Can Harm Reduction Finally Take Root in America’s Schools?

November 7, 2019

In my second year in junior high in Philadelphia, I sat with two dozen peers, waiting for the start of our mandatory seminar on “drug abuse.” It was 1984. President Ronald Reagan had just won his second term, and the War on Drugs was in surge mode.

As we fidgeted at our desks, waiting for our chain-smoking health class teacher to begin his outdated presentationwith stern warnings about Quaaludes and “Reds” (Seconal), two drugs that to this day I’ve never so much as seen, let alone been offereda far-reaching development was happening outside.

Cheap, potent crack cocaine was spreading across America’s cities. The evening news buzzed with regular reports of how violence associated with the illicit drug trade was turning cities into war zones. By 1991, homicides in Philly would surpass 500 a year for the first and only time in the city’s historya milestone that authorities attributed almost entirely to the burgeoning drug trade.

In Washington, restoring “law and order” had become one of the few domestic policy imperatives on which Republicans and Democrats agreed. Amid dog-whistle rhetoric about the race of people who used and sold crack, Congress approved millions in new funding to target them. The Anti-Drug Abuse Acts of 1986 and 1988 established an infamous 100:1 disparity in the quantity of crack versus chemically near-identical powder cocaine that triggered mandatory minimum sentences—with well-documented racist consequences.

Yet even as new prisons sprang up, demand for drugs remained largely unaffected. Meanwhile,  the national perception at the time was of a nation in a crisis. According to the Drug Policy Alliance, over the course of just four yearsfrom 1985 to 1989—the proportion of Americans who saw drugs as the nation’s “number one problem” grew from 2-6 percent to 64 percent.

Like any other wartime propaganda effort, it favored fear-mongering and hyperbole over reasoned discourse and facts.

To target demand, the government launched a massive public awareness campaign, with the goal of eliminating drug “abuse.” It focused largely on youth, and like any other wartime propaganda effort, it favored fear-mongering and hyperbole over reasoned discourse and facts.

By the end of the 1980s, abstinence-based drug education was dominant throughout America’s schools, and mass media had emerged as a favored propaganda tool. Hundreds of public service announcements in print and broadcast media ran during this period to spread the anti-drug message. 

By one estimate, the US Office of National Drug Control Policy, which oversaw the effort, spent more than $1 billion targeting youth with this messaging. Much of it was funneled through the Partnership for a Drug-Free Americaa nonprofit subsidiary of the American Association of Advertising Agencies, founded in 1985 with the mission of eliminating illicit drug use by targeting adolescent demand. 

Their most memorable PSA, “This is Your Brain on Drugs,” which debuted in 1987, was ranked as the eighth-most popular ad of all time by Entertainment Weekly

The message was clear: Use drugs just once and face the consequences of addiction, incarceration or death. Instead of nuanced discussion of the physical and psychological impacts of different drugslet alone why people use them in the first placewe received the three-word slogan of former First Lady Nancy Reagan: “Just say no.”

Today, her words symbolize all that was wrong about our approach. Numerous studies have shown that programs’ abstinence-only messaging has not only failed, but potentially increased teen use of some substances.

It would be difficult to overstate how deeply this messaging penetrated the American psyche, or the influence it had on those of us who came of age back then. Still, the mass abstinence urged by those thousands of anti-drug ads, seminars and PSAs, failed to take root.

In 1992, President Bill Clinton infamously claimed that he tried pot a few times during college but “didn’t inhale.” He and many other leaders chose to pass along stigma instead of authenticity. And so an entire generation of uswho grew up humming the jingle to “Users are Losers,” a media campaign featuring a crime-fighting dog named McGruff, but also saw our friends who used marijuana not meeting with instant disaster—chose to tune them out.

Despite the national fervor, almost everyone sitting beside me that day in junior high school health class would go on to use drugs. Some were fine; others struggled with drug-related problems for years. None received any official guidance on how to keep themselves safer while using.

The author in his junior high years.


Three decades later⁠—after many years of opioids dominating national attention⁠—the “drug problem” is as misunderstood as ever, even as the death-rate has soared.  


Green Shoots, Continuing Resistance

American drug education has been characterized by a catastrophic failure to acknowledge that young people who use drugs might not be irrevocably broken and marred—or that abstinence-only education completely excludes kids who are going to use anyway, and in many cases already do.

In a radical shift from this line of messaging, the Drug Policy Alliance* has inaugurated what it calls the first-ever schools-based drug program based on harm reduction.

Safety First: A Reality-Based Approach to Teens and Drugs is available in eight languages. It was introduced last year as a pilot program at Bard High School Early College Manhattan. Six high schools in the Bay Area have also since begun piloting the program, which launched in full last month. Among other things, Safety First (which is aimed at high school freshmen and juniors), includes frank discussions of the potential harms and benefits of a range of legal and illicit substances, as well as lessons in using naloxone to reverse an opioid overdose.

“The focus is to empower young people to make decisions that reduce the risks … while accepting that some teens will use mood-altering substances.”

“As far as we know we are the only organization with a program for adolescents that’s been made in the harm reduction model,” Stefanie Jones, DPA’s director of audience development, told Filter. “The focus is to empower young people to make decisions that reduce the risks associated with substance use, while accepting that some teens will use mood-altering substances. We have a big emphasis on teaching actual harm reduction in practice.”

The program uses a similar philosophy to modern sex education⁠—which sparked controversy back during the 1980s AIDS crisis, when it began adopting harm reduction principles by teaching safe sex practices and sometimes dispensing condoms at schools.

Jones says she sees parallels between that situation and today’s overdose crisis. She believes parents and students alike have reached a tipping point in favor of realistic, authentic messaging on drug use. 

“I think there is going to be a paradigm shift away from abstinence-only education to teaching adolescents how to lessen the harms associated with substance use,” she said.

As we wait to see how widely Safety First is adopted, “Just say no” remains the unofficial motto for most drug programming for youth and adolescents.

Even as harm reduction principles based in science have garnered more mainstream support, the dialogue on substance use, addiction and “recovery” remains imbued with a mentality that recognizes no gray area for reducing risks for people who use drugs—let alone the possibility of non-damaging youth use.

“‘Evidence-based’ has become the real hot-button word among those of us who study these programs but it’s still a real touchy subject for schools,” Philip Massey, a researcher at Drexel University in Philadelphia who consults with school districts on youth programming, told Filter.

Massey notes that the ways youth typically receive information on drugs have changed dramatically since the 1990s, and that this needs to inform our notion of how and at what age kids are first exposed to educational messages. He spends most of his time on social media, weeding through the newest platforms used by young people, and has concluded that these platforms parallel local peer influence as a conduit for information.

Dr. Philip Massey, an Associate Professor in the Department of Community Health and Prevention at the Drexel Dornsife School of Public Health in Philadelphia.


Massey’s recent studies have demonstrated that youth perceptions of the risk associated with prescription drug use have increased as use has declined. While he says the data is too limited to draw conclusions on exactly which factors have driven this shift, it is likely that frank discussions about overdose prevention and reversal are at least partly responsible.

Conversations with young people indicate that communication about the risks (and rewards) associated with using mood-altering substances is best received when delivered through peer networks.

“We want to have fun, we don’t want to die.”

“My friends and I look out for each other, and in my social group opioids are sort of looked down upon,” said Tim, who is in his early 20s, works for a political consultant, and asked that his last name not be used. He spoke to Filter from his Philadelphia-area  home, where an eighth of an ounce of cocaine that he wanted tested for fentanyl sat on the kitchen table (it tested negative).

Cocaine waiting to be tested for fentanyl by the author.


“We do just about everything else,” Tim said. “Sometimes we will party all weekend but then on Monday we get up and go to work. We want to have fun, we don’t want to die.”

Amid the overdose crisis, we might wonder why those words—“We want to have fun, we don’t want to die”—have yet to replace “Just say no” as the mantra of US drug education efforts. But experts are divided on whether the nation is ready for that.

“School systems are terrified of controversy, and no one wants to get accused of teaching kids to do drugs— even though that is obviously not what harm reduction is.”

“Certainly, harm reduction for teens has been considered and attempted for many years, often informally—designated drivers, parents saying ‘call me if you need a ride, no questions asked,’ letting kids drink at home with supervision and known peers,” said author and journalist Maia Szalavitz, who has been researching the history of harm reduction in America. “In the ‘70s or early ‘80s, I remember being taught ‘don’t mix depressants (downs)’ which remains excellent harm reduction advice.”

In cases where these platforms were adopted more broadly they’ve been a resounding success. Efforts to stem drinking and driving among teens using harm reduction principles have helped contribute to a 55 percent reduction in the number of teens who drive drunk since 1991, according to the Centers for Disease Control and Prevention. This has happened even though studies have revealed that in many cases designated drivers still drinkthey simply maintain lower alcohol levels. 

The Ad Council has reported that 68 percent of Americans exposed to the “Friends Don’t Let Friends Drive Drunk” ad have tried to prevent someone from drinking and driving.

Still, Szalavitz says when it comes to teens, most schools find harm reduction too radical to incorporate in official programming. “For the most part, school systems are terrified of controversy, and no one wants to get accused of teaching kids to do drugs—even though that is obviously not what harm reduction is,” she told Filter.

One school program director went so far as to inform her (wrongly) that teaching harm reduction to adolescents is against the law.

“Amanda,” who spoke to Filter on condition of anonymity because her employer prohibits her from talking to media, contracts for the Philadelphia School District providing assessments for youth deemed at risk of substance use disorder.

The population Amanda works with is largely youth of color from low-income families. She says that many use drugs as a way of dealing with trauma or stressors in their lives.

“These kids often come from communities where they have seen the impact of drug use first hand, sometimes in their own families,” she said.

Though her own thinking is rooted in harm reduction principles, she rarely gets a chance to put them into practice at her job. In one case, a school program director went so far as to inform her (wrongly) that teaching harm reduction to adolescents is against the law.

Speaking of the roughly 400 cases she’s handled for the district so far, Amanda⁠—who also volunteers with a Philly-based harm reduction group in her spare time⁠—said drug and alcohol programming for youth remains largely intervention-based.

“By the time I see a young person they are already exhibiting behaviors indicative of substance use disorder,” she said. “I try to engage them on harm reduction when I can but it’s not part of our protocol. Whatever they learn about reducing or mitigating the harms of drug use, they largely pick up themselves or from family and peers.”


Opioids and Vapes: Differing Indications

For many people, complete abstinence from drugs and alcohol isn’t a viable, or even desired, option. But instead of making a place for everyone, American policymakers continue to draw a line in the sand separating the “good crowd” from the “bad crowd.”

However, combined with policy reforms like state-level marijuana legalization, public attitudes to drugs in America have undergone a notable evolution over the past decade. For better or worse—and under the influence of different racial stereotypes as compared to crack—people who use opioids are often seen as suffering from a chronic but treatable “disease.”

Meanwhile, those opposed to medication-assisted treatment (MAT) on the grounds that it “trades one addiction for another” have been increasingly silencedthanks to a push for evidence-based therapies first embraced by the administration of former President Barack Obama (who, unlike Bill Clinton, told reporters that he “inhaled, often”).

The opioid-involved overdose crisis has thus paved the way for an approach that focuses on mitigating the ancillary damage of drugs, rather than eliminating use.

Despite these gains, there’s still much resistance to anything other than complete abstinence when it comes to youth. And in no arena has this been more evident recently than that of vaping.

A seeming determination to tie vaping to serious health consequences came to a head with an outcry about lung disease and deaths associated with vaping contaminated, illicit THC oils—ignoring the extent to which the rise of nicotine vaping has coincided (though correlation is not causation) with a sharp decrease in teen smoking rates, from 28 percent to 7 percent between 1996 and 2015. Public Health England has estimated that vaping is about 95 percent less harmful than smoking.

From his office at Drexel University, Massey has been studying the role social media networks like Twitter and Instagram play in influencing teen vaping behavior. His research underscores the ongoing battle over where we draw the line between acknowledging that kids use substances and encouraging them to. “There is a lack of regulation over how products like these are marketed online, so in place of advertising there are ‘influencers’ who are paid to promote vaping products,” he said. While he acknowledges the beneficial role of vaping in transitioning he calls flavoring nicotine products to taste like donuts and cotton candy “dubious.” 

“Much of this is being done in the name of protecting kids. But we will eventually find that it will harm adolescents from more disadvantaged backgrounds, as they would be more likely to smoke.”

Yet Clive Bates, a tobacco harm reduction advocate and former director of ASH (Action on Smoking and Health), calls the backlash against youth vaping “one of the worst public health blunders in recent memory.” 

“Anti-vaping activists have generated a full-on moral panic by grotesque exaggeration of minimal risk and the sly pretence that serious lung injury problems associated with adulterated black-market cannabinoid vapes are a problem common to all vaping,” Bates told Filter. “Unsurprisingly, the result of hysteria-driven media and policymaking is people switching back to smoking and believing that it is unsafe to switch to commercial nicotine vaping products.” 

“Much of this is being done in the name of protecting kids,” he continued. “But we will eventually find that it will harm adolescents from more disadvantaged backgrounds, as they would be more likely to smoke and vaping is probably helping them.” 

Writing for the American Council on Science and Health, health writer Stephanie Bloom similarly warned anti-vapers that they are “making perfect the enemy of good.”

“Abstinence-only believers, who want to regulate electronic cigarettes and vaping devices out of existence, focus on claims of perceived harm of e-cigarettes, rather than on their ability to help people quit what we know is killing them,” she wrote. “They argue that e-cigarettes are creating addiction rather than helping current smokers quit. What they, and many studies, fail to accept is how many e-cigarette smokers would have taken up [smoking] or continued to smoke combustion cigarettes if there wasn’t an electronic alternative.” 

The Trump administration’s September announcement of a planned effective nationwide ban on flavored vapes, citing youth use, demonstrates how abstinence-only attitudes to youth still prevaileven with thousands of lives in the balance.


This is Your Brain on Bad Drug Education

In the 1980s, the national dialogue on drug use reflected the zeitgeist of the Cold War. In a rare joint address with First Lady Nancy Reagan delivered in 1986, President Reagan declared that “Drug abuse is a repudiation of all things American,” and “a mockery of our national heritage.”

According to the most powerful man in America, drug users weren’t just risking their lives with every toke or snortthey were being downright unpatriotic; and selling drugs was nothing short of treason. (Indeed, the Reagans, like Trump, publicly supported the death penalty for drug dealers.) 

So it’s little wonder that even though many of our parents had smoked “grass” in their own youth, honest discussions about safe, recreational drug use among adolescents were virtually nonexistent around family dinner tables in the 1980s. 

Instead, drug education for teens was relegated to ill-equipped educators like my middle-school health teacher. Worse, it was handed off to law enforcement officers. 

“Decades of research are unequivocal: The D.A.R.E. of yesteryear didn’t work, and it may have actually made the drug problem worse.” 

 In 1983, Daryl Gates, then-Chief of the Los Angeles Police Department, introduced a program called Drug Abuse Resistance Education (D.A.R.E.), which brought cops into schools to warn students about the dangers of drug use. The abstinence-based program quickly spread across the country, and by the end of the decade had become the de facto national model. 

Upwards of 80 percent of America’s school districts adopted the program, which had an annual budget topping $10 million in 2002. However, numerous studies, dating back at least to a meta-analysis in 1994, have concluded that the program failed to reduce teen drug and alcohol use. 

As Christopher Ingraham excellently summed up in a retrospective for the Washington Post, “Decades of research are unequivocal: The D.A.R.E. of yesteryear didn’t work, and it may have actually made the drug problem worse.” 

Today, D.A.R.E. still manages to eke out an existence despite exposure of its ineffectiveness and steep budget cuts. Repackaged by Penn State researchers under the name “Keeping it Real,” (KiR), D.A.R.E. is now recognized as an “evidence-based program” by the Substance Abuse and Mental Health Services Administration (SAMHSA). And KiR remains “the most widely disseminated prevention program in the United States,” according to one study

While the current program addresses a broader array of skill sets, including social and emotional competency, it remains firmly abstinence-based, teaching kids a four-pronged approach (Refuse, Explain, Avoid, and Leave) to resist using.

There are now dozens of SAMHSA-approved drug and alcohol programs for schools to choose from, yet the agency’s own data acknowledges that 80 percent of youth with mental health issues and/or SUDs go untreated. But with metrics that are based largely on quantitative (abstinence from drugs and alcohol) rather than qualitative goals, it behooves us as a nation to ask if we have created an unreasonably high bar for measuring the well being of our children when it comes to drug and alcohol use.   

“We need to constantly reevaluate how these programs are doing because attitudes and cultural trends change,” said Massey. “Even a program developed in 2010 would look radically different than one developed today.”

*The Influence Foundation, which operates Filter, has received a restricted grant from the Drug Policy Alliance to support the creation of a drug war journalism diversity fellowship.

Top photo by NeONBRAND on Unsplash. All other photos by, or courtesy of, Christopher Moraff.

R Street Institute supported the production of this piece through a restricted grant to The Influence Foundation.

Christopher Moraff

DISPATCHES is Christopher Moraff's weekly column for Filter, featuring analysis and beat reporting. Christopher has spent over a decade reporting on the intersection of policing, criminal justice and civil liberties. His immersion reporting from Kensington, Philadelphia, has earned him a reputation as an expert on injection drug culture and the fentanyl crisis. His work has appeared in publications including the Daily Beast, the Washington Post and Al Jazeera America. He is co-host of the podcast Narcotica, and curator of the stock photo site

Disqus Comments Loading...