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May 2004
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What if they just say “yes?”

One of the many problems with abstinence-only education is that it is all or nothing. It is sending an amateur across a tight-rope without a net, under the philosophy that if you give them a net it might encourage them to fall off. The drawback? If they fall without a net, they might die.
Many overdose deaths could be prevented if people knew more – proper dosages, dangers of mixing drugs and alcohol, drug reactions – and were not afraid to get help. But abstinence education specifically rejects this information, thereby condemning to death some children who fall off the rope. Drug warriors who push for abstinence-only are saying “We would rather have some children die than tell them the truth.” (They will say that they are preventing deaths by keeping kids from using drugs, but studies show that kids will experiment anyway.)
Marsha Rosenbaum is probably the best OpEd columnist out there writing about kids and drugs (here are some past columns), and she knows her stuff well — she directs the Safety First drug education project of the Drug Policy Alliance in San Francisco.
Her most recent piece is a response to the death of a 14-year-old Belmont, CA girl who had taken ecstasy (among other things) with her friends, titled “Fallback Strategy for Teens Who Say Yes to Drugs.”

… Especially disturbing is that, in the opinion of San Mateo County coroner Robert Foucrault, Irma Perez’s life could have been saved with professional intervention.

According to the paramedic’s report, Perez had taken an excessive dose – three “Valentine ecstasy” pills – and possibly alcohol and/or other drugs as well. While her two friends suffered no ill effects, Perez had an extremely rare reaction. She experienced what emergency physician Dr. Karl Sporer calls “serotonin syndrome”: rapid heart rate, high blood pressure, high fever and agitation.

Because adverse reactions are so rare with ecstasy, what caused Perez’s idiosyncratic response? Did the pills contain adulterants? Did Perez have a pre-existing condition that made her especially vulnerable, such as a cardiac arrhythmia? Was she dehydrated or did she drink too much water, causing dramatic drops in sodium levels? We don’t know the answers to these questions yet, but it is hoped the coroner will issue his report soon and make it public.

As a drug educator, I agree with Belmont-Redwood Shores Superintendent John McIntosh that in this “teachable moment” we must provide information to both parents and teenagers. At this critical juncture we need to be very careful about what we say so we can win back the confidence of young people. After more than two decades of exaggerations about drugs in general, and a recent scandal leading to the retraction of “brain damage” claims about ecstasy, adults have lost a great deal of credibility with teens.…

Missing from our educational efforts is a fallback strategy of harm reduction for those teens who, like Perez and her friends, say “yes” despite our efforts.

In addition to providing sound information about alcohol and other drugs, young people should learn to recognize signs of distress and know that they can and must get help. This was not what happened in Perez’s case. For five hours her friends tried on their own to help, using makeshift methods, such as giving her a bath. Perez finally lapsed into the coma from which she never recovered. …

Many in law enforcement, such as Commander Trisha Sanchez of the San Mateo County Narcotics Task Force, agree that the message we send our teens should be clear. The use of alcohol and other drugs is a poor choice, but if you do experiment and there is a problem, you will not be punished by calling for help.

“You will not be punished by calling for help.” That should be the number one message taught in drug education programs, followed by sound information about alcohol and other drugs. Remember, if all you tell thim is “just say no,” then you’re sending them out there without a net when they say “yes.”

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