it’s not clear why he decided to take an opioid pill. He tried to purchase a prescription-grade pill from a dealer on social media. In fact, it was a counterfeit pill containing a deadly dose of fentanyl.

While grieving, Jon Epstein started learning about fentanyl, digging through public health data. He found other kids in his town of Beaverton, Ore., were dying. “They had lost four students [to fatal overdoses in the local school district] in the preceding year,” he recalled.

Jon and his wife, Jennifer Epstein, connected with a growing network of shattered parents around the country who were waking up to a terrifying fact: Fentanyl, often sold on social media platforms, was making it into their homes and killing their kids.

Like many grieving families, they turned their sorrow into activism. Through the group Song for Charlie, they worked to educate young people and parents about the unique dangers of fentanyl.

“The game has completely changed, especially for kids who are going through an experimental phase,” Jon Epstein warned in a video distributed nationally. “An experimental phase is now deadly.” This message — summed up by the phrase One pill can kill — began spreading in schools and on social media nationwide but for years the wave of death seemed unsolvable.

In a study published last month in the journal Pediatrics, researcher Noa Krawczyk at the NYU Grossman School of Public Health found deaths attributed entirely to fentanyl “nearly quadrupled” among people people age 15 to 24 from 2018 through 2022.

“In your generation, people used drugs. In my generation people used drugs, we just didn’t use to die as much from them,” Krawcyzk said.

Especially among teenagers in the U.S., fentanyl deaths seemed stuck at catastrophic levels, between 1,500 and 2,000 fatal overdoses a year. Then last year, federal data revealed a stunning decline, with 40% fewer teens experiencing fatal overdoses. “We’re super heartened to finally see teens dropping,” Epstein said.

While the improvement is dramatic, Dasgupta at the University of North Carolina, found the recovery among teens appears uneven.

Some teens and twenty-somethings are seeing far fewer deaths, but he identified one cluster born between 2005 and 2011 who actually saw a slight uptick in deaths over the past two years. The increase is relatively small — about 300 additional fatalities nationwide over two years — but Dasgupta said it’s an area of concern that needs more study to determine why.

The question now is what changed that is suddenly saving so many young lives? Drug policy experts are scrambling to understand the shift.

Many U.S. kids appear more cautious about drug use

Theories include the wider distribution of Narcan, or naloxone; a trend of weaker, less deadly fentanyl being sold by dealers; more readily available addiction healthcare; and also the loss of so many vulnerable young people who have already died.

Many researchers believe another key factor may be less risky drug and alcohol use among teens and twenty-somethings, a pattern that emerged during the years of the COVID epidemic. One study by a team at the University of Michigan found the number of teens abstaining from substance grew to its highest level in 2024.

“This trend in the reduction of substance use among teenagers is unprecedented,” Nora D. Volkow, who has served as director of the U.S. government’s National Institute on Drug Abuse since 2003, said in a statement last December.

Keith Humphreys, an addiction researcher at Stanford University, credits this apparent behavioral shift with helping save lives. “There’s fewer people initiating with these substances. That should work in our favor,” he told NPR.

According to Dasgupta at the University of North Carolina, years of devastation caused by fentanyl and other opioids might mean more people in their teens and twenties are choosing to experiment with less risky drugs.

“Alcohol and opioids are on the outs with Gen Z, and instead we see [a shift to] cannabis and psychedelics, and those are inherently safer drugs,” he said.

Overall, this positive trend among younger Americans is outpacing the wider opioid recovery in the U.S., which saw 27% fewer fatal overdoses across all age groups in 2024.

Will drug deaths keep dropping for young Americans?

While this news is promising — roughly 15,000 fewer drug deaths among young people in the U.S. in 2024, according to preliminary data, compared with the deadliest year 2021 — researchers say sustaining progress may be difficult.

That’s because many of the young people still most at risk, like Justin Carlyle in Philadelphia, aren’t just experimenting with drugs. They’re struggling with full blown addiction.

“What I’m used to is getting high, you know?” he said.

Despite the danger of a fatal overdose, Carlyle told NPR he has tried to quit fentanyl repeatedly, even using the medication suboxone to to try to curb his opioid cravings, so far without success.

“I wish I had the answer to that. I know all of us fighting addiction right now wish we had the answer,” he said.

But many experts, activists and front-line healthcare workers say there’s more hope on the streets, too. The spread of Narcan is helping. Researchers studying street drugs say the fentanyl being sold by dealers in the U.S. is less potent, less deadly, than it once was.

That matters because studies show people who survive addiction long enough do typically recover.

There are also growing efforts around the U.S. aimed at reaching young people experiencing severe addiction, programs that ramped up over the past four years with federal funding from the Biden administration.

On a recent afternoon, two city drug response workers in Philadelphia, Kevin Howard and Dominick Maurizio, offered counseling to a young man huddled in a bus shelter.

“Anything we can help you with? Want to go in-patient?” Howard said. “Want to go to a shelter?”

Howard and Maurizio are themselves in recovery after surviving what they describe as their own battles with heroin and crack cocaine addiction when they were young men in their 20s.

Both said they believe this kind of outreach is helping. “If we help one person, we’re winning in some capacity,” Maurizio said.

“I see it as me saving lives,” Howard said. “Any time I give someone Narcan or just check on them to see if they’re alive, I believe we’re winning.”

But experts point to one other uncertainty in this first hopeful moment since the fentanyl crisis began.

The Trump administration wants to cut billions of dollars in funding for science and health agencies responding to the fentanyl crisis. The federal government has already moved to freeze or end grants that support front-line drug treatment and harm reduction programs.

In a statement, the U.S. Department of Health and Human Services said the goal is to “streamline resources and eliminate redundancies, ensuring that essential mental health and substance use disorder services are delivered more effectively.”

But doctors, researchers and harm reduction activists told NPR if addiction services are scaled back or shut down, the promising recovery among teens and young adults could unravel.