Trends and Circumstances of Pediatric Fentanyl Deaths in North Carolina: A 10-year Retrospective Study

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ID: 319163
2026
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Abstract
This study describes the contextual factors and scientific data associated with fentanyl-related deaths among individuals aged 0-17 years in North Carolina. Using information from the North Carolina Medical Examiner System from 2015-2024, 138 pediatric fentanyl deaths were identified. Manually abstracted scene information, toxicology results, and pathological findings allowed for a rarely examined in-depth analysis of circumstances surrounding these deaths. Children less than two years (n = 33, 1.38 per 100,000) and adolescents aged 15-17 years (n = 80, 1.96 per 100,000) experienced a fentanyl-related death rate higher than the statewide pediatric fentanyl-related death rate of 0.60 per 100,000 residents. Among children less than two years, 78.8% of overdose onset occurred in the decedent's primary residence, and drugs or paraphernalia were present at the scene in 51.5% of cases. Co-sleeping was documented in 60.6% of deaths, with 80.0% occurring in adult beds. Postmortem blood concentrations of fentanyl among children less than two years ranged from less than 0.50 to 280 ng/mL (mean 27.0 ng/mL, median 17 ng/mL). Among adolescents, 62.5% of overdose onset occurred in the decedent's primary residence, followed by a friend's residence (13.8%). History of substance use was documented in 82.5% of cases and drugs or paraphernalia were present in 67.5% of cases. Blood concentrations of fentanyl among adolescents ranged from less than 1.0 to 330 ng/mL (mean 21.7 ng/mL, median 11.0 ng/mL). Scene investigation and documentation allow for the recognition of behavioral trends which can be targeted for age-specific overdose prevention strategies. Among decedents less than two years, notable trends included children co-sleeping in adult beds with access to drugs and drug waste and/or prolonged periods without supervision. Among older adolescents, several cases involved suspected counterfeit pharmaceuticals and/or periods of non-contact with primary caregivers. Improved workflows for pediatric medicolegal death investigation and electronic reporting strategies are already underway.
Reference Key
openalex_W7166547012 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Meredith Welch, Laura Friederich, Mary E. Cox, Michelle B. Aurelius, Sandra C Bishop-Freeman
Journal journal of analytical toxicology
Year 2026
DOI
10.1093/jat/bkag057
URL
https://doi.org/10.1093/jat/bkag057
Keywords Keywords not found

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