According to a new study, drug overdose deaths among high school-aged US teens have more than doubled since 2019, owing to an increase in the deadly opioid fentanyl.

Researchers at the University of California, Los Angeles, examined mortality rates among 14- to 18-year-olds over the last decade and discovered that, while drug use is declining, fatalities are increasing, rising from 492 in 2019 to 954 in 2020 and 1,146 in 2021.

This is being attributed to a flood of counterfeit pills that look exactly like real oxycodone or Xanax tablets but contain fentanyl, a synthetic opioid so powerful that just one counterfeit pill can be fatal. Smuggled into the country in large quantities, these fake pills circulate in the illicit drug market, resulting in teens unknowingly ingesting the deadly drug.

“We’re seeing really young kids start to die because the illicit drug supply has become extremely toxic,” said Joseph Friedman, the study’s lead author, who published the findings in the journal Jama on April 12.

The study discovered that Indigenous and Hispanic teens have the highest rates of drug deaths, but that young people of all races are affected.

“It’s scary stuff,” Friedman said, adding that despite the fact that teen drug use was at an all-time low, the deaths represented the first major overdose spike seen in adolescents since the study began. “Teens are continuing to experiment with pills; the pills are just getting much more deadly.”

According to a recent study by researchers at the University of California, San Francisco, law enforcement agencies seized more than 2 million fentanyl-filled fake pills in the last quarter of 2021 alone, indicating how common they have become in the country’s illicit drug supply.

According to the UCLA study, the number of 10th graders reporting having used drugs in the previous year remained stable at around 30% between 2010 and 2020, before dropping to only 18% in 2021 as the pandemic continued.

“A really important fact here is that more kids aren’t doing drugs,” Morgan Godvin, a drug addiction researcher and co-author of the study from Portland, Oregon, said. “The drugs they’re using are incredibly more lethal.”

The research comes at a time when the number of overdose deaths in the United States has risen to more than 100,000 per year as a result of the massive amounts of fentanyl and other synthetic opioids that have flooded the country’s drug supply. Fentanyl has a potency up to 100 times that of morphine.

While many adult users may be aware that the pills they buy on the street contain fentanyl, youth are more likely to believe they are getting genuine pharmaceuticals, according to the researchers.

The opioid dosages in counterfeit pills, on the other hand, can vary dramatically. According to the Drug Enforcement Administration, four out of every ten pills seized contain potentially lethal doses.

The authors advocated for more drug education in schools, providing students with practical advice on how to avoid becoming addicted to drugs. The researchers said youth should also be given education about and access to Narcan, the overdose reversal drug, which can revive someone who has overdosed, and fentanyl test strips, which can detect counterfeit pills.

Researchers and youth advocacy groups say teens are often easily able to obtain the pills from friends or from local dealers, who offer them on social media apps like Snapchat or Instagram and sometimes deliver them straight to teenagers’ homes.

In February 2021, Sammy Berman Chapman, a 16-year-old straight-A student and the son of the television therapist Laura Berman, died in his bedroom in Los Angeles after taking what he thought was a single Xanax. Zach Plunk, a 17-year-old star high school running back from Arizona, died in 2020 after taking one tablet that was labeled to look exactly like a pharmaceutical “M30” oxycodone pill. The tablets, which were purchased over social media in both cases, turned out to be lethal doses of fentanyl in both cases.

Snapchat recently announced new measures to combat drug dealing on the platform, and Instagram has stated that it is working to remove such content.