How Do I Talk with My Teen about Fentanyl?

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Reena Ninan:
Episode 162. How Do I Talk to my Teen About Fentanyl?
Okay, well this is a topic, Lisa, you have always wanted to talk about.

Dr. Lisa Damour:
Yeah, I’ve been thinking about this for a long time. This is a huge topic in the care of young people. Reena, I attended the funeral of a young woman I knew who died from a fentanyl poisoning. It is big, it is scary, and I wanted to do this really carefully and do it right. So we found exactly the right people to have this conversation with. And when I think about the episodes we’ve put out, there’s no question in my mind this will be one of the most important if, and certainly I have no question, probably lifesaving episodes.

Reena Ninan:
It affects so many people. And even if you don’t know someone, a lot of the episodes we do are to raise awareness in communities of issues your child might not be dealing with, but how other people are dealing with it and if God forbid you ever come down that road, you’ve got resources and you’re right. The next two guests are incredible. I can’t wait to share the work they’ve been doing. Marcia Lee Taylor is the former president and CEO of the partnership for Drug-Free Kids and founder of MLT Strategies, a behavioral health consulting firm. She also created and ran the medicine abuse project. It’s a five-year very successful campaign to drive down teen misuse of prescription medication. And she also served as a senior advisor for drug policy and research for the Senate Judiciary Committee on Crime and Drugs. And she’s a proud parent of two teenage daughters.
Ed Ternan in May, 2020 lost his 22-year-old son Charlie, who was poisoned by a counterfeit prescription pill. Since that time, Ed and his wife Mary have dedicated themselves to informing young people about the new risks of self-medication and recreational drug use in the age of synthetic drugs like fentanyl. They also have a nonprofit charity called Song for Charlie. They create and distribute fentanyl awareness and drug education materials online to campuses and also via social media.
Welcome to you both.

Ed Ternan:
Thank you.

Marcia Lee Taylor:
Thanks so much for having us.

Dr. Lisa Damour:
Thank you for the work you’re doing. Thank you for the time you’re taking with us. I will say I have always been uneasy about drugs the entire time I’ve cared for teenagers. I don’t know that I’ve ever been as frightened of anything as I am of fentanyl.
So, actually Ed, let’s start with you. Walk us through the basics. What is fentanyl and how are young people coming into contact with it?

Ed Ternan:
Right. Well, I think what’s really important for parents to understand is that there’s been a seismic shift in the drug landscape in the last several years, and it’s driven by this movement of drug traffickers from using plant-based materials as the main ingredients in their street drugs to chemicals. They’re way more profitable and easier to move around. And so fentanyl is a very potent opioid and it began to emerge on the US market in the heroin supply in 2013, 2014. But what began happening really in 2019 was the production of pressed counterfeit prescription medications that young people are familiar with, like fake oxys, Xanax, Percocet that are made with this very potent opioid. So young people who may be experiencing either physical or emotional pain, they seek to self-medicate. They go outside of normal channels to get what they think is a familiar medication that they’ve seen in the medicine cabinet, and they get one of these street pills that’s loaded with fentanyl and that’s putting them at higher risk of accidental drug poisoning than has ever happened before, really.

Reena Ninan:
Marcia, you now Ed’s walked us through where we’ve come, but I am from the eighties. My childhood was Nancy Reagan, first lady telling us just say no to drugs. And that was considered drug prevention. What are we not doing and what do we need to do? If Nancy Reagan was just say no in the eighties, what are we right now?

Marcia Lee Taylor:
So I think Lisa mentioned that she’s never been more scared of the drug landscape than now. And I think she’s exactly right. I mean, Reena, you mentioned 1980s. In 1980 we had about 6,000 overdose deaths per year. Last year we had more than 108,000 overdose deaths. It is just an entirely different landscape, and it is scary for parents raising teenagers right now because unlike when we were growing up, there’s absolutely no margin for error. Fentanyl is in fake pills and it’s also in powders like cocaine and methamphetamine and heroin. So kids need to understand that those substances can be deadly, that they just cannot wander into them. There is just no margin for error for them. And that’s something that I think we just need to have those very specific conversations with kids so they understand that risk. But what’s different from the 1980s is that “just say no” mentality, sort of assumed that that was easy.
And I think we need to look at really a holistic reason of why are kids reaching for substances and you can’t separate the drug conversation from the mental health conversation. And really we need to be checking in on how kids are coping with all of the stresses in their lives to make sure they have healthy coping skills and healthy ways of dealing with all of the pressures that they face without reaching for substances. So it’s really much more than a one slogan. It’s an everyday kind of conversation that sometimes will be specific about drugs. And sometimes we’ll just be checking in on how kids are.

Dr. Lisa Damour:
Thinking about this. Your statistics are harrowing, and one thing I know, and I know you know this is that drug use is actually dropping among teenagers. And so drug use is dropping, but overdose deaths are skyrocketing, I think is a fair way to characterize it without being hyperbolic. As we think about what’s out there and who’s out there, are there particular groups at higher risk for this? Is there someone in more danger than someone else? How should we size this up?

Ed Ternan:
Well, this is really an equal opportunity risk. And when you think about the eighties and just say no, our tagline is that we say just say no, but we spell it K.N.O.W.
Because young people are dying really from a lack of information. What’s really different about this, and the reason it affects all groups across the whole country is this deception. So these substances, like the counterfeit pills are presented as one thing when they’re really another. And so people going out to use cocaine recreationally are not aware that cocaine can be contaminated with fentanyl. So that’s why our mission really is to just give people a level of knowledge, both families, parents, caregivers and young people directly to understand this new chemical drug landscape because really no one is immune from this risk. And another thing that’s different is there may not be any warning signs because this can happen. So suddenly one mistake, one impulsive decision. I’m not feeling well. I’ve seen the Xanax in mom’s medicine cabinet. I’m going to go for one of those on the street or from a friend and they don’t get a Xanax. What they get is not a Xanax at all.

Dr. Lisa Damour:
I want to ask a follow-up question on this one, Marsha, just from the marketing side or, and I hate thinking in these terms, but I just have a question. Why would dealers create drugs that kill their potential customers? I don’t get that piece.

Marcia Lee Taylor:
Yeah, it’s a great question, Lisa, and one that Ed and I get all the time. I think that what people need to understand is that this is a business and that the goal behind this for drug manufacturers, drug distributors is to get people addicted to this new, cheaper, easier to manufacture chemical substance. So along the way there are going to be some casualties, but a lot of people don’t overdose and die. A lot of people get addicted and then become the repeat customers. So I think you just need to look at it like a business. And what is tricky is that these substances are not manufactured in a chemical laboratory. The dosing is very imprecise. Oftentimes we hear these tragic stories of kids who split a pill and one kid lives, the other kid dies or who buy from the same dealer in the same situation. One person lives, one person dies, and that is because of the imprecise dosing. And the intent is not to kill people. The intent is sort of to get it right and get people addicted and coming back for more. But there are unfortunately a lot of casualties along the way.

Reena Ninan:
Ed, as we mentioned at the top, you lost your son Charlie because of a fake prescription pill laced with fentanyl. What do you want parents to know about this?

Ed Ternan:
Well, what it’s important for parents to know is that they have to have this conversation. We’ve started a new initiative called The New Drug Talk Connect to Protect. And we did that because we think we need to normalize an ongoing dialogue and discussion in the home around mental wellness and self-medication and this new chemical drug landscape because that’s the highest leverage thing we can promote to protect young people from this risk. We know that drug prevention education actually works. We kind of have abandoned it post D.A.R.E. and “just say no”. We’ve gone from just say no to just say nothing. And some of the polling we do indicates that young people, this misperception of harm that’s out there, they rate fentanyl as less dangerous than say heroin and cocaine. And yet 12 times more young people die from fentanyl than heroin and cocaine combined. But what’s the learning there? They know heroin and cocaine are risky. They’ve been told that and they pick it up in popular culture. They’re not aware of what fentanyl is. So just by getting the conversation started in the family room around the kitchen table in a welcoming and curious and supportive way, we think that’ll be a real protective factor. So that’s what parents need to know, and we want to give them the tools through the new drug talk and the confidence to have this conversation.

Reena Ninan:
What are things I could say to my child like your son lost his life because of a fake prescription pill. Where are ways that this could happen to your child that parents might not think about in today’s age?

Ed Ternan:
Well, I think that kind of an interesting pro tip to get this discussion started and keep it going is to do it together. So we have this unique opportunity in that this is new, so it’s new to mom and dad and it’s new to the kids, so it doesn’t have to be a one-way lecture. “Listen, you’re old enough now to have this talk. There’s drugs out there and you need to stay away from ’em.” It can start with, “Look, I’m concerned. I’ve heard something. I’m just learning about this. What are you hearing? And I think this is very important and I’m concerned for you and your friends. Let’s learn about this together. Let’s make a promise to one another that we’re going to talk about this. If you find something on the internet, if you find new information, if you hear a new story, let’s discuss it because we both need to really get smart about this so we can keep you and your friends and everyone we love safe from this new risk.”
There’s new ways and kind of tricks I think of the trade that maybe we need to think about to help families normalize this conversation.

Dr. Lisa Damour:
Marcia, help build it out even further. I love that, Ed, what you said, and especially thinking as a psychologist and thinking about how we open lines of communication and keep them open and make sure the kids feel they can come back to us as landscapes change for them. Marcia, what else would you have us bring up in that conversation or what else can you tell us about how to approach that conversation? Help us out here.

Marcia Lee Taylor:
Sure. And I think there are some things that we can think about for different developmental stages too, right? I think all kids need to know that pills and powders are dangerous and potentially deadly and that kids, that needs to be a no-go zone. But I think kids also need to know what to do in the moment when they’re at that party and someone offers ’em something. What are the refusal skills? And this is something that kids have to practice. They have to have something in their back pocket that they know they can use. And I always say that for my teens. I always say, blame me. Use me as the bad guy and text me if you need to get out of a situation and I will be the bad guy saying, you have to come home right now. And really talking through those scenarios with your kids so that they are comfortable in that very stressful moment and knowing what to do. But something else that I think all parents should be aware of is that there is a medication called Naloxone, which can reverse an opioid overdose and it is essential to have that in your house. I know some parents think, not my kid, it’s not going to happen. Every parent needs to have this. It should just be part of the first aid kit because you never know if it’s your kid, someone else at your house who’s going to need that. And it can really be the difference between life and death.

Dr. Lisa Damour:
This is available over the counter now, right? You can go get it at your drugstore.

Marcia Lee Taylor:
This is new. The FDA just made it available over the counter. It is available at your local drugstore. You can also order it online. It is very easy to get. There are also resources in communities, harm reduction organizations that will give it out for free if there’s about a $40 price tag on it. And for some families that may not be accessible. So there are other ways to find it, and I would urge every family to have it on hand.

Dr. Lisa Damour:
Actually, when I sent my older daughter to college in the fall of 2022, Ohio had an initiative I trust that they still do, where you could go online and watch a video about how to administer Narcan, when to worry and what to do, and you watch the video and then you get sent Narcan. We watched the video together. I sent her to college with the Narcan, and it was, I will tell you, a very uncomfortable conversation to have. And it also felt absolutely essential. And she was surprisingly open to it. I think I was much more uncomfortable about it than she was. But I said to her, when I think about you being in college, this is what really scares me. And I think that you or your peers could encounter this by accident. I think that’s likely how, if it’s going to happen, it’s probably going to be entirely accidental. I’ve said to her, you need to keep this with you and everybody needs to know you have this. Is there more we can do?

Marcia Lee Taylor:
So, I think having those conversations like you did with your daughter and making sure that parents are really checking in with kids on a daily basis about their wellbeing and their mental health. And so many of the things Lisa and Reena that you talk about on this podcast about coping skills and about resilience and making sure that kids are reacting in appropriate ways to the different sad events that may happen in their lives is really important. Because if parents have their finger on the pulse of what’s going on with their kid, they’re able to intervene earlier before kids may reach for something else to be a quick fix to an uncomfortable feeling that they’re having.

Reena Ninan:
What do you think in your experience and research works in getting young people to see that you might not think you’re taking fentanyl, but it could be laced in something that you don’t even know it’s in that pill?

Ed Ternan:
When we talk to young people directly, we use a couple of kind of techniques. We know that young people are kind of programmed to take risk and think, “Well, I’ll figure it out. It won’t happen to me.” So sometimes we triangulate and we talk about, “Listen, you need to know this because you would not want this to happen to anyone in your friend group, your girlfriend, your boyfriend, your cousin. You don’t want this to happen to anyone you love. That would be terrible, right?” So you need to understand that for reasons that are outside of all of our control, the pills,” especially when you’re talking to younger people, “the pills that are out there are not what you’re looking for. If you’re looking for relief and you need help, there are ways to get that with your parents, with your doctor, and that’s okay. But if you go outside of those channels and you go for a pill, the first thing you need to know is it’s not real.”
I say just like there’s no chicken in a nugget, there’s no Xanax on Snapchat. You will not find that relief on the internet. And so that’s the first thing. And we try to engage young people and empower them with really actionable information they can use to make healthier decisions for them and their friends. We think that’s very important because our kids are under enough stress. So we don’t want to hit them with this messaging of, Hey, here’s one more thing you have to worry about. We kind of hit it with there’s a new public health issue out there. It affects you and your friends. You need to get as smart as you can about it so you can protect yourselves. And we do it with a sense of hope. We’ve nicknamed ourselves team hope. We wouldn’t be doing this work, if we didn’t think we could make a significant dent in the risk to young people just by making them smarter and more informed and their parents and their caregivers about what’s going on so they can navigate this new minefield better.

Dr. Lisa Damour:
I love how you’re approaching this. I do know that if you come at teenagers with this is on fire, this is out of control, they just shut down and what else could they possibly do? So I love your approach. And so then along those lines, Marcia, you have given us some incredible dues about how to have this conversation. Any don’ts that you want to share with us in terms of don’t do this as a way to approach this conversation?

Marcia Lee Taylor:
I would say don’t approach the conversation from a place of judgment. When Song For Charlie did some research before launching the new Drug Talk, one of the key things we learned is that one of the top reasons why kids don’t talk to their parents about substances is fear of judgment. So I think you need to have this open line of communications. You need to set your expectations clearly of what you expect them to do. But we know that kids’ brains aren’t fully developed. They’re going to trip up, they’re going to make mistakes. So you want to create an environment where they will come to you. And the other thing I would say is don’t think that you’ve sort of checked the box. The conversation is done. The other nugget from that research is that when we ask parents, have you had the conversation with your kids? 70% of parents say that they had had a conversation about fentanyl with their kids, but only 30% of kids reported hearing that conversation. So I think repeat yourself, sit them down and talk about it again, look for those moments when you can bring it up in conversation. Because the drug talk, as in all things with teenagers, they tend to tune things out. And I think you really need to make sure that it’s getting through.

Dr. Lisa Damour:
I know what you mean about teenagers not taking it in. I think sometimes when I’ve cared for teenagers, it’s because the parent approaches and the kid’s thinking, I’m not going to parties. That’s not part of my life. So they tune out and then six months later, that kid is wildly social or around that stuff and the window needs to open again. And so I think I’ve so come to appreciate how quickly kids change and develop and how I could not agree more. You can’t just be like, yep, check the box, had the conversation, we don’t need to do it again.

Reena Ninan:
Yeah. Also, Lisa, you always talk about how we need to have these ongoing conversations. There isn’t one sex talk. There isn’t one drug talk. There isn’t one that one isn’t enough that you’ve got to keep engaging. And I love that. I love that message all three of you are saying. So I’m curious, what should we do to prepare our kids for the possibility that they might be present when a drug overdose happens? If you call the cops and the cops show up and there are illegal drugs, does this mean your child’s going to get in trouble with the police? How should a kid respond if they know there’s been a drug overdose and they don’t have the resources to help deal with this on their own?

Ed Ternan:
Well, I’ll take this opportunity to echo what Marcia said about Naloxone or Narcan. The interesting thing about Narcan is it’s an antidote. It reduces an opioid overdose. And what I tell families is what you should know about that is Narcan or Naloxone is the only thing that reverses an opioid overdose. So if you are in somewhere where there’s an overdose occurring and you call first responders and you’re giving CPR, you are all just buying time for the first responders to get there, and then they’re going to administer Naloxone. And the sooner you get Naloxone going, the better. So very important, first of all, to have it at the ready and know how to use it. It’s very, very easy to use. And the other thing to know is know that doing the right thing and calling 911, which you have to do, even if you administer Naloxone, you have to get someone to the hospital that the US government law enforcement is doing everything they can to encourage Naloxone distribution to get it all out there and to assure people that if you call authorities during an overdose, you will not be punished for having illegal substances, being intoxicated, underage, having a party at your house.
I tell the kids, now, listen, they’re going to shut the party down, turn the music off, take the drugs away. That’s going to happen, but nobody’s going to go to jail, right? Sorry, I get emotional. The first responders will shake your hand and say, you did the right thing. So very important for young people to feel empowered to say, “I’ve got my Narcan. I take it wherever I go, and I’m ready in case this happens. And I don’t have to worry that there’s going to be negative consequences if I step in.” It’s super important in this environment.

Reena Ninan:
I’ve never heard anybody tell me that.

Marcia Lee Taylor:
Just one really important piece to add to that because I think this is such a critical conversation. I think there are some kids who are afraid, or some adults who are afraid that they’ll do harm if they use Narcan on someone. And I just want to reassure everyone that if someone is not overdosing and you use Narcan on them, nothing bad is going to happen. Only good can come of using Narcan. So people should not hesitate. They should not wait to sort of see if this is really an overdose or if the person’s just fallen asleep. There is absolutely no harm in using Naloxone on someone.

Dr. Lisa Damour:
That’s good to know. That’s good to know. And I will tell you, the only thing that allows me to sleep at night in the context of the Fentanyl crisis is the reality that Narcan is available, does work, can be accessed increasingly easily. I mean, I think otherwise this would be beyond terrifying. This is now somewhat terrifying because we do have that available as a solution.

Reena Ninan:
Wow, this is such a deep episode, and I think I’m listening to this thinking, it’s not going to be my kid. It’s not going to be my kid, but how many parents out there have that feeling? It’s not going to be my kid. Wow. It’s just so powerful.
Before we go, what would you guys like to leave our audience with that you think they might not know about? The moment we’re in, the Narcan thing was so big. Can I tell you? I left for college with a TV VCR combo and thought that that’s the one thing every kid should have in their dorm room. And to hear you say that this is the one thing, it’s just how times have changed, that was powerful. But what do you want to leave us with before we go?

Ed Ternan:
I would say that parents need to understand that through no fault of their own and certainly no fault of their young peoples, that their kids are navigating now in a drug landscape that while in the past we described it more like a path where you could get off on the wrong track and eventually harm might come in the form of an overdose. Now it’s more like a minefield where one false move, one misstep could cost your child, his or her life. That’s not the child’s fault, and we don’t want to stress him out and freak him out about that. But it is important information, and we’ve created this culture that’s normalized kind of self-medication and the quick fix. There’s a pill for every ill kind of thinking. And there needs to be a change in mindset to say, you know what your grandmother told you was right.
There are better, more natural ways to change your mood, to change your brain chemistry, fresh air, sunshine, prayer and meditation, exercise, all those things are now like critical life skills. They’re not nice to have. It’s really important that your kids embrace those things, that you encourage those things, that you model those things instead of the I got a problem, I’m going to pop a pill and feel better for a little while because that behavior just a few short years ago was fairly benign, but today it is really, really potentially deadly. So that’s what I would leave parents with.

Dr. Lisa Damour:
Thank you. And I want to direct people to your website, the New Drug Talk. We’ll link to it in the show notes. It is so smart. It is so well done. It is broken down developmentally. It is not overwhelming. It’s got just what people need. I know that you are partnering with states who are getting this out to people, that the work you’ve done is just excellent. I cannot overstate my gratitude to you for what you’ve created. And I get choked up where you’ve taken this moment in your life, this experience, this terrible thing that happened in your family, and the generosity you have shown in just doing everything within your power. And it’s substantial to help keep more young people safe.

Ed Ternan:
Thank you very much, Lisa. Thank you. Appreciate it. God bless.

Reena Ninan:
Marcia and Ed from the New Drug Talk, be sure to check out their website. It’s got incredible resources as Lisa mentioned. It’s called www.songforcharlie.org. We’re going to link to that in our show notes so you can find it there as well. Thank you for joining us.

Ed Ternan:
Thank you.

Marcia Lee Taylor:
Thank you.

Reena Ninan:
Lisa. I can’t tell you what an incredible moment that was to have Ed come on and talk about taking personal pain and tragedy. What is probably the worst moment of your life and helping so many parents out of that grief just remarkable to me.

Dr. Lisa Damour:
I know, I know. Incredible work.

Reena Ninan:
So what do you have for us for Parenting to Go?

Dr. Lisa Damour:
There’s so much I could say, but I will say this. I really, really appreciate the gentle approach that Ed and Marsha are suggesting because one of the things I know can also happen with teenagers is a parent listens to an episode like this, and then the kid comes home and they’re like, “We need to talk about fentanyl.” And the way the teenager takes that in is, “What did I do? What did I do?”

Reena Ninan:
“I screwed up.”

Dr. Lisa Damour:
“Where is this coming from? Why would?” They personalize it? Because they’re adolescents. And so the language provided of, “Hey, this is going on. This is happening around us. We need to learn about this together.” I can’t overstate just as a psychologist who cares for teenagers, how essential that framing is to keep the lines of communication open. Because kids take this stuff, they’re sensitive to it, they take it personally, and you’ll lose them with that approach. So I am so grateful for how they laid out a tactic to get into that conversation and stay in that conversation.

Reena Ninan:
So you’re saying while they might be surprised and wonder, this is coming out of left field, you’re saying have the talk with them and explain why you’re doing this now?

Dr. Lisa Damour:
Give them context for why this is coming up now. That will keep the door open.

Reena Ninan:
Well, I see why you wanted to have this episode. I’m so glad we did. And what I love about our podcast is you might not be at that destination just yet, but it could be coming right around the corner. And so thank you for preparing us for it, Lisa, and our thanks to Ed and Marcia for joining us today.
I’ll see you next week.

Dr. Lisa Damour:
I’ll see you next week.