Beyond Fearmongering: Youth Overdose Prevention That Works

When 19-year-old MJ* walks into the clinic, she’s grappling with a loss that’s become tragically common: a friend who died from an opioid overdose. While her friend’s death scared her, MJ continues using substances to help manage the challenges of homelessness, including vaping and occasionally taking pressed pills of unknown origin to help her sleep outdoors. 

Her story illustrates why healthcare professionals are fundamentally rethinking youth and teen overdose prevention—moving away from fear-based messaging toward evidence-based approaches that provide young people with practical tools and knowledge to stay safe. 

Understanding the scope of children and teen overdose

Recent data shows that drug overdoses have become the third leading cause of death among children and adolescents, following firearm injuries and motor vehicle crashes. What makes this particularly concerning is that many young people who experience fatal overdoses may not have the same risk factors for overdose as adults—CDC data from 2019 to 2021 found that only one in 10 had a history of substance use treatment. 

The rise of fentanyl in the drug supply has changed the landscape dramatically. This synthetic opioid, which is 50 times more potent than heroin, now appears in counterfeit pills and substances that typically contain no opioids, meaning young people may unknowingly consume it. Importantly, overall youth substance use rates have remained stable or even decreased, suggesting the crisis stems more from a contaminated drug supply than increased usage. 

Moving beyond fear-based approaches for overdose prevention

Traditional drug education programs like D.A.R.E., despite widespread implementation, showed no significant impact on reducing drug use. These programs often relied on fear tactics and exaggerated negative effects, which may have actually undermined teens’ trust in drug education efforts. 

Despite the stark truth behind the newer “One Pill Can Kill” campaign, Sarah Bagley, MD, Boston Medical Center (BMC) expert on youth substance use disorder, notes the echoes to prior ineffective, one-size-fits-all awareness campaigns like D.A.R.E.: “If you look at the messaging and the images used in some of those campaigns, they’re based on fear.” 

Instead, she reasons, education and curiosity should center opening a dialogue. 

“Opening conversations around safety and drug use in a more universal way opens the door for conversations about harm reduction and risk in general,” says Bagley, who founded BMC’s Center for Addiction Treatment for Adolescents/Young Adults Who Use Substances (CATALYST). “By normalizing these conversations, we allow teens and younger kids to feel like it’s not only okay to be asking these questions—but we actually expect and invite these conversations about how to stay safe.” 

New approaches emphasize harm reduction alongside abstinence, providing scientifically accurate information that empowers young people to make informed decisions. Programs teach practical skills, including how to use fentanyl test strips and administer naloxone. Early results from pilot programs in San Francisco and New York City showed increased harm reduction knowledge and decreased substance use. 

Naloxone: Accessible and life-saving 

Central to opioid overdose prevention is naloxone, a medication that reverses opioid overdoses by temporarily blocking opioid receptors. As of 2023, naloxone nasal spray became available over-the-counter, removing prescription barriers. About 67% of adolescent overdose deaths occur with a bystander present; however, the bystander may not always be aware of the drug use. This could look like a parent in the living room while the teen is in their bedroom. In the case where the bystander is aware of drug use, naloxone can be an effective, life-saving tool. However, naloxone has been found to be administered in only 30% of the cases where the teen died from an overdose.  

Moreover, research consistently shows that expanding naloxone access saves lives without encouraging increased drug use. A comprehensive study of 44 states over 12 years found no association between naloxone availability and increased substance use among teens—dispelling concerns that access might promote risky behavior. 

However, barriers persist. While 82% of pediatric healthcare trainees report frequent exposure to patients at overdose risk, only 42% discuss prevention and just 10% prescribe naloxone. At pharmacies, about half incorrectly state age restrictions exist, and costs can reach $150 for a two-dose package.

“Opening conversations around safety and drug use in a more universal way opens the door for conversations about harm reduction and risk in general. By normalizing these conversations, we allow teens and younger kids to feel like it’s not only okay to be asking these questions—but we actually expect and invite these conversations about how to stay safe.”  

sarah Bagley, md, founder of BMC’s Center for Addiction Treatment for Adolescents/Young Adults Who Use Substances (CATALYST).

Healthcare advocates increasingly view schools as natural sites for overdose education and naloxone distribution. Both the National School Nurse Association and American Medical Association endorse school-based naloxone programs combined with education, recognizing that this approach creates individual and community-level benefits. 

Dr. Bagley explains the dual benefits: “There are benefits for the teens, middle schoolers, and even younger students who could learn about overdose prevention. They learn about strategies that they could employ to reduce their own risk, but they also get to learn about how to recognize and respond to others, either their friends or their family members who may be experiencing overdose.” 

Bagley envisions naloxone training much like youth are educated on other life-saving and emergency responses, such as dialing 911 or administering an EpiPen in case of allergic reaction. CDC guidelines recognize that children as young as 11 can learn to recognize and respond to overdoses. 

Centering youth voices in overdose prevention 

A critical component of effective prevention involves including young people in developing solutions. Destiny Tolliver, MD, a pediatrician at BMC, emphasizes: “One important principle—that I know we say all of the time, but is really worth emphasizing here—is actually spending time listening to youth, incorporating them into the coalitions that are making some of these decisions, having them as part of the conversations.” 

This approach challenges assumptions about youth decision-making capacity. 

“There is this concern that if we put the youth in the decision-making rooms that they’re going to say, ‘There should be no rules,’ or ‘Recess forever’—things like that, Tolliver says. “But when we take time to listen, kids have very nuanced thoughts. They are excellent at advocating for themselves and thinking about what the next steps for themselves are.” 

The youth overdose crisis demands comprehensive responses, but effective tools exist. Evidence shows that when communities embrace harm reduction education, expand naloxone access, and center youth voices in prevention efforts, lives can be saved. 

For young people like MJ, the goal isn’t to eliminate all risk—it’s to provide the knowledge, tools, and support needed to navigate a complex world more safely. By moving beyond fear-based messaging toward practical, evidence-based approaches, healthcare systems and communities can build a foundation for meaningful prevention that respects young people’s autonomy while prioritizing their safety and wellbeing. 

---

*Descriptive demographic information and names have been changed.

This story was adapted from a presentation by BMC’s Health Equity Rounds team.