{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:04:36Z","timestamp":1784268276865,"version":"3.55.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study describes the contextual factors and scientific data associated with fentanyl-related deaths among individuals aged 0\u201317\u2009years in North Carolina. Using information from the North Carolina Medical Examiner System from 2015 to 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 2 years (n\u2009=\u200933, 1.38 per 100\u00a0000) and adolescents aged 15\u201317\u2009years (n\u2009=\u200980, 1.96 per 100\u00a0000) experienced a fentanyl-related death rate higher than the statewide pediatric fentanyl-related death rate of 0.60 per 100\u00a0000 residents. Among children less than 2 years, 78.8% of overdose onset occurred in the decedent\u2019s 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\u2009ng\/mL (mean 27.0\u2009ng\/mL, median 17\u2009ng\/mL). Among adolescents, 62.5% of overdose onset occurred in the decedent\u2019s primary residence, followed by a friend\u2019s 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\u2009ng\/mL (mean 21.7\u2009ng\/mL, median 11.0\u2009ng\/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 2 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.<\/jats:p>","DOI":"10.1093\/jat\/bkag057","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T11:48:15Z","timestamp":1782388095000},"source":"Crossref","is-referenced-by-count":0,"title":["Trends and circumstances of pediatric fentanyl deaths in North Carolina: a 10-year retrospective study"],"prefix":"10.1093","volume":"50","author":[{"given":"Meredith","family":"Welch","sequence":"first","affiliation":[{"name":"North Carolina Office of the Chief Medical Examiner , Raleigh, NC 27607,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2536-1535","authenticated-orcid":false,"given":"Laura W","family":"Friederich","sequence":"additional","affiliation":[{"name":"North Carolina Office of the Chief Medical Examiner , Raleigh, NC 27607,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E","family":"Cox","sequence":"additional","affiliation":[{"name":"Injury and Violence Prevention Branch, North Carolina Division of Public Health , Raleigh, NC 27609,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle B","family":"Aurelius","sequence":"additional","affiliation":[{"name":"North Carolina Office of the Chief Medical Examiner , Raleigh, NC 27607,","place":["United States"]},{"name":"UNC Department of Pathology and Laboratory Medicine , Chapel Hill, NC 27559,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0900-457X","authenticated-orcid":false,"given":"Sandra C","family":"Bishop-Freeman","sequence":"additional","affiliation":[{"name":"North Carolina Office of the Chief Medical Examiner , Raleigh, NC 27607,","place":["United States"]},{"name":"UNC Department of Pathology and 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