Opioid Prevention: How to Help Teens Flourish and Make Healthier Decisions

0:00:13 William Moyers
Hello and here we are again, Let's Talk. A podcast series produced and delivered to you by Hazelden Betty Ford. I'm your host, William C. Moyers. We're glad that you're with us today. And today, I'm glad to be joined by Ian Groves, my colleague and a prevention specialist at Hazelden Betty Ford who is an integral member of the organization's prevention solutions division. [turns to Ian] Ian, welcome to Let's Talk.

0:00:39 Ian Groves
Thank you very much for having me. It's really, really good to be here!

0:00:44 William Moyers
I gotta ask you: how in the world did you get interested in prevention and what is prevention?

0:00:51 Ian Groves
It's a great question. For me personally, I actually I'm in long-term healthy recovery from substance addiction. And I entered recovery at the age of 16. I'm 26 now and one thing that I realized really early on in my recovery were that a lot of the people who were in treatment for substance abuse or addiction, they either were young themselves like me or they had started using substances very, very young. And it's very similar to the experience that the founder of Prevention Solutions, formally known as FCD Prevention Works, Donald Cutler, he realized that as well. And you know I realized that this is a message that needs to be given as early as possible. And at Prevention Solutions, the way that we really approach prevention in terms of what it is and how it works, it really is a process, it involves an entire community of people. We work in schools around the world and over 70 countries. In almost all 50 states. Really helping to empower young people to make the healthiest versions of themselves possible. And we're using our stories in a way to really, you know, from a research and data perspective, to book-end a lot of that research. To give kids the ability to make those decisions from the health perspective.

0:02:04 William Moyers
Well we're glad that you've harnessed your personal journey to this professional work at Hazelden Betty Ford. And today we wanna tap into your expertise as it relates to young people and the use of Fentanyl. Tell us, what is Fentanyl?

0:02:21 Ian Groves
So Fentanyl is a synthetic opioid and, you know, one of the ways that it's been coming up a lot recently is you know we maybe we've seen it on the news, maybe there have been, you know, there have been stories unfortunately of overdoses of Fentanyl that have been happening across the country. And in my work with teens, a lot of what, you know the discussion is to what Fentanyl is, students may see it as an opioid but a lot of them are unsure as to the actual concentration of Fentanyl and being that it is a prescription, it's a synthetic opioid similar to heroin. However, you know, heroin for example is about five times stronger than morphine. Fentanyl is fifty times more potent than heroin. And a hundred times stronger than morphine. So it's a very, very high potency pain opioid.

0:03:12 William Moyers
Are young people using Fentanyl deliberately or are they getting in trouble when they use another substance that has Fentanyl in it?

0:03:24 Ian Groves
It's a great question. So, you know, this is essentially how it comes up a lot and how it has been coming up especially the last year, two years. Many of the Fentanyl use—much of the Fentanyl use that's been happening is not intentional. A lot of the times, it is, you know, maybe you know occasionally it can be prescribed in very, very small amounts. You know whether it be a severe accident, sometimes that might be the only time. Even then most quality physicians won't prescribe it due to the potential for abuse. But, teens are mainly getting Fentanyl without the intention of even receiving it. So this is illicitly manufactured Fentanyl, they call them IMFs, and other synthetic opioids even Benzodiazepine analogs are increasingly sold as heroin or counterfeit prescription pills. There is a study done very recently in early 2022 it was about 423 adolescents who were living on the streets and they were surveyed and tested for recent Fentanyl use. And 92 percent of them didn't admit to using Fentanyl. Of those 92 percent, 35 percent still had it, had Fentanyl, in their system. So a lot of that, the illicit non-medical Fentanyl use, is being introduced into heroin without any knowledge of use or any knowledge from the user themselves.

0:04:48 William Moyers
What do teens think about Fentanyl?

0:04:52 Ian Groves
So, at Prevention Solutions, in the way that our work with the students—what we know is that we see an increase in the use of a substance when we see a decrease or lowered perception of risk. Vaping is a great example. We saw e-cigarette use, you know, spike relatively significantly because teens didn't understand what was in it. Most students that I work with even now still haven't had prevention solutions programming recently, you know, a lot of times aren't sure what nicotine even is or where it comes from, that they're present in vapes. In class, teens typically see opioid use as risky especially when we're talking about the lethality and the doses discussed. They're curious but they're unsure. And we really focus heavily on the risks that opioids and opiates can have on the central nervous system. You know, they're depressant substances, they're respiratory suppressants, the overdose risk is very, very high. And you know over the last 18 years, about 9,000 adolescents and children died from opioid poisoning. And the mortality rate has increased threefold. So, discussing with teens why might this be happening especially more so in the last year is really crucial to helping young people, you know, make this health-based decision. Specifically with Fentanyl, the unsureness of whether or not they're even in many of these products that can be sold on the street, something that they should definitely keep in mind. You know, I think to myself ten years ago when I was—I was addicted to prescription painkillers as well, I knew for the most part, what I was getting when I was addicted to those. And nowadays, it's not the case.

0:06:25 William Moyers
So what is the message? I mean, what you just said there is a truth that we don't know what's in the drugs that we buy off the street or even the drugs we think we're getting from somebody else's medicine cabinet. Yet we know that you can't scare somebody into not using. So Ian, what is the message that you would have for a teenager who has tuned in specifically to this podcast wanting to know more about Fentanyl?

0:06:53 Ian Groves
Yeah, so, what we know is that all use of a substance especially for a young person, all use equals risk. Whether it be alcohol, marijuana, nicotine. With Fentanyl specifically, there's this idea that sometimes using a substance in smaller amounts or quote unquote "microdosing" might be healthy, but at the end of the day, especially with a drug that's as potent as Fentanyl is, there is no quote unquote "safe" way to use it. You know, a teen's brain is in this crucial process of growing and developing and needs to be nurtured without the presence of alcohol or other drugs. And with Fentanyl, you know, it's one of those things where we know the younger an individual uses a substance, the higher the likelihood of developing an addiction. You know, just for example, 93 percent of those who are diagnosed with alcohol use disorder in the United States started using alcohol before they were 21. So, my main message and it's one of the things that I'm the most passionate about, mainly because I myself used or began using opioid medication that I was not prescribed when I was 13, 14 years old. My addiction developed much more quickly and in a much more severe manner because my brain was going through that process of growth and synaptic pruning.

0:08:07 Ian Groves
[continued]
You know I'll always say what fires together, wires together; what the brain does when it's young, those behaviors seal in there much faster than when the brain is fully developed around the mid-twenties. And, you know, I think there's a lot of different ways to approach it, but again, always thinking about the fact that there are certain risks that a young person might be at for developing an addiction that others may not have. You know, it's a family history, genetic predisposition, which plays about a 40 to 60 percent role in addiction. The age, again, the age of first use is monumental in whether or not a young person does progress to addiction. And early intervention. If, you know, a young person sees their friend may be experiencing some of the signs or the symptoms of use of Fentanyl or other substances, and with Fentanyl, you know, there's a lot of different ones. Confusion, chest pain, blurred vision, having a persistent cough. There's a lot of different things that you know we may not—as a young person seeing this in their friend, they might not you know say oh well maybe they're using Fentanyl, but friends know their friends pretty well. And I always say if there's something you see that just feels off, check in with them, see how they're doing. I say the same to parents as well, you know, you know your child, if you see anything that's not normal, it doesn't mean they're using substances but it definitely is a time to check in.

0:09:26 William Moyers
I wanna come back to the parents piece in just a minute but I wanna ask a question that's popped up—I'd like to pretend that I'm well-prepared [grins] for these podcasts but then, when I get to talk to experts like you, you mention something that then piques my interest and I don't have the answer to it, so I apologize if this sounds ignorant, but I'm gonna have to be ignorant I guess. [Ian laughs] I always imagine that Fentanyl and that people who die from a Fentanyl overdose are getting it because it's been cut into cocaine or into heroin or something else. Can Fentanyl be introduced into vaping cartridges or into cocaine or methamphetamine, or is it a stand-alone substance?

0:10:11 Ian Groves
It can be both. So, in regard to vaping there hasn't been any research or anecdotal evidence stating that that's happening yet. I think it's in terms of like the logistical function of how an e-cigarette works, Fentanyl as far as I know and as far as, you know, researchers have found, can't be introduced into vaping quite yet. However, with cocaine, most definitely Fentanyl is a much cheaper and more powerful opioid. So one of the reasons why it's being cut, you know, for example if there's someone who's addicted to heroin, maybe the person who's supplying the heroin realizes oh if I can get Fentanyl, that's much cheaper, I can cut it with this pure heroin. That makes it A it makes it stronger and B it's cheaper to produce, and it makes the user coming back for more. And that really is again the goal of whoever is cutting these—whether it be cocaine or ecstasy pills, MDMA, methamphetamine, which can be cut with Fentanyl. The goal is to keep—due to the fact that Fentanyl and opioids in general release over a thousand units of dopamine in the brain, comparatively to food, which releases anywhere from 50 to 150 units of dopamine, it's this very powerful response in the brain's pleasure reward system that, you know, essentially takes over the person's brain to give them the idea that that substance is going to be more essential for my survival. Which is in a very general sense is how addiction sort of begins. But, it can be introduced into a lot of different substances and again that's a large part of the risk there is, you know, there are pill presses, there are ways that things can be, you know, manufactured with Fentanyl added to look exactly like the product was supposed to. Whether it be a pill, et cetera.

0:11:53 William Moyers
[shakes head] Let's turn from the problem towards the solution, starting with parents. What role do parents play and how do parents talk to their daughters and sons, or grandparents to their grandchildren, about Fentanyl?

0:12:11 Ian Groves
Mmm. The most—you know, we work with thousands of parents every month across the world at Prevention Solutions. And there's a lot of things that we have found to be the most effective and with Fentanyl specifically, one of the questions that I get as a Prevention Specialist—and I'm in a different school every week year-round—one of the most common questions I get is how can we prevent Fentanyl use. How can we prevent opioid use in general. 'Cause you know I'm going to schools and I'm talking about substances a lot of the times that aren't opioids. 'Cause, you know, the rates of opioid use amongst teens are actually very low, compared to other substances that might seem more socially acceptable, et cetera. But talking about alcohol, marijuana, e-cigarettes, cigarettes, that is the way that we can prevent opioid use essentially. 'Cause no one wakes up one day at 18 and just says, 'You know what, I think I'm gonna try heroin today!' A lot of the times, when someone progresses to those drugs that some might consider to be the "hard drugs" [uses air quotes], again, we know that all use equals risk, but, those substances are almost always proceeded by alcohol or marijuana, drugs that a young person may not think is very risky. So having parents open that kind of a conversation about alcohol, talking about the risks of marijuana use specifically for an adolescent, nicotine as well. Keeping the conversation health-based is very, very important. We really like to take all the moralization out of it, you know. Addiction is a disease and it's one of these things—it's a chronic illness that needs to be treated as such. Keeping it health-based and age-appropriate.

0:13:44 Ian Groves
[continued]
And then I think also, you know, a lot of the times when I work with parents, you know, they'll say, 'Oh well I had a conversation with my kid, I sat 'em down for an hour and you know we talked about drugs and I told them you know don't do drugs, drugs are bad, and here's why.' That can be effective for a lot of young people but what we've found at Prevention Solutions to be much more effective is instead of having one 60-minute conversation, having 60 one-minute conversations. Anytime of the day that a parent or a grandparent can find to open up the conversation around not only substances but prevention and health. And you know whether it be something that's going on in the news. You know, marijuana is legalized in another state or another country, that's an opening for a conversation. It doesn't have to be talked about all day, every day. But whenever it comes up naturally, that does a lot of things and one of the biggest things it does is it keeps that communication channel open for a young person to feel comfortable talking to whatever adult in their life they go to for support and to answer questions.

0:14:42 William Moyers
We've talked about the role that parents play, what is the role that teachers play or school administrators in addressing substance use among the student population?

0:14:53 Ian Groves
Yeah and you know, when we think about prevention being a climate, it really involves, you know, everybody like I said everybody in a community in administrators and faculty, coaches even. One of the things that we've noticed and it sort of really is a pillar of what we do in Prevention Solutions is we talk about the social norms approach. It's this idea that there's such a large amount, you know, generally in society, substance use in normalized. There's you know I've been to schools where teachers have talked about, and this is again very rare, but teachers will say, you know, 'I'm a little hungover today,' or you know, 'I think everybody's probably vaping now,' there's all these things that might make it seem like there are a lot more people using substances than actually do. One of the biggest things that teachers and administrators can do is help support this idea, the fact, really, based off of data that we both have at Prevention Solutions we gather data from I think a little over 200,000 students over the last ten or so years. And monitoring the future based out of the University of Michigan. We know that most young people don't use alcohol or other drugs. And faculty and administrators supporting that idea and helping their community realize that it a normal thing to be healthy. And a lot of the times when I go to a school, I'm really there to, you know, I'm there to work with students who might be struggling but for the most part I'm there to help support the health. Keep healthy kids healthy and highlight a lot of the protections that a young person has in their life that actually keep them from using substances. So, faculty play a large role in that in the sense that they're a lot of the times faculty see the children more than the parents actually do. If they're at work a lot of whatever the case may be. So setting in a role model sense what is normal for a young person is crucial. Catching that language of 'everybody's doing it.' Is it really everybody? A lot of things like there's so many different ways that faculty can support health and well-being for young people. And I think the fact that they really are role models, they set the tone for what to expect, what is normal, and what's healthy.

0:16:56 William Moyers
Ian, we've got about a minute left and so last question: I was very touched by how you opened this conversation on the podcast disclosing your own journey from addiction to recovery at a very early age. You said you found recovery at 16, it's ten years later, you're still young! [chuckles] What is your message to young people who don't think that recovery is possible and if it is, it's pretty boring out there if you're a young person?

0:17:22 Ian Groves
Well first of all, I'll say it most definitely is possible. One thing that I get asked a lot is oh, how did you—you know I entered recovery when I was halfway through my sophomore year in high school, I got to experience the rest of high school and college as someone who didn't use substances. And I thought personally that I wasn't gonna make friends, I wasn't gonna have fun, I wasn't gonna fit in. But what I realized was that A, I've had more fun in the last ten years of my recovery than I ever had when I was using substances. It's most definitely possible. And you know I'm able to enjoy life the way that a healthy high schooler does. They have things they do for fun, I have things that I do for fun. I like to rock climb and ski and surf and hike, and I have all these things that I find joy out of life. And one thing that I'll also sometimes say to a group of high schoolers who ask me that question is there's nothing wrong with getting high, it's how you do it. I get high every day, but I don't have to put any chemical into my body to give me that. So it's been a blast! And I wouldn't see it any other way, frankly. I've got a beautiful family and I've got obviously a profession that I'm very passionate about. And I'm able to spread this message that it is possible for anyone regardless of age or where in the world we live, it's possible and it's worth it. So, that's my message for y'all.

0:18:40 William Moyers
And it looks like Ian Groves. [smiles] Ian, thank you so much for bringing that personal experience, that remarkable passion, and that professional expertise to our podcast. And to those that are served through Hazelden Betty Ford's mission, Ian Groves, thanks for being with us today.

0:18:58 Ian Groves
[smiles, nods]
Thank you very much.

0:19:00 William Moyers
[turns to camera]
And thanks to all of you for tuning in to our Let's Talk podcast. My email address is wmoyers@HazeldenBettyFord.org if you wanna shoot me a question. Remember, from prevention and research to treatment, recovery, advocacy, and resources for the community, Hazelden Betty Ford covers it all. So tune in next time for Let's Talk. On behalf of our Executive Producer Lisa Stangl and the great crew at Blue Moon Productions, I'm your host William C. Moyers. We'll see ya again.