As the opioid crisis continues to claim the lives of dozens of Americans each day, parents, educators, and healthcare professionals are seeking solutions to this unprecedented problem. Opioid abuse presents a unique challenge because of the drugs’ legal status and important role in providing relief for legitimate pain sufferers. Many are familiar with the story: as opioids became the go-to for acute pain cases ranging from sports injuries to routine dental surgery, addiction and overdoses skyrocketed. Opioids became the “gateway drug” to heroin.
How do we prevent addiction when so many will be prescribed these drugs in their lifetime?
While a legitimate opioid prescription may lead to abuse, only a small subset of those who misuse drugs started out with a 30-day prescription of pills for a procedure like wisdom tooth removal. And anyone who uses prescription opioids to cope with chronic severe pain will be quick to point out that most patients who rely on these pills to manage their pain are not addicted. Most of the people who abuse prescription pain relievers acquire their pills from an illegitimate source other than a doctor (source). But an overabundance of opioid prescriptions results in unused pills that provide an opportunity for some to be stolen, shared, or sold.
Health care professionals have a role in decreasing the diversion of pills to others for whom they were not prescribed, and some strides have been taken in this direction. In March of 2016, the CDC published prescribing guidelines focused on patients 18 or older in primary care settings. The Comprehensive Addiction and Recovery Act of 2016 strengthened monitoring programs that would help track drug diversion. Congress has also proposed a follow-up bill that would limit prescriptions for acute care, to prevent patients with short-term pain from going home with 30-day prescriptions that will go largely unused. (The fate of that bill is still unknown.)
Law enforcement has a vital role in combating the opioid crisis as well, since a huge number of overdoses are caused by heroin and illicitly produced synthetic opioids (source). Yet thwarting the trafficking of illicit opioids poses a unique challenge, because of the flood of fentanyl into the country. Fentanyl is a synthetic opioid that can be produced in a lab anywhere in the world; much of it is shipped from China. This potent drug can be up to 50 times stronger than heroin, and many overdose cases result from heroin that was laced with fentanyl.
Education is the preventative measure necessary to confront the new reality in which opioid abuse contributed to a recent decline in life expectancy for two years in a row (source). Parents and youth need to understand the risk of abusing prescriptions, and the very real possibility of any illicit drug being laced with fentanyl or the next deadly synthetic opioid with an even higher profit margin. But educating youth about the risk is not enough, because of what we now know about their developing brains. The brain’s reasoning and decision-making capabilities are not fully realized until the mid-twenties, which explains what may be seen by adults as baffling risk-taking behavior with little regard for the future. Education programs need to get at the heart of what leads some adolescents to use drugs in the first place.
Substance abuse prevention curriculum needs to equip young people with the appropriate social emotional skills to avoid drug use. Educators need to be honest about the fact that people use drugs to feel good – but at what cost? Young people can learn healthy coping skills to better handle stressful life events and negative emotions, rather than looking for a quick fix. Goal-setting is also an important part of this conversation, to help emphasize the value of delayed gratification. These are skills that could be established as a part of all drug prevention curricula, even for young children who have not ever considered using drugs.
The role of peer pressure has long been a staple of drug prevention curricula, and it remains as crucial as ever. Students need to know not only how to resist peer pressure, but they need to be able to recognize when it is happening. Some teenagers are overtly bullied into trying drugs, but often this pressure comes in the form of an unconscious desire to fit in, which starts to make drugs seem a lot more appealing. Helping youth to understand how their families, friends, and the media all converge to influence their worldview is a major step toward critical decision making.
Opioid addiction is a devastating illness from which it is notoriously difficult to break free. An investment in education can prevent addiction from taking hold in the first place by providing adolescents with the tools they need to take on life’s challenges.