Confronting an Epidemic of Drug Use in Schools

“It came out of nowhere,” sighs principal David Maxwell, like someone describing a meteor crashing to Earth. But Principal Maxwell isn’t talking about cosmic debris; he’s talking about vapes, the portable smoking devices marketed by companies like JUUL and Elf Bar.

When the devices first started appearing at his Iowa-based Valley High School—home to approximately 2,200 students in grades 10 through 12—kids were “so brazen,” Maxwell says, that they would blow clouds of vapor right in front of him. “Are you serious?” he’d think. “Come on, man. You can’t do that in school.”

Kids would shrug their shoulders. It’s just vapor, they told him: harmless water. While vaping is reportedly less harmful than smoking a cigarette, there is still a great deal we don’t know about the long-term impacts—though medical professionals link it to increased risk for severe lung disease or cancer. To the un-listening ears of teens, Maxwell’s insistence that the vapor was laced with highly addictive nicotine was fruitless—like using a water pistol to extinguish a wildfire. And the vape detectors installed in almost all of the school’s bathrooms? They’re constantly going off, Maxwell says, with little to no effect: “They’re not a deterrent by any means.” 

What seemed to be a fad, at least in the early days, has snowballed into what the United States Surgeon General referred to in 2018 as an “epidemic of youth e-cigarette use.” When news articles and public service announcements began to expose some of the dangers of vapes, Maxwell hoped the problem would simply fade away. If anything, he says, things have gotten much worse, with new devices and new drugs in the mix. A few years back, the use of marijuana vapes—similar, portable electronic devices designed to vaporize cannabis concentrates—resulted in the hospitalization of four Valley High students in a single month. 

And this isn’t just happening in Iowa. 

Rapid changes in the national political environment have made formerly illicit substances like hash and weed widely available, and commercialization of the products has improved their packaging and made them more enticing, powerful, and portable. The recreational use of marijuana is now legal in over 20 states; a handful of others have legalized medicinal use, often a precursor to full legalization. Cannabis has gone crassly commercial in states like Colorado and New York, where you can hardly walk a block without passing dispensaries with names like Brooklyn Puff offering fingernail-sized cannabis gummies and candies in flavors kids love. Storefronts are often adorned with cartoonish characters that appeal to a younger audience.

The combination of availability and miniaturization has made THC-based products alluring to kids—and sent staggering numbers of young people to the hospital. Though older teenagers and young adults under the age of 25 “accounted for the vast majority” of a more recent spike in cannabis-related ER visits, Erika Edwards reports for NBC News, alarming trends are also emerging among children under the age of 11: The CDC recently reported a 214 percent increase in cannabis-related ER visits within this age group.

“It would be an unusual week if we’re not seeing a child presenting to our emergency room with side effects from cannabis ingestion,“ Dr. Caleb Ward at Children’s National hospital in Washington, D.C., told NBC News. His words underscore a troubling new reality. This isn’t just a middle or high school problem; our youngest and most vulnerable populations are not immune. The drugs are reaching them, too.

ILLUSORY NUMBERS

At the height of the pandemic, there were signs of a possible reprieve. In 2021, outlets like The New York Times and the Associated Press shared news that seemed almost too good to be true: Youth vaping was in decline. Some reports showed “the largest single-year drops we’ve ever seen,” explains Richard Miech, principal investigator of Monitoring the Future, an ongoing series of youth-focused studies that began in 1975. 

But the declines came with significant caveats. According to Miech, Covid-related school closures cut a lot of kids off from their initiation into drug culture. School attendance is “one of the largest risk factors for kids to [start to] use drugs,” he says. So in 2021, it made perfect sense that a lot of kids weren’t using: The need for a social adhesive—something to have in common with others, to talk about or engage in together—was gone. By 2022, it was clear that the decline had stuck. “There’s a lot of literature out there that says if you don’t smoke by a certain age, you’re never going to smoke,” Miech says, explaining the finding. “If you can delay someone using drugs for a year or two, then they’re probably never going to start.”

His recently published study attributes much of the current decline to this phenomenon and identifies seventh and ninth grades as important junctures: “Lower levels of initiation in seventh grade in 2020–2021 accounted for half or more of the overall prevalence decreases in eighth grade [in 2021–2022],” Miech and his coauthors wrote. Likewise, less “initiation in ninth grade in 2020–2021 accounted for 45 percent or more of the overall prevalence decreases in 10th grade in 2021–2022.”

As school systems weigh their options for responding to the crisis, Miech’s study suggests that the question of timing should be front and center: “If you have anti-drug policies or anti-drug interventions, seventh and ninth grade are pretty crucial.” 

Other data reveals a more complicated picture than the reporting around declines in usage might suggest. A recent analysis of National Youth Tobacco Surveys, for example, found that by 2021, 10.3 percent of American youth who vaped did so “within 5 minutes of waking up in the morning,” indicating a troubling upward trend in acute nicotine dependence. That’s up from 1 percent in 2017.

Meanwhile, THC levels in marijuana products have surged as perceptions of harm from its use have dramatically declined among adolescents. Gone is the joint of yesteryear, containing less than 4 percent THC, writes Caitlin Gibson for the Washington Post. “Dried cannabis flower now averages closer to 15 to 20 percent THC,” she writes, and “the high-potency products most popular with teens—including THC-concentrated oils, edibles, waxes and crystals—often contain anywhere from about 40 percent to upward of 95 percent THC.” 

But since 2015, the segment of 12th graders “who perceive great risk of harm from regular use has hovered around 30 percent,” the researchers write, having fallen steadily from a high of 79 percent in 1991.

This decrease in the perception of harm associated with marijuana use should be a cause for concern, the researchers explain, especially because in the past it has been a likely predictor of future increased use. While fewer kids are vaping and consuming drugs for now, the other shoe feels ready to drop.

SELF-RELIANCE (NOT COMPLIANCE)

Removing doors from stalls and locking bathrooms, using metal detectors to find and confiscate vapes, school resource officers issuing tickets to students—responses like these have been hallmarks in the story of drug intervention since the cigarette wars began several decades ago. 

These coercive prevention measures don’t work, explains Kriya Lendzion—a school counselor, addictions clinician and prevention specialist—because they simply don’t take into account “what is and isn’t” going on in the teenage brain. In adolescents, the brain is still developing and maturing—notably, the areas of the brain that generate and then manage impulses and emotions. This often results in what clinical professor of psychiatry Dan Siegel refers to as “Russian roulette thinking.” 

“The research term is hyper-rational thinking,” Siegel explained in a 2013 interview with ZDNet. “It’s related to the idea that the appraisal centers of your brain… amplify the meaning and significance and import of a positive aspect of an experience. If I’m going to drive a car 100 miles an hour, it would [emphasize] how thrilling that will be. The potential cons—I could crash into a tree, I could kill someone, I could kill myself—are minimized.”

For example, a student may fully understand that getting caught vaping in the bathroom will lead to a suspension, immortalized on their permanent record. They also most likely don’t want the consequence of vaping, whether it’s three, five, or 10 days of suspension. But in that moment, when faced with the decision of whether to use or not, the teenage brain is weighing the potential short-term outcomes and rewards associated with each choice. Factor in a heavy dose of dopamine and a lack of perspective and experience, and you end up with students disproportionately deciding that the risk is worth the reward. Once they become addicted, the choice is no longer their own.

THERE’S GOT TO BE A BETTER WAY

More holistic approaches can help address the underlying needs that kids are meeting through vaping and experimenting with other drugs. For students, the root causes of drug use can range from their struggling mental health or a deep need for connection and belonging to a simple lack of comprehensive drug education. Sometimes, they just don’t know what’s in the vapes until it’s too late—whether that’s nicotine, THC, or a near-lethal dose of fentanyl.

Schools that are successfully making progress with prevention and intervention, even if it may seem like the smallest of steps, are taking a longer view and opting for approaches that focus on counseling, stress management, and peer-led initiatives. This is a task of enduring effort, school leaders explained, rather than a swift sprint. 

Student voices against vaping: Social capital is the currency of adolescents, explains school counselor and therapist Phyllis Fagell. When dealing with a problem that arises again and again, like bullying, for example, she suggests engaging the student body in conversation and bringing some of the more popular kids on board to help facilitate. “If you can, try to get kids who have social capital involved in leading that conversation, because the research shows the kids who have the social capital are going to drive that behavior and can help air it out,” she says.

The same can be applied to anti-drug policies. Gregg Wieczorek, principal of Arrowhead High School in Milwaukee, sent students to seven of the feeder middle schools in the surrounding area to talk younger kids out of vaping before they started. The Santa Clara County Office of Education in California took a similar approach, turning to their students in an effort to leverage the power of positive peer pressure. The county teamed up with the public health department and Stanford University to train students in effective public speaking as well as how to debunk the myths and miscommunication surrounding vaping to their peers. 

“When [the message] comes from an adult, it sounds so antagonistic but also like they don’t understand us,” 17-year-old attendee Selena told CNN’s Michael Nedelman. “But I think when it’s coming from a friend, I feel like it means much more to the person receiving it.”

Building pathways toward cessation: Making connections with cessation programs can have a big impact, Lendzion urges. Whether support groups are coming into the school to host meetings or having events in the community, connecting kids to resources that will help them stop using is key. “You just can’t say, don’t do this thing,” she says. “If they had another alternative for managing their stress, depression, and anxiety or connecting with each other and feeling belonging, they’d be doing it. So they need connections to other ways to meet those needs that are convenient and that work.”

Organizations like Truth Initiative offer a free, anonymous text messaging program called This Is Quitting, designed to help kids stop vaping, using the same guiding principles of peer-to-peer communication. Used by over 600,000 young people, the text program shares messaging from other kids their age who have attempted to or successfully quit vaping. That peer-to-peer perspective, their research suggests, can be much more effective in curbing negative behaviors than the words of any adult, explains Amy Taylor, the organization’s chief of community engagement.

“It’s those peer-led conversations that are really making the difference,” she says. “We are not finger wagging. We are not adults telling kids what to do. What we do is, we empower young people, give them the facts, and let them make decisions on their own.” 

Balancing prevention and suspension: Meanwhile, in Watervliet, New York, superintendent Donald Stevens says vaping has become “a daily challenge.” Staff are “constantly finding vapes disposed of in toilets or urinals that have clogged the drains,” and vape detector sensors are inconsistent—either very sensitive or not sensitive enough. The district is trying to view substance use through a more humane lens, changing their philosophy about consequences to ensure that “they are matching the infraction and matching what we want as a desired outcome.” 

Their aim is to counsel students and ask them why they make certain choices, what they learned from those choices, and ultimately how they can prevent that behavior from happening in the future. To support the effort, the district increased their mental health counseling tenfold—an investment that will allow them to delve deeper into the underlying issues that may drive students to vape in the first place—and used a grant from the Office of Children and Family Services to pay a family outreach counselor who focuses on substance abuse and family needs. 

The practices can be a mixed bag when it comes to application and results, and the community is navigating the issues in real time. When caught vaping for the first time, students are required to research the effects of vaping and present their findings as a project to administrators, a few teachers, and sometimes their parents. For some students, this is enough of a deterrent to change their behavior, at least while on school grounds. But kids who can’t or won’t stop have posed a real challenge, especially when the addiction has taken hold and communication with parents results in little follow-through. “Then we resort back to those consequences of suspensions and detentions,” Stevens says. “That’s not saying that we’re not trying and that we’re not putting forth as many efforts as we possibly can. But it leaves us questioning, like what do we do next?”

The case for discretion: Several hours away, in Portland, Maine, Principal Scott Tombleson is confronting a similar dilemma. At South Portland High School, when a student is caught vaping for the first time, they’re sent home for the day. They return the next day and meet with a restorative coordinator who walks kids through the impact of their actions. But just as in Watervliet, some kids determine that a day’s suspension from school and a conversation with the coordinator are well worth the risk of getting caught vaping—or they’re simply too hooked to stop vaping overnight. 

South Portland High School staff are using everything at their disposal—from coaches to law enforcement and health care providers. Tombleson hopes their behavioral health liaison at the police department and a newly appointed drug and alcohol counselor can provide more intensive counseling and a restorative-focused response. But in some instances, compassion often clashes with a need for accountability, explains Kara Tierney, a licensed clinical social worker working in the South Portland school system for over 20 years.

“It can work to respond in a therapeutic way,” Tierney says. When the football quarterback has a substance use problem, she believes it’s possible to provide help that can keep him on the team and keep him healthy while also holding him accountable—with some caveats. “It doesn’t mean you’re just saying, ‘Oh, I’m sorry you were using. Let’s have a little conversation with the social worker.’ In the end, if we find that students aren’t receptive to doing the rehab or the therapeutic response, especially if they happen to be someone who’s risen to the level of now dealing, in our policy administrators have some discretion around that.”

Sometimes these students do have to be out of the building, Tierney adds, in addition to some really direct conversations with families. “Your student can’t come back in until we all sit down together and figure out what we’re going to do,” she says. “Because now your child is impacting the well-being of other students, and that’s not OK. So there does have to be a line.”