Drug-overdose death rates among older adolescents nationwide inched up to 722 in 2015, following several years of declines, according to a new analysis.

Drug deaths among teens 15 to 19 remained well below their 2007 peak, the National Center for Health Statistics reported Wednesday, using federal data that go only through 2015. But more increases are likely. Opioids drove drug deaths among all ages up 37 percent in Pennsylvania in 2016, according to coroners' reports compiled by the Drug Enforcement Administration's local division, suggesting that teen fatalities may rise again as well.

Because many in this age group live at home, attend school, and have closer ties with their parents than adults do, however, there may be more ways to intervene.

Total overdose deaths among all ages have been rising for years as the result of increasing use of opioids such as Vicodin, fentanyl, and heroin. Among the 15 to 19 age group, however, boys' fatality rates peaked a decade ago and declined for several years before rising again between 2014 and 2015, the new analysis showed. Teen girls' overdose fatality rates have risen in most years since 1999 and faster in the last several years, but still are about 60 percent that of boys nationwide.

In Pennsylvania, 32 boys and 16 girls ages 15 to 19 died of drug overdoses in 2015, according to federal statistics. In New Jersey, 11 boys and seven girls died.

Perhaps the most striking finding in the national analysis was this: While most of the deaths were deemed accidental, 22 percent of girls' fatalities were determined to be suicides, compared with 8.7 percent among boys.

That pattern parallels adult statistics, but to an extreme. While men overall are much more likely to commit suicide, and to do so violently, especially with firearms, women tend to take their own lives using pills. Fifteen percent of drug overdoses in women in 2015 were declared suicides, federal data shows.

The report about older adolescents didn't include information such as histories of drug use.

Suicide, even when considered for a long time, tends to be an impulsive act, experts say. "The whole concept of adolescence is about impulsivity," said Michael Ogden, executive director at the Bridge, the only comprehensive mental health and substance abuse treatment program for teens and adolescents in Philadelphia.

The higher purity of heroin available now, sometimes mixed with even more lethal fentanyl, amplifies the danger, Ogden said.

Many of the young people at his residential and outpatient programs have experienced horrific traumas, and seek refuge in drugs. "The problem is already there, and the [addictive] drug is the medication for that," he said. So treatment conversations are largely about dealing with emotional pain and decision-making.

"I tell them, one decision, one time, one day can change the rest of your life."

He added: "One of the things that we have to do as treatment providers, as parents, as a community, we really need to talk to kids about the lethality of decision-making."

report in March from the National Poison Data System noted that  many children and teens have easy access in their homes to prescription opioid medications, often the gateway to street drugs. Wednesday's release on fatal overdoses from all drugs found that opioids were the biggest culprit, specifically heroin.

Parents frequently ask about the early warning signs of substance use and mental health issues in teens. Many of the signs are the same — although they usually are different for each sex.

"Boys act out. They become aggressive, they will punch things, get into physical altercations," said Erin Goodhart, senior clinical director of women's services at Caron Treatment Centers in Wernersville, Berks County. "Girls, they act in: things like eating disorders, substance use, self injury."

Goodhart, whose center includes separate treatment programs for teen girls and boys, said that "in adolescents, any drastic changes indicate that something is happening."

She said parents should look for changes in:

  • Behavior: "If you have a kid who is really outgoing and becomes introverted."
  • Friends: ditching longtime companions or acquiring questionable ones.
  • School performance and grades.
  • Activities, like an avid soccer player who is no longer interested in sports.
  • Personal habits, like grooming and clothing choice.

"Even if [a girl] is wearing long sleeves and that's not something she did before," Goodhart said. Adolescents "are going to cover up their arms to hide track marks or to hide cutting, and things like that."

Parents can contact a local treatment center or school psychologist by calling the national hotline (1-800-273-TALK) or visiting suicidepreventionlifeline.org.