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Prevention must be a tool in attacking the opioid crisis


The "Save a Life, Carry Naloxone" campaign, the first phase of a $3 million public education effort to counter opioid overdose deaths, was announced by city health department officials on Dec. 12, 2016. Above, a kit of Naloxone. Photo Credit: Getty Images / Andrew Burton

The growth of the opioid crisis has generated an outcry for more resources to fight addiction and provide treatment, and that outcry is working. The availability and use of Naloxone, which can bring users out of overdoses from heroin and prescription pain pills, has mushroomed. And more federal, state and local resources are funding rehabilitation beds; treatments like methadone, suboxone and vivitrol to help addicts stay clean; the fight against overprescription of opioid medications; and the prosecution of drug dealers.

But all this action is being sought and put in place by experts and advocates who fret even as they labor. Some addicts take a dozen attempts to get clean, or never make it. More than 40,000 people in the United States died from opioid overdoses in 2015, four times the numbers killed by gun homicides or drunken driving. Addiction treatment is both expensive and frequently ineffective. And when the cure is so very difficult to fund and administer, prevention must be a priority.

We’ve been trying to prevent addiction to cigarettes and alcohol and drugs among young people for decades, with mixed results, but experts say those uneven outcomes can tell us a lot about how to proceed.

The key message to kids about cigarettes, alcohol and all drugs has been, “Say no.” With cigarettes, it has largely worked. Since 1997, the number of high schoolers who smoke cigarettes has declined from 36 percent to 11 percent. But in the same period, attempts to curb drug use were less successful, and a recent survey showed a growing acceptance among high schoolers of occasional use of even hard drugs.

The different outcomes seem linked to honesty and hypocrisy. Young people believe smoking kills, and they know adults believe it because adults are quitting — and dying. Since 1980, the rate of American adults who smoke has declined by half. But told that a little drinking or pot will destroy their lives, young people don’t believe it, and they don’t believe adults believe it. They know many adults drink and smoke pot recreationally. And, their thinking can go, if they are being lied to about beer and marijuana, perhaps they are being lied to about heroin and pain pills.

Addiction experts increasingly agree that successful prevention messages don’t tyrannize children with tough love. They don’t group all substance use in the same category regardless of the substance used or the frequency. Strong prevention programs identify kids who are at risk by focusing on traits that can identify 90 percent of such kids as early as middle school: sensation-seeking, impulsiveness, anxiety sensitivity and hopelessness. And they teach those at-risk students cognitive behavioral and coping techniques that can help them address problems and avoid addiction.

Most addicts begin to develop problems in their teens and early 20s. But the vast majority of young people who try booze and marijuana, or even opiates or cocaine, never become addicts. Programs that try to convince kids that one slip will ruin everything fail. What works are truthful information programs that identify kids who are at risk, and strategies adopted by parents, schools and prevention programs that accept the possibility that young people will try substances and help them decide what to do once they have. These programs need to be in the schools, funded fully and given community support. These messages need to come from parents and teachers. Because as hard as we’re trying to ramp up badly needed addiction treatment, addiction prevention is, in the long run, a much smarter, more loving and more cost-effective way to approach opiate addiction. — The editorial board


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