The night before Jose Alberto Perez overdosed on fentanyl, the 14-year-old pleaded with his mother not to take him to the hospital because “he was not a drug addict.”

“His lips were ash white. His pupils were popping out,” the boy’s mother, Lilia Astudillo, said. But she yielded to his wishes, despite his obvious distress. 

Astudillo planned to get her son medical attention the next day, but by morning he was dead. 

“It hurts you to see your son after he’s gone and ask yourself, Why didn’t I know about this sooner to help him?”

Jose, who died in January, is among the nearly one dozen students spread across three schools in the Carrollton-Farmers Branch Independent School District in Texas who have overdosed on fentanyl from September to March. He is one of three who have died. 

The rash of overdoses has brought shock and anger to families in the Carrollton community, about 20 miles north of Dallas. It is also a sobering reminder of how rampantly fentanyl has made its way to young people in recent years. 

“I never thought in a middle school there would be drugs like this,” said one mother whose 14-year-old daughter, also a student in the Carrollton-Farmers Branch district, survived a fentanyl overdose this year. 

“I can’t imagine the pain of another parent who is going through what I’m going through,” said the woman, who asked that her name not be used to protect her daughter’s privacy. 

Fentanyl, a highly potent and addictive synthetic opiate that can be deadly with a dose as small as the tip of a pencil, has ravaged adult populations for nearly a decade. But mass proliferation of the drug in recent years, coupled with a Covid pandemic that eroded teen mental health, has given it a wider path to young people. 

Median monthly overdose deaths involving fentanyl for people ages 10 to 19 increased 182% from July to December 2019 compared to the same period in 2021, according to a December report from the Centers for Disease Control and Prevention.

More than 2,200 teens fatally overdosed in the two and a half year period from July 2019 to December 2021, with fentanyl involved in 84% of the deaths, the report found. 

Teen fentanyl overdoses have been reported in communities across the country, from Arlington, Virginia, to Portland, Oregon. In the Los Angeles School district alone, at least seven teens overdosed in a one-month span last year after taking pills possibly laced with the drug.

The overdoses in the Carrollton-Farmers Branch Independent School district were connected to three individuals, who lived a few blocks from the school, according to a federal complaint. 

All have been charged with conspiracy to distribute and possess with intent to distribute a controlled substance. 

But that is small comfort for parents in Carrollton who are devastated and terrified for their children. 

“I painted a world of wonder for my children,” said Astudillo, adding that she immigrated to the United States to get away from crime in Mexico. “And it turns out it was worse here.”

The mother of the 14-year-old who survived an overdose said victims’ families are clinging to one another for support. Many, like her, are Spanish-speaking immigrants who have not been able to get help accessing treatment and resources, she said. Some are too embarrassed to speak out.

“I think they have shame, but we shouldn’t be ashamed, because this could happen to anyone.”

Teen overdose epidemic is ‘superimposed’ over crumbling mental health

Carmin Williams’ daughter, Khloe, was introduced and became addicted to fentanyl when she was 12 years old and attending Bea Salazer, an alternative education school in the Carrollton-Farmers Branch school district, last spring. 

Williams said Khloe, now 13, had been transferred to the school — the same one Jose attended — because of behavioral issues. She had been struggling with anxiety and depression, Williams said. 

Someone at the school “offered her a pill and said ‘if you’re depressed or if you’re going through something, this will pick you up’ and that’s how they are getting so many kids hooked,” Williams, 39, said.

That’s not an uncommon story, said Dr. Scott Hadland, an addiction specialist and head of adolescent medicine at Massachusetts General Hospital in Boston. Hadland said fentanyl began seeping into the teen population before the Covid pandemic, but the period of social isolation negatively affected mental health in young people, leading some to seek out ways to self-medicate with drugs that are not prescribed to them, and which are often counterfeit.

According to the CDC’s 2021 Youth Risk Behavior Survey, released in February, more than 40% of boys and girls said they felt so sad or hopeless within the past year that they were unable to do their regular activities like schoolwork or sports, for at least two weeks, with girls more likely to report such feelings.

A separate CDC report found that 41% of teens who died of an overdose had evidence of mental health conditions or treatment. 

Teen mental health is a crisis upon which the “overdose crisis is now superimposed,” Hadland said. 

“For some teens, many of whom I care for, getting a pill or getting medication for a mental health problem is exactly the right treatment,” he said. “It’s just that you want to go be assessed by a clinician, get connected to therapy, and get prescribed the correct medication, not an illicit counterfeit pill.”

After her daughter overdosed on fentanyl last summer, Williams moved her family from Carrollton to give her daughter a new environment away from the one that led her to addiction. 

“We should discuss mental health more and be more open to getting help when we know that we need it,” she said. “This starts at home, but it should continue in school.” 

Some Carrollton parents said their anger has been compounded by a lackluster response from the school district.

Astudillo said that, despite her language barrier, she had asked the school for help for her son many times before he and the other students overdosed, but the school did not act. 

In a statement to NBC News, the district said it is “deeply concerned” about the safety of its students.

“We have taken several actions to educate parents on the dangers of fentanyl. In November, CFB organized and held two community parent drug awareness programs (in both English and Spanish) to inform parents about the dangers of drug use among teens. Our Crisis Team and two Licensed Chemical Dependency counselors have developed student drug awareness presentations and are presenting these talks at the secondary campuses. CFB has started random canine searches at our campuses.”\

Some parents criticized the school for taking action too late.

“The worst is, how could they not know all of this was going on?” Astudillo said.

Community needs a ‘comprehensive attack plan’

More than 30% of Carrollton’s residents are Hispanic or Latino, many of them immigrants.

Latino teens are proportionally overrepresented in overdose deaths, according to the CDC data, which counts fatal and nonfatal overdoses from all drugs, not just fentanyl, and that 21% of victims were Hispanic or Latino. About 60% of those who died were white, and 13% were Black.

“It’s a major problem that affects everyone, but it’s exacerbated in the Latino community,” Carlos Quintanilla, who heads Accion America, a nonprofit group that works on issues facing Latinos in the Dallas metro area, said. 

“Parents are monolingual, many are undocumented, many are afraid to reach out to police, many believe that they can’t get any access to any kind of medical treatment, so they keep quiet, they remain silent, they’re embarrassed and then they’re devastated,”  Quintanilla said.

Outreach to the community needs to be “outside the box,” he added.

“This traditional kind of all these white counselors and assistant principals talking about fentanyl addiction, that doesn’t work in our community,” he said. “You got to go to the bazaars, you got to go into the businesses. You got to go into the soccer fields, you got to go out and create a comprehensive attack plan to deal with this life-threatening situation.”

Schools, however, are rarely given guidelines or standards for drug education, so it becomes “dealer’s choice,” Nichole Dawsey, executive director of PreventEd, a Missouri nonprofit group that educates youth on drugs, said. For most, education happens after a tragedy occurs, she said. 

“There is no comprehensive education, prevention or early intervention happening at the federal level or at the state level,” Dawsey said, adding that nonprofit groups or foundations, “mostly that have been started by parents of victims or after a person lost their life, are the ones that go out and educate.” 

Like PreventEd, these groups are funded partly through government grants and private donations.   

Federal grants awarded with the intention of funding drug prevention programs haven’t always produced results that match the National Drug Control Strategy’s prevention goals, the nonpartisan Government Accountability Office found in a 2020 report.

Dawsey said fentanyl awareness was incorporated into PreventEd’s drug program about two years ago as overdose rates climbed. 

In his State of the Union address last month, President Joe Biden vowed to “launch a national campaign to educate young people on the dangers of fentanyl, and how naloxone saves lives,” through the Office of National Drug Control Policy and the Ad Council. 

Schools should be supported more and given more funding and infrastructure to take this on, but the onus doesn’t just rest on them, Dr. Sarah Bagley, associate professor of medicine and pediatrics at Boston University Chobanian and Avedisian School of Medicine, said. Prevention is “a shared responsibility,” and federal- and state-based strategies to address youth overdoses would be helpful in identifying stakeholders in the community who could be responsible for different parts. 

After Khloe survived an overdose, Williams said she visited multiple treatment centers that refused to treat her daughter because of her age. She had to navigate treatment alone, just like many other parents in Carrollton.

“Parents want to get their kids help, but it’s just not working out,” she said. “They fight the battle, it’s not easy. It’s hard. It’s stressful. It takes a toll.”