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Drug Education Curriculum Moves Beyond 'Just Say No' to Teach Harm Reduction

white-boy-vaping-smoking-600x400-Article-Getty.jpgAfter decades of "just say no," a new health education curriculum is taking a different approach to teaching about drug use. 

Safety First, a new set of 15 lessons created by the nonprofit Drug Policy Alliance, doesn't follow the abstinence-only model popularized by school programs like D.A.R.E. (Drug Abuse Resistance Education). 

Instead, it's based around harm reduction—the idea that teaching students a set of ideas and strategies can help reduce some of the negative consequences associated with drug use. 

The curriculum still encourages students to avoid drugs "first and foremost," said Sasha Simon, the Safety First program manager. 

But it also acknowledges that teenagers might encounter drugs in their lives. Lessons provide information that allows students to evaluate potential risks, and strategies that the curriculum's creators say can help teenagers stay more safe.

The group that created the curriculum, the Drug Policy Alliance, advocates for decriminalizing some drug offenses, reforming marijuana laws, and putting in place harm-reduction policies. 

"The fact that overdose is the leading cause of death under the age of 50, we need to try something different," said Simon. "An abstinence-only approach is not working." 

The curriculum covers the drugs that teenagers are most likely to encounter, said Simon, which includes things like alcohol, e-cigarettes, and cannabis, but also stimulants and opioids. It's been piloted in six schools in New York and San Francisco, and now is available online for free. 

In the first few units, students learn about the potential harms that drugs can cause—physical, academic, social and emotional, and legal. But they also learn about the philosophy of harm reduction. 

They're presented with a list of harm-reduction strategies that they'll learn more about throughout the units. The first on the list is abstinence. Others require more understanding of how drugs work and what their effects are—like learning how to recognize the signs of an overdose. 

For example, a lesson on prescriptions and opioids introduces students to naloxone, a medication that can reverse an opioid overdose. Students watch a video on how to administer it, and discuss what the procedure would be if they ever had to do so.

Perhaps most controversial are strategies for making drug use safer. One of these is "start low and go slow": taking a low dose the first time a drug is used, and waiting to see the effects of the substance before trying any more. 

What does it look like in practice for a teacher to introduce this idea, while still promoting abstinence at the same time? A lesson on cannabis provides an example.

The lesson starts with the teacher explaining that no matter how cannabis is taken, there are always risks—especially for young people, whose brains are still developing. But then it introduces a scenario: What if someone you know does the drug anyway?

"Your friend, Eddie, tells you that he ate a weed brownie 15 minutes ago," the scenario reads. "He hasn't felt anything and wants to eat another one. What information and advice would you give them to reduce possible harm?"

In discussing this scenario, the teacher is instructed to provide basic facts about how cannabis works, including that it might take 45 to 90 minutes for Eddie to feel anything, so they should wait at least two hours before eating any more, to be safe. 

Learning the Policy Landscape

The cannabis lesson also talks about where the drug is and isn't legal. 

Preparing students with this information about drug policy is another goal of the curriculum, said Simon. What's legal in one state isn't necessarily legal in another, and the consequences for breaking the law can vary as well.

"We wanted young people to have at least some language, and some information, so that they can be able to at least govern themselves," Simon said.

And while the program cautions that many drugs are illegal, it works hard not to suggest that drug users are bad people, said Drew Miller, a health teacher at Bard Early College High School in New York who helped pilot the curriculum.

"We create a place of empathy, and that kind of starts our conversations on a different note," he said. In this environment, students are comfortable asking curious questions, said Miller. 

And throughout, the curriculum emphasizes the importance of seeking out reliable information when they're making choices about drugs. Students learn to ask questions like: Is this information recent? What are the author's credentials? Is it supported by scientific evidence? And does the author have an agenda? 

In the unit on vaping, students interrogate sources of information using these questions. Advertising campaigns that promotes the benefits of e-cigarettes without discussing the risks can be misleading, the curriculum argues. And because e-cigarettes are so new and there are so many different types, scientists can't yet know all of the possible harms that might exist.

Several recent deaths have been linked to vaping, and the Centers for Disease Control and Prevention are advising people not to use e-cigarettes. And multiple school districts have sued e-cigarette companies, alleging that vaping is harming their students. 

But in an open environment, there's also the possibility that students may choose to disclose their own drug use. 

For that reason, teachers need to be aware of their school or district's drug policy—and what action they or their school might be required to take if a student did choose to share, said Simon.  

Image: Getty

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