Dr. Sandie Morgan is joined by Stephan Lambert, the Prevention Coordinator with OCDE. Together, they discuss the prevalence of substance use amongst youth, prevention strategies, and intervention to teach youth about the harms of substance use and the signs of withdrawals, addiction, and mental health disorders.
- Orange County fentanyl overdoses have significantly increased
- Substance use prevention strategies:
- Start conversations around health, safety, and poison control
- Cultivating a warm and supportive relationship
- Be a role model
- Knowing the risk factors
- Know their friends
- Monitoring, supervising and setting boundaries
- Have conversations with youth to help them understand the signs of addiction and mental health disorders so they know when to seek help.
- Building a healthy and caring relationship with youth so they understand they have safe place to turn for help.
- Fentanyl visuals showing the potency of fentanyl and the appearance of real vs counterfeit pills
- A comprehensive resource e-book for families with a young person struggling with opioid use
- The Six Parenting Practices to help prevent substance use
- A guide from the CA Department of Public Health on what parents and mentors need to know about cannabis
- Free support to quit vaping or smoking, or call 1-866-NEW-LUNG
- NAMI WarmLine – National HelpLine Directory
- Health Care Agency Behavioral Health line online chat, or call 1-855-OC-LINKS
- Ensure Justice Conference | March 4-5, 2022
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Dave [00:00:00] You’re listening to the Ending Human Trafficking podcast. This is episode number 263, Substance Use Prevention in Schools with Stephan Lambert.
Production Credits [00:00:10] Produced by Innovate Learning, maximizing human potential.
Dave [00:00:30] Welcome to the Ending Human Trafficking podcast. My name is Dave Stachowiak.
Sandie [00:00:36] And my name is Sandie Morgan.
Dave [00:00:39] And this is the show where we empower you to study the issues, be a voice, and make a difference in ending human trafficking. Sandie, we’ve had so many conversations over the years about partnership, and of course, schools have come up in these conversations often. Today, I’m so glad for us to be able to welcome an expert that will help us to look at this issue through the lens of school. And of course, some of the current things that are happening right now that’ll help us all to be better educated and to be able to take the next steps. I’m so pleased to welcome Stephan Lambert to the show today. He is the prevention coordinator at the Orange County Department of Education. His 14 years of experience and substance abuse prevention, positive youth development, family and community engagement and developmental asset building. In his role at OCDE, he supports schools and districts with training and technical assistance around alcohol, tobacco and other drug prevention. Stephan, we’re so glad to have you on the show.
Stephan [00:01:37] Thank you. So glad to be here.
Sandie [00:01:39] Well, I’m excited to have this conversation. Every time I have the opportunity to learn from you I walk away shocked, sometimes a little overwhelmed, but definitely better equipped to deal with what our kids are facing and how I can help other parents know exactly what to do. So I thought of you recently because I’ve read yet another story in our Orange County newspaper of a fentanyl overdose death. Can you describe what’s happening with this very disturbing trend and why it’s happening?
Stephan [00:02:28] Yes. So this has been a great concern for us at OCDE and I think really the entire Orange County public health community right now is that the young people who are experiencing an overdose of fentanyl has absolutely exploded over the last few years. Now, fentanyl was something that had been out in the community for a while, but the rates for young people and particularly those under 18, was fairly low. It was fairly low. Obviously, any overdose death of a young person is extremely tragic. But what happened in the last couple of years is it absolutely skyrocketed and went from about, you know, two to four a year all the way up to 19 in the last year. So it absolutely if you look at the data and you look at the trend over time, it really did take off in the last year. You know, there are all kinds of reasons that could explain that. And part of it could be, you know, all of the extreme stress and anxiety that young people are dealing with right now because of COVID 19. And another side of it is on the supply side. So what’s happening right now is that there are drug trafficking organizations that are churning out thousands and millions of counterfeit pills. So counterfeit pills is really what we’re focusing on as far as raising awareness because young people believe that they are taking a Xanax or Valium or an oxycodone that they bought off of a friend or social media, when in fact what they’re taking is a fake pill. It’s a fake pill that’s laced with fentanyl and very often a lethal dose. So this is the issue that we’re dealing with right now, and it’s causing all kinds of, you know, heartache and tragic situations throughout Orange County.
Sandie [00:04:21] And it sounds like this is our situation right here in Orange County. But if those organizations are producing at such high levels, this is national an emergency for a lot more than just Orange County.
Stephan [00:04:37] Yes, absolutely. I mean, it also applies at the state level throughout California. Many, many people are reporting just an absolutely astronomical increase in fentanyl overdoses, particularly among young adults, is the hardest hit population. But it is extremely troubling to see such a high rate among our teens because typically that was not the case before.
Sandie [00:05:01] So two things. First of all, I want you to explain the counterfeit process a little bit. Why did they look so real?
Stephan [00:05:11] Yeah. So what is being done is folks are acquiring pill presses essentially. So what you have are these machines that you can get some powder, this inert powder filler, basically and then add fentanyl and you put it in the machine and it’ll create a stamped pill that looks legitimate, that has the dosage supposedly on it, the same markings, the same lines, logos that you would see on an authentic Xanax or an authentic oxycodone. And really, it passes inspection. It’s really difficult to tell. And in the show notes, I’ll post a visual showing three different pills, only one of which is genuine, and it’s almost impossible to tell. And because it’s so easy for these things to be made, and many young people just have no awareness of the fact that these that these counterfeits are out there, it leads to very dangerous situations and what the lethal dose of fentanyl for most adults is only two milligrams. And this is an amount of powder that could fit on the end of a number two pencil. It’s extremely small, so you can imagine when these organizations are churning out all of these pills, they’re not particularly concerned with quality control. Right? This is not a pharmacy. And so you end up with very unpredictable amounts of this drug distributed through these pills.
Sandie [00:06:29] So kids are really unknowing consumers of these counterfeits. And I’m pretty sure in school you’re telling them that these are counterfeit. So why did they continue to think it’s safe?
Stephan [00:06:45] So that’s I mean, the issue of counterfeit pills has been around, I would say, for at least the last few years. And you know, I think that we didn’t really have that big of a focus on it because there wasn’t that much prevalence. And again, while there were fentanyl overdoses among young people, they were very low prevalence. But it seems like something has changed on the supply side, and there’s just so much more availability and so many more incidences of this occurring that we’re really ramping up the awareness around it. And I think that the larger issue, too, is we have had a concern with medication misuse for, you know, a couple of decades now looking at the opioid crisis. And, you know, a lot of the messaging around that wasn’t necessarily around counterfeits. It was around the fact that it was purely unsafe to be misusing medication in general. That hasn’t changed. I think that young people still do have the perception that, Oh, you know, this isn’t a street drug. This is something that came from a pharmacy. It’s safe, regulated. There’s a, you know, a strict amount of the substance in there. And you know, that, first of all, was not an accurate risk perception, right? We know that medication misuse has killed more young people and more Americans than all illegal street drugs combined. Year after year, right?
Sandie [00:08:05] No. Wait, wait. You got to say that again. I don’t think I knew that.
Stephan [00:08:11] Yes. Prescription misuse, particularly opioids, but also including including other drugs like Xanax and benzodiazepines, has taken more lives through overdose than illegal street drugs locally, statewide and nationwide, particularly during the peak of this opioid crisis. And that’s why, you know, it’s so important to realize that these pills, even if they weren’t counterfeit considering them safer than street drugs is actually inaccurate. And so we try to correct that perception with young people.
Sandie [00:08:42] OK, so kids think it’s safe because it looks like it came from the pharmacy. But they can’t walk in and get it from a pharmacy. And you mentioned that they purchase from their friends and on social media. And I kind of had this sense that everything going on on social media, there was actually no real connection. It’s out there and your kid is in the house sitting right there in the living room and they’re safe. But I guess I’m wrong again.
Stephan [00:09:17] Well, no. I mean, I think that there are many there are many avenues when it comes to discussing safety on social media. But I mean, you know, there are all kinds of risky behaviors and transactions and things happening over social media, much of which is not monitored. And it’s, you know, it’s so large of a problem that the companies don’t have the capacity to monitoring a lot of this, their privacy issues as well. So what it really comes down to, unfortunately, and I hate to put this burden on parents, is that we have to be aware of what the young people in our lives are doing on their who they’re talking to, you know, the conversations they’re having and how it connects to what they’re doing in real life. Because if we don’t have that awareness, we’re not monitoring that. I mean, it’s not like the old days where you had one phone line in the house and, you know, if somebody was on it. Now there are conversations that can be happening all day all night and setting up some of these these transactions, which again, young people think are safer than they are.
Sandie [00:10:19] So my granddaughter was explaining to me how some of her friends tricked their parents. They’d hand them their phone and say, see, my social media looks are wonderful, and the parents didn’t know that her friend had another account that the parents never saw.
Stephan [00:10:40] Yeah, the concept of a fake Instagram or finsta, as the young people will say, has been around a while where you have kind of a clean, sanitized version of your social media that family and, you know, potential colleges can look at. And then you have sort of the more intimate account where you keep it private and only a small circle of friends can see it. And I think that you know this, it does come down to kind of personal parenting styles and your own comfort level. But sometimes it can be helpful to just spot check, you know, surprise. Like, Hey, let me let me take a look, let me see what you’re doing. And I know everyone has different relationships with their kids, different versions of what that looks like with monitoring. But it’s important to know that we are that last line of defense, that we are responsible for our kids safety. And sometimes, you know, we have to take authority and do things like that, even though, you know, it makes some people uncomfortable. And that’s OK. It’s not for everyone. But if you feel, for instance, that your child or young person in your life is starting to engage in some risky behaviors, you just feel like something’s off. You feel intuitively that something is going on. It can be worth it just to inquire and to be honest about it and say why you’re doing it and that you care about them and you’re looking out for their safety. And you just want to, as they say, trust but verify. Right? So that’s always an option is to to make sure that what you’re seeing reflects their reality.
Sandie [00:12:14] So how old should a child be before I start talking to them about drug use?
Stephan [00:12:21] Wow. Well, definitely in the elementary school age is when these conversations begin, and of course, we want to emphasize that there are age appropriate ways to do it, right. We’re not going to go into all of the scientific details about every kind of substance out there when they’re, you know, in first grade. I’ve got a 14 month old and, you know, it’s a little early. Yeah, you’re talking about some of those technicalities. But very early on, I mean, even when they’re in, like the kindergarten age, we talk about what we put in our bodies, whether it’s food or other things like that. And as they start to observe the world around them and see, you know, the things that we use on a daily basis, it can be helpful to start this conversation around. No, we don’t use that or we only use this based on what a doctor tells us as they grow older. You start to explore those things and and they can see the effect that things have on their health. So it is important to start conversations around health, safety, poison control when children are very young and then sort of progress as they get older. One of the the kind of six strategies, if you will, the six research based strategies on preventing substance use in your kids is to have those ongoing conversations as they grow and develop so that you can check in and see have their attitudes and perceptions changed around substance use. Maybe before they would never even think about touching a cigarette or alcohol or anything like that. But then, because of what they’ve seen, maybe on social media or advertising or just the world around them, those attitudes start to shift. And so by taking advantage of moments where maybe you see something on the news or you listen to a podcast, right, you have these opportunities to bring up that conversation organically and continue it as they grow and develop.
Sandie [00:14:12] So there are six strategies, and we just heard one can you like run through the other five and we’ll put a link in the show notes.
Stephan [00:14:20] Yeah, yeah. I’ll make sure that we put a link to the document in the show notes, and they’re really quite simple and yet can be difficult to implement. I don’t want to say difficult, but what’s simple is not always easy. So number one is cultivating a warm and supportive relationship with young people in your life and, you know, taking an interest in what their interests and passions are. Really connecting with them and having that ongoing conversation and trust, the two way trust, so that they feel more comfortable again to come to you if they start to feel pressures or they start to think about experimenting with things that you can be a sounding board, of course, while maintaining rules, boundaries, expectations, but that they feel they can have that open communication. The second principle is to be a role model. So role modeling the use of alcohol and medicine and stress coping in the home because our kids are watching. And if they see that perhaps, you know, we deal with stress in ways that aren’t as healthy, they’re watching that as well. And if we’re sharing prescriptions, you know, we’re keeping them up in the medicine counter. We’re all guilty of this. We have leftover prescriptions and we kind of just share them among our family members when we’re feeling under the weather or, you know, we hurt our back. They noticed that as well. So it’s so important that we keep modeling the best healthy behaviors around those and then knowing the risk factors would be the third one. So being aware of family history or if they have mental health concerns, trauma, those sorts of things that can increase the risk of substance use. Number four is knowing their friends. I think this comes back to the social media aspect as well of knowing, you know, who our kids are hanging out with, what they’re doing. Are they all on the same page when it comes to substance use? And knowing those friends parents also is so important because you may have a strict no use policy. You’re clear in your home how things are done, but not all parents see things the same way. Number five and this is the last one because we talked about the conversations is monitoring, supervising and setting boundaries. Like when I say, a warm and supportive parenting relationship, I don’t mean to say, you know, just let your kid do whatever they want. That structure and rules are so important and no teenager is going to tell you, please, please, you know, give me rules, give me boundaries. But it’s so interesting when I speak with young people about, you know, if you could ask parents for one thing or say to the parents that I educate. Why is it that you would want? What is something that was so beneficial? And they would say to me, you know, just having those rules like having that structure, caring where I am because when the parents don’t check in and monitor, sometimes the message that the child receives is, I don’t really care what you’re doing or where you are. You know, and it sounds so weird to say that because, you know, I was a teenager once, and I don’t think I would ever say that to my parents that please give me rules because I want to feel like you care. But honestly, that structure and having, you know, having that place that box that they can step in and out of and test and flex those boundaries is important. It’s important to have the box so that you can push the boundaries if you don’t have any boundaries at all. It creates, you know, problems developmentally.
Sandie [00:17:52] Wow. We could spend a little more time there, but I have some other questions specifically to these really high risk things, and I want to know what does it look like if you think, what should you be looking for if you think your kids are starting to get involved with drugs, alcohol, nicotine?
Stephan [00:18:11] Yeah. So some of the signs that maybe it’s time to check in and have kind of a deeper conversation, a lot of them are behavior changes. If you notice that your child is not interested in, you know, a lot of activities that they used to be interested in. They’ve moved on from some of their friends. They dropped their best friend all of a sudden. They seem disinterested, disconnected. You’re seeing changes in their sleeping habits, their eating habits and in their openness. Right? So we talk about cultivating that open communication. If all of a sudden that’s shutting off, right? That can be something that needs to be addressed. And if you’re noting, you know, other physical changes, well, rapid weight loss, rapid weight gain, things like that. But a lot of it is behavioral. And when I say these risk factors or I’m sorry these signs, I don’t want everyone to panic because a lot of these are just part of being a teenager, right? It’s like who who when they were a teenager, didn’t start to, you know, hide things from their parents or, you know, have rapid weight loss, rapid weight gain or change their sleep patterns, right? So I would just want to emphasize you’re watching to see if things are progressing, if things are kind of adding up. And, you know, like you have an instinctual sense if something’s going on with your child and it’s okay to just use that as a jumping off point, as a springboard for a conversation because it may not be substance use, right? They may just be dealing with a lot of stress at school. Or, you know, maybe there’s bullying going on, or maybe they’re just having a tough time with everything going on in the world, right? And so whatever it is, when you notice that something’s off with how your child is behaving or feeling that’s a great opportunity to check in and just have a candid conversation.
Sandie [00:20:01] Wow. Good advice. When I look at a 15, 16 year old, it’s really hard for me to tell how old they really are. And I’m here at Vanguard University and when my freshmen come and maybe they’re 19, seniors maybe 21, 22, there doesn’t feel like there’s a big difference in that age range, but a lot of the substances available are legal once they turn 21, but they start accessing earlier. And so can you talk a little bit about legal marijuana and vaping and those kinds of things?
Stephan [00:20:49] Yeah. So 21 is now the age across the board, whether we’re talking about tobacco, vaping devices, cannabis, marijuana or alcohol. So it’s across the board 21 for access to many of these things. And the higher the age, the better because we know that the younger that people are when they start to use substances, the more likely it is they’ll develop a substance use disorder or addiction because of brain development. And, you know, when marijuana legalization, it’s only been, I would say, about nine years I think since that happened. And you know, there were these thoughts about what impact is that going to have on young people, about the availability around the kind of social norms related to marijuana. And yeah, I think that it has changed the conversations that we have with young people. We have to approach it differently in prevention because now it is something that is sold to adults over 21. And so we have to frame it much like we frame our conversations around alcohol. And a lot of it has to do with introducing any sort of drug, legal or not, counterfeit or not, early on in the brain is extreme, can be extremely damaging and raise the risk of addiction and other disruptions. And so the thing around vaping and marijuana over the last couple of years, you may remember right before COVID happened nationwide, there were a number of deaths and illnesses and hospitalizations due to vaping. And it was called a valley e-cigarette or vaping associated lung injury. And it was very hard to explain and people were really scrambling to figure out what was happening. The only thing they could identify was that these sometimes very young people ending up in the hospital all they had in common was they were vaping and some of them were vaping nicotine, some of them were vaping THC. What it turned out is that many of these cases were related to vaping marijuana. And what they were vaping was in many times counterfeit cartridges. So the THC liquid, the marijuana liquid concentrate that they were vaping was tainted with fillers that were extremely harmful to inhale. And the reason that those fillers were in there, of course, was greed. It was people who are trying to make more money by using cheap fillers in the products that they were selling. And that’s just a theme that runs throughout substance use in today’s communities; is that the reason for the counterfeit oxycodone pills, the reason for these counterfeit marijuana cartridges, counterfeit puff bars, you know, all kinds of vaping devices. Counterfeits everywhere. The reason for all of that is greed. And I think that young people, when we talk with them around making decisions around substances and thinking about what they’re being sold, I think they respond well if we point out, like, why do you think that counterfeits exist? Why would people sell things that they know are dangerous that can be harmful and even deadly? Why do you think that they would continue to sell those things to you and people your age? And they really they understand it’s because they want to make more money and they think that their money is more important than your health. And I think that the more that we can emphasize that nobody likes to feel like they’re being taken advantage of and young people can start to make more critical decisions based on their understanding of how these systems are working and why, you know, why you need to stand up for yourself in the face of it.
Sandie [00:24:24] Okay. Greed in my world, working in human trafficking, that’s what it comes down to as well. And that’s a great conversation to be able to have with any young person, even first, second grade, they start understanding those kinds of concepts. Now I’m thinking about my pre-teen and then into adolescence, and my experience has been kids don’t ask for help. How do you help kids know how to ask for help? How to make it easy? Are there some tips for that or numbers they can call?
Stephan [00:25:05] Yes, absolutely. So whether we’re talking about substance use or talking about mental health concerns, help seeking behavior is something that really comes up a lot because there are many different reasons why young people might not want to ask for help. Things like maybe they have tried to talk to a professional or someone and they had a bad experience. You know, that counselor or that therapist didn’t, maybe they didn’t have weren’t culturally proficient. They didn’t understand how to work with that young person or they just, you know, had an approach that didn’t work at all. Or maybe they don’t, the young person doesn’t recognize the symptoms. They don’t know that what they’re experiencing could be a mood disorder or what they’re experiencing could be tolerance, withdrawal and addiction to a substance. So part of that then, is helping young people to understand the signs and to know like, hey, you know, these are the signs that if you see this in yourself or in one of your friends, ask an adult for help. So starting there, helping young people understand what it means to see the signs of addiction, understand those and also to see the signs of a mental health disorder. So the other part, too, is not knowing who to ask or feeling confident enough to ask for help from an adult. And so we try to build these relationships between young people and their school communities, in particular, because a lot of young people, they need trusted adults. And in a school setting, we really think that those trusted adults have the capacity to bring resources and help to students, even if they themselves aren’t, you know, a substance use counselor or something like that. They can find the right door. And so we are really focused on training educators, on recognizing signs and understanding what resources are out there. I think the most important thing when it comes to helping young people ask for help, is again, and I, you know, I sound like a broken record, that warm, caring relationship. Whether it’s a parent, grandparent, aunt, uncle, teacher, counselor, doesn’t matter? Youth pastor. Having that warm relationship opens that door in a way that absolutely nothing else can. And so it’s so, so important that young people feel they’re supported and this is a safe place for me to go when I have concerns. And I’ll make sure that I list the resources and local help lines in the show notes after this. But we do have the NAMI WarmLine. We have O.C. Links. 855-OC-LINKS here in Orange County, which is our health care agency behavioral health line that can help find services. And there’s an array of different services when it comes to treating substance use for young people. It’s not always, you know, I think people have a view of what, you know, quote on quote rehab looks like. But there are so many services up to and including what’s called, you know, residential care. And so we don’t want young people to be intimidated thinking, if I get help, it has to look like this. But there’s many, many different kinds of ways that they can be supported in transitioning away from substance use.
Sandie [00:28:16] Last question. I have encountered a number of young people in the last few months as we return to in-person meetings and classes and events. And what I’ve seen trending is higher levels of anxiety and the sense that I don’t know how to cope. If you had one minute with a 15-year-old and you could teach them one way of coping, what skill would you teach them?
Stephan [00:28:54] Wow. I mean, I think that the number one and when you look at research and you look at what actually works for people, I mean, there’s so many things that work. But the number one, I think, would be mindfulness and just the idea of slowing down, thinking about your thinking and being able to understand when feelings come and go. I think that core skill can help so many people, and it’s I think that there is not stigma, but there’s a certain sense of like, Oh, this is a very, this is not for me, right? This is a very particular kind of person, just meditation, mindfulness, but it’s not true. I mean, there are so many different ways to engage with mindfulness. I would say that is, any young person could benefit from at least trying, at least trying mindfulness practice, finding something that works for them and that that would be the the number one. Although there are so many other things when it comes to, you know, nature and going outside and exercise and connecting with others. But just that core of being able to sense your feelings, think about your thoughts can help so much.
Sandie [00:30:04] And I started during COVID doing a daily mindfulness practice where I write down specific incidents of positive things that happened that I’m grateful for. And it really has helped me because I think we sometimes as adults, we aren’t as transparent with our kids as we ought to be, and we kind of set the standard a bit high. And that may be a barrier for them to admit that they are having any challenge with coping. And then it becomes easier to try a chemical way of coping, and we want to stop that. Stephen, I can hardly wait for Ensure Justice. OCDE is our partner for Ensure Justice every year, and I already saw the list of workshop speakers from Department of Ed and you’re on the list. So listeners, make sure you’re at Ensure Justice and get a chance to talk to Stephan in person.
Stephan [00:31:10] Yes, I’m really looking forward to it. I mean, like, like you said, it’s been a number of years and I think each year it gets even bigger and better. And I’m looking forward to, what is it, in February, March?
Sandie [00:31:21] March. March 4th and 5th.
Stephan [00:31:23] That’s right. So looking forward to it.
Sandie [00:31:25] We’ll put that in the show notes, too.
Dave [00:31:27] Indeed. Thank you so much to you both for this conversation. I know I’m going to be passing along to several friends and colleagues and just to reinforce that invitation. Ensurejustice.com is where to go if you’d like to find out early information about the conference coming up March 4th and 5th, 2022. You can find out details there. Also, I would encourage you to go to the show notes, especially for this episode, even if you’re not in the habit of doing that for most of our episodes. Stephan’s been really gracious to share some of the resources. The photos he mentioned, absolutely something if you have young people in your life, but almost all of us do in some capacity. What a what a wonderful thing we can do to take that first step of being able to study the issue, and of course, as we always talk about Sandie, then you can be a voice and make a difference if you’re knowledgeable about what’s happening. While you’re online, we’d invite you to take an additional step. Download a copy of Sandie’s guide, The Five Things You Must Know: A Quick Start Guide to Ending Human Trafficking. It’ll teach you the five critical things that Sandie’s identified in her work here at the Global Center for Women of Justice at Vanguard University that you want to know before you join the fight against trafficking. All of that at endinghumantrafficking.org. And of course, we’ll be back in two weeks for our next conversation. Always a pleasure, Sandie. Thanks so much.
Sandie [00:32:50] Thanks, Dave.
Dave [00:32:51] Take care, everybody.