The Opioid Crisis and Schools—A Commentary

Ms. Brown, a high school teacher, notices that a student is nodding off in class and no longer turns in homework on time. She asks the student in private if he is all right. He tells her that last month he had a wisdom tooth extraction and started taking prescribed pain medication. When the teacher asks if she can talk with the school nurse, he discloses that his parents are not aware that he has continued to take pain medication, which he is now getting from a friend. Ms. Brown is unclear what to do, especially because the student has just turned 18. Adolescents have an increased susceptibility for substance use due to a number of risk factors, ranging from genetic heritability, peer influences, adverse childhood experiences, and a low perceived risk of harm.1-4 Around 1.3 million, or 5.1% of adolescents ages 12 to 17 need treatment for a substance use problem. Unfortunately, only 6.3% of those who needed treatment in 2015 were able to access specialized care.5 Many of these adolescents are actively using substances and struggling in school. According to the Youth Risk Behavior Survey, 21.7% of high school students have been offered, sold, or given an illegal drug on school premises in the last 12 months.6 The use of prescription opioids for nonmedical purposes has been increasing, with 12.4% of students endorsing a lifetime nonmedical use of these drugs.7 Approximately 20% of 12th grade students describe heroin as either ‘‘fairly easy’’ or ‘‘very easy’’ to obtain.3 Given the ongoing opioid crisis, school personnel should have an understanding of reasons for opioid use, signs of active use, existing screening tools, and how to respond effectively. A common misconception is that teenagers are only ‘‘experimenting’’ when they use substances. However,