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October 9, 2019

Tactics evolve in battle against opioid abuse

Photos/Kenneth Garrett

“About 75 percent of people who are addicts become addicted by the age of 27,” says Sallie Morgan, executive director of the Mental Health Association of Fauquier County. “Research has shown that if you don’t use before you’re 17, it can greatly reduce your risk.”

Capt. Ray Acors and Sheriff Bob Mosier have helped shift the emphasis to first saving lives, then making arrests to cut off illegal access to opioids.

We try to teach it’s a brain chemistry issue. It’s not that someone’s a bad person. Their bad behavior comes out of their addiction. It’s a Jekyll and Hyde drug.

— Fauquier sheriff’s Capt. Ray Acors

About This Series

Jointly produced by two independent, nonprofit civic news organizations, the Piedmont Journalism Foundation and Foothills Forum, “Opioid Ripples” examines the addiction epidemic from a variety of perspectives.

The series covers the challenges and potential solutions in Fauquier, Culpeper, Rappahannock and Prince William counties.

The Warrenton-based PATH Foundation provided a grant for this series.

The participating news organizations seek to increase in-depth coverage and public discussion of issues in their communities.

Part 1: The crisis has touched everyone

> Part 2: Addiction recovery slow and painful

Coming soon

• For all the raised awareness about opioid addiction, its stigma persists and plays out in many ways.

What do you think so far?

Let us know what you think of this regional reporting project. Send feedback to .(JavaScript must be enabled to view this email address)

Third of four parts

By Randy Rieland
Piedmont Journalism Foundation

Fifty years ago, the nation declared war on drugs.

President Richard Nixon described drug abuse as “public enemy No. 1.” Money was allocated for treatment programs, and a new federal bureaucracy, the Drug Enforcement Administration, was created. The foot soldiers were state and local cops doing battle one bust at a time.

For the most part, that’s how the “war” has gone for the past half century, built around an expectation that law enforcement officers, rather than public health officials, would staff the front lines.

The opioid crisis changed that. Drug users still end up in jail, but ask a police chief or sheriff how he feels about stemming the tide of addiction and you get the same response over and over: “We can’t arrest our way out of this.”

Then how do you break the cycle?

More than 700 people have died of opioid overdoses in Virginia's Piedmont during the past decade. Thousands have become addicted — many not through a spiraling of recreational drug use, but by taking prescribed painkillers for injuries or disease. How do you ensure that people with pain fully understand the risks of taking opioid medications for long periods?

And, how do you protect the next generation from another wave of trauma?

“High school kids aren’t dropping dead from heroin,” Culpeper Police Chief Chris Jenkins said. “But that’s the age where you need to start educating kids about opioids, probably sooner.”

‘Jekyll and Hyde drug’

So, law enforcement agencies in the region are taking on a larger role in teaching their communities about a crisis that few saw coming, and with a focus more nuanced than it would have been 10 years ago.

“We try to teach it’s a brain chemistry issue,” Fauquier sheriff’s Capt. Ray Acors said. “It’s not that someone’s a bad person. Their bad behavior comes out of their addiction. It’s a Jekyll and Hyde drug.”

Chief Jenkins thinks addiction prevention doesn’t get the attention it merits. He has both professional and deeply personal reasons for feeling that way. Five years ago, his 26-year-old son, Jordan, who had become addicted to prescription medications, committed suicide.

“I actually think prevention is as important as law enforcement now,” he said. “And it’s the part people kinda forget about.”

Mr. Jenkins said a complicating factor is that it’s usually up to local communities to develop their own prevention programs.

“What’s the best model? It’s not coming from Richmond,” he said. “It’s not coming from Washington. And fighting for prevention programs is a challenge. They don’t make money. Treatment programs make money.

“Look, we already have our hands full for the next 10 to 15 years dealing with what’s happened. If we don’t focus on addiction prevention now, we’re going to get another whole segment of our community dealing with it.”

> Overdose deaths decline, thanks to Narcan

Prevention as a mindset

Not surprisingly, Alan Rasmussen is a big believer in the value of prevention in slowing opioid use. As “prevention specialist” for the Rappahannock-Rapidan Community Services Board, his top priority is promoting programs that help prevent substance abuse and suicides. He cites research suggesting that every dollar spent on prevention saves more than $7 on treatment.

“It’s vital,” Mr. Rasmussen said. “If you can help people early, they don’t have to have everything they want to do destroyed — their academic achievements, their careers, their relationships.”

Mr. Rasmussen makes that point a lot when he’s working with community groups or coalitions wrestling with the ripple effects of the opioid crisis. Prevention, he said, needs to become a mindset.

“It’s about energizing anybody and everybody,” he said. “Some people will say, ‘I’m not sure we have a problem.’ I tell them you don’t want to have a problem. Besides, they probably do have a problem and it’s bigger than they think.”

Some prevention programs are pretty straightforward, such as encouraging people to clear their medicine cabinets of leftover prescription painkillers. Police say that because of their street value, they’ve become a favorite target of burglars. Beyond that, a survey by the Substance Abuse and Mental Health Services Administration found that 60 percent of those who said they misused opioids didn’t have a prescription. Roughly half reported that they got the drugs for free from friends or relatives.

Twice a year, the DEA stages a drug “take back day,” when people can drop off unwanted prescription medications at designated locations, usually local police departments or sheriff’s offices. Through the past four collection days — the last one in April — the DEA hauled in an average of 464 tons of unused or expired drugs nationwide.

The next take-back day is Saturday, Oct. 26, between 10 a.m. and 2 p.m. (You can search for the nearest drop-off location on DEA’s Diversion Control Division’s website.

Some law enforcement offices — including the Fauquier County Sheriff’s Office —allow people to drop off unused prescription drugs anytime. That initiative appears to be catching on. In Fauquier County, 96.5 pounds of narcotics were dropped off at the sheriff’s department last year; through this September, 109 pounds have already been collected and destroyed.

> Education requires more than “Just say no”

Looking for clues

At the same time, police and sheriff departments work to make parents and grandparents better comprehend the risks that come with being a teenager today. Two and a half years ago, the Culpeper police department took a step in that direction by launching its version of a program called Hidden in Plain Sight. It’s a traveling demo of teenager’s bedroom, filled with items that might indicate he or she is using drugs or alcohol, or engaging in other risky behavior.

An innocent-looking soda can might be a reconfigured storage space for drugs. A container of a cleaning agent usually kept under the kitchen sink could mean they’re using it to get high. Parents or grandparents are encouraged to search for clues. Often they miss a lot of them.

Lt. Ashley Banks estimates that she and Officer Michael Grant have given Culpeper’s HIPS presentation at least two dozen times for other police departments, civic organizations and churches around the state. That has prompted the Fauquier and the Madison County sheriff’s offices to create their own versions.

The idea is not to turn parents into snoops, said Capt. Acors, but to show them how to become more aware of what their kids might be dealing with, whether it’s drug use, eating disorders or bullying.

“Parents don’t know where to look when there’s a crisis,” he said. “They start Googling for answers at 3 in the morning. We’re trying to help them before a crisis happens.

“We don’t want the parents’ first reaction be to call law enforcement,” he added. “We don’t want to come over to your house and lock a kid up because you suspect something. This program is designed to help you have those difficult conversations in a more positive way. Instead of having it be a reason to hand out punishments, you want it to be an opportunity to say, ‘Help me understand what’s going on.’ ”

Sometimes parents seem uneasy about what they see as invading their children’s privacy. Fauquier Sheriff Bob Mosier said they need to consider the consequences of not going into that room.

“What you’re doing is looking for clues to prevent harm,” he said. “It could be something that could be stopped in its tracks now. If you do not seize upon the opportunity at that age, you could be talking about a lifetime of hurt.”

Capt. Acors made another point: “That room doesn’t belong to them. That phone doesn’t belong to them.”

Risk factors

Meanwhile, area school systems look for ways to squeeze lessons about opioids into curriculums already packed to meet state academic requirements. They’re exploring how to raise awareness among students about crucial addiction risk factors, such as genetic predispositions and the significance of when a person first uses drugs or alcohol.

The latter can make a big difference in whether a person develops a substance abuse problem, said Sallie Morgan, who as executive director of the Mental Health Association of Fauquier County has worked closely with the school system in developing substance abuse and mental health programs.

“About 75 percent of people who are addicts become addicted by the age of 27,” Ms. Morgan said. “Research has shown that if you don’t use before you’re 17, it can greatly reduce your risk.”

Results of a 2019 PRIDE student survey — a national questionnaire used by some school systems every four years — are still being compiled, but the last one, in 2015, found that the average age of first drug, alcohol or tobacco use in Fauquier schools was 13.

The story is equally sobering in Culpeper County. In a 2017 Youth Risk Behavior Survey, more than a third of seventh-graders said they had used alcohol, and 8 percent indicated they had smoked pot by the time they were 14.

The survey also reflected another disturbing trend. The number of high school seniors who said they had taken pain medication without a prescription? Twelve percent.

Perilous potential

The challenge for school districts is finding the most effective way to help kids avoid the awful fate of so many unwitting opioid victims. In short, how do you teach them about drugs that are legal but have the potential to be so perilous?

For years, the program of choice for most school districts was Drug Abuse Resistance Education. Launched through a partnership of the Los Angeles Police Department and the Los Angeles Unified School District in 1983, DARE was largely about police officers delivering lectures on the dangers of using drugs. At one point, more than 75 percent of the school districts in America were using DARE.

But there was a problem. It didn’t work very well. That was the conclusion of public health studies done in the 1990s, including one funded in part by the Justice Department that found DARE had little or no effect on rates of teenage drug use. In fact, research at Indiana University suggested that students who completed the DARE program had a higher rate of using hallucinogenic drugs than those who hadn’t taken it.

DARE’s popularity faded, as did much of the funding it received from the Justice Department. In recent years, the nonprofit has abandoned its “Just say no” message and focused instead on helping students develop decision-making skills.

While it hasn’t regained its dominance of the drug curriculum market, DARE’s shift reflects a philosophy more school systems are starting to follow — that teaching kids how to cope with tough decisions is a better way than giving them drug lectures.

Starting early

Another issue is that traditional drug education programs haven’t dealt directly with the risks of legal painkillers. This summer, Culpeper County Public Schools tried to address that by adopting an opioid curriculum initiated by a member of the Virginia Beach School Board, whose daughter died of a heroin overdose. (See sidebar).

Nate Clancy, a member of the Culpeper School Board who pushed for more opioid education, said the curriculum is being added primarily through health classes at different grade levels. Opioids aren’t really discussed until sixth grade, he said, but lessons about medications start as early as first grade.

“They’re told that if they see pills they’re not familiar with, they shouldn’t touch them,” Mr. Clancy said. “And, that they shouldn’t take medicine without their parents present. Third grade deals more with proper and improper use of medicine. Also, how it affects your body. How it can make you better, but there also can be consequences.

“Twenty years ago, this would have been taboo,” he added. “You didn’t mention drugs in the first grade.”

Fauquier’s school system also has updated its curriculum, according to Frank Finn, assistant superintendent for student services and special education. He has worked with the Mental Health Association of Fauquier County and other community groups to identify better resources for teachers, including material specifically about opioids Mr. Finn said.

As in Culpeper, the lessons start early, but with an emphasis on basic coping skills. The goal is to help young students develop the confidence to not be easily swayed into making risky choices.

“I think if you get the elementary learning right, they’ll have the skills to deal with problems they face when they get older,” Mr. Finn said. “It increases the likelihood they’ll make better decisions.”

With substance abuse closely tied to mental health issues, school systems also focus more on being able to spot students struggling emotionally or psychologically. Some offer Youth Mental Health First Aid, an eight-hour training certification course that teaches participants how to identify and, if necessary, get help for kids. Fauquier staff members who have had the training wear purple lanyards so students can find them easily.

Mr. Finn said that as part of a pilot project, the training will soon be made available to high school students in Fauquier. That would enable kids who are reluctant to open up to a teacher to instead seek out a peer who is trained to help them.

“There’s no one program or curriculum that’s going to fix everything — whether it’s drug use or academic performance,” Mr. Finn said. “You have to have a multifaceted approach.”

Changing the brain

One key nuance the training teaches kids is that for some people, addiction is not a choice.

“If someone has a trauma history or they have a family history of substance abuse and a genetic predisposition, we’re keeping in mind that this may not be as much a choice,” said Kathy Sickler, social worker in Rappahannock County Public Schools. “A child may be kind of set up for failure. So, we watch that closely and I can start to link them up with community resources if we need to.”

Ms. Sickler said that it’s equally important for kids to know what’s at risk.

“We want them to understand that this is something that can affect you mentally, physically, emotionally. It could even affect your sex life,” she said. “It’s going to affect all areas of your life. This is a disease. That’s part of the addiction education.”

Ms. Morgan, of the Mental Health Association of Fauquier County, agreed that education is critical to how communities battered by the opioid crisis move forward.

“We want to help people understand that addiction is a brain disorder,” she said. “The substances themselves change the brain. So, it’s not a matter of will power. It’s not a matter of good versus bad.

“But there are some choice points, and if you’re informed, you can avoid going down a path where you really don’t want to go.”