Countermeasures Season 2 Episode 3 Podcast Transcript: Keeping Students Safe From Opioid Overdose

[00:00:01] Hays We have a massive struggle in our nation. Hundreds of thousands have died, but we can stop that. Individuals can save lives. Naloxone is a tool for that. And we can empower students to not feel hopeless in the face of this insurmountable crisis. But you know that they can do their part. They can protect their peers. They can reach out a branch of compassion instead of isolation. And they can reach out a branch of love instead of rejection. And that’s what I want our education system to do.

[00:00:27] Narrator This is Countermeasures brought to you by Emergent, maker of NARCAN^® Nasal Spray. Join us as we explore the shifting complex world of the opioid crisis. Today, opioid overdose is the leading cause of accidental death for so many families, loved ones and friends behind these lives lost. This season will continue to explore some of the communities hit the hardest by the crisis, from prisons and construction sites to schools and elderly care. We will hear from changemakers offering a new way forward. Students are increasingly at risk of fentanyl overdose. Twenty-two high school age adolescents died each week in 2022 from an accidental overdose driven by fentanyl-laced counterfeit pills. Across the country, students are rallying together to help protect their peers, advocating for access to naloxone and better education about overdose, the adulterated drug supply and the dangers opioid misuse can pose. As you’ll hear in this episode, students want to participate in conversations about the opioid crisis and its effects and have become advocates for finding solutions. In this episode, we hear about efforts to allow students to carry naloxone at school and what young people are doing to address the crisis in their communities. Hays Stritikus, who you heard at the beginning of this episode, is a student from Durango, Colorado, who has become an advocate for allowing students to carry naloxone.

[00:02:00] Hays Durango is a town of about 18,000 people. So, we’re very small community. A student overdosed, actually, three students overdosed. Two ended up in the ICU and one, unfortunately, died from a fentanyl poisoning. And that kind of kick started a conversation in my town about drug abuse and, you know, the dangers of fentanyl and on the dangers of the opioid epidemic, which kind of transferred into naloxone and harm reduction work. I was an ex-officio student board member. My term ended just about the same time the overdoses occurred. And I’m also a twin, and my twin brother ran for class president on a platform of harm reduction and at drug education, which was pretty funny because everyone else is running on, you know, better school dances and more activities. And he’s sitting here talking about fentanyl test strips and naloxone. The students were very receptive of that. And that kicked off what equated to be about a year long struggle and conversation between students in our school district about allowing students to carry naloxone on campus, as well as what can be done to better educate students for drug use. Following our success in the state, our school board, my brother and I and a group of other kids founded the organization Students Against Overdose, which I currently serve as a co-director of, and we helped write a bill that made Colorado in that putting Colorado statute that students are allowed to carry naloxone on school campuses, as well as updating language regarding additive test strips.

[00:03:23] Narrator Montgomery County Public Schools in Maryland has also adopted a program to allow students to carry naloxone. Dr. Patricia Kapunan, a pediatrician and adolescent health specialist who served as MCPS’ school system medical officer, says that the policy was adopted earlier than in other districts, which put the school in a good position to address the crisis as it continues to evolve.

[00:03:47] Dr. Patricia Kapunan We addressed it at a system level earlier than some other districts who only now are looking at the tragic events and scrambling to respond. You know, we were in a good position because in Maryland, since 2017, every school already had naloxone. So we had a little bit of a head start. And when we came out and said illicit fentanyl is a huge problem, people were surprised. So the first barrier was, is this a problem? Yes, this is a problem. Is it in your community? Yes, it is in your community. And doing that at a time when not a lot of districts across the country were coming together at that level. But one of the things about having a voice for health at the system level is someone can say, hey, guys, this is what’s happening. So I think that initial barrier of just spreading awareness was the first one that we encountered, and we did that right at the time that, you know, a study came out in JAMA that showed an increase in youth opioid overdose deaths. And the, you know, most recent articulation of the monitoring the future study showed gave us more information about trends in substance use, especially that, you know, the subgroup of kids who are using opioids.

[00:05:07] Narrator Like many students, Hays was distantly aware of the opioid crisis. But after an overdose in his community and the response on social media, it suddenly felt personal.

[00:05:18] Hays I think everyone was distantly aware of the dangers of overdose and poisoning, but hadn’t been forced to confront that reality. And for me, in many students, what that looked like is, you know, seeing Snapchat stories of test your pills, throw out your pills, you know, be careful, you all are loved and trying to figure out what happened and calling people and seeing who’s okay. And that forced a very candid conversation, at least among students, about the dangers of drug use and kind of also the inadequacy of drug education, where very few people really fully understood the dangers of fentanyl use and which drugs can be laced. I think this wasn’t something we were really focusing on or many people were thinking about. And now, unfortunately, it is something that is on the minds of people.

[00:06:03] Narrator Like students, parents can sometimes underestimate the effects of the opioid crisis and can be resistant to acknowledging that it’s present in their community. However, most parents are open to learning more about naloxone and how their family can be prepared.

[00:06:17] Dr. Patricia Kapunan The kind of resistance that I’ve seen from parents is more like this is not a problem. This is not happening in our community. Can you show me the data that it’s impacting kids in AP classes? So I think that once we push through that, I haven’t seen a whole lot of resistance to, can you teach my child a lifesaving skill? And I think a lot of folks, you know, they see their kids being more independent. They see their kids maybe, you know, next steps after high school graduation, leaving home. So preparedness maybe has outweighed the fear of what access to that particular harm reduction strategy is.

[00:07:00] Narrator Jackson Taylor and Sujit Hegde are students in Montgomery County Public Schools, where Dr. Kapunan works, who have become involved in naloxone advocacy. As a senior, Jackson ran the student led task force against the opioid and drug crisis. In this role, he began traveling to other schools and spreading awareness and education.

[00:07:19] Jackson They told me how they have this huge training program created by the state that is the whole overdose response program. And I told them, Hey, I want to start teaching this to students and things like that. And around December, like right around Christmas, I’d say, there was something called the Save the Student Summit and was the first one of these that had existed. And it was the first time in the history of the state that a student gave a presentation to other students on this whole overdose response program. And I was the one there doing that. And when that happened, I’m thinking like I got a lot of great feedback from it and everything. And I got people that kept telling me, Hey, can you come do this here, come do this there. So it led to me going to schools during lunches, going to events on weekends, speaking at big student leadership conferences around the state and giving this presentation to kind of help expand the knowledge on everything.

[00:08:18] Narrator Sujit first became exposed to the opioid crisis when he began volunteering as an EMS provider, which led him to become involved in advocacy and testify to the Board of Education.

[00:08:29] Sujit So I think the most eye opening thing about the opioid crisis was that some people like to think that, you know, they live in very well off communities, that they won’t be affected by the opioid crisis. But the one thing I can tell you is that it’s the most unexpected places. I’ve had overdoses that are near my high school and my high school is in a pretty obviously well-off area. And to see that this is the place where I go to school and now, you know, someone’s overdosing. It’s really eye opening to realize that, like, you know, you may think that you’re not affected by this crisis, but, you know, you definitely are in ways that you don’t even know. There were definitely some things I was expecting, but I think it was anything it was about the thing that I wasn’t expecting. So, you know, I never thought I would get calls that are like so close to my school. You don’t think you will get opioid overdoses, but then you get the call and, you know, you see the unconscious patient. It’s super close. You know, it’s in a it’s a suburban area. You know, like I said, it just showed me that that is life. Like, everyone is affected by this. You know, my entire life I’ve been in a pretty well sheltered area. And to see that this is like the other side of life that I just never realized until I got involved with the EMS.

[00:09:38] Narrator Hays and Jackson both got involved with government to help make lasting change so that students could carry naloxone and receive training on how to use it.

[00:09:48] Hays So for our bill, the process with that was, you know, a number of times we’d had just employees of our school districts say we’re not the right place for this, take it to the state or like we will, but we want to make sure that our community is protected first. We reached out to our representative, Representative Barbara McLachlan, and started working on drafting up legislation for what we wanted to say. And what we wanted was basically, essentially every single district in America right now has a de facto ban on students carrying naloxone because they ban all medications, prescription or over-the-counter, unless they have an exemption from the school district. So hypothetically, I could get in trouble for having ibuprofen in my backpack. What we wanted was a state policy to create exemptions for every single non-private school in our state. That said that students must be allowed to carry naloxone and then encourage districts to educate students on the use and distribute it. We applied the same statutory language to fentanyl test strips, although we removed the encourage because encouraging district to distribute fentanyl test strips was something that was seen as controversial by a number of our partners on this bill. We furthermore included language to encourage school bus drivers to carry naloxone, as well as some statutory updates and to bring state statute up to more present terms. There was an incredible process. We had a group of students testify on this issue at the State House and State Senate over Zoom. And in the end, it passed with bipartisan support. I think, in the Senate, in both chambers, it passed with an immense amount of bipartisan support. It was added to the consent agenda in the Senate and I believe had only one individual vote in opposition. You know, the state of Colorado, not many people know this is actually the most partisan legislature, statistically speaking. And to see our bill be able to pass with the nonpartisan support was truly incredible. I think it showed the urgency and necessity of this, as well as the importance of education. We had a number of people who are representatives who originally voiced concern after listening to student testimony, after listening to public health testimony, kind of understand better why we need that. That’s one of the most important things about naloxone is we need more education so people understand that this doesn’t enable drug use and it helps save lives.

[00:11:59] Jackson Working as a page is kind of the highlight of my last kind of school year. It was a really great opportunity to kind of be there and see how legislation works and how it’s passed. As being in Maryland, we have a democratic supermajority and it was fun to kind of see how some people would sometimes cross lines and just how those would lay out in the end. At the same time, I got to meet a lot of the delegates, and when I’m on the floor, they are kind of talking. And then in this different nature, because they see us all the time, they are seeing the pages walk around, getting them coffee, things like that. And then I would have the opportunity to sometimes go up to them afterwards and talk to them about these ideas. And some of them, not some of that, most of them usually would always listen and they’d love to hear from it and get this kind of idea, the more younger generations thoughts on everything. During my second week, I met up with Delegate Joe Vogel, and I had been looking at the General Assembly’s website and I had been looking, every time I would get on it, I’d search for bills that involved naloxone and the opioid crisis in schools. And I realized he had a bill that was trying to expand education through K-12. I gave him my contact information. I told them, Hey, I want to help you fight for this bill. I told him on a day when he was very interested, to say the least. And in the end of it all, I testified before the Ways and Means Committee within and be this huge speech about this student perspective. The delegates were genuinely receptive. It’s just can we have that safety measure in place in order to allow students to, actually, like, how have help if there’s an issue, and especially answering the rise in things being waste, it really didn’t help. But for the most part, the delegates were receptive.

[00:13:56] Narrator With students across the country at risk for accidental opioid overdose, the stakes are higher for drug education. Dr. Kapunan stresses a nuanced safety first approach, rather than telling students to just say no.

[00:14:10] Dr. Patricia Kapunan There’s plenty of evidence that that whole period of that whole approach that was popular a few decades ago didn’t translate to sustainable changes in youth behavior. And like the whole package of just say no and how as a society, as a society, we handled drug use and illegal drug use and what we considered criminal was not equitable and actually caused a lot of harm. So I’m an adolescent physician, and anyone who has a teenager will tell you if you tell somebody to do something, they may just do the opposite. So, like just say no is kind of like I told you, you know, because I said so. And then that’s not a way that builds skill. So I have a colleague who was just talking to Ben Stevenson, who’s head of our Harm Reduction Unit here in Montgomery County, and he always reminds me it’s prevention in Harm Reduction Unit. Dr. K. And his approach to harm prevention, I think is like the real way, which is, you know, just reduce harm by telling kids not to do something, but you give them skills and a way and a purpose to move forward. You know, how do I say no, how do I act safely, how do I make decisions and why would I do all of these things? Right? So the don’t do this approach is like it’s not very useful, even for youngest kids, right? Don’t touch the oven. Like, do this instead. You know, don’t stand up. Put your, you know, put your bottom in your chair. Like we’re constantly telling teenagers what they’re doing wrong and what they shouldn’t be doing. And we could use more focus on what they’re doing right and how do they get to where they’re going and how do they decide what that is in the context of their strengths, interests and values.

[00:16:12] Hays So I think something when we talk about education, what’s important to remember is my generation is the Covid generation. My health was an online class. That we kind of met on Zoom. It was the very beginning of the Covid pandemic and no one really knew what was happening. So my drug education was a couple videos that were probably produced before I was born. You know, our school tried its best during Covid, but there’s only so much that can be done. I think very much in America we still suffer from the ramifications of DARE and Officer McGruff and all of these education systems focused solely on abstinence. And I think, you know, abstinence is a very important tenet of drug education. We cannot deny that. But at the same time, you have 1 in 5 students of the state of Colorado. Well, I’ve tried hard drugs before the time they graduate. You know, it’s based off the Healthy Kids Colorado survey data. All school districts do it right. So we can’t only use abstinence based education. I think that’s something that school districts across the nation are struggling with. It’s very uncomfortable to have to confront the fact that in a class of 30 students, you know, a large portion of them will have tried hard drugs by the time they graduate. That’s an uncomfortable fact. But it’s a truth and it’s a reality that students are living. And, you know, I think a lot of students receive only abstinence based drug education. And the problem is when students then eventually, unfortunately, engage in drug use, engage in substance use, you know, people don’t understand that it’s increases risk to mix alcohol and opioids. They understand, you know, different potential substance interactions or the risk of lacing. And the problem is then these students are unprepared for these hazards. And like I said earlier, this is the scars. You know, this is the ramifications of our society treating drug abuse as something that must be shunned and cannot be talked about. And what we needed is an education system that both teaches abstinence, but also teaches students the resources that are there does not alienate students. It does not teach them as criminals, but shows human compassion and provides realistic education that’s, you know, more useful and more practical for the reality that we live in.

[00:18:16] Narrator As you’ve heard in this episode, students want to be involved in the solution. For solutions to reach them, their voices need to be part of the conversation.

[00:18:25] Dr. Patricia Kapunan I think it’s critical and it’s like central to the work, right? And I think for us, without us, this time in history is really different. I tell it to parents all the time, this is not what you remember from like movies or the 70s or the 80s or even the 90s, which were pretty bad. And the only way for us to understand what teenagers are going through and what they need is to include them in the work. You know, they say, you don’t understand. And they’re actually right. I’m like, you know what? You’re right. I don’t know what you’re going through. I don’t know what it is you care about. And I learned this during Covid. You know, there was not a lot of youth directed public health education during Covid. We rapidly turned around to communicating with kids through telehealth. And sometimes if they were really sick, they would come into our teen center. But finding out what kids knew about Covid and what they cared about and how they were experiencing it, was completely different than like adults who are baking monkey bread and being lonely. Right. The way that you talk to kids about safety during a time where time in life where like they’re averse to being safe and they want to do more exploration. I’m trying to understand what they understood when nobody was talking to them about what was going on. Like, there was no way to help somebody through that without understanding what it was they knew, you know, how do we get them to know what they need to know, how is it impacting them and what are they ready to be able to do? You know, is a 14 year old ready to respond to an overdose and administer naloxone? What are they most worried about it during the pandemic when and maybe this is going too far off topic. When we looked at why, what would compel a young person to get a vaccine or wear a mask? And it wasn’t because I want to protect myself, It was things like because, you know, I my grandma was really sick and I would do anything for my mom or my family or, you know, it’s a peer norm. And it’s like really awkward when I show up and I don’t have my mask. You know, so there are different things and they’re not disingenuous or non generous things that motivate teenagers. There are very heartfelt things that motivate them, but they’re different than what motivates adults. And when adults try to solve problems, they sometimes don’t even know what the right problem is, let alone what the best solutions are. And I’m not saying that it should all come from youth, but they need to be at the table. So, you know, have you come to me all the time saying, I want to, you know, be a leader in this and this is what we should do, and we’re going to present this great white paper and solution to legislator X or leader Y. And what I tell them is just come to the table where we talk about the problems, look at the data and make the decisions because we need your voice in how the sausage is made. But if you’re over here and we’re over here solving problems in silos, it’s like not actually going to be the most effective way to collaboratively approach a complex problem.

[00:21:25] Hays Like students are starting to become more of a part of the conversation. But I still think a lot of it we’re excluded from. I think especially when we’re talking about like how we’re going to make these presentations or how we’re going to make these demonstrations we’re not involved in. But I think nowadays with advocacy becoming a bigger thing for students, I think we actually are. The fact that I had the opportunity to be a part of a student led naloxone demonstration that could be included in the health module, I think that’s a big step in the right direction because students relate more to other students. They don’t like to see some adult telling them what to do. And so if they see other students, I feel like there’s a more of a connection and there’s a higher chance that they’ll actually, like retain the knowledge that we’re trying to get.

[00:22:12] Jackson From my experience, I think adults are understanding about including the unique voice in the issue. I was never not listened to because of my age, thankfully. And if anything, I felt like it was kind of the opposite, where a lot of the adult also want to hear this youth perspective on the issue, and especially when it’s kind of kind of becoming a more issue with how much things are meaning ways and things like that. When you go out there and give them these statistics and things about how much overdoses are rising in schools, the statistics on just the overall overdose statistics within schools and things like that, and then how much things are becoming waste and how big of an issue that is becoming, they realize just how big of an issue this is for youth. And then I have like I said again, I was never not talk to you because of my age. And it’s all in all, I felt like it was quite the opposite where everybody was very eager to hear what I had to say. And with the right evidence, they were definitely very understanding and wanting to help the issue. And there’s an issue affecting everyone.

[00:23:27] Narrator Hays wants to continue his advocacy work as he goes off to college and still thinks there’s a lot of work to be done.

[00:23:35] Hays I would like to see more honesty and compassion. You know, we have a system that is a remnant of a war on drugs, which failed. We have a system that truly isolates individuals at a time when society must embrace them. In terms of more concrete policy, I would like to see naloxone education at every high school in America. I think, you know, at least in many districts, in many states, all students are trained in CPR. I’ve got my CPR certification when I was a ninth grader in high school. And that’s a great skill to have. It’s a lifesaving skill. And usage of naloxone is another lifesaving skill. You know, unfortunately, a high school student is probably more likely to encounter a peer overdosing, a peer with a rare heart disorder who needs CPR. And it’s treating naloxone with other best practice. We know as a fact that abstinence only education for drug use fails. It’s failed the students of the state of Colorado, where one in five of them will have tried hard narcotics by the time they graduate. That statistic is excluding marijuana, which is one of the most prevalent, which is the most drug narcotic used in the state of Colorado. Abstinence only has failed. It’s a regrettable fact, but it is a fact. And what we need to do is continue to educate students on the values and importance of abstinence. While already while also including real life implications. And like I said earlier, you know, carrying naloxone is a daily reminder of the dangers of fentanyl far better than anything we can do. Educating students that make have them have a peace, a reminder, but at the same time, empower them.

[00:25:14] Narrator Hays and Jackson are both heading off to college, but they hope to continue their advocacy work and continue to make change. Sujit is still in high school where he will work to get the locks on training implemented while continuing to volunteer with EMS. Students and young people have seen firsthand the effects of this crisis and they want to be an active part of the solution. Giving them tools like nolaxone and evidence-based drug education are important steps to raising a generation who understand that they have the power to help save a life, are compassionate about opioid dependency and knowledgeable about the risk of overdose. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to help address public health challenges like the opioid crisis, visit emergentbiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.