It’s a drug prevention conversation—and program—that was largely missing as recently as a decade ago in most middle and high schools. In those days, the principal concern of health educators and disciplinarians alike was to keep students from misusing alcohol and illegal street drugs such as ecstasy, cocaine and even heroine.
But driven by the proliferation of high-powered prescription drugs, from the highly addictive painkiller OxyContin to the ADHD remedy Adderall—and sobered by prescription drug abuse statistics for school-age children—educational leaders are answering back with a host of new initiatives targeted to that very problem and aimed largely at middle schools, where such drug abuse often begins.
The statistics are daunting. According to a 2011 study funded by the MetLife Foundation, more than 3.2 million—1 in 4—high school students admitted to abusing prescription drugs at least once in their lives. In a 2008 survey by the White House Office of National Drug Control Policy, using prescription drugs illegally ranked second only to marijuana use among teens. Another government study in 2007 found that illicit prescription drugs were the drugs of choice for 12- and 13-year olds.
Besides the risk of addiction and overdoses, the widespread and unauthorized use of these drugs is having other far-reaching effects. The 2009 National Risk Behavior Survey conducted by the Centers for Disease Control showed a strong correlation between illicit prescription drug use and academic performance in high school. Of those students who had taken such drugs once or more, 26 percent earned mostly Cs, while 41 percent registered Ds and Fs.
Last fall, the National Association of School Nurses (NASN) started distributing “Smart Moves, Smart Choices,” a comprehensive “school toolkit” designed to prevent prescription drug abuse and featuring noted authority Drew Pinsky in a series of video segments. “It was a data-driven decision,” says NASN’s director of government affairs, Mary Louise Embrey, of the new initiative. “Every day, 2,500 young people abuse prescription drugs for the first time.”
The National Education Association’s (NEA) Health Information Network is creating an anti-prescription-drug-abuse curriculum that its framers promise will adhere to the National Health Education Standards and to the Common Core State Standards. The curriculum is scheduled for release at the NEA’s national conference in July.
Some school districts, meanwhile, have taken prescription drug education into their own hands—the result, say their leaders, of growing abuse in their communities and fatalities in their schools.
A New Epidemic
The creators of the new programs say it’s no surprise that the teenage abuse of prescription drugs has reached epidemic proportions. Besides the unprecedented abundance of such drugs, many teens think these substances are perfectly legaand safe. “They don’t necessarily have the maturity level to understand that a drug—even if it comes from a doctor—may not be safe if it isn’t used as prescribed,” Embrey explains. “In the teenage mind, there’s the perception that (abusing) the drug is not illegal because it comes from a doctor.”
“Most kids would never consider doing heroin,” adds Lisa Roberts, co-founder of the Scioto County Prescription Drug Abuse Task Force in southeastern Ohio, which has provided funding for surrounding school districts to create new programs. “A lot would consider taking a pill because it came from a doctor and must be safe. But the reality is that OxyContin and hydrocodone (the generic form of OxyContin) will addict you. I know tons of kids who became addicted that way.”
It doesn’t help that some popular institutions take the misuse of prescription drugs lightly, adds Pamela Bennett, executive director of healthcare alliance development at the pharmaceutical company Purdue Pharma, which developed the widely distributed pain killer OxyContin and is funding the new NEA curriculum.
“There are symbols in our culture that make this [kind of drug abuse] appear to be more of a social norm than using methamphetamines and heroin,” she observes.
Bennett recalls an episode of the television series Will and Grace in which one character kept a “party bowl” of prescription drugs, and she also notes that rapper Eminem wears a tattoo spelling out Vicodin, another powerful painkiller to which the singer was once addicted.
What complicates matters, adds Bennett and other advocates for prescription drug education, is that parents—often without knowing it—have become the “dealers” of prescription drugs simply by leaving them unguarded in the medicine cabinet. Most of the new anti-abuse programs include components to raise parental awareness and to promote the proper disposal of any unused medications.
More than a decade ago, a study of 11- to 18-year-old students with ADHD in Wisconsin and Minnesota revealed that 34 percent reported being approached to sell or trade their medicines, such as Ritalin. Since then, reports the National Institute of Mental Health, the number of youngsters and teens with prescription medications for ADHD has risen by more than 500,000, raising the specter of even more illicit sharing and selling.
Smart Moves, Smart Choices
The National Association of School Nurses made a splash last October when it released “Smart Moves, Smart Choices,” which contains everything from guidelines on running school assemblies and finding local speakers to a flier that can be sent home to parents. The flier covers the statistics and risks of prescription drug abuse among teens, identifies the most commonly abused medications, and offers steps for securing such drugs at home and recognizing signs of abuse in children.
Colorful posters from the kit present snappy slogans such as “Small things can be deadly,” along with pictures of an overturned bottle of pills next to a tarantula. The success of NASN’s anti-abuse initiative is also riding on the video segments of Pinsky—better known through his television appearances as “Dr. Drew”—addressing a high school assembly at King-Drew High School in Los Angeles.
The segments run about five minutes long and are divided into topics with titles such as “What Is Addiction?” and “Why Kids Abuse.” In the segment “Smart Moves for Teens,” Dr. Pinsky explains how to help peers involved with illicit prescription drugs. “Talk to your friends about the dangers of prescription drug abuse,” Pinsky suggests. “Reach out to resources in your community; your school nurse is a perfect place to go—your teachers, guidance counselors, even your friend’s parents. There is help. You could save your friend’s life.”
“He has the star power of a well-known professional in the world of substance abuse,” says Embrey. “I was at the assembly where we filmed the videos, and I’ve never seen students so attentive. They were hanging on every word.”
Embrey also points to the five video segments created with MacNeil/Lehrer Productions and included in “Smart Moves, Smart Choices.” These videos cover areas such as the science of addiction, myths about prescription drug abuse—including the belief that these drugs are harmless and that abusers are immune from addiction—and testimonials by students who formerly abused.
“The combination of real students talking on this issue, along with Dr. Drew, make this a winner,” Embrey says. NASN has distributed almost 4,000 of the kits and also offers their entire contents—minus the posters—online.
Dee Smith, the school nurse at Mountain Trail Middle School in Phoenix, did not take long to order the kit—or to put it into action. A week after receiving it, Smith put on an hour-long assembly for about 150 of the school’s 850 students. Besides holding additional assemblies for the remainder, Smith plans on spreading the prescription drug message over the school year by running individual videos during her school’s morning announcements, which are broadcast through video monitors in each classroom.
“I love how the snippets are less than five minutes each,” Smith notes. “And there are not many programs that focus on prescription drugs.”
Smith hopes that the parental piece will have more success than past drug education initiatives. “I’ve had an auditorium reserved for 600 people and had fewer than 10 show up,” she recalls. “There’s a ‘not my kid’ mentality. When I call home suspecting a kid of using drugs, the parents deny it. If I offer them a free drug-testing kit, they don’t come in to pick it up.”
Building a Standards-Based Curriculum
The NEA also is developing free materials on prescription drug abuse and is integrating that subject into a broader approach to using prescription drugs properly throughout life. Nora Howley, NEA’s manager of programs, is aiming to find a place in the middle school curriculum of standards-driven school systems.
“We’re not aware of anything else like we’re doing,” Howley explains. “These materials will be tied to Common Core standards in health education and also to the reading standard of navigating and using nonfiction information.”
Reading about the dangers of prescription drug abuse and the choices individuals can make, for instance, would align with that reading standard. The curriculum would also cover health education objectives from identifying personal behaviors that cause health risks to assisting others in avoiding such risks.
“Teachers can drop it into the curriculum and it will help them meet their standards,” adds National Education Association President Jerald Newberry.
Howley says that the new curriculum, due out in July, focuses on grades 6-8 and will consist of life skills units that not only cover the abuse of prescription drugs but that teach students such lessons as not to take leftover medications for a future illness without a physician’s guidance.
“We think it’s really important that students understand all of these life decisions. The idea is to have students set a behavioral goal around prescription drugs,” Howley says. “Until now, most students would finish high school and not have one conversation about this subject.”
The NEA will distribute 10,000 of the new curriculum packets, with an eye toward state and local health education coordinators, who would pass them on to health and science teachers in schools across the nation. The materials will also be available online.Both the NASN and NEA initiatives are funded by pharmaceutical companies—Janssen Pharmaceuticals in the case of “Smart Moves, Smart Choices” and Purdue Pharma for the forthcoming NEA materials.
Lessons From Experience
Some districts that have come face-to-face with prescription drug abuse and its consequences have embarked on prevention programs of their own. Mark Selle, the superintendent of the Chewalah and Valley School Districts in rural eastern Washington state, has witnessed no shortage of tragedies. In one case, a 12-year-old brought hydrocodone tablets to a slumber party. In another case, a 21-year-old former student died after smoking the contents of a Fentanyl patch, originally prescribed for pain management. And an eighth-grader had died from a methadone overdose.
“Kids were dying, suddenly, and so young,” Selle says. “I knew a principal who had OxyContin prescribed after a skiing accident and became addicted. He stopped cold turkey but described to me the hell it was to break the addiction.
“In our little town of Chewalah, drugstores were getting held up all the time,” says school counselor Loretta Kron. “And we said, ‘Let’s find some stakeholders and people as passionate as we are. Let’s do something to help our small community.’”
The result was the creation in 2007 of the organization Prescriptions for Life. The effort was spearheaded by fourth-grade teacher Sherry Tilla and her husband, Jim, whose daughter Hayley first tried OxyContin in her sophomore year in high school and became addicted. Besides circulating a DVD telling her story, the parents make the rounds of schools as far as an hour away to speak with students in assemblies and classrooms and with teachers in staff development sessions.
Kron recalls the Tillas’ first presentation at the Valley Elementary and Middle School four years ago. “A lot of kids had the attitude, ‘That won’t happen to me.’ When the Tillas told their story, you could probably hear a pin drop. It was affecting a fourth-grade teacher whom these students knew.”
Selle and other school leaders were active in advocating for a statewide prescription monitoring program, a shared database for pharmacies that keeps track of anyone receiving a prescription and prevents abusers from “pharmacy hopping” to get multiple prescriptions filled. The program started collecting data from pharmacies around the state last October. “It’s essential that the schools be involved,” Selle insists. “In terms of advocating for legislation, the voice of school personnel speaks loudly. We have the stories, and the more kids we can get speaking out the better.”
Last year in the Appalachian community of Lucasville in southeastern Ohio, the Valley Local School District implemented a 30-minute bimonthly period at the Valley Middle School and tapped “student ambassadors” from the neighboring high school to focus on prescription drug abuse and other issues affecting students, from bullying to the proper use of social networking.
“It’s about more than drugs,” explains school counselor Jeff Rase. “It’s building a positive culture in our school.”
At the same time, Rase adds, prescription drugs are a primary topic, and with good reason in a poor community with a high unemployment rate. In a survey of Valley Middle School students before the program began, 42 percent identified prescription drugs as “very dangerous,” compared to 75 percent and 56 percent when asked about marijuana and alcohol, respectively.
“Pills have become not only something to abuse and something addictive, but a driving force in our local economy. They’re like money here,” adds Roberts, also a nurse with the Portsmouth City Health Department in Scioto County, Ohio. “We’ve got little old grandmas and grandpas selling their pills (to drug abusers in the community) to supplement their Social Security income.”
Through a $5,000 grant, Roberts is funding the ambassador program for eight districts in the county. The program trains high school students who are already leaders in student government and sports teams to work with their middle school peers about prescription drug abuse. “We’re not going to be able to solve poverty,” Roberts reasons. “But we can do some education in the schools so kids realize that prescription drug abuse isn’t normal.”
“It adds another relationship that they can look up to,” says Rase, who plans to have middle school students become ambassadors to the district’s elementary schools in the near future.
When it comes to any kind of drug abuse, Rase says, “we all know that peer influence is one of the biggest things we have to fight. So why not put a positive spin on peer relationships?”
For more information, please go to http://www.smartmovessmartchoices.org