Fentanyl epidemic: A doctor's advice on talking to kids about drugs

Dr. Mark Yarema has seen the tragic consequences of drug epidemics first hand. He offers sobering stories and tips for talking to kids about addiction.

Dr. Mark Yarema has seen the consequences of addiction first hand

Fentanyl, a synthetic opiate 100 times more powerful than morphine, killed 145 people in Alberta in the first six months of this year. (Canadian Press)

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In his piece, Dr. Mark Yarema writes about drug epidemics and how to talk to children to prevent addiction and abuse before it starts.

Fentanyl. Greenies. Oxy. Ecstasy. K2. Ivory Wave. N-Bomb. Lean. Sizzurp. Sticky green. Purple drank.

I know they all sound like comic book characters or superheroes, but these are just a few of the street drugs I encounter in my practice every day as an emergency room physician and medical toxicologist.

We're in the midst of a crisis of fentanyl poisonings and deaths in Canada. Assuming history repeats itself, the fentanyl supply will eventually dwindle and a new drug will take its place.

I've seen the tragic outcomes of these epidemics first hand. The most recent was an 18-year-old boy who purchased some fake oxy tablets and was later found unresponsive and not breathing. His heart had stopped, but paramedics got it started again.

He spent several weeks in the intensive-care unit connected to a breathing tube. We found fentanyl and methadone in his urine. He now has permanent brain damage. I met his father on several occasions and I can only imagine the pain he was going through seeing his son like that.

War on drugs

There are many who consider the war on drugs a failure. The police can only do so much to enforce the law. The federal government can only act so fast to make possessing these drugs illegal. Pill testing booths at raves and festivals can't possibly test for all the illicit drugs out there. Naloxone, the antidote for fentanyl, only works if it gets into the right hands and is used before it's too late. Abstinence doesn't work.

While I understand the exasperation, I don't agree the war has been a failure, or that it is destined to fail.

I believe we need to tailor our response to each epidemic and accept that different approaches will be necessary depending on the drug. There is no antidote for an ecstasy overdose, so a firm abstinence message makes more sense. With respect to fentanyl, naloxone is being made available to those who need it most. This is not admitting failure, nor does it mean that other anti-drug efforts such as law enforcement or legislation should cease. Rather, this is about saving lives.

I realize the message of complete abstinence from alcohol and drugs won't work for everyone, but I always encourage patients who come to the hospital with alcohol and other drug-related problems to stop using their drug of choice completely. This includes people I've seen in the past week — those with evidence of liver damage from chronic alcohol use; the patient who is withdrawing from alcohol and is vomiting or seizing; the homeless person who is addicted to crack cocaine and has skin infections and lice.

Many demonstrate addictive behaviour that destroys families, finances and friends. Some, like the 25-year-old alcoholic in liver failure I saw in the intensive care unit, ultimately pay for it with their lives.

No discrimination

The disease of addiction doesn't discriminate. There's a strong genetic component to it and other mental health disorders, and all it takes is that exposure to something that makes the brain want more. Sheer willpower doesn't make the problem go away.

On the flip side, you probably know people who seem to make it through life drinking alcohol responsibly, smoking the occasional joint, or even experimenting with ecstasy and having no ill effects. Even these so-called "recreational users" have been poisoned with fentanyl after their first-and-only use. Some have survived; some have died. Unfortunately, it's like Russian roulette. With street drugs, you really have no idea of the dose you're getting or if it's contaminated with something else.

So what's to be done? 

As parents, we need to speak to our children about the dangers of street drugs and we need to start at an early age. A five-year-old will not understand a discussion about street drugs like a 15-year-old will, but they can be told that alcohol and prescription medications are kept out of reach and out of sight, and that prescription medications should not be called "vitamins" or "candy."

And yes, the conversations about those uncomfortable topics, like sex, drugs and rock and roll need to come from parents rather than from rapper Lil' Wayne (who, by the way, developed seizures in part because of excessive use of Sizzurp).

How to talk to kids

Here are a few tips that might be helpful for you to begin the discussion about drugs and alcohol with your own child:

  • Stay calm. Remember, you are the parent and you are in charge. 
  • Try speaking to your child side-by-side instead of face-to-face; it may seem less threatening that way.
  • Use facts, not emotions, and avoid saying everything all at once. Less is more.
  • Use the news. Fortunately (or unfortunately) there is no shortage of stories about drugs on TV, the newspaper, or the internet. Use stories, current events, or discussions on school life as an opportunity to ask them for their opinion. "What did you think about that?" might be one way to open up the discussion.
  • Be a good listener. Give them room to participate and ask questions. Respect their opinion.
  • Don't preach. Kids are more likely to be turned off the message if they think you're preaching from the pulpit.
  • Remember to tell your child that you love them and you're concerned about them.
  • And finally, accept that you will have this discussion many times. Think of it this way: how many times have you had to remind your child to brush their teeth, comb their hair, put their toys away, or pack their school bag?

I also encourage parents and children to remember that heroes and role models are closer to you than you think. As a fan of the NBA, I will always remember this classic quote by the outspoken Hall of Famer Charles Barkley: "Just because I can dunk a ball, doesn't mean I should raise your kids."

For more information on the dangers of drugs of abuse like fentanyl, and tips on how to talk with your kids about drugs, visit the following websites:

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