Let’s Talk About Drugs: Teen Drug Use From A Harm Reduction Perspective

In Season 2 of Sam Levinson’s Euphoria (which premiered earlier this year), the series’ 17 year old protagonist Rue grapples with heroin addiction, befriends a sinister sex trafficking drug dealer, and somehow becomes responsible for a suitcase containing $10,000 worth of misc narcotics. Over 16 million people tuned in every Sunday night to witness Rue’s unraveling as she grappled with some of the darkest and most fragile human experiences. With the growing popularity of shows like Euphoria, parents are being confronted with some of the most gruesome examples of how drug use can impact teens.

Regular access to this kind of media makes it easy to feel like every high schooler is doing drugs at rates unparalleled to previous generations. But recent studies suggest that teen drug use is actually declining. In 1999, the CDC found that 47% of all high school students had used marijuana at least once (Robison, 2002). In 2019, only 37% of students reported using marijuana (National Survey on Health and Drug Use, 2018).

We are not saying that there is no reason to be concerned about teen drug use in 2022. While marijuana use has been declining, 2021 marked an all-time high for opioid-related overdoses and deaths. More than 80,000 people (not just teens) died using opioids in 2021. Deaths from methamphetamine and cocaine also rose, as both drugs are more frequently laced with fentanyl. In 2018, more than 695,000 adolescents aged 12-17 reported misusing prescription pain medications, a number that has only increased in the years since (Source). 

So teen drug use is scary, it’s sensationalized in the media, and there are scary trends and studies that reinforce our fear. 

How should parents (and other adults in teens’ lives) react? 

It’s important to note that fear surrounding teen drug use is nothing new. In 1969, 48% of Americans reported that drug use, and specifically marijuana use, was a “serious problem” in their community. At that time, a mere 4% of the American population had ever smoked weed (Robison, 2002). 

This fear about teen drug use has, historically, been very unhelpful. Rhetoric about drugs and teen drug use led to the ‘war on drugs’ and fear-based anti-drug programs such as ‘D.A.R.E.’ (Drug Abuse Resistance Education). 

In the years since these programs were enacted multiple studies have shown that they caused much more harm than good. As we discuss in our section on Risk-Taking in ‘Unlocking Teen Motivation’ D.A.R.E was intended to educate young people about drugs and scare them away from substance use. Instead, it introduced kids to new substances they had never heard of before and led to increased drug use among teenagers (Source). This doesn’t mean that talking about drugs with teens is damaging (as we’ll talk about below) but scare tactics have been largely shown to be ineffective. 

Recently, among the medical community (and some policy makers) there has been growing support for a new strategy to help combat the harm that drugs can cause to teens and adults: Harm Reduction*.  

However, because of the pervasive fear most of us feel about drugs, and the stigma that drug users face, Harm Reduction (also known as risk-reduction) techniques have not been widely embraced by the American public when it comes to drug use. 

So in this article we want to talk about what Harm Reduction is, why it’s important, and what are some basic Harm Reduction techniques parents can practice to help keep their teens safe. 

WHAT IS HARM REDUCTION?

Harm reduction is rooted in risk reduction. A good comparison is to think of it in terms of ‘abstinence only’ vs comprehensive sex education.

Drug prevention programs like D.A.R.E. are like ‘abstinence only’ sex education programs. They focus on telling teens not to do drugs and why they shouldn’t do drugs. The abstinence-only approach to drugs focuses on enforcing strict rules and boundaries and normally uses fear-based and shame-based tactics. The underlying message these programs send is that people who use drugs are bad, immoral, or weak and if you use drugs you should be punished for it. 

Like abstinence-only sex education programs that lead to higher rates of teen pregnancy, these types of drug prevention programs inevitably lead to higher rates of teen overdose (Source).

What these programs ignore is that it is inevitable that some teens will use drugs and have sex.

Harm reduction programs (like comprehensive sex education programs) accept that some teens will use drugs and have sex. These programs focus on teaching individuals how to safely interact with drugs should they come into contact with them. 

These programs have shown far more positive outcomes than abstinence only drug programs. Teens who are taught harm reduction techniques are less likely to overdose or suffer other adverse effects from drug use (source). 

CAN TEACHING MY KID HARM REDUCTION TECHNIQUES BE DAMAGING?

Every year, hundreds of thousands of children suffer life-threatening injuries from car crashes. In 2019 alone, 2400 teenagers were killed (CDC, 2020). 

Still, sixty-one percent of teenagers have their driver's license by age 18. When our teens turn sixteen, we don’t prohibit them from getting in a car. We take them to defensive driving classes, we pay for supervised instruction, and we enforce a set of rules and guidelines dependent on our trust in our kids. We practice harm reduction, or in other words risk reduction. 

There are arguments that say when parents try to teach their teens about drug use from a harm-reduction standpoint that can be seen as an endorsement of drug use by some teens. 

But this is easily remedied by being crystal clear when we have conversations with teens that we are not endorsing the use of drugs. We’re simply acknowledging that they exist, that our teens may be exposed to them, and it’s important to be informed about how to safely interact with them if/when that happens. 

Any conversations about drug use need to be approached with care. But like comprehensive sex education, it is better to have these conversations with teens than to ignore them completely. 

Avoidance is never the best strategy!

It is always helpful to practice harm-reduction techniques, but it’s also important to do so with care and intentionality. 

4 WAYS TO SAFELY PRACTICE HARM REDUCTION AT HOME:

1). Don’t attach judgment, stigma, or shame to drug use or drug users

The most important part of harm reduction is creating an environment at home where teens are able to have open and honest conversations about drugs and/or their experiences with drugs without the fear of being punished or shamed. 

Try to avoid using language like ‘good, bad, right, wrong’. Instead, be honest and open about the reasons that people might do drugs and the reasons they can be dangerous. 

2). Ask your teens open ended questions

This is a tool for almost any situation with teens! Asking your teen open ended questions can help them explore and process their thoughts and emotions about complicated subjects (like drug use). It’s also an opportunity for you (the adult) to establish yourself as a safe person to talk about this subject with. 

Some examples of open-ended questions you can ask are: 

1. Ask them what kind of drug education they’ve received in school
2. Ask them what they think of the drug education they’ve received in school
3. Ask them what they think about how drugs are depicted in the media (either in the news or in shows like Euphoria)
4. Ask them how they feel about the way their friends and peers talk about drugs and/or interact with drug culture

Bonus: You can use these conversations as an opportunity to ask them where they get their information about drugs from & share some resources that are reliable & trustworthy

1. Some examples of reliable sources for information on drugs is the National Institute of Health (NIH), the Centers for Disease Control (CDC), the Lower East Side Harm Reduction Center (LESHRC), Vocal NYC

3). Create rules and expectations around drug use that do not involve punishment

The key to a harm reduction approach is empowering people to come up with their own rules and expectations.

That can sound scary, but many parents find that having open and honest conversations about drugs with their teens is actually reassuring. 

When Teen Brain Trust CEO and Founder Mya first talked with her boys about narcan (see point #4) she was highly anxious regarding what they might say about opioid use. Instead, she was relieved to hear that they hadn’t come into contact with opioids and never wanted to. They weren’t at all interested in experimenting with prescription medication and wanted to stay far away from any illicit and highly addictive substances. 

Example of a rule or expectation that doesn’t involve punishment: 

When setting rules and expectations, Mya’s primary goal was to keep her kids safe. One way they did that was they came up with a safety plan. If any of her boys ever got into a party or social situation with drugs and alcohol where they felt unsafe or as if they were being pressured, they had an agreed upon emoji they could text her and she would then call them and pretend like they needed to come home to help with some made-up emergency.

That way, her kids could always have a socially-acceptable escape plan.

The rules and expectations you set around drugs with your teen will depend on your relationship and ability to be open with one another, but the more your teen is involved in creating them, the more likely they are to be upheld. 

Some things to consider when having this conversation are: 

1. Make sure to state explicitly that you are not endorsing drug use. You can say something like, “I’m not encouraging you to go out and use substances OR giving you permission. However, there is no sense pretending that you will not encounter drugs in your life. I want to make sure that when that happens, you have a plan for what to do and how to act. I also want to make sure that you feel comfortable coming to me for help and/or advice if you find yourself in a situation involving drugs that feels out of your control.” 
2. Agree in advance on what will happen if your teen violates the rules and expectations you have set together. Try to avoid making these consequences punishment-oriented. Setting punishments will only make your teen less likely to be honest with you in the future.
3. Come up with a safety plan
   • Ask your teen questions like, ‘What will you do if you find yourself in a situation with drugs where you feel unsafe?’, ‘What will you do if your friend is under the influence and wants to drive?’, ‘What will you do if a friend has had too much to drink and has passed out?’ etc . . .. 
   • Make sure that your teen knows that you are a safe place to go if things go south. It is integral that they feel comfortable calling you or asking for help if they find themselves in a dangerous or even uncomfortable situation.
   • Share resources for places that they can go or people they can call if they can’t contact you, whatever the reason may be. Perhaps a trusted family friend or member of the extended family that they feel more comfortable talking to. 

4). Encourage your teen to get trained in naloxone (an overdose prevention drug)!

It’s really easy to read words like ‘naloxone’, ‘narcan’, or ‘overdose’, and immediately want to skip to the next section.

This is such a scary and anxiety producing subject that many parents would rather avoid it entirely and that is a totally valid, normal, and natural response.

Other parents may skip this section because they don’t think it applies to them; their teen would never be in a situation where an overdose is happening. 

If you fit into either of those groups, I still recommend you read the following.

By the way, my name is Pia. I’m a psychology student that does research and writes for Teen Brain Trust. I also work at the Lower East Side Harm Reduction Center in NYC. We distribute hundreds of naloxone kits and report dozens of life-saving reversals every month. 

Even if your teen has no interest in opioids and would never get involved with someone who does, having them get trained in naloxone can still provide a ton of benefits, which we outline below. 

But first, What is naloxone (aka narcan)?

Naloxone, also known as narcan, is an opioid receptor antagonist, which basically means taht it can block the effects of opioids and reverse overdose. 

Naloxone is most commonly distributed as a nasal spray and using it is a rather simple process; you simply unpack the nasal spray and spray it in the nostril of someone you believe to be overdosing. There is NO HARM in giving narcan to someone, even if they are not overdosing. 

Narcan has been found to be 93.5% effective when administered, which shows a massive success rate. It is one of the most important tools we have to combat the opioid epidemic. I’d also like to mention that even though it is simple to administer, it is still essential to attend training, get certified, and receive state legislated naloxone. 

With the rise in opioid related overdoses and the presence of fentynal in drugs like cocain, it’s more important than ever that as many teens as possible have access to naloxone to help prevent overdoses amongst their friends and peers. 

What are the benefits of encouraging your teen to be trained in narcan?

1. Ironically, even though the thought of getting your teen trained in narcan may be anxiety producing, it can actually be a great way to start a proactive conversation with your teen about drugs.

This is what happened for TBT CEO and Founder Mya when I first introduced her to the idea of narcan training and encouraged her to talk to her teens about it. Neither her nor her teens had heard of narcan and talking about it opened up a great conversation where they got to speak openly about drugs and their anxieties surrounding the opioid epidemic. 

1. If your teen gets trained in narcan they’re more likely to see themselves as someone who is helping fight against the opioid epidemic rather than as a potential victim. 

This is why one district in Tennassee that’s been hit hard by the opioid epidemic is now training kids as young as six in the use of narcan. The kids who are trained feel empowered AND are equipped with the ability to save members of their family or of the community. 

1. Getting trained in narcan is essentially a public service. 

It provides a positive, practical, way to take action against the opioid epidemic. In that way it can actually counteract anxiety and also encourage healthy and proactive ways of thinking in teens around drugs and drug use.

It may happen that by getting trained in narcan you or your teen will save a life. 

How do you get trained in narcan?

Overdoseliveline.org has an online course and resources on where you can find clinics and help near you. You can also simply Google ‘narcan training near me’. 

The US Surgeon General says, ‘Expanding the awareness and availability of this medication is a key part of the public health response to the opioid epidemic.’

There is growing government support for narcan training initiatives so it shouldn’t be too hard to find a course near you. 

Additional reading:

• Narcan FAQs for Parents - https://www.upstreamparent.org/?p=1435
• Expert Answers: How can I talk to my teen about drugs and narcan? - https://hvparent.com/real-talk-oct-19-expert
• Online Narcan Training Course - https://www.overdoselifeline.org/opioid-training-and-courses/layperson-naloxone-administration/ 
• Study: Naloxone Saves Lives - https://nida.nih.gov/publications/naloxone-opioid-overdose-life-saving-science

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To borrow a quote from Dr. Paul Schwartz, “We would all be happier if none of our children experimented with drugs or alcohol—but unfortunately the vast majority do. With our involvement in their lives we can all try to make this often harmless adolescent curiosity a phase that passes quickly rather than something that causes the trauma of overdose—or worse.”

We know how important it is for parents to keep their children safe and healthy. We also know that sometimes anxiety and fear take over at full speed. But when we (adults) react to teens by shutting them down, getting angry, punishing them, and/or shaming them, we only discourage teens from communicating openly with us. This doesn’t keep them safe. If/when they DO get involved with a situation involving drugs, it means they will be less likely to turn to us for help.

Scare tactics and abstinence-only approaches to drug use and drug education do not prevent teenagers from using drugs. Harm reduction techniques have been shown to be the safest and most effective means of keeping teens (and adults) educated about drugs and drug use. 

We understand that not all the harm reduction techniques recommended in this article may feel comfortable to you or even necessarily possible, and that’s okay too. The goal is to help our teenagers keep themselves safe. The evidence around harm reduction says the best way to do that is to provide them with a safe space where they feel they can be honest with us without fear of punishment or judgment. 

Getting started with any of the harm reduction techniques listed above, even if it’s just initiating a conversation, will help achieve that goal. 

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*The concept of harm reduction first came about in the 1980s with the growing AIDS epidemic, as the injection drug use population was one of the most vulnerable communities impacted by HIV and AIDS. Syringe service programs came to a rise in the late 1980s, where people who injected drugs could come bring back their used syringes and obtain new, sterile syringes. They have since expanded to cover myriad services for the drug use population, including drug education, therapy services, STI testing, group counseling, and naloxone training to reduce near- fatal overdoses. 

Insight into the effectiveness of these programs comes from research conducted in Canada. Wodak and Maher found that there was a 78% decrease in HIV infection as well as 42,000 referrals made to other services, including housing and mental health programs between the years of 2002 and 2011. An example of harm reduction in action in New York City comes from the first supervised injection drug sites that opened at the end of 2021. Between just December and February, over 130 near- fatal overdoses were reversed, and about 1000 New Yorkers had been served by that site.