In the fentanyl crisis, infants and toddlers become unsuspecting victims

As the fentanyl crisis ravages communities across the country, toddlers and infants increasingly are becoming unsuspecting victims of an opioid that is 50 times more potent than heroin. Adults make up the vast number of fentanyl-related deaths, but public health experts say they are alarmed that more children below the age of 5 are dying or arriving in emergency rooms testing positive for the drug.

The number of drug overdoses nationwide has fallen for the first time in years, but the incidences of children overdosing has surged, doctors say, as they are exposed to opioids and drug paraphernalia at home or by accidental ingestion.

Although West Virginia has the highest fentanyl-related death rate, California has the most deaths overall, with 6,473 in 2022. Officials nationwide are struggling to come up with solutions to prevent young children from dying.

"If you have these children that are left in chaotic homes, in homes that have … drugs around, that just increases the risk exponentially, particularly for these little vulnerable kids that explore their world by putting everything in their mouths," said Dr. Emily Rose, co-author of a study about recognizing and treating pediatric and adolescent opioid overdoses.

America's Poison Centers, which represents 55 accredited poison control centers in the U.S., reports a dramatic increase in fentanyl exposure in young children nationwide. In 2016, the centers received 10 reports of fentanyl exposure in children under age 6. That number was 539 in 2023.

Although fentanyl can be prescribed by doctors in pill or patch form, illegally it is typically smoked, injected or found laced with other drugs as a white powder.

Preliminary data from the California Department of Public Health show 11 fentanyl-related deaths occurred in the state in children younger than 5 years old during the first three quarters of 2023, the most recent statistics available. There were 10 deaths for all of 2022 and six fentanyl-related deaths in 2021.

In Kern County, the rate of fentanyl-related deaths is higher than the 2022 state average: California had a rate of 0.77 deaths per 100,000 residents, while Kern County had 1.4 deaths, according to the county's annual child death report.

Brynn Carrigan, the county's public health director, said she expects the number of 5-year-olds getting sick or dying from fentanyl to be even higher in the coming report, which will be released in October.

"I have an idea that there's going to likely be some of our much younger children that are impacted by fentanyl in this next report," Carrigan said.

A study published in March in the Journal of the American College of Emergency Physicians Open acknowledged the recent increases in pediatric and adolescent opioid fatalities due to "accidental ingestions, prescription misuse, and household exposure."

"Historically, opioid overdose has been associated with adults, but trends show an increasing incidence among pediatric patients," the study says. "Opioids are the most common cause of fatal poisonings in young children and represent a significant public health challenge."

Rose is a co-author of the study and an associate professor of clinical emergency medicine at the USC Keck School of Medicine.

The drug decreases the ability to breathe, Rose said. An adult can become hypoxic in a matter of minutes, but for a child, it can happen in less than one. Naloxone, which can reverse an opioid overdose, must be administered quickly.

In the last five years, she said, she's seen more young children coming into the hospital with fentanyl overdoses. The youngest patient she treated who tested positive for fentanyl was 2 months old.

"It's our duty as a society to protect the most vulnerable group of us," she said. "It's absolutely shocking and horrifying."

A bill authored by state Sen. Dave Cortese (D-San Jose) asks the California Department of Public Health to monitor trends of fentanyl-related deaths among those ages 5 and younger and develop guidance to distribute information to local health departments on how to protect children from fentanyl exposure.

SB 908, Cortese said, would allow for a multiagency approach—such as those charged with family services and child welfare—on how to navigate situations such as family reunification when a parent has a history of substance abuse. The bill has passed in the state Senate and currently awaits a fiscal review.

Cortese said in an interview that the fentanyl overdose death of 3-month-old Phoenix Castro pushed him to introduce the bill.

Phoenix and her family lived in San Jose. She died May 13, 2023, from methamphetamine and fentanyl while in her father's care, according to the Santa Clara County district attorney's office. In court, prosecutors said the crime lab found fentanyl on the infant's onesie, including on the snaps, according to the Bay Area News Group.

The home she lived in was "littered with opioids," the district attorney's office said. A baby bottle was found next to glass pipes.

Her father, David Anthony Castro, is facing a felony count of child endangerment with a special allegation of causing the infant's death and a misdemeanor count of possession of a controlled substance, said Deputy Dist. Atty. Maria Gershenovich. Castro has pleaded not guilty.

In November, the Santa Clara County district attorney's office charged two parents with murder after their 18-month-old daughter Winter died from ingesting fentanyl and methamphetamine. The county coroner's office found the toddler's "fentanyl blood concentration" to be more than 14 times the fatal amount.

More recently, 1-year-old Justin Bulley died in February from the "effects of fentanyl" while in custody of the Los Angeles County child welfare system, during an approved visit with his mother, according to Justin's father.

According to the medical examiner's investigation, there were "several versions" as to what happened, but Justin's mother said she'd been drinking alcohol, and Justin's grandfather had been smoking fentanyl. The grandfather told officials that the child had an "interaction with fentanyl at some point."

Cortese said "there's a clock ticking in my head," insisting that officials act fast.

"Whatever the state can do to further guide counties on how to avoid the incidences of babies and toddlers showing up in mortuaries over substance abuse exposure," he said, "the state has to do."

2024 Los Angeles Times. Distributed by Tribune Content Agency, LLC.