Tackling Opioid Addiction Early

opioidMiddle school students learn skills for substance abuse prevention in their health class. Photo by Adrianne Mathiowetz.

Governor Baker’s New Plan to Enhance Substance Abuse Education and Prevention

Governor Charlie Baker has released his second major package to tackle the opioid crisis that has swept the country and ravaged Massachusetts in recent years.

The package includes a piece of proposed legislation called the CARE Act—Combating addiction, Accessing treatment, Reducing prescriptions, and Enhancing prevention—and several administrative actions.

Baker’s plan came a few weeks after President Donald Trump declared the opioid crisis a public health emergency. Opioid-related deaths in Massachusetts quadrupled between 2000 and 2015, according to state data. Somerville also saw a spike in fatal narcotic overdoses, from three in 2010 to 21 in 2016, the Wellbeing of Somerville report shows.

The governor’s plan emphasizes the need to start substance abuse education early. The administrative actions include creating a working group to identify at-risk children in schools, to find school-based education programs that have proved effective, and drawing up a grant that schools can use for implementation.

The actions also call for the expansion of the SBIRT program—Screening, Brief Intervention, and Referral to Treatment—that is running in 283 of the state’s schools, and aim to integrate opioid education into all college orientations.

“This package builds on the state’s existing framework by identifying populations at-risk of developing a substance use disorder, particularly children and young adults, and empowers schools with the tools they need to integrate education about these harmful drugs into their everyday curriculum,” Lieutenant Governor Karyn Polito said in a statement. “We have to begin these critical conversations and prevention techniques with our kids before it’s too late.”

Somerville’s Office of Prevention and public schools have taken this education-centered approach over the past few years.

When K-12 Supervisor of Health and Wellness Steven Simolaris came to the school district three years ago, substance abuse and prevention education in the middle school was “minimal” and high schoolers were taught with standard health textbooks.

Those approaches have been revamped with the advent of three programs: LifeSkills, HealthSmart, and Second Step.

LifeSkills, running in grades six through 12, focuses on “building skills to resist temptation,” Simolaris says. There are some lessons on specific drugs, but the program also emphasizes good decision making and healthy relationships, according to Simolaris. HealthSmart is a similar program geared toward grades four and five.

“A lot of the research says that students that don’t have the necessary social-emotional skills partake,” Simolaris says.

Second Step, which is taught in all pre-K through eighth-grade classes, doesn’t address substance use directly but rather focuses on developing the necessary social and emotional skills that children need to make safe decisions later in life.

“For us, all prevention will help everything,” Director of Prevention Services for the Office of Prevention Cory Mashburn says. “If we work on alcohol prevention, it works on marijuana prevention. We try to focus on kids making healthier decisions. The issue is, people that have addiction move onto other substances. It’s not really the substance; it’s the disease of addiction.”

Guidance counselors used to drop into classes to teach the Second Step curriculum, but now classroom teachers work it into students’ usual routines. Second Step lessons for fourth graders include hands-on activities around being assertive, understanding different perspectives, showing compassion, and emotional management.

Seventh and ninth graders are screened through SBIRT, Mashburn says. The screening consists of a short interview that assesses risks—with questions like “Have you ever gotten into a car with someone who’s been drinking?”—and then, if necessary, refers a student to the appropriate resources.

Teenagers are not the primary age group in Somerville affected by opioid use, Mashburn and Simolaris explain. People between the ages of 25 and 34 are most at risk, according to Mashburn. But the 2017 Wellbeing of Somerville report emphasizes how health factors at various stages of life influence health later on, and so efforts to warn teens about the dangers of opioids can pay off later in their lives. In 2016, over 89 percent of high schoolers thought that illegal drugs other than marijuana were risky, according to the wellbeing report.

“An important step in preventing opioid dependence later in life is to avoid any illicit drug use in adolescence,” the report says.

Since these programs are new to the district—SBIRT and the classroom curricula in their current forms were adopted in 2016—the city isn’t able to measure their effects yet. The youth risk behavior survey that will be administered to high schoolers next year will shed some light, but Mashburn says the effects can’t truly be gauged for four to six years.

But there is hopeful data both locally and statewide. Fatal opioid overdoses across Massachusetts in the first quarter of 2017 were nine percent lower than the same period in 2016, according to Somerville’s wellbeing report, and opioid-related fatalities decreased in the city.

Baker’s emphasis on early prevention and education is in line with Somerville’s current approach, Mashburn explains.

“We’re not going to treat our way out of the epidemic, but we can prevent it from happening again. If we give people the tools, such as kids, that they need to make effective decisions in life, then we’ll have a better outcome,” he says. “That doesn’t mean that treatment and intervention is not needed,” he adds.

Better access to better treatment is one of the other goals of Baker’s package, which Mashburn says will largely be tackled at the state level due to the significant costs involved. It also aims to work with the medical community to address addiction to prescription painkillers. Somerville has already made strides in this area as well; according to Mashburn, Cambridge Health Alliance’s emergency department only gives out certain drugs in two- or three-day doses, with patients needing to be reevaluated before receiving a refill. The Office of Prevention has also encouraged doctors to have information available in their offices on the potential hazards of prescription drugs, and has worked with doctors, police officers, and fire fighters to make sure that Narcan is readily available.

“We’re doing a bunch of it already, but it’s nice to get the governor to put it in writing and say these are the steps that people should take,” Mashburn says. “And it’s nice to confirm that we’re doing the right thing.”

This story appears in The Wellness Issue Scout Somerville, which is available for free at more than 220 drop spots throughout Somerville (and just beyond its borders) or by subscription.

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