Youth Overdose Crisis Swells Because Drug Warriors “Cried Wolf”

Since time immemorial—well, the early 20th century—youth have been inundated with messages about the extreme dangers of drugs. From Reefer Madness on the homicidal side effects of marijuana to the iconic frying pan PSA of “this is your brain on drugs,” the contours may have shifted, but the message stayed the same: Drugs will cause near-certain harm and likely death.

Yet these messages overlooked that teen drug use has never really been that dangerous, at least according to the relative numbers. Teens have always been far less likely than adults to overdose. During the decades of PSAs about drug danger and risk, youth overdose remained mostly flat, contrary to the alarm bells. As death rates for adults have skyrocketed over the past four decades, rates for teens have stayed relatively low.

But now that is changing.

For the first time recorded, teen drug use—specifically pill use—is becoming rapidly riskier. Research published today in JAMA shows a doubling of teen drug overdose fatalities in a single year (2019 to 2020) and rates still rising steeply in 2021. We appear to be in the early days of an exponential rise like the one seen for adults decades before.

Critically, more youth are not using drugs. In fact, youth drug use rates have fallen to historic lows.

Instead, the problem is that illicitly manufactured fentanyls have turned the drug supply into a minefield. Research shows that the West Coast is particularly hard-hit, likely due to the influx of counterfeit pills such as Blues.

The overdose crisis as a whole exhibits deep racial disparities. Indigenous adults have among the worst rates, whereas Latinx adults have some of the lowest. The new JAMA data show that both Indigenous and Latinx youth are the most affected, so the spike among Latinx teens is a divergence from previous patterns.

The sharp uptick in adolescent deaths is prompting familiar alarmist outcries about the dangers of drugs for teens, led by the police and the DEA. The trouble is, the drug warriors have become the Boy Who Cried Wolf.

Absolutist messaging taught generations of adolescents that government figures—and adults at large—were lying to them about drugs. Kids of the 1990s saw PSAs about the high risk of sudden death from taking ecstasy, then witnessed hundreds of young people using MDMA at raves without a single death. They used marijuana or other drugs and were fine. The obvious mismatches that youth experienced prompted their large-scale rejection of DARE and the entire concept of drug “education.”

Mocking the absurdly extreme stance of American schools’ drug and sex teaching has become firmly embedded in our culture. The classic figure of an awkward PE teacher forced to describe something they know nothing about to bored kids. While other countries have been able to embrace more nuanced messages about reducing harms, the US has overwhelmingly clung to messages of abstinence.

Any departure from “just say no” narratives has typically been met with swift blowback. In 2013, Los Angeles attempted a more realistic messaging campaign for raves after one death occurred there, emphasizing the risks but also safer use strategies. It was derided as “teaching young kids how to use drugs.” Despite decades of research to the contrary, harm reduction practices are dismissed under the vague auspice of the nation needing to “send the right message” about drugs—specifically, that they’re bad.

That American impulse to “send the right message” is now beginning to send kids to their graves. Accurate drug education and harm reduction would save lives—and fears about harm reduction somehow increasing drug use by decreasing its risks have proven unfounded. Trumpeting only the danger of drugs does become a self-fulfilling prophecy, as restricting any and all safety measures exponentially increases harms.

The DEA’s response to the doubling of teen overdose rates has followed this predictable trend. It unrolled a campaign called “One Pill Can Kill.” Instead of illuminating any real-life nuance or complexity—including the reasons people may use drugs in the first place—the campaign presents drugs in the most reductive fashion. And the “solutions” presented by the DEA et al. are always the same: “good” kids saying no, more policing for those who don’t, and more incarceration for drug sellers.

In a country so addicted to incarceration, it should be no surprise that the teen overdose crisis is prompting the next wave of the War on Drugs: drug-induced homicide laws, also known as drug delivery resulting in death. Some grieving parents, who have never been provided with an alternative to “lock them up,” are among those calling for people who share or sell drugs to be charged and sentenced as murderers.

But most people who sell drugs also use them. Many times, it’s a friend of the person who died, who shared what they had. And many drug sellers—eking out a meager existence, often on less than minimum wage, and far from the racist “king pin” or “predator” stereotypes—they take active steps to protect their clients when given the tools to do so.

The tragic truth of these measures is that they protect no one and create new victims. One parent devastated at losing their child with addiction to overdose could be the indirect cause of another parent losing their child to a 20-year minimum sentence.

Instead of spending more money on policing, or on telling kids to categorically avoid all drugs, it’s time to give kids accurate information. They need to be presented with a hierarchy of risks, from cannabis to alcohol to the powders and pills that so often contain fentanyl and other adulterants.

Accurate drug education curricula do exist. School politics have proven especially toxic since COVID, but the overall rate of teen overdose remains lower than for adults. If rapid government intervention and adoption of empirically-backed policies had occurred two decades ago, we could have averted an overall crisis of the current scale. There is still time to do that with youth.

A number of harm reduction measures, most commonly available for adults, can also be made available to teens.

While fentanyl test strips are largely ineffective in heroin/illicit opioid markets that are fully saturated by fentanyl, they still hold value to pill users. Experienced drug users buy counterfeit oxycodone knowing that it’s fentanyl—but several links down that chain, that knowledge is no longer passed on. People—especially young people—sincerely believe that Blues are 30 mg oxycodone or that their “Xanax” pill is actually a pharmaceutical benzodiazepine. Warning this population of the prevalence of counterfeit drugs and equipping them with the tools to stay alive is critical.

Making naloxone available in schools is another important step towards reducing harms from fake pills, and has been undertaken by several initiatives recently.

It should be noted that a safe supply for adults would have the unintended bonus of not allowing volatile counterfeit drugs to “trickle down” to youth. The counterfeit pill market was created when supply of bona fide pharmaceuticals was reduced abruptly, no alternatives were presented, and demand (mostly among adults) remained steady. The counterfeit pill market is currently self-sustaining, with most consumers intentionally seeking out fentanyl pressed pills, now that their tolerance is so high that heroin won’t cut it.

Providing those adults with access to safer alternatives—where the adulterants don’t vary between inert substances, benzodiazepines and horse tranquilizers—would dry up both the supply and demand for counterfeit pills for the vast majority of that market segment. In turn, those high-risk pills would not reach youth.

Supply interdiction attempts and incarceration have led the United States to an overdose crisis never before seen in human history. The problem is not intractable: In fact, decades of research show us exactly what to do to prevent death and harm. The problem is political will, with an American preference for fear-mongering and punishment crowding out the measures that work.

This next phase of the overdose crisis—teen tragedy—is not fundamentally different. Rapid uptake of harm reduction measures, accurate drug education, drug checking and safe supply would save lives. Making harm reduction appealing to youth, for example by merging it with hip hop music that may already speak of drugs and overdose, is one of many approaches to innovate education.

Fifty years of “sending the right message” has resulted in the deaths of more than a million Americans. As the overdose crisis moves into deadlier and deadlier phases, and more politically complicated terrain, it is time to truly embrace harm reduction. This cannot just mean syringes and naloxone for people whose lives already involve drug use. It must mean presenting realistic truths about drugs, in popular culture and beyond, for the next generations of American drug users.

 

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Photograph courtesy of Liliana García