Effective Prevention Strategies for Teens

(Originally published by WEconnect Health Management October 21, 2021)

In October 2019, I attended my first Drug Policy Alliance conference in St. Louis, Missouri with thousands of other Harm Reductionists and drug policy wonks from all over the world. I attended many memorable and groundbreaking sessions that were incredibly powerful; they offered a glimpse of what compassion, science, and sensible drug policy could do to change the world. Amidst a jam-packed itinerary of amazing content, the most impactful breakout session I attended was called “Safety First: A Reality-Based Approach to Teens & Drugs.” 

In February 2021, television personality Dr. Laura Berman tragically lost her teenage child to accidental drug poisoning due to counterfeit prescription pills. The pills were marketed and sold on the black market as Xanax, but as is extremely common these days, the pills the teenager purchased were actually pressed with fentanyl—an extremely potent opioid analogue. For an opioid-naive person that is expecting a Benzodiazepine like Xanax, fentanyl is potentially deadly. 

Many of these unfortunate deaths have rocked our country in recent years, killing many people of all walks of life—including celebrities like Lil’ Peep, Mac Miller, and Prince (to name just a few). In the wake of these deaths, the loudest community response is usually “We need to keep these drugs off our streets and prevent our children from trying them.” While this response is totally understandable and comes from the right place, it’s a tired, outdated, and ineffective strategy for saving lives. 

Human beings have had the desire to be in an altered state since the beginning of time. A neanderthal’s remains were discovered to have been buried next to the Ephedra Plant 65,000 years ago—a plant widely used (even today!) as a stimulant for weight loss and athletic performance. The ancient Sumerians’ use of opium started in about 5000 BCE. Coca leaves (the source of cocaine) have been chewed for thousands of years in South America.

Americans use substances every day to serve a variety of purposes; from prescribed medications that treat health concerns to legal drugs like caffeine and alcohol that can make you feel more energetic or less socially awkward, our culture is constantly pointing to the positive effects of being in an altered state. Teenagers who grew up steeped in that culture are the same as they’ve always been: they grow up in a society where most of their idols, mentors, and family members imbibe various forms of recreational and medicinal drugs. It’s no surprise that many of them will decide to experiment with those very same substances—some doing so safely with no negative consequences, and others who aren’t so lucky. 

It’s no surprise that “just say no” or telling teens that they’re “too good for drugs” is not an effective strategy to prevent the negative consequences of this experimentation process. We can’t convince them that using substances means “frying their brains” when they’ve grown up watching uber-successful adults using drugs openly, all while still earning lots of money and achieving elevated status in our society. A song called “Mask Off” by popular recording artist Future peaked at number five on the US Billboard Hot 100 for the week of May 6, 2017, becoming Future’s highest-charting overall single. The chorus of this song—“Percocet, Molly, Percocet”—can still be heard today, blaring from big stadium speakers at sporting events and popular radio stations across the US. These teenagers grow up in a society where accidental drug poisoning is the number one cause of accidental death for adults under the age of 50, while drug use is also very much a normalized part of mainstream culture. 

How do we prevent these kids from causing harm to themselves while they navigate their relationship with substances? How can we prevent drug poisoning deaths amongst teenagers? The answer is simple: Harm Reduction Education. An evidence-based curriculum that acknowledges the reality that some kids will indeed experiment with substances, whether that’s in high school, college, and beyond. By accepting that reality, we can teach kids how to stay safer when experimenting and how to survive their drug use. 

Luckily, this curriculum already exists! Safety First: A Reality-Based Approach to Teens & Drugs is an evidence-based curriculum that is available for FREE, with favorable results backing it up. In this curriculum, teens are able to have healthy and robust conversations with adults about the myths, facts, and dangers of drug use. They learn ways to stay safer and about the harmful effects of each drug on the developing adolescent brain. The curriculum is grounded in fact, but is not presented in an inflammatory way—instead, it’s presented in a way that allows teens to feel that they have access to the information needed to make an informed decision about their lives. For example, the students learn how and when to use the life-saving opioid reversal drug Naloxone. They also learn about potentially deadly drug combinations to avoid and how to test drugs for deadly contaminants like fentanyl should they decide to experiment. They’re also educated about the current mass drug poisoning event in America that includes the counterfeit pills that are killing so many, and how to avoid becoming another tragic casualty. 

The availability of curriculums like this, combined with evidence-based coping skills that teach kids how to process grief and trauma and manage their self-esteem—such as mindfulness and Cognitive Behavioral Therapy—could greatly improve the health and wellness of our youth. The vocal opponents of this Harm Reduction approach for teens are akin to the folks that vehemently opposed Sex Education, claiming that it would inspire teens to have more sex as opposed to teaching them how to stay safer when they do. We know after years of research that this is not the case; there is no evidence that teaching kids about safer sex caused them to have more sex more often. The same is true of Harm Reduction curriculum for teens; giving teens the power of knowledge and information will encourage them to stay safe (and more importantly, to stay alive) should they ever decide to imbibe substances that have been used throughout history. 

‍To learn more about this extraordinary curriculum, follow this link.
‍To learn more about Harm Reduction principles, check out https://harmreduction.org/
To attend a Mutual Aid Support Group for anyone interested in learning about or practicing Harm Reduction, check out Harm Reduction Works’ linktree.

This blog was originally published by WEconnect Health Inc.

Here at WEconnect, people gather from all over the world every day on Zoom to practice mutual aid and support each others’ journeys at our online recovery support meetings. These meetings are a source of strength, support, and encouragement for so many who are exploring what recovery and wellness looks like for them… But one challenge that seems to come up for many is self-deprecation for perceived failure in reaching their goals. 

Many people inflict painful judgement on themselves when they do not successfully maintain big changes for consecutive days in a row. For example, if someone is trying to abstain from alcohol and succeeds for 25 days, but consumes alcohol on the 26th day, they feel that they have completely failed to achieve their goal and must start from day one. Worse yet, many may even feel that they have completely failed at their goal and quit pursuing it altogether, resuming chaotic usage. 

It is true that in some pathways of recovery, counting days in a row and celebrating milestones is sometimes contingent on those days being consecutive. Drinking and using substances moderately may be problematic for many, making abstinence the solution that makes their lives better. For some, it’s a great motivator and helps them to achieve their wellness goals. For others, this experience may have been helpful in the past—but can lead to more and harsher judgement when they are not able to achieve it again. 

There’s a harsh side to the expectation that healthy changes must occur perfectly in order to achieve that goal; it lies in the self-shame and judgement that comes with these perceived failures. 

My personal forays into creating a daily meditation practice have hit this point home over the years. I will have weeks, even months of almost militant “rise-and-meditate” regimens, only to wake up and skip for a few days due to a sore neck or a tight schedule. Once I realize I have missed more than one day in a row, the dread and self-judgement kick in—and my internal dialogue can become nasty and judgmental. I fall into the trap of shaming myself into not doing the things I know will make me healthier and happier just because I was unable to do them perfectly. 

So what’s the solution for this? It turns out, academia has published research about this phenomenon. Those findings concur that our expectations for linear change are unrealistic and deprive us of the rewards we deserve for our efforts:

“Change does not always occur in a ‘slow and steady wins the race’ approach—its pattern isn’t always gradual and linear. Quite the opposite is true, as continuous change often takes place born out of the nonlinear dynamical systems theory that is akin to shaking a snow globe, whereby the bits of snow experience a whirlwind of disturbance and variability before settling into a beautifully new snowy landscape.” (Hayes, Laurenceau, Feldman, Strauss, & Cardaciotto, 2007) 

What if we viewed big changes in our lives as a snow globe: disturbed, but settling? Maybe we could stick with the plan even when it changes. 

Sometimes it helps to reflect on what happened to change the course of your plan, and to remind yourself of the reasons why you set that goal in the first place. For example, when I miss a day in my meditation practice because of my tight schedule or body aches, I try to respond rationally to my judgmental internal dialogue: “I know I missed a day, but I was stressed and/or hurting, and what I’ve gained from my practice is not invalidated because I wasn’t able to show up this time. Meditation helps me ground myself, reach clarity, and focus, so I’m going to keep at it because it’s worthwhile to me. I will keep going.” 

Some days it’s harder to think this way than others, and that’s okay. Self-love and compassion are practices, too; and like anything else, there will be days when it’s more difficult to forgive yourself. 

One thing’s certain: self-compassion in the face of perceived failure is a difficult practice indeed. Let’s all keep in mind that mistakes are part of the process, and even the smallest of incremental change is worth celebrating! 

If you’d like to celebrate your healthy changes with us, or unpack some of the challenges in your life in a supportive space facilitated by a certified peer support specialist, please join us in one of our free online mutual aid support meetings, offered 8+ times a day!

This blog was originally published by WEconnect Health Management

The holidays are a time of celebration, love, and family that can be exhilarating for some and soul-crushing for others. Whether one is of the former subset or dreads the holidays like going to the dentist, the anesthetic of choice in America is alcohol. 

In America, the holidays are a time of excess. Excess shopping, excess eating, and definitely excess drinking. It’s the time of year where weight loss goals are swept aside and sugary treats abound. Many of us go into debt trying to “win” Christmas, Kwanzaa, Hanukkah, etc. And of course, the boozy eggnog, sugary cider, champagne, and more are imbibed in the shared indulgence of jolly gatherings… then the hangovers come crashing in, full of regret. 

Most of us know some ways to reduce the harms of alcohol. Some of us had parents that gave us a get-out-of-jail-free card: “Call me if you’ve been drinking.” We learned to never drive drunk and always have a designated driver, but typically that’s the only piece of cookie-cutter wisdom shared around safer drinking. Luckily, there are some more easy tips and tricks that can help keep us all a little healthier and a little safer this year as we move through the holiday season.

1. Plan ahead. Be realistic about the fact that you are going to drink. Not having a plan is definitely starting off on the wrong foot. Even the basic tenets like “never drive drunk” are on the chopping block if we don’t acknowledge we are likely to have a few drinks beforehand. 
2. Hydrate. Alcohol is literally toxic sludge that is slowly poisoning our insides, leaving us dehydrated with pounding heads. Just remember to have water before you drink, while drinking, and after the party’s over. Even a final glass chugged before bed can help balance out the toxins and render them much less of a threat to our bodies. A good rule to follow is to have a glass of water between drinks. 
3. EAT! Make sure to have a meal before or while drinking. Alcohol is absorbed slower with food in your stomach, preventing the “sloppy” episodes that can inspire embarrassing confessions, drunk dials, and Facebook posts. Which leads us to the next tip:
4. Put your phone away. Whoever you hand over your car keys to, consider handing them your smartphone, too! Logging into social media or engaging in conversations with folx who aren’t with you in real time can be problematic for all involved and require major clean-up later. 
5. Practice safe sex. Let’s face it: “liquid courage” can sometimes lead to unplanned sex. As unrealistic as this may sound while you are preparing for your night of drinking, it happens. Carrying condoms or other contraceptives are an excellent way to avoid lifelong consequences.
6. Drug-related decisions. The same “liquid courage” that can lead to unplanned hookups can also lead to unplanned drug use. For those of us with a history of chaotic drug use, alcohol might lead us down a slippery slope. Being mindful of our past can help us navigate the future. Having a trusted peer to discuss decisions while we’re drinking can be a difference maker, so consider having someone with you that knows your boundaries; this is the ultimate form of harm reduction. 
7. Consider abstaining. The only way to mitigate all harm from drinking is to not drink. If your drinking feels like it’s becoming problematic, there is NO shame in asking for help or swapping out booze for the latest mocktail. 

For more information about alcohol harm reduction, check out the HAMS: Harm Reduction for Alcohol site. To find a supportive community in the form of Harm Reduction mutual aid support meetings, please visit the Harm Reduction Works link directory. 

The Emergency room came to life as a female voice repeated the words “Code orange” over the intercom. Nurses in scrubs communicated in nervous whispers with palpable anticipation. I flipped my ID card over to look up what the hell code orange meant. My heart sank as I scanned down to the orange block: “Code Orange: Mass Casualty Event”. I wondered when my life became a scene out of Gray’s Anatomy.

I was there that day to connect with two individuals who’d overdosed. We call them heroin overdoses but most likely it was fentanyl. Fentanyl is a powdery substance primarily created in Chinese labs, crossing oceans to arrive smack dab in the middle of our Opioid epidemic. It’s mixed with, or sold as heroin, frequently causing overdose due to the astronomically higher potency.

Sometimes people realize it’s fentanyl when they fill their syringes and the liquid inside does not turn a familiar brown. The problem is by then they’re starting to feel their insides churning. Their body has grown frigid and clammy, skin crawling in a papery dread. Their legs have started to kick and jerk on their own, possessed and endlessly restless. Their eyes flood with tears, not from emotion but an unseen force that commands fluids to pour out, needlessly purging nothing. The nose gets a cue from the eyes and commences to stream watery mucus obliging them to sniffle and snort. The pupils dilate mercilessly from an opiate induced speck to eclipsing all color, turning the eyes a demonic black. There is no relief. There’s no remedy like one would turn to if this were a garden variety ill. They could swallow 7 Ibuprofen, wash it down with Nyquil and Xanax and still be tossing and turning in misery. The ONLY thing on earth that can relieve them from this infinite suffer-fest is an opiate. So the excruciating morning is spent stealing a family heirloom from a relative, selling it at a pawn shop for 1/10^th of the value and pacing the block in 10 degree weather waiting hours for the dealer. Next comes standing in line at the Pharmacy dripping in sweat as they fork over their last 4 bucks to purchase a bag of hypodermic needles since this is the only instrument that will deliver them from their nightmare.

After these humiliating, guilt dripping gut wrenching activities they must find a public restroom, search for a vein to the ambiance of someone pounding on the door while they drip blood on their only clean hoodie. In the midst of this glamorous experience, they notice the loaded needle is too clear. It’s probably fentanyl. The fear of imminent death is silenced by the need to end suffering.

They awaken on the bathroom floor projectile vomiting; a warm, sticky feeling in their pants that they’re hoping isn’t what they think it is, surrounded by wrinkled judgy faces. A select few agree to hospital transport, aware that the shot of breath enabling Narcan could wear off, sending their body back into respiratory failure. Their lips will again turn blue, foam gathering on the sides of their mouths as breath is replaced with a “death rattle” as they slowly drown. I once asked a guy what it felt like, having been spared the experience myself. His answer was “Ya know when you’re standing on the beach with your feet in the sand right next to the ocean and a wave comes and sucks the sand out from under your feet? It feels like that.” He said. I can pretty much guarantee that no one living this way planned to end up there. The brain, once dependent on opioids is chemically altered, shifting what was once a choice to a necessity.

My title was Peer Specialist; which meant I had found recovery and tried to help others find it too. Without connection to people like me, OD patients are discharged within hours with no follow up or aftercare, likely to relive the event like Groundhog Day.

I asked one of the nurses where I could find the two patients. Her reply made my heart sink and my blood boil “Oh we discharged them to make way for the REAL medical emergencies en route”. The “real” emergencies never came. The Code Orange, which beckoned every available surgeon, nurse, and x-ray tech down to the ER, was the report that there’d been an explosion at a nearby nail polish factory. The problem is that the nail polish factory survivors were fictional. The explosion was real having only seriously injured one individual who was being treated elsewhere. “They wanted to leave she said, so we discharged them”. What she and all the other staff fail to understand is that yes, when told they’re free to go, they will most likely run. At the same time, if they are kindly offered help they are often just as likely to receive it. If every hospital in America were to treat the people recovering from overdose as REAL medical emergencies, offering help instead of judgment, stigma, guilt and shame, this epidemic could end overnight.

The stigma is alive and well in this Emergency room and others like it all over the country, putting a huge brick wall between people who are suffering and the help they so desperately need from the medical community.

A recent study published in The Journal Of Addiction Medicine titled An Exploration of Emergency Physicians’ Attitudes Toward Patients with Substance Use Disorder reported “A significant portion of our study population had low regard for patients with substance use.”

Until we treat the disease of Substance Use Disorder with the same compassion and urgency as diabetes, heart disease, cancer and burn victims, we will continue to bury an entire generation.

Last Sunday I was hunkered down at home, listening to the wind howl and the ice crack outside. We were experiencing a period of polar air, making the Hudson Valley feel more like the Arctic Circle. A look out the back window revealed a frozen creek, the nearly full moon illuminating perfect corkscrew holes from ice-fisherman searching for Yellow Carp.

Extreme weather alerts were issued that night, warning us of the 15 minutes it would take exposed skin to become frostbitten. Trapped inside most of the day by the bitter cold, my eyes glazed over as I binged on Netflix and Hulu, my most urgent concern being loss of power. God forbid I go to bed without finding out who survived the longest on a deserted island without clothes, food or a restraining order for their assigned partner.

I’ve clocked more hours than usual on the couch lately due to an injury caused by my trail running addiction. Trail running is a sport where you pay money to run mostly uphill until your toenails fall off. I was lying there feeling sorry for myself, ice pack under my butt, heating pad around my neck, grateful that the howling wind gave me an excuse other than my injury to be immobilized. I got up to hobble to the small wicker basket containing the various hippty-doo herbal remedies I rely on to dull the pain of crumbling teeth and aging tissue. The previous Friday I went to get one root canal and left with three. Not cool, but way cooler than when I couldn’t afford root canals, went to get one tooth pulled with Medicaid and they pulled four. According to Medicaid teeth are a cosmetic issue, not a necessity. If you happen to be an inmate or in my case at the time, would-be inmate mandated to rehab, the protocol is pull the teeth and give ‘em dentures. More commonly, pull the teeth, promise them dentures and send them packing before this even happens.

I threw some tiny white spheres under my tongue which the girl at the health food store promised would “like totally help with inflammation” and headed back to the sliver of couch not occupied by my two sprawled felines.

I flinched mid-step as the stock ring-tone of my “work-phone” chimed on the counter. I glanced at the clock, 11:30pm, which means this isn’t going to be good. Technically I work a 35 hour Monday through Friday workweek as a Recovery Coach for a non-profit, using my lived experience to connect with people in Hospitals. As a survivor of an opioid epidemic that’s killing upwards of I44 souls a day, I tend to answer my phone when it rings like someone’s life depends on it which it often does, especially on a brutally cold Sunday evening at 11:30pm. I took a deep breath and answered, “Hey this is Meghan how can I help you?” There was loud breathing on the other end accompanied by an echo of the same icy howl I was hearing outside my house only louder. The voice revealed itself to be a man, a man who was asking for help, a man who was literally freezing to death in an abandoned building due to his addiction. I could actually hear his teeth chattering as he begged for help through tears and choking. “I keep trying and trying but I can’t stop, please help me, IM GOING TO DIE!” he said. “Ok, I got you. You’re going to be ok, I’ve been where you’re at I get it and I’m going to help you. Hang up the phone with me and dial 911. They will come pick you up and take you to the Hospital where you can ask for a medical detox” I said. The would-be silence during his long pause was filled with the violent wind barging through shattered windows and decrepit doors. “He finally answers “Ok, I’ll do” it. I pleaded with him to stay in touch and don’t leave the hospital no matter what!

If I bought into the stigma of addiction being a moral failing, I would have shut off my phone and gone back to the jungle with the naked people far removed on my screen. I have a different perspective; I know that people like that man on the phone are one compassionate voice away from a whole new life. A life where teeth are worth saving and life is worth living.

In that moment I was shaken to the core not from the artic wind but from empathy and gratitude. In my previous life when couch surfing didn’t pan out, I took to the subways of NYC in the cruel winter dozing off long enough between stops to get through the long frosty nights. I was understanding with great clarity in that moment how fortunate I was to be pulling him out of that abandoned building instead of dying in there with him.