Teen deaths from overdose have never been higher in the US as young Americans are increasingly being poisoned by the synthetic opiate fentanyl, even as fewer teens are using the drug. More than 100,000 Americans died from drug overdoses last year - the vast majority of them adults - but the group that died from overdoses the fastest were teenagers. Melanie Ramos' family is well aware of this. The 15-year-old girl died in her school bathroom last month after taking pills mixed with fentanyl.
Melanie and her friend thought they were taking Percocet, a pain reliever that is sometimes abused. But the fake pill was mixed with fentanyl and he was poisoned. "She was a beautiful and sweet girl who came from hard-working parents," her uncle Oscar said at a candlelight vigil on the steps of Bernstein Middle School, where friends and family prayed in Spanish and laid flowers at a shrine to Melanie.
Fentanyl is usually smuggled into the United States by Mexican drug cartels. While it used to be mixed with the most difficult drugs like heroin, the cartel is now mass-producing fentanyl pills in rainbow colors to mimic prescription pills and, some say, to target children who are more willing to experiment with it. In Los Angeles, a spate of pill overdose deaths alarmed authorities, and on Wednesday, the state of California seized 24 kg of fentanyl powder - enough to make a quarter of a million pills - as part of a Court-led statewide operation.
But the problem extends across the US. In New York last week, authorities confiscated 15,000 rainbow-colored pills hidden in a Lego toy box. The US is an extraordinary country when it comes to overdoses, with a death rate of 20 times the global average - although Scotland is not far behind.
"Unfortunately, we are far from the world leader in overdose deaths," said Joseph Friedman, a substance use researcher at the University of California Los Angeles.
Overdose rates among school-age children in the US doubled between 2019 and 2020 and then rose another 20% last year, he said.
"Adolescent drug use is becoming more dangerous but not more common," Friedman said, adding that fentanyl, not pandemic stress, is to blame: Teen drug use actually drops sharply during the pandemic because it's usually a social activity.
At a controversial meeting at Bernstein High School, where Melanie died, officials and police warned angry families and children that "one pill can kill". His death has prompted LA officials to provide the overdose-reversing drug, Narcan, in every school.
The drug, which is usually in the form of a nasal spray, can be used by anyone to reverse the effects of an overdose.
Improving access to Narcan is also part of the federal response to the opioid crisis announced this month by the Biden administration, which said it would inject $1.5 billion (£1.3 billion) into funding programs and supporting law enforcement to pursue drug dealers. Experts say teens will experiment with drugs no matter what they're told or taught in school, so overdose prevention is the only way to slow the growth of overdose deaths.
Los Angeles Public Health Project workers provide free Narcan and fentanyl test strips — so people can test the drugs before they get high. They are happy the school will now keep Narcan, and have urged parents and children to carry it in their backpacks. At a recent training, drug and alcohol counselor Sandra Mims demonstrated how to use the spray - one spray into the nose, followed by rubbing on the breastbone. Then spray again 2-3 minutes later if the person who overdosed doesn't respond.
"Kids start as young as 12," says Ms Mims. "It's much more lethal now with fentanyl and synthetic pills." Nick Angelo, who has used opiates in the past but now works for a nonprofit, saved three people with Narcan in one week. But he sounded tired rather than heroic when he talked about it."When my friends and I take opiates, we don't have to worry that every hit we take could be our last," he says.