School-based drug education changes with opioid addiction

United States and Germany are starting education about substance abuse for young children in schools to combat their mutual epidemic.

By: Maggie Campbell

ATHENS, Ohio—Athens City School District nurse Heidi Shaw sat across from a student in Athens Middle School in Athens, Ohio. She wanted to explain to this student the importance of only taking the prescription prescribed to them. Shaw realized this simple lesson could be applied in schools in the district to aid with drug abuse prevention through education, which has become a goal in other parts of the United States and European countries like Germany.

One type of drug abuse that has made staggering headlines is opioids. Countries like the United States and Germany share one thing in common related to opioid abuse: Numbers for each location indicate a growing problem.

Germany saw a nearly 9 percent increase in drug overdoses between 2015 and 2016, from 1,226 to 1,333 deaths. Eighty-one of those 2016 deaths are attributed solely to opioids, according to the European Monitoring Centre for Drugs and Drug Addiction.

The United States saw a nearly 28 percent increase in opioid-related overdose deaths, from 33,091 in 2015 to 42,249 in 2016. The 2015 number is from the Centers for Disease Control and Prevention; the 2016 number is from the National Institute on Drug Abuse.

A study completed by the European Monitoring Centre for Drugs and Drug Addiction found that in Saxony, Germany, 10.4 percent of overdose deaths involved methadone. Ohio saw a decrease of nearly 10 percent of unintentional drug overdose deaths related to prescription opioids between 2015 and 2017 according to the Ohio Department of Health. Ohio did see an increase, though, of nearly 30 percent of unintentional drug overdose deaths related to fentanyl and other drugs between 2015 and 2017.

Statistics from the 2012 National Survey on Drug Use by the Substance Abuse and Mental Health Services Administration shows a high percentage of children are being exposed to drug abuse at younger and younger ages. The survey said an estimated 7.5 million children, or 10.5 percent of the population 17 years of age and younger, live with at least one parent who abuses drugs or alcohol.

School-aged children of parents who have abused drugs are more likely to show aggressive behavior, have a small social circle and shows higher rates of hyperactivity and inattentiveness, according to research completed by the Centre for Drug Misuse Research at the University of Glasgow in Scotland in 2004.

United States and Germany developed and implemented different programs to address this issue. In Athens, Ohio, the Athens City School District is using programs called Preventure. D.A.R.E and the HOPE curriculum. Germany, Greece, Finland and five other European Union countries, though, are beginning to match the substance abuse prevention efforts for students in the U.S with Unplugged.

The brainchild of two European endeavors in the 1990s to evaluate school-based drug prevention, Unplugged was created from a 2003 collaborative project called EU-DAP, according to the official guide provided by European Drug addiction prevention trial. In 2017 the program had been used by Austria, Belgium, Germany, Greece, Italy, Spain and Sweden according to the trial.

The program is a classroom commitment for students ages 12 to 14 years old with the teacher filling the role of the trainer. It occurs 12 hours over a course of 12 weeks, each with a different lesson for each hour, according to the guide.

Lessons involved reflecting on what students knew about drugs and its impact, how students expressed their feelings, the differences in verbal and nonverbal communication and looking at how this all impacts students’ relationships with others. The goal of these lessons, according to EU-DAP, was to help the students learn better self-control, coping strategies and how to make better decision-making.

According to the “Unplugged” guide released by EU-DAP, there was a marked reduction in behaviors related to advanced substance abuse. The guide also said it was encouraging that the effects of the program sustained over at least one year. The European Monitoring Centre for Drugs and Drug Addiction found that students in the program were less likely than other students to begin to smoke cigarettes less. This finding, the Centre believed, could be applied to other drug use. If that finding applied to other drug abuse then students would begin to use drugs less.

Addressing behavior related to advanced substance abuse is a similar goal for one of the programs the Athens City School District hopes to implement in the middle school, Preventure. Thomas Gibbs, superintendent of the Athens City School District, said the program would hopefully help students think through their actions.

The program would be taught by trained staff in the schools in the district, NBC4 in Columbus, Ohio said. The lessons would be geared towards each student’s unique personality. A Substance Abuse Risk Profile Survey will be distributed in schools and it is meant to identify high-risk personality traits. The Athens News reported trained school officials will conduct at least two 90-minute individual or group workshops to implement this program.

“Whenever you start talking about a program that is centered around the concept of personality profiles, then you start thinking about labeling people,” Gibbs said. “How do you do that in such a way — it’s embedded in such a way — that doesn’t occur?”

Preventure was created by the Athens County Ohio Prosecutor’s Office and school personnel to target students who show risky behaviors. The program would be implemented in the health curricula along with the Drug Abuse Resistance Education program that is led by the Athens (Ohio) Police Department, Gibbs said.

Similar to Unplugged, these programs are all researched based. The Athens City School District relies on research to trust its programs will have the desired impact.

“One of the difficulties in implementing the program of this nature is just often times you do not know the benefits for potentially years to come,” Gibbs said.

He said the district’s evaluation efforts rely mostly on students self-reporting in different surveys.

Gibbs said the district is figuring out how to implement parts of a third prevention effort: the Health and Opioid Abuse Prevention Education curriculum, HOPE. HOPE is a K-12 curriculum developed by Start Talking! to meet the requirements of Ohio House Bill 367, according to the Start Talking! website. HB367 required the board of education of each local school district to select a health curriculum that includes instruction on the dangers of prescription opioid abuse.

The HOPE website describes the impact of the curriculum in the six school districts the curriculum is now implemented in. Two school districts, Marysville Local Schools and Genoa Area High School, were both recognized for their prevention efforts and highlighted the impact of the curriculum.

Marysville Local Schools openly campaigned and recommended resources provided to students and parents, according to the Start Talking! website. The school board also included updates on its safety and drug committee in its agendas. It received an Innovation in Education Award from Gov. John Kasich in January 2017. Genoa Area High School in Ottawa County submitted an award-winning video in the Start Recording/Start Talking statewide video contest to the Prevention Action Alliance, Start Talking! and Verizon.

The introduction of this curriculum to the district was the result of awareness by Molly Wales and the dedication of Shaw, the school nurses for Athens City School District. For Wales, “Dreamland,” a book by Sam Quinones about the opioid epidemic in Portsmouth, Ohio, and across the nation, was a wakeup call for her.

“I started to think as educators do when you hear about a problem that our kids are facing — what can we do about this?” Wales said in a phone interview.

She then discovered the program through an organization called Athens HOPE. Athens HOPE, not directly affiliated with the HOPE curriculum, is short for Athens Halting Opioid Abuse through Prevention and Education. It collaborated with different partners to help optimize skills and resources to help educate students and the community about the opioid epidemic, according to its website. Wales involvement in the Athens HOPE group helped her discover and implement the HOPE curriculum by different techniques discussed in the group, such as how to start conversations in the community and provide better education about addiction.

Wales and Shaw, along with Athens High School teacher Steve McCollum, got permission from Gibbs to accept an invitation from Kevin Lorson. He is the developer of the HOPE curriculum and hosted a training for the curriculum at the Meigs Educational Training Center.

“It’s wonderful,” Shaw said in a phone interview. “It’s really extensive. It’s really easy, but it’s every grade level.”

Kindergarteners through second graders learn about trusting adults, healthy choices and how to help others according to the HOPE curriculum website. Third through fifth graders continue to discuss healthy choices as well as rejecting peer pressure. Sixth through eighth graders begin to use the proper use of drugs and what influences can lead to drug misuse. Ninth through twelfth graders take what they learned up through that point and begin to look at the impact of addiction, refusing drugs and the best ways to prevent drug abuse.

Shaw said she and Wales took the curriculum back to the teachers and social worker in the school district. Wales and Shaw realized a full implementation of the curriculum would be a huge ask because of what would be involved in implementing a whole new curriculum.

“The teachers are sort of saturated with what they have on their plates, and what they are trying to do is a good effort,” Wales said.

Shaw said the Drug Abuse Resistance Education (D.A.R.E.) program will be an avenue the district hopes to use even though it is used mostly in elementary schools. Health teachers in the district are implementing a few of the HOPE lessons still.

The Athens City School District is looking at prevention through education by implementing this three-thronged approach of the D.A.R.E. program, Preventure and HOPE. According to an article published in the Ukranian Psychiatry News in 2000, Saxony, Germany prevention efforts followed the life skills approach. This approach is similar to the goals of all three programs used in Athens.

While different states Germany are involved in the Unplugged program, Saxony, Germany is beginning to use an alcohol abuse prevention program called Klar Bleiben. Klar Bleiben, translated in English to Stay Clear, is focused on students in ninth grade and higher. The students sign a contract that says they will not consume alcohol for nine weeks. In the 2017-18 school year the program was implemented in 500 classrooms.

McCollum has used two lessons regarding decision-making and the proper use of prescription medicines. He said he believes the students are getting something out of these lessons because of how interactive they are. Both Wales and Shaw agreed there is still room for improvement, but the district is doing the best it can.

“We’re just at the beginning of this in terms of school (curriculums),” Shaw said. “We’re at the beginning of having a lot of students that are coming into us that are going to need even more education, even more services because they have some kind of direct result from drug abuse.”