Safety First A Reality-Based Approach to Teens and Drugs

Marsha Rosenbaum, PhD

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Safety First: A Reality-Based Approach to Teens and Drugs Safety First A Reality-Based Approach to Teens and Drugs

Marsha Rosenbaum, PhD

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Printed in the United States of America.

To obtain additional copies of Safety First: A Reality-Based Approach to Teens and Drugs please contact: Drug Policy Alliance 212.613.8020 [email protected] www.drugpolicy.org Table of Contents

3 Introduction

8 Understanding Teenage Drug Use

10 Problems With Current Prevention Strategies

19 Just Say No or Say Nothing at All?

20 Safety First: A Reality-Based Approach

23 Put Safety First

25 A Model for Drug Education

26 What’s a Parent to Do?

32 Epilogue

34 Resources and Endnotes

40 Acknowledgements

41 About the Author

2 Safety First: A Reality-Based Approach to Teens and Drugs Introduction

Like many parents, when my children cheerleaders and sports team entered high school, I wished captains – have rejected the “Just Say “the drug thing” would magically No” mantra and used alcohol and/or disappear and my kids would simply other drugs while in high school. abstain. Yet as a long-time researcher supported by the National Institute on Most youthful drug use is experimental Drug Abuse, and as a realistic parent, or occasional and the vast majority I knew this wish to be a fantasy. of young people, fortunately, pass through adolescence unscathed. Today’s teenagers have been Still, I worry about those whose exposed, starting in elementary experimentation gets out of hand; who school, to anti-drug messages fall into reckless patterns with alcohol in school, on television, and in and/or other drugs; and who put community-based programs. themselves and others in harm’s way.

Largely these anti-drug messages Let me be clear from the outset. As are designed to generate fear in a mother myself, and now a grand- young people and encourage them mother, I do not excuse, encourage or to abstain from alcohol and other condone teenage drug use. I believe drug use. abstinence is the safest choice.

Parents, too, have been advised, My deepest feelings are expressed indeed bombarded, with billboard, in a letter written to my son when newspaper and electronic messages he entered high school, published urging them to talk to their teens by the San Francisco Chronicle on and establish clear limits and September 7, 1998.2 consequences for disobeying the rules.

Yet despite federal drug prevention expenditures totaling more than $1.3 billion per year1 on a variety of programs, coupled with admonitions from their parents, many teenagers – including student body presidents,

www.drugpolicy.org 3 Dear Johnny,

This fall you will be entering high school and, like most American teenagers, you’ll have to navigate drugs. As most parents, I would prefer that you not use drugs. However, I realize, that despite my wishes, you might experiment.

I will not use scare tactics to deter you. Instead, having spent the past 25 years researching drug use, abuse and policy, I will tell you a little about what I have learned, hoping this will lead you to make wise choices. My only concern is your health and safety.

When people talk about “drugs,” they are generally referring to illegal substances such as marijuana, cocaine, methamphetamine (speed), psychedelic drugs (LSD, Ecstasy, “Shrooms”) and heroin. These are not the only drugs that make you high. Alcohol, cigarettes and many other substances (like glue) cause intoxication of some sort. The fact that one drug or another is illegal does not mean one is better or worse for you. All of them temporarily change the way you perceive things and the way you think.

Some people will tell you that drugs feel good, and that’s why they use them. But drugs are not always fun. Cocaine and methamphetamine speed up your heart; LSD can make you feel disoriented; alcohol intoxication impairs driving; cigarette smoking leads to addiction and sometimes lung cancer; and people sometimes die suddenly from taking heroin. Marijuana does not often lead to physical dependence or overdose, but it does alter the way people think, behave and react.

I have tried to give you a short description of the drugs you might encounter. I choose not to try to scare you by distorting information because I want you to have confidence in what I tell you.Although I won’t lie to you about their effects, there are many reasons for a person your age not to use drugs or alcohol. First, being high on marijuana or any other drug often interferes with normal life. It is difficult to retain information while high, so using it, especially daily, affects your ability to learn.

Second, if you think you might try marijuana, please wait until you are older. Adults with drug problems often started using at a very early age.

4 Safety First: A Reality-Based Approach to Teens and Drugs Finally, your father and I don’t want you to get into trouble. Drug and alcohol use is illegal for you, and the consequences of being caught are huge. Here in the United States, the number of arrests for possession of marijuana has more than doubled in the past six years. Adults are serious about “zero tolerance.” If caught, you could be arrested, expelled from school, barred from playing sports, lose your driver’s license, denied a college loan and/or rejected from college.

Despite my advice to abstain, you may one day choose to experiment. I will say again that this is not a good idea, but if you do, I urge you to learn as much as you can, and use common sense. There are many excellent books and references, including the Internet, that give you credible information about drugs. You can, of course, always talk to me. If I don’t know the answers to your questions, I will try to help you find them.

If you are offered drugs, be cautious. Watch how people behave, but understand that everyone responds differently even to the same substance. If you do decide to experiment, be sure you are surrounded by people you can count upon. Plan your transportation and under no circumstances drive or get into a car with anyone else who has been using alcohol or other drugs. Call us or any of our close friends any time, day or night, and we will pick you up, no questions asked and no consequences.

And please, Johnny, use moderation. It is impossible to know what is contained in illegal drugs because they are not regulated. The majority of fatal overdoses occur because young people do not know the strength of the drugs they consume, or how they combine with other drugs. Please do not participate in drinking contests, which have killed too many young people. Whereas marijuana by itself is not fatal, too much can cause you to become disoriented and sometimes paranoid. And of course, smoking can hurt your lungs, later in life and now.

Johnny, as your father and I have always told you about a range of activities (including sex), think about the consequences of your actions before you act. Drugs are no different. Be skeptical and, most of all, be safe.

Love, Mom

www.drugpolicy.org 5 Introduction (cont.)

Immediately following the publica- I must have hit a nerve. tion of “Dear Johnny,” I received dozens of calls, emails and letters Since 1999, hundreds of thousands from parents, teachers and other of copies of Safety First have been concerned adults who wanted to requested by and distributed to know more about why so many teens individuals and educational, health weren’t listening to our admonitions and governmental institutions and to abstain. agencies in all 50 states, Puerto Rico, the District of Columbia and What, if anything, could they do in 35 countries around the world. about it? How might they educate The booklet has been translated into themselves so they could counsel Spanish, Chinese, Russian, teenagers more effectively? Was Ukrainian, Romanian, Czech, Hebrew, there anything that could be done to Portuguese, Greek, and Papiamento. ensure the safety of teenagers, even ”Dear Johnny” has been published in if they persisted in experimenting at least a dozen languages. with alcohol and/or other drugs? I have made countless presentations, To research these questions, I written opinion pieces for news- consulted experts, including a papers, spoken with thousands of diverse group of parents, teachers, parents, teachers and students, and researchers and young people them- appeared on numerous radio and selves. I looked at school-based TV shows. drug education, its history, curricula and existing evaluations. The result The education I’ve received over the was the first edition (1999) of Safety past twenty-one years has shaped First: A Reality-Based Approach to this new booklet, which is intended Teens, Drugs, and Drug Education, for parents and other adults who which was revised and updated in care about the health and safety of 2002, 2004, 2007, 2012, and 2014. teenagers, and who are willing to look beyond convention for pragmatic strategies.

6 Safety First: A Reality-Based Approach to Teens and Drugs The abstinence-only mandate puts adults in the unenviable position of having nothing to say to the young people we need most to reach.

www.drugpolicy.org 9 Understanding Teenage Drug Use

The 2018 Monitoring the Future survey 53 percent within the past year; states that almost half of high school and more than 30 percent of those seniors say they have tried illegal surveyed within the past month.4 drugs (including prescription drugs not under doctor’s orders) at some point in The Centers for Disease Control and their lifetime; nearly 39 percent admit Prevention’s 2017 Youth Risk Behavior to having used an illegal drug during Survey found that 18 percent of high the past year; and nearly one-quarter school students reported taking “more profess to having used drugs in the than a few sips” of alcohol before the past month.3 age of 13.5

The numbers are even higher for In order to understand teenage drug alcohol: 58 percent say they have tried use, it is imperative to recognize the alcohol (itself a potent drug in every context in which today’s teens have regard) at some point in their lives; grown up. Alcohol, tobacco, caffeine, over-the-counter and prescription drugs are everywhere. Although we

8 Safety First: A Reality-Based Approach to Teens and Drugs urge our young people to be “drug- Today’s teenagers have witnessed free,” Americans are constantly first-hand the increasing, sometimes bombarded with messages encour- forced “Ritalinization” of their fellow aging us to imbibe and medicate students.10 Stimulants such as Adderall, with a variety of substances. We use an amphetamine product, have alcohol to celebrate (“Let’s drink to become a drug of choice on many that!”), to recreate (“I can’t wait to kick college campuses. We see prime-time back and have a cold one!”) and even network commercials for drugs to to medicate (“I really need a drink!”). manage such ailments as “Generalized We use caffeine to boost our energy, Anxiety Disorder,” and teenagers see and prescription and over-the-counter increasing numbers of their parents drugs to modify our moods, lift us out using anti-depressants to cope with of depression and help us work, study life’s challenges. In 2017, 15 percent of and sleep. 12th graders claimed to have used at least one prescription drug Drugs are an integral part of American (amphetamines, tranquilizers, seda- life. In fact, nearly half of U.S. adults tives and/or narcotics) without a report using at least one medication in doctor’s orders, in their lifetime; the past month,6 and nearly a quarter almost 10 percent in the past year; and of women aged 60 or older are using 4.2 percent in the past month.11 antidepressants.7 Fifty-six percent of adults in this country have used “Peer pressure” is often blamed alcohol in the last month8 and more for adolescent drug use. However, than 123 million Americans over the teenage drug use seems instead to age of 12 have tried marijuana at some mirror modern American drug-taking time in their lives – a fact not lost on tendencies.12 Indeed, some psycholo- their children and grandchildren.9 gists suggest that given the nature of our culture, teenage experimentation with legal and illegal mind-altering substances should not be considered abnormal or deviant behavior.13

www.drugpolicy.org 9 Problems With Current Prevention Strategies

Americans have been trying to Use Versus Abuse prevent teenage drug use for more In the effort to stop teenage experi- than a century – from the nineteenth- mentation, prevention messages century Temperance campaigns often pretend there is no difference against alcohol to Nancy Reagan’s between use and abuse. Some use “Just Say No.” A variety of methods, the terms interchangeably; others from scare tactics to resistance emphasize an exaggerated definition techniques to zero-tolerance policies that categorizes any illegal use of and random drug testing, have been drugs as abuse.16 used to try to persuade, coax and force young people to abstain. Teens often dismiss this hypocritical message because they see adults Although some newer, more routinely making distinctions between nuanced programs are stressing use and abuse. Most observe their good decision making,14 most are parents and other adults using compromised by: alcohol without abusing it. They know • the unwillingness to distinguish there is a big difference between between drug use and abuse, having a glass of wine with dinner proclaiming “all use is abuse”; and having that same glass of wine • the use of misinformation as a with breakfast. Many also know or scare tactic; and suspect their parents have used mari- • the failure to provide juana or some other drug at some comprehensive information to help point in their lives without abusing it young people reduce the harms or even continuing to use it.17 that can result from drug use.15 Few things are more frightening to a parent than a teenager whose use of alcohol, marijuana, and/or other drugs gets out of hand. Yet virtually all studies have found that the vast majority of students who try legal and/or illegal drugs do not experience problems with them.18

10 Safety First: A Reality-Based Approach to Teens and Drugs We need to talk about alcohol, marijuana, and other drugs in a sophisticated manner and distinguish between use and abuse. If not, we lose credibility.

Of course, any substance use Today, in light of the growing involves risk. But it is important to talk movement to legalize marijuana about alcohol, marijuana and other for adult use, opponents’ claims of drugs in a sophisticated manner marijuana’s dangers are especially and distinguish between use and exaggerated, and widely publicized. abuse. If not, we lose credibility, and Although the old Reefer Madness teens stop listening. Furthermore, style messages have been replaced by acknowledging these distinctions with assertions of scientific we can more effectively recognize evidence, many of the most serious problems if and when they occur.19 allegations, though scary to parents (if not their children), falter when Scare Tactics and Misinformation: critically evaluated. Close scientific Marijuana as a Case in Point scrutiny has revealed that claims of While the use of alcohol presents marijuana’s risks have often been the greatest risks to young people, overstated, and in some instances, marijuana – the second most popular even fabricated.20 drug among teens – has consistently been mischaracterized in an effort to frighten them into abstaining.

www.drugpolicy.org 11 Problems with Current Prevention Strategies (cont.)

In the following sections I address Potency the questions regularly asked by Many people believe that the parents: marijuana available today is signifi- • Is it true that marijuana is cantly more potent than in decades significantly more potent and past. The government says so; dangerous today than in the past? growers marketing their product • Is today’s marijuana really more say so; and adolescents trying to addictive than ever before? distinguish themselves from their • Does marijuana really cause users parents’ generation say so. And to seek out “harder” drugs? those who used marijuana 30 years • Is it true that smoking marijuana ago, stopped, and then try it again, causes lung cancer? certainly say so.21 • What about the impact of marijuana on the adolescent brain? As marijuana-growing techniques • How will legalization of marijuana have become more advanced and affect teens? refined, there has been a

12 Safety First: A Reality-Based Approach to Teens and Drugs corresponding increase in its average Modes of ingestion can make all the psychoactive potency, known as its difference. THC-infused products, THC (delta-9 tetrahydrocannabinol) also known as “edibles” such as content level.22 As a result, average baked goods, candy, and soda, THC levels have increased since can produce adverse effects when 1983 from approximately 2.4 percent consumers exceed the recom- to almost 12 percent.23 In short, it mended dose. According to Zimmer appears that marijuana is now, on and Morgan, “{While} it is difficult average, stronger than in the past, to consume large doses of THC by though variation has always been the smoking, it is easy to do so by eating. norm.24 Does this mean that the mari- When swallowing large doses of juana available today is a qualitatively THC, people experience not only the different drug than that smoked in effects of THC, but also the effects of the past? Not really. Essentially, 11-hydroxy-THC, a distinct psychoac- marijuana is the same plant now as it tive compound produced by the liver was then, with any increased strength as it metabolizes THC… The higher akin to the difference between beer incidence of adverse reaction {after} (at 6 percent alcohol), and wine eating cannabis products is probably (at 10-14 percent alcohol), or between due to the combined effects of THC a cup of tea and an espresso. and 11-hydroxy-THC.”27

Furthermore, even with higher It can take significantly longer for the potency, no studies demonstrate that body to metabolize edibles, since increased THC content is associated they pass through the gastrointes- with greater harm to the user or any tinal system. When people don’t risk of fatal overdose.25 In fact, among understand this, or grow impatient, those who report experiencing the some ignore warnings or package effects of unusually strong marijuana, instructions and consume more many complain of dysphoria and than advised. By the time the THC subsequently avoid it altogether. is metabolized, the individual can Others adjust their use accordingly, feel overly intoxicated, sometimes consuming very small amounts to anxious, even panicky. Within a few achieve the desired effect.26 hours, the effects of overconsumption typically wear off.

www.drugpolicy.org 13 Problems with Current Prevention Strategies (cont.)

Marijuana Use Disorder Rates of marijuana use and marijuana Marijuana does not cause the use disorder have remained stable physical dependence commonly among teens across the United associated with drugs such as States. The number of marijuana- alcohol, nicotine and heroin. related treatment admissions among Nonetheless, a small minority of youth actually fell by half between users find it temporarily difficult 2005 and 2015. While some of these to moderate their use, or quit. teens are in rehab because they (or According to a national survey, only their families) believed their marijuana nine percent of people who have ever use was adversely impacting their used marijuana go on to develop a lives, the greatest number of referrals marijuana use disorder, and some to treatment (39%) were made due addiction professionals argue that the to contact with the criminal justice actual rate may be even lower.28 system, often for simply possessing small amounts of marijuana.30 The small minority of those who do experience difficulty with marijuana, The Gateway Theory according to a study published in The “gateway” theory suggests the top-ranking journal, Addiction, that marijuana use leads to the use also have pre-existing mental health of other drugs, such as cocaine problems that were exacerbated by and heroin, and that’s why it’s marijuana.29 dangerous.31 Population data compiled by the National Survey on It is important to note that as with Drug Use and Health and others, other forms of substance use however, demonstrate that the vast disorder (with a variety of substances majority of people who use marijuana and/or activities), the psychosocial do not progress to more dangerous aspects of a teenager’s life, including drugs.32 The gateway theory has poverty, a dysfunctional family, also been refuted by the Institute of violence at home and/or in the Medicine33 and numerous academic community, lack of support systems, studies.34 and even teenage rebellion may be contributing to, and manifesting as, “addictive” behavior.

14 Safety First: A Reality-Based Approach to Teens and Drugs The overwhelming majority of The largest study of its kind to date marijuana users never try any other compared more than 2,000 lung can- illicit substance.35 cer cases with nearly 3,000 control subjects without cancer. Researchers Of the nearly 123 million Americans found no association between even who have tried marijuana, less than 2 long term, regular marijuana smoking percent report having tried heroin.36 and lung cancer. The authors of the Research also reveals that the major- study, published in the International ity of teens who try marijuana do not Journal of Cancer, concluded that develop marijuana use disorder or their results “provide little evidence even use marijuana itself on a regular for an increased risk of lung cancer basis.37 among habitual or long term canna- bis smokers.”40 Furthermore, those who report using marijuana in early adulthood typically Moreover, marijuana smoking is not report voluntarily ceasing their mari- associated with any other permanent juana use by the time they reach age lung harms, such as chronic obstruc- 30.38 Consequently, for most who use tive pulmonary disorder (COPD), it, marijuana is a “terminus” rather emphysema or reduced lung function than a “gateway.” – even after years of frequent use.41

Lung Cancer Still, it is simply a matter of good Although inhaling marijuana can health to refrain from inhaling irritate the pulmonary system, combustible particle matter. Since research has yet to demonstrate that many worry about the adverse smoking marijuana, even long term, effects of inhaling smoked marijuana, causes diseases of the lung, upper vaporizing has become popular, aerodigestive tract, or mouth.39 with one young man telling me in confidence, “Joints are so passé, nobody smokes anymore!”

www.drugpolicy.org 15 Problems with Current Prevention Strategies (cont.)

The Adolescent Brain There has been much discussion Other researchers, at the lately about the possible impact of University of Pennsylvania and marijuana use on the development of Children’s Hospital of Philadelphia, the adolescent brain. recently compared 147 cannabis users with 634 non-users, ages Some studies have shown that 14-22, using neuroimaging heavy marijuana use starting in the measures. They reported, in early teens has an impact on the Neuropsychopharmacology, “Our brain, suggesting that the structure data converge with prior large-scale of the developing brain, especially studies suggesting small or limited that which controls emotional associations between cannabis use development, is particularly sensitive and structural brain measures in to marijuana.42 youth.”44

Questions have been raised, Of course, parents are particularly specifically, about the possible effect concerned about anything that may of heavy marijuana use on IQ. A increase the likelihood of long term recent study of 2600 young people, impairment. however, found that when taking into account socioeconomic factors Any intoxicating substance such as environment, poverty, poor (including alcohol) ingested by nutrition, parenting style, mental young (as well as older) users health, and alcohol use, most can temporarily alter normal brain deleterious effects disappear.43 functioning. Since much of the research suggests that it is heavy/ daily marijuana use among very young teenagers that is most problematic, there is unanimous agreement that, as with alcohol, DELAYING use until adulthood is imperative.

16 Safety First: A Reality-Based Approach to Teens and Drugs On either side of the marijuana legalization debate, there is consensus that protecting youth is a top priority. That’s why each of these laws clearly specifies that legalization applies to adults only, and contain built-in safeguards that restrict sales to minors.

Legalization In addition, over half of the states With 62 percent of Americans now in the U.S. have decriminalized in favor of marijuana legalization, the possession of small amounts and/ end of marijuana prohibition seems or legalized marijuana for medical very likely to proceed.45 purposes. These laws apply to people over the age of 21, with very Colorado and Washington were limited exceptions for young people the first states to pass legalization with a clear medical need.46 initiatives in 2012. Since then, several additional jurisdictions have legalized On either side of the debate, there is marijuana for adult use through ballot consensus that protecting youth is a initiatives or through the legislature. top priority. That’s why each of these They include Alaska, California, laws clearly specifies that legalization Maine, Massachusetts, Michigan, applies to adults only and contains Nevada, Oregon, Vermont and built-in safeguards that restrict sales Washington D.C. to minors.

www.drugpolicy.org 17 No change in teen use after marijuana legalization Share of high school students using marijuana in the past 30 days in the first four states which have legalized marijuana for adult use.

30%

25% Washington

Alaska Colorado 20% Oregon

15%

10%

5%

0% -3 -2 -1 0 1 2 3 4 5 Years before Marijuana Years after legalization legalized legalization

Although over half (56 percent) For example, data from the 2017 of teens say they would not try Healthy Kids Colorado Survey, marijuana, even if it were legal released by the Colorado Department for adults, some analysts have of Public Health and Environment speculated that use would increase (CDPHE), found that high school post legalization.47 marijuana use in the past month decreased between 2011 and 2017.49 Recently, numerous researchers have looked at teen marijuana use in Similarly, marijuana use among 11th states that have legalized marijuana graders in Oregon (which legalized for adult use. Their findings clearly marijuana in 2014) fell from 2012 to indicate that marijuana legalization 2017. 50 And the Washington State has not led to any increase in teen Healthy Survey results from 2000 to marijuana use, and in some cases, 2016 show that marijuana use in the use has actually decreased.48 past month by 10th and 12th graders remained largely unchanged for several years, with legalization having little or no impact on rates of youth marijuana use.51

18 Safety First: A Reality-Based Approach to Teens and Drugs Just Say No or Say Nothing at All?

Most drug education programs are aimed solely at preventing Concernsdrug use. After instructions to abstain, the lesson ends. No information is provided about how to avoid problems Aboutor prevent abuse for those who do experiment. Abstinence is treated as the sole measure of success, and the only Overdoseacceptable teaching option.52 The abstinence-only mandate is well-intended, but this approach is clearly not enough. It is unrealistic to believe that at a time in their lives when they are most prone to risk-taking, teenagers – who almost by definition find it exciting to push the envelope – will completely refrain from trying alcohol, marijuana, and/or other drugs.53

The abstinence-only mandate puts adults in the unenviable position of having nothing to say to the young people we most need to reach – those who insist on saying “maybe,” or “sometimes” or even “yes” to drugs – and prevents us from having conversations about how to reduce risks and keep them safe.54

Teenagers will make their own choices about alcohol, marijuana, and other drugs, just as we did. Their mistakes, like ours, are sometimes foolish. If we really want to minimize drug abuse and drug problems among teenagers who do experiment, we need a fallback strategy that includes comprehensive education, and one that puts safety first.55

No drug, including marijuana, is completely safe, especially for teenagers. Yet the mischaracterization of drugs such as mari- juana, as discussed above, may be the Achilles’ heel of current drug prevention approaches because such messages too often contain exaggerations and misinformation that contradict young people’s own observations and experience. As a result, many teens have become cynical and lose confidence in what we, as teachers, parents and/or other caregivers, tell them.

www.drugpolicy.org Safety First: A Reality-Based Approach

Surveys tell us that despite our make responsible decisions – and the admonitions and advice to abstain, vast majority actually do. large numbers of teenagers will occasionally experiment with intox- According to the 2017 National Survey icating substances, and some will use on Drug Use and Health, although more regularly. This does not mean experimentation is widespread, more they are bad kids or we are neglectful than 92 percent of 12- to 17-year-olds parents. The reality is that drug use is choose to refrain from regular use.57 a part of teenage culture in America today. Most young people will come Effective drug education should out of this phase unharmed. be based on sound science and acknowledge even the seemingly most Keeping teenagers safe must be reckless and impulsive teenager’s our highest priority. To protect them, ability to understand, analyze, evaluate, a reality-based approach enables and take responsibility for their teenagers to make responsible actions.58 Drug education programs decisions by: also need to be culturally sensitive. • providing honest, science-based information; Rodney Skager, Professor Emeritus at • encouraging moderation if youthful the University of California at experimentation persists; Los Angeles, and author of Youth • promoting an understanding of the and Drugs: What We Need to legal and social consequences of Know, suggests that through family drug use; and experience, peer exposure and the • prioritizing safety through personal media, teenagers often know more responsibility and knowledge. about alcohol, marijuana, and other drugs than we assume. Therefore, Honest, Science-Based Education students should be included in the Young people are capable of rational development of drug education thinking. Although their decision- programs, and classes should utilize making skills will improve as they interaction and student participation mature, teenagers are learning rather than relying on rote lecturing. responsibility and do not want to If drug education is to be credible, destroy their lives or their health.56 In formal curricula should incorporate fact, students consistently request the the observations and experiences of “real” facts about drugs so they can young people themselves.59

20 Safety First: A Reality-Based Approach to Teens and Drugs Teens clamor for honest, compre- hensive drug education, and it is especially apparent when they leave home and go to college. According to Professor Craig Reinarman at the University of California at Santa Cruz:

Students seem to hunger for information about licit and illicit drugs that doesn’t strike them as moralistic propaganda. I’ve taught a large lecture course called “Drugs and Society” for over twenty years and each year I have to turn away dozens of students because the class fills up so quickly.

I always start by asking them, “How many of you had drug education in high school?” and nearly all of them raise their hands. Then I ask, “How many of you felt it was truthful and valuable?” Out of 120 students, perhaps three hands go up.60

The Importance of Moderation They should know how to recognize The vast majority of teenage irresponsible behavior when it comes drug use (with the exception of to place, time, dose levels and cigarette smoking) does not lead to frequency of use. If young people dependence or abusive habits.61 continue, despite our admonitions, to use alcohol and/or marijuana, they Teens who do use alcohol, marijuana must control their use by practicing and/or other drugs must understand moderation and limiting use.63 there is a huge difference between use and abuse, and between occasional and daily use.62

www.drugpolicy.org 21 Drug use can negatively affect With increasing methods of detection academic and work performance, such as school-based drug testing, making it much more difficult to do drug-sniffing dogs, and zero- well in school or meet one’s other tolerance policies, penalties for responsibilities. violating the rules present risks that often extend well beyond the health It is never appropriate, and can be risks of drug use itself: expulsion from very dangerous, to be intoxicated school, a criminal record, and social at school, work, while participating stigma – all of which make it harder in sports, while driving, or while to find employment in the future. engaging in any serious activity. Zero-tolerance policies have come Understanding Consequences under serious criticism. The American Teens must understand the Psychological Association concluded consequences of violating school in 2008 that such policies “run rules and local, state and federal counter to our best knowledge laws against the use, possession and of child development” and have sale of alcohol, marijuana, and other created “unintended consequences drugs – whether or not they agree for students, families, and with such policies. communities.”64

They need to know that if they are Such policies have contributed caught in possession of alcohol, strongly to the “school to prison marijuana, or other drugs, they will pipeline,” whereby young people, find themselves at the mercy of the often minority youth, are expelled juvenile and criminal justice systems, from school, are unable which can be very harsh on young to find employment, and land in offenders. prison as adults.65

When teenagers turn eighteen, they In an effort to curb this downward are prosecuted as adults and run spiral, support is now growing for the risk of being incarcerated for “restorative practices” that attempt to months, even years, for nothing more bring students closer to their than being caught in possession of a communities and schools rather than controlled substance. suspending and expelling those who are troublesome or truant.66

22 Safety First: A Reality-Based Approach to Teens and Drugs Put Safety First

Safe Sex as a Model A useful model for A useful model for envisioning safety- oriented drug abuse prevention is envisioning the modern, comprehensive sex education approach. safety-oriented drug abuse In the mid-1980s, it became clear that the use of condoms could prevent prevention is the spread of HIV and other sexually transmitted diseases, as well as teen the modern, pregnancies. At this time, safety- comprehensive oriented parents, teachers and policy makers took action by introducing sex education reality-based sex education curricula throughout the country. This approach. approach combined encouraging abstinence with providing the facts and accurate “safe sex” information.

According to the Centers for Disease Control and Prevention, this approach has resulted not only in the greater use of condoms by sexually active teenagers, but has served to decrease overall rates of sexual activity and teen pregnancy.67

This effective, comprehensive, reality-based prevention strategy can provide a model for restructuring our drug education and prevention efforts that will result in healthier teens.

www.drugpolicy.org 23 Alcohol as a “Safety” Case in Point What worries me is the impact of Alcohol is a useful example of the these ordinances on young people. need for safety messages because Will teens stop drinking as a response alcohol-related motor vehicle to crackdowns? Probably not. Too accidents continue to be the number many say they will just move the party one cause of untimely death among to the street, the local park, the beach young people.68 or some other place where adults are not present. And they’ll drive to In suburban communities, where so get there. many young people drive, the teenage practice of having a These are hot-button issues to be “designated driver” has become sure, with reasonable and well- commonplace. In such communities, meaning people coming down on all many parents, while encouraging sides of the debate. their teens to abstain, have assessed reality and reluctantly provided their Drug-free gatherings should, of homes as safe, non-driving spaces course, be promoted in every way to gather for parties. possible. Parents should devise strategies for minimizing the harm Some see these practices, as well that can result from the use of as designated driver practices, as alcohol. But to involve the criminal “enabling.” They hope to stop alcohol justice system in parental decisions use completely by passing laws that is not the answer, and will certainly make it a crime to be a teenaged reduce, not improve, teen safety. designated driver, as well as “social host” ordinances. These impose civil or criminal penalties that include arrest and subsequent trial of parents whose homes are used for parties – with or without their knowledge and/or consent.

24 Safety First: A Reality-Based Approach to Teens and Drugs A Model for Drug Education

Safety First: Real Drug Education The curriculum covers: Concernsfor Teens was created by the Drug • An initial examination of Policy Alliance (drugpolicy.org) students’ beliefs about alcohol Aboutto provide high school students and other drugs; with honest, scientifically accurate • A lesson about how drugs affect information, empowering them, if the brain and body, especially theyOverdose choose to experiment with the teenage brain, and factors alcohol or other drugs, to reduce that contribute to physical potential harms. dependence; • Harm reduction concepts and This harm reduction-oriented strategies that can empower curriculum is the first of its kind. students to make healthy It was developed with education choices, using accurate, professionals and aligns with scientifically-based information; National Health Education • Substantive lessons about Standards (NHES). What makes the major categories of drugs Safety First unique is that it can available to teens: stimulants, be taught by high school teachers marijuana, e-cigarettes/vaping, and incorporated into health alcohol and other depressants, education classes. psychedelics, prescription and other opioids; Safety First: Real Drug Education • How to recognize problem use, for Teens helps students use signs of an overdose, and how to critical thinking skills to access respond in an emergency; and evaluate information about • The ways in which drug use can alcohol and other drugs; learn be a mechanism for dealing with decision-making and goal-setting mental health issues, especially skills that can help them make stress, and how to locate healthy choices about substance resources that can help students use, including abstinence; and cope; develop personal and social • How zero tolerance and other strategies to manage the risks, penalties for drug use can benefits, and potential harms of impact students’ lives, families, alcohol and other drug use. and communities.

For more information about Safety First: Real Drug Education for Teens, see drugpolicy.org/safetyfirst. www.drugpolicy.org What’s a Parent to Do?

Today’s parents get more detailed Our greatest challenge is to listen and advice about how to raise their chil- try to help without excessive admon- dren than any generation in history. ishment. If we become indignant and Yet they’re open and listening be- punitive, teenagers will stop talking to cause they’re concerned about their us. It’s that simple. teens’ safety and well-being, and worried that the world has become a Remember that advice is most likely much more dangerous place. They to be heard when it is requested. want to know what to do and are look- Realize that teens bring their own ex- ing for solutions. periences to the table, some of which you may not want to hear. There are no easy answers, but for But breathe deeply and be grateful parents who have requested specif- when they share these experiences ics, here are the steps I suggest: because this means you have estab- lished trust. Step 1: Listen The first step is to “get real” about Step 2: Learn drug use by listening to what teens Parents and teachers need to take have to tell us about their lives and responsibility for learning about the their feelings. This will guide us physiological, psychological and toward intelligent, thoughtful action. sociological effects of alcohol and other drugs. This involves reading A useful venue is the dinner table. and asking questions. As much as possible, families should eat together once a day so they Familiarize yourself with teenage can “catch up,” talk and otherwise culture through print and electronic connect.69 media, especially the Internet. Learn what your teens like to watch and There are many other natural open- watch it yourself. Learn about the ings for conversation, such as drug array of drugs available to young use in movies, television and music. people, but be sure your sources If we can remain as non-judgmental are scientifically grounded and bal- as possible, teenagers will seek our anced. Any source that fails to de- opinions and guidance. Let them scribe both risks and benefits should know they can talk freely. be considered suspect.

26 Safety First: A Reality-Based Approach to Teens and Drugs The Drug Policy Alliance website Several other websites provide useful contains balanced, evidence-based information. Erowid (erowid.org) is information, with facts about the one of the oldest and most compre- effects of today’s most popular drugs, hensive drug information databases at: drugpolicy.org/drug-facts. on the web. The Multidisciplinary Association for Psychedelic Studies For an all-around resource that (MAPS) provides substantial covers nearly every popular drug, research and general information you and your teen should read the about psychedelic substances on classic, From Chocolate to Morphine: their website (maps.org). Dancesafe Everything You Need to Know about (dancesafe.org) is an organization Mind-Altering Drugs, by renowned dedicated to harm reduction in the health expert, Andrew Weil, MD, and party setting. Finally, Students for former high school teacher, Winifred Sensible Drug Policy (SSDP) provides Rosen (Boston: Houghton-Mifflin, useful resources for peer drug 2004). education (ssdp.org/justsayknow).

www.drugpolicy.org 27 What’s a Parent to Do? (cont.)

Step 3: Act should advocate for such programs Drug education is more than a in their community and teens’ school. curriculum or “magic bullet,” so make some plans. Prevention is fundamentally about caring, connected relationships and It is important to keep teens engaged an open exchange of information. and busy, not just during the school There are no simple, ready-made an- day, but from 3 to 6 p.m., when the swers, just thoughtful conversations. use of drugs by unsupervised teens is highest. Teens whose time is When it comes to opening the occupied are not only less likely to ongoing “drug talk,” some parents use marijuana and/or other drugs, but don’t know where to begin. Many also less likely to get into trouble with have started with my “Dear Johnny” drugs. Extracurricular programs letter, still useful today, or other such as sports, arts, drama and other resources listed above. Teens creative activities should be available often respond better to these “just to all secondary school students, at say know” approaches than to the low or no cost to parents. Parents one-sided messages they’ve been hearing all their lives.

28 Safety First: A Reality-Based Approach to Teens and Drugs Many parents today have direct Trusting relationships are key in experience with marijuana and other preventing and countering drug use. drugs, especially since marijuana While it is tempting to cut through is now legal in so many states. The difficult conversations and utilize question, “What should I tell my child detection technologies such as about my own past (or present) drug urine testing, think hard before you use?” comes up in each and every demand that your child submit to a workshop I facilitate – from California drug test. Random, suspicionless to Connecticut. Many parents are school-based drug testing – which uneasy about revealing their own is opposed by the California State experience, fearing such admissions Parent Teacher Association (PTA), might open the door to their own has been shown to be ineffective and teen’s experimentation. often counterproductive.

There is no one simple resolution to Regarding in-home test kits, this difficult dilemma. While you do researchers at Children’s Hospital not need to rehash every detail, it in Boston, who studied home can be very helpful to share your own drug testing products, warn that experiences with your teen because it most people are not appropriately makes you a more credible confidant. educated about the limitations and technical challenges of drug tests Honesty is usually the best policy in (including collection procedures, the long run. Just as parents often the potential for misinterpretation know or eventually find out when their and false positive/negative results). child is lying, teenagers have a knack They also note unanticipated for seeing through adults’ evasions, consequences and the negative half-truths and hypocrisy. Besides, effect on parent-child relationships of if you don’t tell, you can rest assured collecting a urine sample to ascertain that eventually one of your siblings or drug use.70 close friends will delight in recounting your “youthful indiscretions” to your The reality is that a trusting, open eager child. relationship with a parent or other respected adult can be the most powerful element in deterring abusive patterns. And trust, once lost, can be hard to regain.

www.drugpolicy.org 29 What’s a Parent to Do? (cont.)

Perhaps most important, teenagers For instance, a person who has need to know that the important consumed too much alcohol, and adults in their lives are concerned is passed out, should not lay on primarily with their safety, and their back because of the risk they that they have someone to turn to may choke on their own vomit and when they need help. If they find asphyxiate. themselves in a compromising or uncomfortable situation, they need The overconsumption of marijuana, to know we will come to their aid usually in the form of edibles, though immediately. not fatal, can be frightening. As many Emergency Room physicians have It is important for parents to get to learned, the best treatment is “chilling know other parents and work together out” in a quiet room, drinking water, to promote safety-oriented strategies. and waiting until the effects wear off. The emphasis on safety does not mean we are giving teens permission Although opioid use is rare among to use drugs. It simply affirms that teens, parents should know what to their welfare is our top priority. do in case of accidental overdose, including the administration of the Finally, trust aside, for those parents opioid-reversing drug, naloxone. who use alcohol, marijuana, pharma- ceuticals or any other psychoactive For more information, see drug, I strongly recommend storing drugpolicy.org/help-save-a-life. your drugs away from your teenager, even if it means under lock and key. In any acute situation, if you or your teen fear something is seriously Step 4: Help wrong – such as when a person It is important to know what to do if is unconscious, having trouble you or your child believe a teenager breathing, or is generally non- (or anyone else) is having a negative responsive, do not hesitate to phone reaction to alcohol or other drugs. 911 immediately. The lives of many Although most parents would rather young people could have been saved not think about these worst case if paramedics had been called – or scenarios, understanding overdose called sooner. prevention and response is essential.

30 Safety First: A Reality-Based Approach to Teens and Drugs Don’t take a chance. If you share Be especially leery of boot camp- nothing else you have read here, style programs that can do more please convey this information to your harm than good, such as those own teen, who may one day need to studied by journalist Maia Szalavitz in assist a friend. And please reassure her book, Help At Any Cost: How the them they won’t be punished by their Troubled-Teen Industry Cons Parents parents for asking for help! and Hurts Kids.72

Many parents want to know how to Ultimately, the healthiest kids, identify problem use, what to do whether or not they experiment with about it and when to seek profes- drugs, have parents who are present, sional help. loving and involved. Carla Niño, past president of the California State PTA I highly recommend the work of (the largest state PTA in the U.S., psychologist Stanton Peele, PhD, who with 700,000 members), gives the lays out criteria for deciding whether following advice: your child needs treatment, treatment options, and your role as a parent, in “Trust your instincts, which are to love his book, Addiction Proof Your Child. your kids enough to give them the For parents concerned that their teen space to explore and grow, to forgive may have a marijuana problem, I also their mistakes and to accept them recommend Dr. Timmen Cermak’s for who they are. Kids go through book, Marijuana: What’s a Parent tough times, sometimes seemingly to Believe? 71 prolonged. Those who make it do so because they’re embraced and loved Keep in mind there is no “one size fits by their families.” all” method for dealing with troubled teens who have alcohol and/or other drug problems. Many of today’s well-meaning programs are still unevaluated, inflexible, and based on a “disease model” that equates all drug use, even the most occasional, with addiction.

www.drugpolicy.org 31 Epilogue

Shortly before graduating from college in 2006, Dr. Rosenbaum’s son, Johnny, read the following letter at an event honoring his mother.

November 15, 2006

Dear Mom,

It has been eight years since I entered high school on the heels of your advice about drugs: “Johnny – be skeptical and, most of all, be safe.” Although I’d like to tell you that I never needed your advice because I never encountered drugs, I’d prefer to be as honest with you as you have been with me.

Just as you predicted, I spent high school and college navigating a highly experimental teenage drug culture. While some of the substances that I encountered were illegal, like marijuana, cocaine, and Ecstasy, many were not, like alcohol, cigarettes, and Ritalin. Because you explained that a drug’s legality does not mean that it is better or worse for me, I approached every substance with skepticism and common sense.

Our household mantra of “safety first” guided me through a maze of difficult decisions, particularly in college where alcohol use and abuse is widespread. Because you didn’t lie or exaggerate the risks of drug use, I took your warnings seriously. I always made plans for sober transportation; I refused to leave friends alone if they were highly intoxicated; and I was never afraid to call home if I found myself in a dangerous situation.

Of course you advised me not to use drugs, but as an expert in the field, you knew that I was likely to experiment. Most parents panic in response to this likelihood, but you and Dad remained levelheaded: You didn’t impose rigid rules that were bound to be broken, and you didn’t bombard me with transparent scare tactics. Instead you encouraged me to think critically and carefully about drug use. When I inquired, you armed me

32 Safety First: A Reality-Based Approach to Teens and Drugs with truthful, scientifically based information from which I could make my own decisions. This was excellent practice for adulthood, and we built a loving relationship based on trust and truth.

Mom, your work does so much more than teach parents how to talk to their kids about drugs; your work keeps parents and kids communicating at a time when most kids shut their parents out. Our relationship is a perfect example. For never ceasing to communicate with me, even when I tried to shut the door on you, and for tirelessly keeping me, my sisters, and so many other kids safe, thank you.

Love, Johnny

This letter is available online at: http://www.alternet.org/story/46618/ Published on January 13, 2007

© 2007 Independent Media Institute. All rights reserved.

www.drugpolicy.org 33 Resources and Endnotes

1 White House Office of National Drug Control Abuse and Mental Health Services Policy, “National Drug Control Budget: Administration, 2018), Table 1.1A, https://www. FY2018 Funding Highlights,” (Washington, samhsa.gov/data/report/2017-nsduh-detailed- DC: Office of National Drug Control Policy, tables. 2017), 16, https://www.whitehouse.gov/sites/ 10 Brad Knickerbocker, “Using Drugs to Rein in whitehouse.gov/files/ondcp/Fact_Sheets/ Boys,” The Christian Science Monitor, May 19, FY2018-Budget-Highlights.pdf. 1999, http://www.csmonitor.com/1999/0519/ 2 Marsha Rosenbaum, “A Mother’s Advice,” p1s2.html. San Francisco Chronicle, September 7, 11 National Institute on Drug Abuse, “Monitoring 1998, http://www.sfgate.com/default/ the Future Study: Trends in Prevalence of article/A-Mother-s-Advice-About- Various Drugs,” https://www.drugabuse.gov/ Drugs-2991952.php. trends-statistics/monitoring-future/monitoring- 3 National Institute on Drug Abuse, “Monitor- future-study-trends-in-prevalence-various- ing the Future Study: Trends in Prevalence drugs. of Various Drugs,” https://www.drugabuse. 12 Peter D. Hart Associates, The State of Our gov/trends-statistics/monitoring-future/mon- Nation’s Youth: 2008-2009 (Alexandria, VA: itoring-future-study-trends-in-prevalence- Horatio Alger Association of Distinguished various-drugs Americans, 2008); for an excellent discussion 4 Lloyd D. Johnston et al., Monitoring of the role of drugs in American culture, see the Future National Survey Results on Craig Reinarman and Harry G. Levine, “The Drug Use: 1975-2017: Overview, Key Cultural Contradictions of Punitive Prohibition” Findings on Adolescent Drug Use. (Ann in Crack in America: Demon Drugs and Social Arbor: Institute for Social Research, The Justice, eds. Craig Reinarman and Harry University of Michigan, 2018), http://www. G. Levine (Berkeley: University of California monitoringthefuture.org/pubs/monographs/ Press, 1997): 334-44. mtf-overview2017.pdf. 13 Michael D. Newcomb and Peter M. Bentler, 5 Centers for Disease Control and Prevention, Consequences of Adolescent Drug Use: “Youth Risk Behavior Surveillance – United Impact on the Lives of Young Adults (Newbury States, 2017,” (Washington, DC: Center for Park, CA: Sage, 1988); Jonathan Shedler Disease Control and Prevention, 2018), 44, and Jack Block, “Adolescent Drug Use https://www.cdc.gov/healthyyouth/data/ and Psychological Health: A Longitudinal yrbs/pdf/2017/ss6708.pdf. Inquiry,” American Psychologist 45, no. 5 6 Centers for Disease Control and Prevention, (1990): 612-30; Robin Room, “Preventing National Center for Health Statistics, Youthful Substance Use and Harm – Between “Therapeutic Use,” https://www.cdc.gov/ Effectiveness and Political Wishfulness,” nchs/fastats/drug-use-therapeutic.htm. Substance Use & Misuse 47, no. 8-9 (2012): 7 Centers for Disease Control and Prevention, 936-43; Kenneth W. Griffin and Gilbert J. “Antidepressant Use Among Persons Aged Botvin, “Evidence-Based Interventions 12 and Over: United States, 2011-2014,” for Preventing Substance Use Disorders NCHS Data Brief, No. 283, August 2017, in Adolescents,” Child and Adolescent https://www.cdc.gov/nchs/data/databriefs/ Psychiatric Clinics of North America 19, no. 3 db283.pdf. (2010). 8 Substance Abuse and Mental Health 14 Revathy Kumar et al., “Alcohol, Tobacco, and Services Administration, The NSDUH Other Drug Use Prevention Programs in U.S. Report: Substance Use and Mental Health Schools: A Descriptive Summary,” Prevention Estimates from the 2017 National Survey on Science 14, no. 6 (2013): 581-92. Drug Use and Health: Overview of Findings 15 Robin Room, “Preventing Youthful Substance (Rockville, MD: Substance Abuse and Use and Harm – Between Effectiveness Mental Health Services Administration, and Political Wishfulness,” Substance 2018), Table 2.6B, https://www.samhsa.gov/ Use & Misuse 47, no. 8-9 (2012); Joel H. data/report/2017-nsduh-detailed-tables. Brown and Amy M. Clarey, “The Social 9 Substance Abuse and Mental Health Psychology of Disintegrative Shaming in Services Administration, Results from the Education,” Journal of Drug Education 42, 2017 National Survey on Drug Use and no. 2 (2012); Julian Cohen, “Drug Education Health: Summary of National Findings and or Drug Propaganda?” in Harm Reduction in Detailed Tables (Rockville, MD: Substance Substance Use and High-Risk Behaviour, eds.

34 Safety First: A Reality-Based Approach to Teens and Drugs Richard Pates and Diane Riley (West Misunderstanding or Exercise in Ambiguity,” Sussex, UK: Wiley-Blackwell, 2012), 17-29. Bulletin of the New York Academy of 16 Thomas Nicholson et al., “Focusing on Medicine 50, no. 1 (1974): 55–75; National Abuse, not Use, in Drug Education,” Research Council of the National Academy of Journal of Substance Use 18, no. 6 (2013); Sciences, “An Analysis of Marijuana Policy”, Julian Cohen, “Drug Education or Drug (Washington DC: National Academy Press, Propaganda?” in Harm Reduction in 1982), http://www.nap.edu/ openbook. Substance Use and High- Risk Behaviour, php?record_id=662; and Janet Elizabeth eds. Richard Pates and Diane Riley (West Joy, John A. Benson, and Stanley J. Watson, Sussex, UK: Wiley-Blackwell, 2012), 17-29. eds. Marijuana and Medicine: Assessing the 17 Robin Room, “Preventing Youthful Science Base (Washington, DC: National Substance Use and Harm – Between Academies Press, 1999), http:// www.nap. Effectiveness and Political Wishfulness,” edu/catalog.php?record_id=6376 (hereafter Substance Use & Misuse 47, no. 8-9 (2012): cited as Joy, Benson, and Watson.) 936-43. 21 Maggie Fox, “U.S. Marijuana Even Stronger 18 United States General Accounting Office, than Before: Report,” Reuters, April 25, Report to the Chairman, Subcommittee on 2007; Katherine Seligman, “Connoisseurs of Children, Family, Drugs, and Alcoholism, Cannabis,” San Francisco Chronicle, April 22, Committee on Labor and Human Resources, 20 07. U.S. Senate: Drug Use Among Youth; 22 Dan Werb et al., “The Temporal Relationship No Simple Answers to Guide Prevention Between Drug Supply Indicators: An Audit (Washington, DC: U.S. Government of International Government Surveillance Printing Office, 1993), http://archive.gao. Systems,” BMJ Open 3, no. 9 (2013). gov/ t2pbat4/150661.pdf, (hereafter cited 23 Fidelia Cascini et al., “Increasing Delta-9- as Drug Use Among Youth); and David F. Tetrahydrocannabinol (Δ-9-THC) Content Duncan, “Problems Associated with Three in Herbal Cannabis Over Time: Systematic Commonly Used Drugs: A Survey of Rural Review and Meta-Analysis,” Current Drug Secondary School Students,” Psychology of Abuse Reviews 5 (2012): 32-40; U.S. Addictive Behaviors 5, no. 2 (1991): 93-6. Department of Justice, Drug Enforcement 19 Robin Room, “Preventing Youthful Administration, 2013 National Drug Threat Substance Use and Harm – Between Assessment Summary (Washington, DC: Drug Effectiveness and Political Wishfulness,” Enforcement Administration, 2013), http:// Substance Use & Misuse 47, no. 8-9 (2012): www.justice.gov/dea/resource-center/DIR- 936-43; Julian Cohen, “Drug Education or 017-13%20NDTA%20Summary%20final.pdf. Drug Propaganda?” in Harm Reduction in 24 James Richard Burgdorf et al., “Heterogeneity Substance Use and High-Risk Behaviour, in the Composition of Marijuana Seized in eds. Richard Pates and Diane Riley (West California,” Drug and Alcohol Dependence Sussex, UK: Wiley-Blackwell, 2012), 17-29; 117, no. 1 (2011); Jennifer McLaren et al., and Thomas Nicholson et al., “Focusing on “Cannabis Potency and Contamination: A Abuse, not Use, in Drug Education,” Journal Review of the Literature,” Addiction 103, of Substance Use 18, no. 6 (2013). no. 7 (2008); Eric L. Sevigny, “Is Today’s 20 Lynn Zimmer and John P. Morgan, Marijuana More Potent Simply Because It’s Marijuana Myths, Marijuana Facts: A Review Fresher?” Drug Testing and Analysis 5, no. 1 of the Scientific Evidence (New York: The (2013): 62-67; Dan Werb et al., “The Temporal Lindesmith Center, 1997); Mitch Earleywine, Relationship Between Drug Supply Indicators: Understanding Marijuana: A New Look at An Audit of International Government the Scientific Evidence (New York: Oxford Surveillance Systems,” BMJ Open 3, no. 9 University Press, 2005); Fiorello La Guardia, (2013). “The Marihuana Problem in the City of New 25 Mitch Earleywine, Understanding Marijuana: York,” (New York: Mayor’s Committee on A New Look at the Scientific Evidence (New Marihuana, New York Academy of Medicine, York: Oxford University Press, 2005). 1944), http://hempshare.org/wp-content/ 26 Peggy van der Pol et al., “Cross-sectional uploads/2012/12/laguardia.pdf; Gabriel and Prospective Relation of Cannabis G. Nahas and Albert Greenwood, “The Potency, Dosing and Smoking Behaviour with First Report of the National Commission on Cannabis Dependence: An Ecological Study,” Marihuana (1972): Signal of Addiction 109, no. 7 (2014): 1101-09;

www.drugpolicy.org 35 Resources and Endnotes (cont.)

Tom P. Freeman et al., “Just Say ‘Know’: Health: Summary of National Findings How Do Cannabinoid Concentrations (Rockville, MD: Substance Abuse and Influence Users’ Estimates of Cannabis Mental Health Services Administration, Potency and the Amount They Roll in 2013), 28-29, http://www.samhsa.gov/data/ Joints?” Addiction 109, no. 10 (2014): NSDUH/2012SummNatFindDetTables/Index. 1686-94; Dirk J. Korf et al., “Differential aspx. Responses to Cannabis Potency: A 33 J.E. Joy, J.A. Benson, and S.J. Watson, Typology of Users Based on Self-reported “Marijuana and medicine: assessing the Consumption Behaviour,” International science base: a summary of the 1999 Institute Journal of Drug Policy 18, no. 3 (2007); of Medicine Report,” Arch Gen Psychiatry, 57, Peggy van der Pol et al., “Validation of 6, (June 2000) 547-52. Self-reported Cannabis Dose and Potency: 34 Karen Van Gundy and Cesar J. Rebellon, An Ecological Study,” Addiction 108, no. “A Life-course Perspective on the ‘Gateway 10 (2013): 1801-08; Ronald I. Herning et Hypothesis’,” Journal of Health & Social al., “Tetrahydrocannabinol Content and Behavior 51, no. 3 (2010): 244–59; Joy, Differences in Marijuana Smoking Behavior,” Benson and Watson; Andrew Golub and Psychopharmacology 90, no. 2 (1986): 160- Bruce D. Johnson, “Variation in Youthful 2; Donald I. Abrams et al., “Vaporization as Risks of Progression from Alcohol/ Tobacco a Smokeless Cannabis Delivery System: to Marijuana and to Hard Drugs Across A Pilot Study,” Clinical Pharmacology & Generations,” American Journal of Public Therapeutics 82, no. 5 (2007): 572-8. Health 91, no. 2 (2001): 225-32; Michael 27 Lynn Zimmer and John P. Morgan, M. Vanyukov et al., “Common Liability Marijuana Myths, Marijuana Facts: A Review to Addiction and ‘Gateway Hypothesis’: of the Scientific Evidence (New York: The Theoretical, Empirical and Evolutionary Lindesmith Center, 1997), 84. Perspective,” Drug and Alcohol Dependence 28 J.V. Anthony, L.A. Warner, R.C. Kessler, 123, Supplement 1 (2012): S3-S17; H “Comparative epidemiology of dependence Harrington Cleveland and Richard P. Wiebe, on tobacco, alcohol, controlled substances “Understanding the Association Between and inhalants: Basic findings from the Adolescent Marijuana Use and Later Serious National Comorbidity Survey,” Experimental Drug Use: Gateway Effect or Developmental and Clinical Psychopharmacology, 2, (1994), Trajectory?” Development & Psychopathology 244–268. 20, no. 2 (2008); Mildred M. Maldonado- 29 Frank M. Tims et al., “Characteristics and Molina and Stephanie T. Lanza, “A Framework Problems of 600 Adolescent Cannabis to Examine Gateway Relations in Drug Use: Abusers in Outpatient Treatment,” Addiction An Application of Latent Transition Analysis,” 97, no. 1 (2002): 46-57. Journal of Drug Issues 40, no. 4 (2010); 30 Substance Abuse and Mental Health Andrew R. Morral et al., “Reassessing the Services Administration, Center for Marijuana Gateway Effect,” Addiction 97, no. Behavioral Health Statistics and Quality, 12 (2002). “Treatment Episode Data Set (TEDS): 2005- 35 Advisory Council on the Misuse of Drugs, 2015. National Admissions to Substance The Classification of Cannabis Under the Abuse Treatment Services,” BHSIS Series Misuse of Drugs Act 1971 (London: Home S-91, HHS Publication No. (SMA) 17-5037, Office Government Printing Office, 2002); Rockville, MD: Substance Abuse and Substance Abuse and Mental Health Services Mental Health Services Administration, Administration, Results from the 2012 2017. National Survey on Drug Use and Health: 31 Denise B. Kandel, “Stages in Adolescent Summary of National Findings (Rockville, MD: Involvement in Drug Use,” Science 190, no. Substance Abuse and Mental Health Services 4217 (1975): 912-4; Steve G. Gabany and Administration, 2013), 28-29; United Nations Portia Plummer, “The Marijuana Perception Office on Drugs and Crime, World Drug Inventory: The Effects of Substance Abuse Report 2014 (New York: United Nations, 2014). Instruction,” Journal of Drug Education 20, 36 Substance Abuse and Mental Health Services no. 3 (1990): 235-45. Administration, U.S. Department of Health 32 Substance Abuse and Mental Health and Human Services, “Reports and Detailed Services Administration, Results from the Tables From the 2017 National Survey on 2017 National Survey on Drug Use and Drug Use and Health (NSDUH),” Tables 1.1A

36 Safety First: A Reality-Based Approach to Teens and Drugs and 1.1B, https://www.samhsa.gov/data/ Head and Neck Squamous Cell Carcinoma,” nsduh/reports-detailed-tables-2017- Cancer Prevention Research 2, no. 8 (2009). NSDUH. Mia Hashibe et al., “Marijuana Use and the 37 Ralph E. Tarter et al., “Predictors of Risk of Lung and Upper Aerodigestive Tract Marijuana Use in Adolescents Before and Cancers: Results of a Population-Based After Licit Drug Use: Examination of the Case-Control Study,” Cancer Epidemiology Gateway Hypothesis,” The American Journal Biomarkers & Prevention 15, no. 10 (2006): of Psychiatry 163, no. 12 (2006): 2134-40; 1829-34; Karin A. Rosenblatt et al., Lloyd D. Johnston et al., Monitoring the “Marijuana Use and Risk of Oral Squamous Future National Survey Results on Drug Use: Cell Carcinoma,” Cancer Research 64, no. 1975- 2013: Volume I, Secondary School 11 (2004): 4049-54; Carrie D. Llewellyn et al., Students (Ann Arbor: Institute for Social “An Analysis of Risk Factors for Oral Cancer Research, The University of Michigan, in Young People: A Case-Control Study,” Oral 2014); Substance Abuse and Mental Health Oncology 40, no. 3 (2004): 304-13. Services Administration, Results from the 40 Li Rita Zhang et al., “Cannabis Smoking 2017 National Survey on Drug Use and and Lung Cancer Risk: Pooled Analysis in Health (Rockville, MD: Substance Abuse the International Lung Cancer Consortium,” and Mental Health Services Administration, International Journal of Cancer doi:10.1002/ 2018); Robin Room et al., Cannabis Policy: ijc.29036 (2014). Moving Beyond Stalemate (New York: 41 Donald P. Tashkin, “Effects of Marijuana Oxford University Press, 2010). Smoking on the Lung,” Annals of the 38 Denise B. Kandel and Kazuo Yamaguchi, American Thoracic Society 10, no. 3 (2013): “Patterns of Drug Use from Adolescence 239-247; Mark J. Pletcher et al., “Association to Young Adulthood: III. Predictors of Between Marijuana Exposure and Pulmonary Progression,” American Journal of Public Function over 20 Years,” JAMA 307, no. 2 Health 74, no. 7 (1984): 673-81; Jerald (2012); Sarah Aldington et al., “Effects of G. Bachman et al., Changes in Drug Cannabis on Pulmonary Structure, Function Use During the Post-High School Years; and Symptoms,” Thorax 62, no. 12 (2007); Monitoring the Future Occasional Paper No. Mark A. Ware, “Cannabis and the Lung: No 35 (Ann Arbor: Institute for Social Research, More Smoking Gun?,” Annals of the American The University of Michigan, 1992); Joy, Thoracic Society 10, no. 3 (2013). Benson, and Watson. 42 Timmen Cermak and Peter Banys, “Youth 39 Stephen Sidney et al., “Marijuana Use and First: Reconstructing Drug Policy, Regulating Cancer Incidence,” Cancer Causes and Marijuana, and Increasing Access to Control 8, no. 5 (1997): 722-8; Daniel E. Treatment in California: A Report to the Ford et al., “Marijuana Use is not Associated California Society of Addiction Medicine,” with Head, Neck or Lung Cancer in Adults (California Society of Addiction Medicine, Younger Than 55 Years: Results of a 2011), 10-12. Case Cohort Study,” in National Institute 43 Maia Szalavitz, “No, Weed Won’t Rot Your on Drug Abuse Workshop on Clinical Brain,” The Daily Beast, April 17, 2014, http:// Consequences of Marijuana (Rockville, www.thedailybeast.com/articles/2014/04/17/ MD: National Institute of Health, 2001), no-weed-won-t-rot-your-brain.html.; H http://archives.drugabuse.gov/meetings/ Harrington Cleveland and Richard P. Wiebe, marijuanaabstracts.html#Ford; Joy, “Understanding the Association Between Benson, and Watson; Mia Hashibe et al., Adolescent Marijuana Use and Later Serious “Epidemiologic Review of Marijuana Use Drug Use: Gateway Effect or Developmental and Cancer Risk,” Alcohol 35, no. 3 (2005): Trajectory?” Development & Psychopathology 265-75; Wayne Hall et al., “Cannabinoids 20, no. 2 (2008): 615-32; Joan L. Bottorff and Cancer: Causation, Remediation, and et al., “Relief-Oriented Use of Marijuana Palliation,” Lancet Oncology 6, no. 1 (2005): by Teens,” Substance Abuse Treatment, 35-42; Reena Mehra et al., “The Association Prevention, and Policy 4 (2009). Between Marijuana Smoking and Lung 44 J. Cobb Scott et al., “Cannabis use in youth Cancer: A Systematic Review,” Archives of is associated with limited alterations in brain Internal Medicine 166, no. 13 (2006): 1359- structure,” Neuropsychopharmacology, (19 67; Caihua Liang et al., “A Population-Based February 2019), https://www.nature.com/ Case-Control Study of Marijuana Use and articles/s41386-019-0347-2.

www.drugpolicy.org 37 Resources and Endnotes (cont.)

45 Hannah Hartig and Abigail Geiger, “About We Been and Where Should We Be Going?” six-in-ten Americans support marijuana Addiction 105, no. 10 (2010); Thomas Nicholson legalization,” Pew Research Center, October et al., “Focusing on Abuse, not Use, in Drug 8, 2018, http://www.pewresearch.org/ Education,” Journal of Substance Use 18, no. 6 fact-tank/2018/10/08/americans-support- (2013). marijuana-legalization/. 53 Drug Use Among Youth; and Robin Room, “Pre- 46 Marijuana Policy Project, “State Policy,”, venting Youthful Substance Use and Harm – Be- http://www.mpp.org/states/. tween Effectiveness and Political Wishfulness,” 47 Lloyd D. Johnston et al., Monitoring the Substance Use & Misuse 47, no. 8-9 (2012): Future National Survey Results on Drug Use: 936-43. For an excellent discussion of teenag- 1975-2013: Volume I, Secondary School ers and risk, see Lynn Ponton, The Romancing Students (Ann Arbor: Institute for Social Re- of Risk: Why Teenagers Do the Things They Do search, The University of Michigan, 2014), (New York: Basic Books, 1997) and Chwee Lye 400-01; Mark A. R. Kleiman et al., Drugs Chng, “The Goal of Abstinence: Implications for and Drug Policy: What Everyone Needs to Drug Education,” Journal of Drug Education 11, Know (New York: Oxford University Press, no. 1 (1981): 13-18. 2011); Sharon Levy, “Effects of Marijuana 54 Gilbert J. Botvin and K. Resnicow, “School- Policy on Children and Adolescents,” JAMA Based Prevention Programs: Why Do Effects Pediatrics 167, no. 7 (2013): 600-02; Joseph Decay?” Preventive Medicine 22, no. 4 (1993): J. Palamar et al., “Correlates of Intentions 484-90; Robin Room, “Preventing Youthful to Use Cannabis Among US High School Substance Use and Harm – Between Effective- Seniors in the Case of Cannabis Legaliza- ness and Political Wishfulness,” Substance tion,” International Journal of Drug Policy 25, Use & Misuse 47, no. 8-9 (2012): 936-43; Julian no. 3 (2014). Cohen, “Drug Education or Drug Propaganda?” 48 Ashley Brooks-Russell et al., “Adolescent in Harm Reduction in Substance Use and High- Marijuana Use, Marijuana-Related Risk Behaviour, eds. Richard Pates and Diane Perceptions, and Use of Other Substances Riley (West Sussex, UK: Wiley-Blackwell, 2012), Before and After Initiation of Retail Sales in 17-29. Colorado (2013-2015),” Prevention Science, 55 Thomas Nicholson et al., “Focusing on 20, 2, 185-193 (24 July 2018), https://doi. Abuse, not Use, in Drug Education,” Journal org/10.1007/s11121-018-0933-2; Scott B. of Substance Use 18, no. 6 (2013); Christiane Harpin et al, “Adolescent Marijuana Use and Poulin and Jocelyn Nicholson, “Should Harm Perceived Ease of Access Before and After Minimization As An Approach to Adolescent Recreational Marijuana Implementation in Substance Use Be Embraced by Junior and Colorado,” Substance Use & Misuse, 1-6, Senior High Schools? Empirical Evidence From (2017), http://dx.doi.org/10.1080/10826084. An Integrated School- and Community-Based 2017.1334069. Demonstration Intervention Addressing Drug 49 Colorado Department of Public Health & Use Among Adolescents,” International Journal Environment, “Data Brief, Colorado Youth of Drug Policy 16, no. 6 (2005); Robin Room, Marijuana Use 2017, Healthy Kids Colorado “Preventing Youthful Substance Use and Harm Survey,” https://drive.google.com/file/d/1M – Between Effectiveness and Political Wishful- 3XdmqznZDl2y6D7Hz6iDGwTFTHSGrtP/ ness,” Substance Use & Misuse 47, no. 8-9 view. (2012); Julian Cohen, “Drug Education or Drug 50 Oregon Health Authority, “Youth Propaganda?” in Harm Reduction in Substance marijuana use, attitudes and related Use and High-Risk Behaviour, eds. Richard behaviors in Oregon,” February 2018, Pates and Diane Riley (West Sussex, UK: Wiley- https://www.oregon.gov/oha/PH/ Blackwell, 2012), 17-29; Richard Midford et al., PREVENTIONWELLNESS/MARIJUANA/ “Drug Education in Victorian Schools (DEVS): Documents/fact-sheet-marijuana-youth.pdf. the Study Protocol for a Harm Reduction 51 Washington State Department of Health, Focused School Drug Education Trial,” BMC “2016 Washington State Healthy Youth Public Health 12 (2012). Survey Data Brief: Marijuana,” https://www. 56 David Moshman, Adolescent Psychological doh.wa.gov/Portals/1/Documents/8350/160- Development: Rationality, Morality and Identity NonDOH-DB-MJ.pdf. (Mahwah, NJ: Lawrence Erlbaum Associates, 52 Richard Midford, “Drug Prevention Pro- 1999); Marilyn J. Quadrel et al., “Adolescent grammes for Young People: Where Have

38 Safety First: A Reality-Based Approach to Teens and Drugs (In)vulnerability,” American Psychologist 48, 64 Cecil R. Reynolds et al., Are Zero Tolerance no. 2 (1993): 102-16. Policies Effective in the Schools? An Evidentiary 57 Substance Abuse and Mental Health Ser- Review and Recommendations; A Report to the vices Administration, “Key Substance Use American Psychological Association Zero Toler- And Mental Health Indicators in the United ance Task Force (Washington, DC: American States, Results from the 2017 National Psychological Association, 2008), http://www. Survey on Drug Use and Health: Summary apa.org/pubs/info/reports/zero- tolerance.pdf. of National Findings,” Figure 12, https:// 65 American Civil Liberties Union, “What is the www.samhsa.gov/data/report/2017-nsduh- School to Prison Pipeline?” https://www.aclu. annual-national-report. org/racial-justice/what-school-prison-pipeline 58 Richard Midford et al., “Drug Education in 66 Ted Wachtel, SaferSanerSchools: Restoring Victorian Schools (DEVS): the Study Proto- Community in a Disconnected World (Bethle- col for a Harm Reduction Focused School hem, PA: International Institute for Restorative Drug Education Trial,” BMC Public Health 12 Practices, 1999), http://www.iirp. edu/article_de- (2012); Richard Midford, “Drug Prevention tail.php?article_id=NTEw; Zili Sloboda, “Back- Programmes for Young People: Where Have ground Paper: Substance Abuse Prevention: We Been and Where Should We Be Going?” Reviewing the Basic Elements of Prevention Addiction 105, no. 10 (2010); Robin Room, Intervention,” in Technical Consultation, ‘Inter- “Preventing Youthful Substance Use and national Standards on Drug Use Prevention’ Harm – Between Effectiveness and Political (Vienna, Austria: United Nations Office on Wishfulness,” Substance Use & Misuse Drugs and Crime, 2012). 47, no. 8-9 (2012); Julian Cohen, “Drug 67 Centers for Disease Control and Prevention, Education or Drug Propaganda?” in Harm “About Teen Pregnancy,” https://www.cdc. Reduction in Substance Use and High-Risk gov/teenpregnancy/about/index.htm; Centers Behaviour, eds. Richard Pates and Diane for Disease Control and Prevention, “Sexual Riley (John Wiley & Sons, 2012). Risk Behaviors: HIV. STD, & Teen Pregnancy 59 Rodney Skager, Beyond Zero Tolerance: A Prevention,” https://www.cdc.gov/healthyyouth/ Reality-Based Approach to Drug Educa- sexualbehaviors/. tion and School Discipline (New York: Drug 68 National Highway Traffic Safety Administration, Policy Alliance, 2013), www.drugpolicy.org/ “Young Drivers,” Traffic Safety Facts (Washing- resource/ beyond-zero-tolerance-reality- ton, DC: Department of Transportation, 2018), based-approach-drug-education-school- https://crashstats.nhtsa.dot.gov/Api/Public/ discipline ViewPublication/812498; Centers for Disease 60 Craig Reinarman, PhD, personal communi- Control and Prevention, “National Vital Statistics cation, 2014. Reports,” June 1, 2018, https://www.cdc.gov/ 61 Thomas Nicholson, “The Primary Preven- nchs/data/nvsr/nvsr67/nvsr67_04.pdf. tion of Illicit Drug Problems: An Argument 69 Lisa Richardson, “Dishing out Dinner as the for Decriminalization and Legalization,” Anti-Drug,” Los Angeles Times, September 26, The Journal of Primary Prevention 12, no. 4 2006. (1992): 275-88; Charles Winick, “Social Be- 70 Sharon Levy et al., “A Review of Internet-Based havior, Public Policy, and Nonharmful Drug Home Drug-Testing Products for Parents,” Use,” The Milbank Quarterly 69, no. 3 (1991): Pediatrics 113, no. 4 (2004): 720-6. 437-59; Erich Goode, Drugs in American 71 Stanton Peele, Addiction Proof Your Child Society, 6th ed. (New York: McGraw-Hill, (New York: Three Rivers Press, 2007); Timmen 2004). Cermak, Marijuana: What’s a Parent to Believe? 62 Thomas Nicholson et al., “Focusing on (Center City, MN: Hazeldon, 2003). Abuse, not Use, in Drug Education,” Journal 72 Maia Szalavitz, Help at Any Cost: How the of Substance Use 18, no. 6 (2013). Troubled-Teen Industry Cons Parents and Hurts 63 Robin Room, “Preventing Youthful Sub- Kids (New York: Penguin Group, 2006). stance Use and Harm – Between Effective- ness and Political Wishfulness,” Substance Use & Misuse 47, no. 8-9 (2012); Richard Midford et al., “Drug Education in Victorian Schools (DEVS): the Study Protocol for a Harm Reduction Focused School Drug Edu- cation Trial,” BMC Public Health 12 (2012).

www.drugpolicy.org 39 Acknowledgements

The 2019 edition of Safety First was Tim Cermak, Chuck Reis, and Rod Skager made possible by the encouragement have shaped my thinking about teens and and support of the Drug Policy Alliance’s drugs. I am especially indebted to Craig Executive Director, Maria McFarland Reinarman, who has generously provided Sánchez-Moreno. I thank my colleagues feedback from his university students’ at DPA – Jag Davies, Stefanie Jones, parents and served as my most ruthless Suchitra Rajagopalan, Sasha Simon, and helpful critic. Gabriella Miyares, and Sheila Vakharia for their hard work and valuable input. I thank the senior staff at the Partnership for Drug Free Kids for their helpful suggestions Since the beginning of the project on earlier drafts. in 1998, DPA, under the visionary direction of Ethan Nadelmann, has My wonderful children, Anne and Johnny provided essential support and Irwin, and my son-in-law, James Conger, assistance in the production of all 6 have, as always, allowed me to expose our previous editions of Safety First. endless conversations about alcohol, mari- juana, and other drugs, as have my step- Past and present DPA staff have daughters, Jeanette and Katy Irwin. I am so provided help. They are: Jennifer proud and grateful to them for allowing me to Kern, Leah Rorvig, Rhett Hurlston, use their stories, insights, and analyses at will. Sue Eldredge, Camilla Field, Aaron Juchau, Jolene Forman, Daniel Robelo, Finally, I thank the many parents who have Tamar Todd, Amanda Reiman, Jerry provided a sounding board and who, in an Otero, Ethan Nadelmann, Kassandra effort to keep them safe, share my commit- Frederique, Malik Burnett, Gabriel ment to delivering honest information to their Sayegh, asha bandele, Yolande Cadore, teens. I remain confident that by continuing Tony Newman, Derek Rosenfeld to work together, we can steadily help to and Sharda Sekaran. I thank these improve the health of our young people. dedicated professionals profusely. Safety First 2019 is dedicated to the Over these 21 years, my colleagues, remarkable California State Parent Teacher (the late) John Irwin, (the late) Lynn Association (PTA). I am grateful to PTA Zimmer, Loren Siegel, Paul Armentano, leadership, especially Carla Nino, Pat Klotz, Harry Levine, Ira Glasser, Peter Brenda Davis, Kathy Moffat, Shereen Walter, Cohen, Sheigla Murphy, (the late) John and Carol Kosivar, who have helped greatly Morgan, Joel Brown, Jerry Beck, Steve in disseminating Safety First to hundreds Heilig, Mitch Earlywine, Stanton Peele, of thousands of California’s parents.

40 Safety First: A Reality-Based Approach to Teens and Drugs About the Author

Marsha Rosenbaum, PhD earned her doctorate in medical sociology at the University of California at San Francisco (UCSF) in 1979. Her research on drug issues was funded for eighteen years by the National Institute on Drug Abuse as she completed studies of heroin addiction, crack cocaine, Ecstasy and drug treatment programs in the United States. She is the founder of the Safety First project and currently Director Emerita of the San Francisco office of the Drug Policy Alliance, which is based in New York.

Dr. Rosenbaum has written many Seattle Post-Intelligencer, The publications, including Women on San Diego Union-Tribune, Pittsburgh Heroin, Pursuit of Ecstasy: The Post-Gazette, The Orange County MDMA Experience (with Jerome Register, San Jose Mercury News, Beck), Pregnant Women on Drugs: Los Angeles Daily News, La Opinión, Combating Stereotypes and Stigma The Daytona Beach News-Journal, (with Sheigla Murphy), Safety First: Oakland Tribune, The Times A Reality-Based Approach to Teens, (Trenton, New Jersey), Orlando Drugs, and Drug Education, Making Weekly and AlterNet. Sense of Student Drug Testing: Why Educators are Saying No, and Dr. Rosenbaum is the mother numerous scholarly journal articles of a 35-year-old son, a 41-year- about drug use, drug abuse, drug old daughter, the stepmother of treatment and drug policy. two “bonus daughters,” and the grandmother of two adorable little Her opinion pieces have appeared granddaughters. in USA Today, Los Angeles Times, Chicago Tribune, The Detroit News, The Atlanta Journal-Constitution, Newsday, San Francisco Chronicle, Praise for Safety First: A Reality-Based Approach to ConcernsTeens and Drugs “Parents have viewed Dr. Rosenbaum’s booklet as a very realistic approach when dealing with the sensitive issuesAbout of teen alcohol and other drug use. California State PTA began distributing the Safety First booklet to its Overdosemembers in 2002 and parents continue to find it a valuable educational tool for developing open and honest dialogue with their teens.” – Brenda Davis, Past President, California State PTA

“Safety First drug education, like comprehensive sexuality education, provides parents and teenagers with the tools they need to make responsible decisions. Whether it’s about sex or drugs, as parents our common goal is the health and safety of our teenagers. I highly recommend this reality-based resource.” – Janie Friend, Supporter, Planned Parenthood

“What a terrific little book! Marsha Rosenbaum’s calm, well-informed and honest discussion of teen drug use, the distinction between youthful experimentation and dangerous patterns of use, and the focus on keeping kids safe will ring true for teens as well as their parents and teachers. We need an antidote to “Just Say No” and over- sold claims regarding drug danger – they just don’t work. Dr. Rosenbaum provides parents with an alternative that allows parents to talk openly to their teens, to take a clear position against drug use, but also to help their kids negotiate a world where experimentation is ubiquitous.” – Molly Cooke, MD, The Haile T. Debas Academy of Medical Educators, School of Medicine, University of California at San Francisco (UCSF)

“Safety First is a rare example of a plan for real, honest drug education. It gives the facts about drugs with the aim of reducing the potential harm associated with them. I recommend it to teenagers, parents and teachers.” – Andrew Weil, MD, Health Expert and Author

Safety First: A Reality-BasedDPA-S1 Approach E6 0519 to Teens and Drugs