Will Texas’ new fentanyl awareness curriculum for public schools succeed where other anti-drug messaging failed?

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More than 40 years after former First Lady Nancy Reagan launched her famous “Just Say No” advertising campaign, Texas and the rest of the nation are once again trying to combat youth drug use through public school awareness programs.

The Drug Abuse Resistance Education initiative — commonly known as D.A.R.E. — was introduced to schools in the early 1980s. It was designed to equip elementary and high school students with the skills to avoid drugs by standing up to peer pressure, but the program began to fade out of school districts across the country by the middle of the 2000s due to lack of results. This hasn’t stopped other anti-drug programs from taking its place over the years as the country constantly scrambles to figure out how to solve the problem of youth drug abuse.

Now, Texas is about to launch its latest anti-drug program in schools. Earlier this year, the state launched “One Pill Kills,” a multimedia campaign designed to warn Texans about the unlawful use of fentanyl, the synthetic opioid that is 50 times stronger than heroin and 100 times stronger than morphine. Reinforcing that message is a new law passed this year — House Bill 3908 — which requires fentanyl and drug abuse prevention instruction in Texas public schools for grades six through 12.

The measure — named Tucker’s Law after Tucker Roe, a 19-year-old from Leander who died after taking a fentanyl-laced pill — went into effect in June and also requires Gov. Greg Abbott to designate a Fentanyl Poisoning Awareness Week in public schools.

Roe died after he took what he thought was Percocet. The pill he purchased on social media was laced with fentanyl. His mother, Stefanie Turner, has been fighting ever since to have students educated about the dangers of fentanyl.

“He told me the first time he was offered a pill, and it wasn’t enough to save him. Having a loving family wasn’t enough to save him,” Turner said at the “One Pill Kills” summit that was held in April. “This can happen to any family.”

Turner’s statement gets to the heart of why previous anti-drug instruction has had such meager results.

Studies on the D.A.R.E. program in the 1990s pointed out that the anti-drug curriculum failed because it didn’t acknowledge that youth drug use is often a symptom of a larger mental health problem.

Many students who have a substance abuse disorder have had a negative experience in their childhood, and being taught healthy ways to manage their emotions could prevent them from turning to drugs.

Some mental health providers in Texas worry the state’s new emphasis on fentanyl education will be a repeat of the D.A.R.E. program mistakes made decades ago.

“Kids have to understand why they are buying pills in the first place,” said Kathleen Hassenfratz, a licensed professional counselor and board member for the nonprofit mental health organization the Engage and Heal Foundation, a group that formed in 2019 to raise mental health awareness.

Youth mental health was declared a national emergency by pediatric experts across the country in 2021 as they warned that stress brought on by COVID-19 was leading to a rise in suspected suicide attempts among young people and an increase in hospital emergency room visits for mental health crises.

School counselors across the country have reported an uptick in the prevalence and severity of depression, anxiety, self-harm, suicidality and eating disorders among students.

“Students who are experiencing thoughts about self-harm are more often advancing those thoughts into action. They now have thoughts, plus a plan, plus action,” Jennifer Akins, a licensed professional counselor and president of the Texas School Counselors Association told Counseling Today in 2022.

One area of study specifically highlighted nationwide is young people’s lack of emotional regulation. Those key years when kids learn how to “monitor, evaluate and modify emotions that arise following a stimulus” happened behind computer screens as they stayed at home for online classes during the pandemic.

“A lot of it has been lumped together as an anxiety crisis. I would say we have seen a crisis in social skills, conflict resolution and self management,” Summer Rose, a Dallas-based chief clinical officer for Communities In Schools, an anti-dropout program that works with public and charter schools. “You forced everybody to only live in a digital world and then put them back in school and told them to do what they were doing but in real life, but they haven’t been taught how to do that in the real world.”

Mental health and substance abuse have been linked for many years, but how closely these two correlate has been a topic of research for years.

A 2002 study that looked at two national surveys on drug use concluded that unmet mental health care needs among those with a mental illness will most likely lead to self-medication in the future.

“Results suggest that timely screening and treatment of mental health problems may prevent the development of substance-use disorders among those with mental disorders,” the study states.

Dr. Sarah Martin, division director of child and adolescent psychiatry at Texas Tech University Health Sciences Center El Paso, said poor mental health and substance abuse among young people can be considered a two-way street.

“Adolescents with psychiatric disorders use more substances, and those who use more substances have more psychiatric disorders,” she said.

Some young people may think that they can use substances like illicit drugs or alcohol as an easier or cheaper way to find relief instead of seeking professional help, but substance abuse often makes pyschiatric symptoms worse.

Martin said she thinks all public health improvement starts with education, and school is a great place to make sure children and adolescents receive accurate information.

“Substance use disorder is one type of mental health problem, and when you have one problem of this type, you are more likely to have other problems in the same area,” she said. “So educating students about mental health and substance abuse makes a lot of sense, and as a psychiatrist, I treat both problems at the same time because they are both so harmful to a child’s future. Good mental health is not possible if a substance use disorder exists, and vice versa.”

Hassenfratz of the Engage and Heal Foundation said that’s why the group is looking to gauge lawmakers’ interest in this upcoming special session about attaching a mental health literacy component to Tucker’s Law. The group would like mental health literacy added for all public school students.

“You’re teaching biology, you’re learning about genetics and genes and the way hereditary things are passed down. At the same time, you can talk about how mental health issues are genetically passed down as well,” Hassenfratz said. “The baseline of mental health literacy is basically helping people understand their feelings and emotions.”

In whatever form it takes, whether a separate bill or an addition to the fentanyl education program, the group would like the potential addendum to be named for Erik Hanson, a highly accomplished 2017 Lake Travis High School graduate who died by suicide one year into college.

Martin, who is also an executive committee member for Texas Child Health Access Through Telemedicine, which provides telemedicine and telehealth programs to schools across the state, said she believes a mental health literacy component would be a great addition to schools.

“While I can only speak for Texas Tech El Paso, TCHATT is in a great position to assist in this effort, if needed,” she said.

The telemedicine program in El Paso serves 34 West Texas school districts, and to date more than 1,550 students have received care from Texas Tech University of Health Sciences Center fellows.

Amelia Floyd, Engage and Heal’s president and co-founder, said if the group can’t get a mental health literacy program in schools then they want to make sure every district’s website has a mental health component to explain emotions, feelings and mental health in general.

“You can be sad, but depression is a whole different thing,” Hassenfratz said. “One is a clinical issue and we need to teach the students the difference because a lot of kids are just self-diagnosing.”

A growing number of young people are turning to social media platforms such as Instagram and TikTok for guidance, resources and support for their mental health or to find a condition they think matches their feelings. This trend has alarmed therapists and school counselors as mental health diagnoses are being used almost as descriptors instead of an illness.

“It has become kind of cool to be able to say you have something even though they haven’t been clinically diagnosed. They just say words, like, ‘I have anxiety,’” Hassenfratz said. She said young people need to learn to recognize when stress becomes unmanageable.

Relying on the internet to self-diagnosis is not a new trend. But mental health providers are concerned that students are now taking any emotion as a sign of mental illness and in turn are now self-medicating their problems away.

Rose, with Communities in Schools in Dallas, said her team has dealt with a lot of mental health questions by students that seemingly spawn from something they viewed on social media.

“A student will say, ‘I have three or four of the things someone had on a slide on TikTok or Instagram. Does that mean I am suicidal?’” Rose said. “They are asking more questions, which we love because me and my team are licensed professionals.”

Rose said schools have a valuable opportunity to reach students at an early age to teach them about emotional regulation.

“Schools are uniquely positioned to be able to play that critical role in supporting students learning about these conditions in a nonstigmatizing way,” she said.

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