Allen/My Turn: Case for primary prevention

The recent flood of news about heroin and other opioid use in our area has been sobering, and the losses suffered have been tragic.

In the face of this crisis, the community is fortunate to have the leadership of Register of Probate John Merrigan, Sheriff Chris Donelan and District Attorney Dave Sullivan, who have been moving mountains to find solutions to this complex problem. The range of community services that can be put in place or strengthened and that members of the task force are working on in order to combat this problem is enormous, and includes: working with doctors, dentists and veterinarians to ensure safe prescribing practices for opioids and other drugs of abuse; further promoting take-back days and drop-off boxes to safely dispose of unused medications; screening all patients that enter the emergency room for substance use disorders; having sufficient beds available for short-term-detox, long-term treatment and transition-back-to-community; instituting policies and trainings so that all first-responders carry Narcan (a medication that can quickly and safely reverse an overdose and can be administered by anyone with a small amount of training) … the list continues and is almost impossibly long. And it starts with primary prevention — preventing someone from ever using drugs in the first place.

While intervention and treatment are absolutely essential, even the best treatment for opioid addiction can still mean a long-term struggle for those seeking treatment and for their friends and family. Primary prevention — on the other end of the spectrum of response to the same problem — aims to stem the problem before it starts.

The field of primary prevention has evolved tremendously over the last few decades, and is more effective than ever before. The days of “just say ‘no,’” “this is your brain on drugs” and “scared straight” are gone — we now know that many well-intended efforts are ineffective or can actually do more harm than good.

Current best-practices in prevention include:

∎ using only strategies that have been researched and shown to be effective (there is even a National Registry of Effective Programs and Practices that inventories these evidence-based strategies);

∎ using a positive-social-norms approach that stresses to young people that most of their peers are making healthy choices;

∎ and changing the environment in order to make healthier choices easier (for example, having less alcohol advertising around, not selling single cigarettes, disposing of pills properly or locking them up in safes and lockboxes).

The Communities That Care Coalition has been working on primary prevention in Franklin County and the North Quabbin for nearly 12 years, during which time we have seen a 37 percent decrease in youth alcohol use, a 50 percent decrease in youth binge drinking, and a 31 percent decrease in youth marijuana use, bringing us from far above national levels to right in line with — and in some cases below — national levels.

Preventing youth alcohol, tobacco and marijuana use is generally considered to be effective prevention for drugs like heroin, meth, ecstasy and cocaine because softer drugs can be “gateways” into harder drug use (a recent national study of 12th-graders shows that those who drink alcohol are five times as likely to try heroin and 16 times as likely to try prescription narcotics as those who do not drink).

Moreover, most of the activities involved in preventing alcohol, tobacco and marijuana use are the same activities involved in preventing harder drug use — activities that teach kids self-management skills, social skills and refusal skills; that help kids set goals for their future; that teach parents strong family management skills; and that work to increase kids’ sense of connection to their schools, their families and their communities … things that make our young people, our families and our communities stronger in their own right.

We need to have high-quality, effective primary prevention programs — in community, family and school settings. Schools are a particularly important part of this equation, as the one place where we can reach virtually all kids with prevention education. At one point several years ago, with support from the Communities That Care Coalition’s Regional School Health Task Force (a group that includes representatives from each Franklin County and North Quabbin public school district), the majority of incoming middle school students in Franklin County were participating in such an evidence-based prevention education program — a fact that likely contributed to the decline in substance use rates cited above. But funding cuts, staff turnover, and time-on-learning demands related to high-stakes testing resulted in the program disappearing from all but one or two schools. The many, many demands on our schools make it challenging for prevention education to rise to the top as a priority. But the current opioid crisis reminds us that we simply must prioritize prevention — the stakes are just too high for us not to.

Kat Allen is co-chair of the Communities That Care Coalition and co-coordinator for Partnership for Youth, a program of the Franklin Regional Council of Governments.

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