Earlier this week, I was lecturing to public policy students about The United States of Opioids: A Prescription for Liberating a Nation in Pain at USC, when a student shared that, as a 9th grader, she and her Boston high school had gotten trained on how to administer Narcan (naloxone), the overdose drugs. The school supplied syringes onsite, she said, for overdose response.
Listening to her, I was struck by what a different world it is for students today. One of my messages about the roadmap out of the opioid crisis in the book is that we need to rethink the opportunity for schools and educators to play a role in combating the opioid crisis. I’ve got to be honest that I didn’t have in mind Naloxone administration training when I wrote the book. It is a sad reality that we need this kind of crisis response training. What I’m interested in is: how far can we go to transforming the school curriculum nationwide from the youngest ages through high school to give age-appropriate training to create new awareness, new language, and new skills that will support greater resilience in facing a new world of pervasive environmental and emotional challenges (that, among other things, are underlying the opioid crisis).
While the idea of focusing on schools as a battlefront in taking on the opioid crisis showed up in the 2017 President’s Commission on Combating Drug Addiction and the Opioid Crisis, my view is that we are thinking too narrowly. The three highlights on this issue from the Commission were:
- At Risk Behavior starts in Middle School: since drug use and at-risk behavior is beginning in middle school (6th grade forward), we need to start earlier than we have been in addressing the issues and provide resources through high school college.
- More Prevention and Early Intervention: we need evidence-based prevention outreach programs in schools, including tools for teachers and parents to enhance awareness of the dangers of drug use, early intervention strategies for kids with environmental and individual risk factors (trauma, foster care, developmental challenges); and
- SBIRT: we need to train counselors and school staff to utilize Screening, Brief Intervention, and Referral to Treatment (SBIRT), in schools to screen for substance use, provide counseling and make referrals as appropriate.
Amen to all of the above. But in The United States of Opioids, I ALSO argue that we need to think about even bigger opportunities:
- Don’t wait for middle school: One of my messages in the book is that middle schoolers may be the earliest age group at which at-risk opioid-related behavior behinds, but the work needs to start right the beginning in early education and elementary school to lay the foundation for a next generation of kids who are more resilient, and less at risk of stress-driven emotional responses.
- Mindfulness and Response Flexibility: As it becomes clearer that the modern environment of technology and nonstop media are not suited for how we as human beings are built (and that the opioid use among the young is being fueled in part by stress-driven emotional responses), we need to teach children how to focus their concentration and assert control over their attention, to notice distraction, and to take time for rest and recovery. Rather than waiting for kids to experience and cope with the inevitable exhaustion and mental and emotional stress resulting from all of the demands on our attention and the many sources of distraction, we need to prepare them. Embedding mindfulness and response flexibility training into the school curriculum means teaching children to be more resilient and help them develop neural pathways for good health. (Note: thank you to Judith Gordon, a human design facilitator, for sharing her important work on this subject with law students with me.)
- The Normalcy of Emotional Stress: The stories of opioid crisis victims are full of children who grew up feeling all alone in a sense of worthlessness, anxiety, depression, and isolation. These are stories of emotional stress and pain that is wrapped in a layer of shame that keeps kids from sharing what they are experiencing with parents, teachers, and friends. We need to teach children that they are not alone — that these feelings are pervasive and part of life (especially in a time of information onslaught). We need to teach awareness, so that no more children make the mistake of thinking they are the only ones who are all alone in feeling worthless or hopeless or living in shame. We need a curriculum that teaches not just self-awareness, but coping skills for mental wellness, including the importance of communal activity, healthy peer group communication, and the way that exercise, sleep, good nutrition are part of wellness. Too many children are at either the extreme of suffering in silence out of shame or being pathologized and prescribed for. While everyone’s experience is different and some cases call for intervention by health professionals, the pervasive nature of these issues calls for an education curriculum to raise self-aware children.
- Skills of Engagement, Prevention, and Intervention: At the broadest level, the opioid crisis is a symptom of how disconnected so many people are. We ought to be teaching the skills of engagement and requiring service opportunities to instill in children a sense of their own power and capacity to be a positive force for change. One of the things that became clear to me in writing The United States of Opioids is how often we are unaware that our expressions of concern are laden with judgment and shame for the recipient. We need to be teaching and learning not just new awareness, but new language and new skills to raise a generation that understand and are motivated to be agents of prevention and intervention in the lives of everyone around them.
What will this look like? I am inviting educators and parents to join me in a new conversation about how we might retool our schools to take on the opioid crisis in these ways. I’ve made a similar case for a new approach to parenting on many of these same issues. What do you think? I look forward to hearing from you.
Harry Nelson is the author of The United States of Opioids: A Prescription for Liberating a Nation in Pain. Harry’s #NotAnotherStat campaign is raising money to support vitally important work in filling gaps in our response to the crisis, including:
-development of standards to require psychosocial counseling and support participation in recovery for patients receiving medication assisted treatment
-developing resources for employers of all sizes to support SUD and mental health in workplace wellness
– supporting the work of other critically important advocacy groups, including the National Association of Recovery Residences and Young People in Recovery, who are working with Harry on resource development
-convening conversations to bring together important voices on tackling the opioid crisis, and supporting the resources to do so.
Harry has pledged to donate $1 million from sales of the book to this effort.