Drugs and Young People: An Under-appreciated National Emergency


A recent DEA warning about deadly fentanyl-laced rainbow pills that look like candy is another reminder that overdoses are killing our kids at an accelerating rate.

This is a national emergency — and few of us are even aware. Young people and their families need more information and intervention to reduce the risk of overdose. Fortunately, programs do exist that can address the problem effectively.

Overdoses account for approximately 20% of all deaths among 15- to 24-year-old Americans. That’s 2.5 times the figure from just 10 years ago — a dramatic increase. The number of young people using drugs is higher than many of us want to admit. A 2020 study found that between 10% and 20% of all high school seniors have used illicit substances other than marijuana. And many use more than one. This use of multiple substances accelerates adolescent overdose deaths.

Why? Because besides the “candy”, other illicit drugs are laced with fentanyl, including heroin, methamphetamine, cocaine, and counterfeit prescription pills like benzodiazepines. With young people using, and using more than one drug, their risk of unintentional fentanyl exposure and overdose has never been greater. The reality of elevated risk is particularly concerning for communities of color, who experience inadequate access to and quality of care. Since 2010, overdose mortality has increased more than five times for Latino adolescents and six times for Black adolescents.

There is a dangerous disconnect between healthcare organizations, providers, and our capacity to respond to the needs of adolescents and their families. Even as we have tried to increase the number of healthcare providers trained and equipped to address substance abuse, the number of providers actually prescribing medication-assisted treatment remain relatively few. And though a raft of evidence shows the influence of parents on young people’s drug use, few programs focus on how best to engage families, particularly parents.

Many organizations are trying to close this gap, however. At the Duke University School of Nursing, where I am dean, we use a nurse-led, family-focused model for adolescent substance abuse prevention. It engages Latino and Black adolescents and their parents in preventing substance use and overdose deaths among youth. It’s evidence-based and can be reproduced elsewhere successfully.

In our program, community health workers and nurses help parents talk to their kids about substance use, encourage strong parent-teen relationships, and review effective parental monitoring and involvement strategies. Each session is personalized to the family’s specific culture and context. These techniques are designed to make it easier for a teen to say no to drugs and foster open exchange between parents and their adolescent children. Adolescents and parents using these substances are referred for comprehensive treatment at a community-based organization. The nurses also teach parents and other family members overdose first responder tactics, including how to administer Narcan and how to use fentanyl detection strips.

These sorts of programs are vital elements in a more informed and effective response, but they must be implemented broadly across the country, and particularly in those areas with high incidence of overdose already. Healthcare leaders and public health officials must take immediate and aggressive action to pilot or implement family-focused, nurse-led programs. The models exist. What’s lacking thus far is the urgency and initiative to follow them.

The dramatic increase in overdoses and deaths is a wake-up call that our young people are struggling. They’re struggling with behavioral health concerns including depression. They’re struggling with anxiety. They’re struggling to see futures with opportunity, hope and meaning. We must take their emotions and the real economic and social challenges facing youth and their families across the United States seriously. Tackling the troubling factors driving substance abuse is the first step to keeping our young people safe and alive. They’re counting on us.

The future of our nation is largely determined by how well youth are able to grow up and become healthy and fully contributing members of society. As a country, we cannot afford to let them down.

Vincent Guilamo-Ramos is Dean and Bessie Baker Distinguished Professor at the Duke University School of Nursing and Vice Chancellor for Nursing Affairs, Duke University. He was also a member of the National Academies of Sciences, Engineering, and Medicine’s committee to develop the workshop entitled, “Family-Focused Interventions to Prevent Substance Use Disorders in Adolescence.”



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