The ABCs of preventing opioid damage as students head back to school

The school supplies are bought. The new pens and pencils and shiny pencil cases are packed away in knapsacks.

For the more than seven million elementary, high school, college and university students in Canada, it's back to school. But as students gear up for another school year, they face a daunting reality: the opioid crisis.

Children and adolescents need to be educated about these drugs, so they are prepared when faced with what might look like a simple prescription pain pill, says Toronto family physician Dr. Sharon Cirone.

According to the Canadian Institute for Health Information, youth 15 to 24 years old experienced a 62 per cent increase in hospitalizations for opioid use since 2007. 

Almost 2,500 Canadians died from opioid-related overdoses in 2016. In British Columbia, where the opioid epidemic has been declared a public health emergency, at least 800 people have died from an opioid overdose this year.

Oxycodone, codeine and fentanyl are some of the most commonly misused opioids in Canada. 

In a 2015 student drug use survey, about 10 per cent of Ontario students in Grades 7 to 12 said they used opioid pain relievers without a prescription. So what role do schools play in addressing this alarming trend?

Here are highlights of an interview with Dr. Cirone, who focuses her work on addiction and mental health, especially with young adolescents. It has been edited for length and clarity. 

Did you foresee this conversation about youth and opioids?

My son just went off with my husband for his first year of university. His first week at school will be orientation, which is basically PARTY! PARTY! PARTY!

So this has been very relevant for alcohol use and marijuana use and other substances. And now the second most commonly used illicit substance by young people is opioids. To me, it's not a surprise, as a parent or as a physician who works with youth.

What would you tell students?

I would start with the message I give as a parent.

My children have grown up in a house where this is a topic of mine because it's the work that I do, and because I have patients who have been very seriously affected by it who are the same age as them.

For some time now, we've been saying to my son, when you're going to make decisions about what's going around and what you might and might not use, the first option is to say no. "No thanks. I'm not using that."

But to also keep another very simple message in mind and that's: No pills. No powder. We live in an era where we can't know what's in any of these substances, including substances that might even look like prescription medication.

So it could be a tablet that's fully filled with fentanyl, or carfentanil, but looks like it's a pharmaceutical pill. So I tell him, "Don't even take an Advil. Don't take a Tylenol unless it's from a bottle that you purchased from the pharmacy."

How can educators address this crisis?

Bring awareness to it. Arm themselves with information they can share with youth.

The youth themselves can take on the responsibility. They're reading the newspapers, Twitter, Facebook. Some of them are even affected, not just through the media, but through their own friends and peer circles having loss or having had near losses of some of their acquaintances.

So they can equip themselves with the knowledge and the awareness that this is an issue.

How does naloxone help?

A lot of us have learned basic CPR skills to help someone who was having a heart attack or a cardiac arrest. So why not the same approach to having a naloxone kit?

Naloxone kits are really important to have around.

My daughter rolled her eyes the first time I mentioned naloxone kits. She said, "Oh mom, none of my friends use that." And I said, "Honey, you really don't want to find that out when you walk into the bathroom of a party and you see someone slumped over the toilet or someone's passed out and not breathing very much. So if you have a naloxone kit, you can make a difference of saving a life."

So she now carries a naloxone kit.

How can we help addicts?

They fear judgment if they're going to talk about their use of opoids.

So I think all of us, every single one of us, can take responsibility for recognizing the stigma that we place on substance use, and particularly those people who have progressed to dependence or addiction.

I don't think we place the same stigma on a young person who might have cancer or diabetes, as we would if they have an alcohol use disorder or an opioid use disorder.

That stigma makes it very difficult for people to come forward. We can take responsibility for having a kinder, gentler, more open-hearted and non-judgmental approach if someone comes to talk to you us about these things.