Oregon education leaders discuss tools for curbing adolescent fentanyl use

Education leaders discussed the rise in fentanyl use in Oregon adolescents and interventions needed to curb abuse during an Oregon Health & Science University (OHSU) panel Wednesday.

 

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The discussion included Jon and Jennifer Epstein, whose son, Cal, died in December 2020 after using fentanyl. The Epsteins have been working with the nonprofit Song For Charlie to raise awareness about adolescent fentanyl use as Oregon faces a drug crisis. The state’s overdose deaths increased by 41% last year, compared to a 16% increase nationwide. 

“This is something that could apply to you,” Jon said. “This is not just to someone else suffering a use disorder. This is not just to someone experiencing houslesness. All of those experiences are tragic and we have great empathy for all of the 107,000 people that are dying annually from illicit substances. However, this particular aspect could really apply to anyone so you need to recognize that youth in your life are at risk even when they might not fit a traditional at-risk profile.”

Beaverton School District Nurse Joni Busche said health care practices have changed dramatically since fentanyl became a part of the drug landscape. 

“What I have been acutely aware of is the fact that if I’m responding to a student who is showing symptoms of possible drug use they actively show symptoms of reduced level of consciousness … Difficult to arouse, difficult to awaken, slow to respond,” Busche said. “I often feel this internal panic that perhaps I have a student who has taken a pill they believe was somewhat harmless.”

Busche noted that fentanyl can be found in pills youths believe to be oxycodone, vicodin, xanax, or percocet.

“Fentanyl has been infused in any drug we could purchase off the streets,” Busche said. “It could be powders, it could be marijuana, most commonly pills. No pill is the same. The only pill that could be considered safe is prescribed from your physician and comes from a pharmacy.”

Beaverton School District has adopted a policy to require fentanyl training and awareness for students, staff, and community members, Busche said. She has also trained her high school and middle school staff in naloxone administration.

Dr. Honora Englander is the Director of OHSU’s Improving Addiction Care Team (IMPACT), which focuses on hospital-based addiction care that includes physicians, social workers, and peers with lived experience in recovery. She said every Oregonian should carry naloxone, which rapidly reverses the effects of an opioid overdose, although gaining access to the drug can be challenging.

“Oregon has terrible access to medications for opioid use disorder,” Englander said. “Not only do we not have enough access, but the treatment we have often makes people work way too hard to access that treatment. People have to stand in long lines. They have to travel long distances. They have to comply with unnecessary rules and regulations. And we can do better.”

Oregon lawmakers recently pushed for greater availability of naloxone during a Senate Interim Committee on Health Care meeting on June 2nd.

OHSU Health Care Provider Dr. Bradley Buchheit focuses on expanding access to addiction medicine. He said there are huge gaps in addiction treatment in Oregon, specifically for adolescents. 

“We have very few residential treatment programs in Oregon, and the ones we do have don’t offer evidence-based medication to treat opioid use disorder,” Buchheit said. “We know there are evidence-based interventions that keep people safe and keep them from using opioids. We really need to make sure that … Adolescents and young adults have access to those medications. It doesn’t mean that they have access on the 18th appointment when they go in to see a provider. They need on-demand, same-day, easily-accessible medications or we are going to have worsening overdose death rates in the state.”

Buchheit said health care providers need to focus on patient-centered interventions, and determine specific treatment procedures patients prefer (virtual vs. in-person sessions).

“These are things that are going to be very important,” Buchheit said. “It’s interesting that even though the American Academy of Pediatrics recommends the use of medications for opioid use disorder, very few pediatricians and primary care doctors actually offer that service. As a medical community, as a state, we need to be doing more. We need to educate families, students, teachers, coaches, and health care professionals about the use of fentanyl.”