Transcript: Building Stronger Connections: Opioid Misuse Prevention in California Schools
Laura Buckner:
Hello, welcome. We’ll give it a minute just to let everybody join. Please take a moment to say hello in the chat where you’re coming from. We love to see people from all over the state joining these sessions. We’re glad you’re all here today. Welcome to our webinar on opioid misuse prevention in California schools. As I mentioned, please feel free to say hi in the chat. Let us know where you’re from. It’s always nice to see folks joining us, especially during these busy weeks, which I’m sure it is for some. So my name is Laura. I’m part of the WestEd team, and I’ll be providing just some framing for today’s session. So again, we’re here to learn about opioid misuse prevention in our California schools. Today’s webinar is presented by the California Department of Education and WestEd.
We’re pleased to be offering the statewide webinar, and I want to especially welcome any of our stronger Connections grantees that are on with us today. As the technical assistance provider for the grant, WestEd, is presenting a series of webinars related to topics that are of high importance to Stronger Connections grantees. And we’re pleased that we’ve been able to open participation to all educators in the state as well because these topics are important to everybody. Everybody cares about things like this. So I do want to briefly share about the goals of Stronger Connections, and you can learn more about it on the CDE website. So, the Stronger Connections Program serves to increase the capacity of local educational agencies to establish safe and healthy learning environments to prevent and respond to acts of violence, and bullying, or harassment to address mental health needs, to develop safety assessments, plans and strategies, and also to promote a positive school culture and climate.
And again, this session was designed to align with those goals, but of course is open to everybody. So we have 60 minutes together today. Our goal is to leave you all with a really clear understanding of the opioid overdose epidemic in our state, and for you to come away with some really clear strategies, tools, and resources for addressing opioid misuse in your communities. I will say that participants will be muted throughout today’s session, but we will invite you to be active in the chat and you can also submit your questions via the Q and A feature in Zoom, and this session will be recorded and posted to the California Safe and Supportive Schools website. We’ll let everybody who registered know when that recording is available. You’ll receive an email. And we are hosting an office hour with our presenters next week. That’s April 3rd from 12:,30 to 1:30 PM Pacific. This follow up session will include some time to address anything that might come up today that we’re unable to address due to time constraints, any follow up questions about the resources or what you may have heard. We could walk through some scenarios that you all may be encountering. And we’d also just love for you to let us know how we can further support you. So, mark your calendars for that. Everyone who is here today will also be receiving an invitation to that session and we hope you’ll join us.
So our agenda for today, I’ll introduce our speakers in just a moment. We’ll have a fact or myth ice breaker activity. We’ll spend some time learning about the impact of opioid use in California, and then we’ll hear from a guest speaker about resources available to all of you. And here’s who you’ll be hearing from. So Dr. Jennifer Loeffler-Cobia is the Justice and Public Health Policy and Practice Director at the WestEd Justice and Prevention Research Center. She’s got over 20 years of experience and substance misuse, prevention and intervention, public health and prevention, violence prevention and juvenile and adult criminal justice, evidence-based practices. So lots and lots of experience and lots to share. Derek Lowry is a senior justice technical assistance specialist with WestEd’s Justice and Prevention Research Center. He’s been a technical consultant, project manager and implementation specialist on reentry focused and public safety projects for a number of years, and also previously served as the co-director of a direct service reentry nonprofit organization. We’re really glad to have Derek with us. And then Stephan Lambert is the prevention coordinator at the Orange County Department of Education. He’s got over 17 years of experience ,and Stephan supports schools and districts with training and technical assistance around alcohol, tobacco and other drug use prevention. So a really, really wonderful group of speakers that we have here today. With that, I will be turning the spotlight over to Derek for our ice breaker activity.
Derek Lowry:
Yeah, thank you for the introductions, Laura. We’re going to get started with a brief ice breaker activity that calls for your participation as well. I’m basically going to make a statement, and you’re going to have a brief poll that’s going to pop up on your screen and we ask you to choose whether or not this statement is factor or myth. So let’s jump to the first one. So, fact or myth, the rate of opioid misuse amongst high school students in California has steadily decreased over the past five years. So take just a moment to answer whether you believe this is fact or myth.
Okay, Regina, if everybody has answered, maybe we could share the results quickly. Okay, so 75% said myth. Let’s go to the next slide. You guys are correct. Although this is a myth, education and prevention efforts have promoted awareness about the dangers of opioids to youth and have contributed to a decline in opioid misuse amongst high school students in recent years. And as we’ll see a little bit later, there was a sharp uptick in use amongst the youth from 2019 to 2020, which we’ll talk about briefly. So let’s jump to the second ice breaker. So factor myth, all public schools in California are required to have naloxone available on campus to treat opioid or fentanyl overdoses among students. So is this a requirement? So maybe we’re ready to see the results of this question. Fact, 61% said fact and 39% say myth. Let’s jump to the next slide. So this is a myth, although there are many new resources provided by the state to promote its use to the public and to public schools, it’s not a statewide mandate, but these resources are accessible. This is the end of our ice breaker. Let’s shift to Dr. Loeffler-Cobia to discuss the historical context of opioid misuse.
Jennifer Loeffler-Cobia
Thanks Derek. And Laura, thanks for the introduction and it’s really great to be here with you all. And I’m just going to go over quickly, just as Derek said, just the historical context of how did we get here with this opioid overdose epidemic that we’re all experiencing nationwide. It’s not just in California. It’s pretty much everywhere and has touched pretty much everyone’s lives in some capacity. So you can go to the next slide. I just want to give everybody, it’s so important, we’re always throwing out terms and I’ve been doing this work for a really long time. I’ll just say that a really long time, and I still get confused sometimes in terms of some of the terminology and the different drugs that are out there that we talk about. So I just want to go over really quickly as throughout this presentation, we’re going to be using some of these terms.
So we often hear the word opioid, and that’s the general term for the drugs that we’re talking about in this capacity. But we really have three categories with opioids, which are really the precursor to all of this, to the epidemic. These opioids are natural. They’re from the poppy fleet seeds, the poppy flour, and what we’ve gotten from that is morphine, which then turned into heroin and coating. So these are natural pain relievers, if you will, painkillers that we have in just a natural plant. But then what’s happened over time is that we’ve taken this poppy seed and we’ve then produced them in the lab to where we get things like oxycodone. Some of you might be familiar with the term Oxycontin, which we’ll talk about hydrocodone, which some might know as Vicodin or Lortab, hydromorphine or oxymorphine. These are semisynthetic opioids where they’re not just solely natural in our environment, but the poppy seed or the opium has been transferred or manipulated to make some of these other painkillers.
And then we have what we know now as synthetic opioids. They are solely made in a lab. There’s no natural component to it whatsoever. They act the same way as these other types of opioids and semi-synthetic opioids, but they’re made solely in a lab. So you’ve heard of methadone, buprenorphine. Those two are used primarily for medical assisted treatment to actually treat substance use disorders. You might have heard of tramadol, and then I’m sure most of us have heard of fentanyl, which is a hundred times more potent than morphine or heroin. And I’m throwing a lot of terms at you, but I just wanted to make sure we all understand kind of the differences between these opioids and opioids that we’re dealing with within this overdose epidemic. Next slide. So this just gives you a quick overview of the legal versus illegal opioids and opioids. We’ve all heard probably of the schedule 1, 2, 3, and 4 drugs. This just gives us a policy and guidelines in terms of how we prescribe these drugs and how we utilize these drugs. So schedule one drugs, and I’m just going to go over this really quickly. I just want us to give us a quick overview. But schedule one drugs, you’ll see, and I’m just talking about opioids, there’s other drugs that are in these schedules like benzodiazepines and other drugs, but I’m just specifically talking about the opioids and opioids. So our schedule one drugs, these are really high potential for abuse.
There’s no medical use whatsoever for them, so they should not be being prescribed. They are illegal. And the main one in the opioid category is heroin. We have schedule two drugs, which you’ve probably heard of, oxycontin, fentanyl, methadone, morphine. These are high potential for abuse, but they do have medical reasons where they can legally be prescribed along with schedule three and schedule four drugs. The higher in the schedule, the lower you have for potential abuse and dependency. So I just wanted to give you an overview of how the California are classified into these drugs and different states have different classifications, but this is pretty close to what other states have as well. Next slide. The other two terms I want you to understand because as Stephan is going to talk about later with naloxone and naltrexone, these are not opioids. A lot of folks, because we talk about methadone and buprenorphine as medical assisted treatment in terms of working with those with substance use disorder, naltrexone and naloxone are not opioids.
They actually act completely different than an opioid. An opioid will actually mimic our endorphins, if you will, that natural pain reliever. But naltrexone and naloxone actually block the opioid receptor in our bodies. And so naloxone is a short term emergency medicine that we use to reverse the opioid overdose and bring some folks back to breathing. Naltrexone is something that we use long-term, but these are not opioids, they’re medicines to actually reverse the opioid effect. Next slide. So how heck did we get here? How did we get into this opioid overdose? I’m going to just go through this history quickly, but really heroin was introduced, or excuse me, morphine was introduced in really the civil war times, right? They understood the poppy seed, they understood that opium, and they started using that morphine in terms of pain reliever back in the Civil War that then turned into heroin.
They were able to revise or manipulate that morphine, turn it into heroin. Then we see, and we actually used heroin back in the late 1800s in our children’s cough medicines. I don’t know if folks knew that, but heroin was widely used in cough medicine as a pain reliever. As we move forward, we understood, we started to learn that morphine heroin were highly addictive. So we started seeing pain killers like aspirin that were non-opioid and started using those more. So heroin morphine started to not be used as much, but then as we kind of moved into the next century, research was coming out about, oh, well maybe these opioids are not as addictive as we thought. And so they started emerging again and people were living longer. So we had a lot of more chronic pain happening. There was a lot more opportunity, if you will, for opioids to be used because we were having a lot more chronic pain as we got older.
Then here comes the introduction of Oxycontin in the late nineties, which again I said was that Semisynthetic opioid? And here we are in with the epidemic with the introduction of Oxycontin and it was being promoted and marketed as non-addictive and through the FDA as well. So here we are, and then we get fentanyl, which is a synthetic, fully synthetic opioid made in a lab, like I said before, a hundred times stronger than its counterparts with morphine and other opioids. So next slide. So I just showed this graphic because now we’re entering into the two thousands. So for the last 25 years we’ve really seen this rise, obviously in fentanyl and this opioid overdose epidemic. We really had kind of in the first part of the two thousands, we had that rise in prescriptions. I mentioned Oxycontin, and we had a lot of deaths related to legal prescribed opioids.
And within that caused the addiction. Once we realized the addiction and the addictive properties of Oxycontin, we immediately said, okay, hey, what do we need to do with the prescriptions? We need to educate doctors, we need to get with the medical field to make sure we lower prescriptions. But what we had then in turn in the system was folks that had substance use disorders. So we basically cut their supply off, but the substance use disorder was there. So then we move into this wave two where folks have the addiction, that substance use disorder, they’re then going to the streets to find heroin, morphine, other substances that can then feed that substance use disorder. And so we get into that wave two, and then we get into the wave three because once we realized, oh, okay, if I have a person with substance use disorder, it’s very hard to get heroin on the streets.
So what else is there available? This then in turn started a marketing spree, if you will, for folks to be developing synthetic opioids and selling them on the street. That’s where we get the fentanyl. So this just gives you an overview of the rise of the opioid epidemic. We’re actually entering into a wave four where we’re having polysubstance use issues where fentanyl is being mixed with things like xylazine, which is in essence a horse tranquilizer. They’re mixing it with benzodiazepines, which are depressants. So lots of different ways that folks are utilizing these drugs, which is obviously killing the folks that we love. Next slide, and I just want to give you just an overview. I talked about that marketing and the distribution of fentanyl entering into the states. So this just gives you kind of a visual of the fentanyl seized by pounds from 2020 to 2023.
So in 2020 we had about 5,600 pounds seized coming into the states to where now that the fentanyl is being easier to develop synthetically or in the lab in 2023, that increased to 22,000 pounds that were seized. So it is literally being marketed, it’s being brought into our communities and we need to work together to be able to figure out how we prevent this from happening. Next slide. And my last slide here, I’ll just show you. I just want to point out a piece of research. You’ll see on the left side of your screen that slide I just showed you about the three waves, and on the right side is a graph that is pretty similar to what you’re seeing. And this is a piece of research that was done back in 2019 where researchers looked at the current system and what was happening and how we were addressing the opioid overdose epidemic.
And they predicted, they did a predictive model saying, Hey, if we’re still on this same trajectory, if you will, of how we’re addressing the epidemic, we’re going to see a tenfold increase in terms of overdose deaths. And you can see literally in 2025, that’s where we’re headed, right? We’re literally going with the prediction that the researchers happened. And so what we’re going to talk about, Derek’s going to talk about some statistics specific to California, and then Steven’s going to talk about just what are we doing in terms of resources and other strategies to really be able to target this overdose epidemic. So we can bring these numbers down and hopefully not continue on with this prediction. So Derek, I’m going to turn it back to you.
Derek Lowry:
Yeah, thanks Dr.Cobia. So let’s shift from the national perspective to looking at the impacts of opioids across California. So the first couple slides, let’s just take a kind of general look at the amount of opioid prescriptions in California from 2019 to 2023 and the date stops at 2023 because that is the most recent data published by the California Overdose Dashboard, which tracks and monitors opioid use within the state and its impacts. So the first number here is that between those dates, there were 74 million opioid prescriptions in the state. In 2023, there were 13 million, 13 and a half million. And I know that these numbers may seem pretty high at this point, but I want to note that there has been a general effort in California and nationally to reduce the amount of opioid prescriptions that are given out for chronic pain and to find alternatives.
And most states, including California, have developed different monitoring softwares and programs to monitor the opioid distributions in the state for prescriptions and to make and promote this information as an awareness tool for the public. And I want to note too that these numbers seem high, but I want to tell everybody that California is actually, I think the third or fourth lowest in terms of opioid prescription rates amongst residents. The highest rates are typically in the southeast, maybe the highest rate may be in West Virginia, and I think Alabama might be and Tennessee. So those are where you see the highest rates of opioid prescriptions in the state, generally in the southeast. So let’s go to the next slide. So let’s focus a little bit on opioid prescriptions for the youth, which might be more interesting for the audience. Between 2019 and 2023, there were a little over a million opioid prescriptions for those age 10 to 19 and general opioid prescriptions in 2023 hovered around 374,000.
And I want to note that there have been reductions in the state when you look at the trend in opioid prescriptions, which has been really helpful in terms of reducing opioid addiction and overdoses. But I also want to note that there was a slight uptick, and this is almost a national statistics as well in fentanyl use, which has its own impacts in the state. So this slide right here looks at general opioid impacts in California in 2023. So the amount of opioid overdose fatalities was 7,847 fentanyl overdose fatalities contributed to 7,137 deaths, and then emergency department visits was about 22,000 and a half. So those are some general impacts in 2023 from the most recent data on California residents, and this is more of a trend line at the opioid related deaths in California from 2019 to 2023, you can see that there is a bit of an uptick in 2020 fatalities from 2019, and that there has been amongst the general population, a slight uptick all the way through 2023.
So this is for the youth. This chart right here tracks fatality trends in opioid use for those age 10 to 19 in California. And I want to draw your attention to the pretty sharp uptick in 2020. And I want to note that nationwide, 14% of high school students have misused opioid prescriptions nationwide, but in California, kind of similar to the opioid prescription data point from earlier, it’s much lower. It’s only 4% amongst high school students. But in terms of what might contribute to that 2020 uptick in fatalities that happened around the COVID-19 pandemic, and a lot of different factors may have contributed to that uptick in opioid use amongst the youth pandemic related stress hardships caused by the pandemic isolation, not having access to networks and resources and friends during that time, and especially reduced access to health services during the lockdown. So those are some of the contributions for that 2020 uptick. But around 2021, you can start to see that there’s more of a sharp downturn in use amongst the youth, unlike the general population. Let’s jump to the next slide.
And this is just a more recent look at youth opioid trends in California from 2023. So 173 overdose fatalities, 223 hospitalizations, and 938 emergency department visits. And let’s jump to my last slide. So this is based on a survey of California students across districts that is pretty recent, and these are the perspectives of California students on opioids in the state. So as I noted earlier, 4% of California students reported using opioids annually. That’s much lower than the national rate. 52% of California students report knowing that people take opioid pills without a prescription. 78% of California students report that their peers take opioid pills without a prescription to get high. Only 30% of California students report actually having conversations with their parents about the illegal use of opioid pills. 77% of California students report having even heard of fentanyl and knowing what it is. And California students reported that they believe fentanyl to be a very dangerous illicit drug, which I think is a pretty good data point. So the promotion of information about the dangers of fentanyl and opioids has been effective and impactful across youth in the state. So having noted that, let me shift to Stephan Lambert from the Orange County Department of Education to discuss resources and how to access them.
Stephan Lambert:
Alright. Thank you so much Derek, and thank you everybody. I also want to say hi to all of my Orange County colleagues and my TUPE colleagues throughout the state. Great to see all of you. So again, I’m Stephan Lambert, I work here at the Orange County Department of Education. We’re a county office, and I have a few specific things that I want to cover for you all. I know that like many of you, I wear a bunch of hats and you might only get a little bit of your FTE to support opioid prevention. So I want you to walk away with strategies that you can implement. I want to share with you what I’ve been doing, access materials that you can adapt. I’m going to give you my presentations, my handouts, all of that so that you can adapt it and use it, please. And then also give you an opportunity to think about the framework of supports.
How do you do this service delivery? How do you determine what’s manageable and at what scale? So I want to start by laying out our three priorities. So, I had to really take some time because the fentanyl crisis really emerged very quickly, as you all know, and it felt like we were being very reactive. So I wanted to take time to sort of organize the ways that we can provide services into three priorities. So the first priority that we pursue in Orange County is outreach and education. The second is overdose response, strengthening that, and the third is increasing access to care. So even within the school system, we have opportunities to do that, and you’ll notice that we’re going to be blending individual level and sort of structural responses in the way that we address illicit fentanyl. So the first priority I want to talk about is outreach and education.
This is the one that I think most people can latch onto pretty easily. I do want to provide for each of these sections also some policy updates. I know there are a lot of questions. This is a very fast moving arena, so I want to clarify some things. And when you get these slides, you’ll be able to click my little citations there for the ed code. So what are some of the policy updates around outreach and education? So first, at the start of every school year, all of our school districts and charter schools have to provide information to parents and caregivers about synthetic drugs, so fentanyl, things like that, counterfeit pills and how they’re sold on social media. So we have to give out that information. It’s kind of up to us to do that and figure out how to do it. I’ll give you some tools later.
And then the second item, which is newer, is AB 2429, which is that beginning in the 26-27 school year. If a district or school requires health for graduation from high school, you must incorporate a specific list of Fentanyl information in there. And again, I link to that so you can find the ed code excerpt that has all of the information that you’re looking for and make sure that your lessons and units are compliant. So what have I been up to around outreach and education? So one of the ways that we’ve been able to address this is by distributing educational materials. So we developed one pagers, we developed all kinds of content, and then delivered it through all of our networks of educators and district leaders through going out to resource fairs and tabling everywhere that we could spread this information far and wide, either directly to students and families or to the school staff indirectly.
And then the second thing that we’ve done is providing educational workshops. So, I, myself will go out and facilitate workshops for students and families. We also have, thankfully, my colleagues at the Orange County Healthcare Agency are here. We’re funded through them to also provide direct classroom instruction. So that’s been excellent, and we have a collaborative of other providers who do the same thing, who can go out and educate students on illicit fentanyl. So that’s been wonderful. And then another thing that I do is just providing interviews. So podcasts, local radio, so like our local Vietnamese serving radio station. I went in and did an interview with them as well, just finding all opportunities to share this information across the community because it’s such a community level issue, it’s not something that’s restricted to the school. So we have to address it with that kind of social ecological model in mind.
Other things that we’ve done, so we have hosted or cross promoted other large forms and summits. So, sometimes instead of the small workshops, we do large summits where we have a hundred plus people. So we did one, for example, right there on Fentanyl Awareness Day back in 2023. I did a couple of sessions after school hours and in the evening to gather folks and provide a naloxone training. Also, aligning things with Red Ribbon Week is a great idea for hosting large gatherings, and then supporting the dissemination of local media campaigns. So again, our partners at the healthcare agency developed a youth facing campaign called Life is Greater Than Drugs, which I link there as well. And the Fentanyl is Forever Campaign, which targets adults. So scaling those up, promoting those as much as we can so that we can have a collective impact. Now, I did promise that I was going to provide resources.
There will be a Google Drive folder that will be dropped into the chat later on that you’ll be able to, oh, by later on, I mean immediately right now that you can access all of the resources that I’m going to be talking about throughout this presentation. So for outreach and education, I want to spotlight a few just to let you know what you can expect when you dive into that folder. So as I mentioned earlier, because of that ED code requirement for parental notification, you can find a sample letter there with some verbiage that you can adapt. Again, that’s editable. You can use that, reformat it, whatever you want to do. The second item that you see there is our multilingual one pager for families, which is in seven languages, English, Spanish, Vietnamese, Korean, Farsi, Arabic, and Chinese. And then the one on the right is a student curriculum supplement.
So it’s kind of a student version of that. It’s a front and back pager in English and Spanish that also outlines the issue, which is a really great compliment to other curriculum or units that you’re doing around opioids because it’s specific to fentanyl and fake pills. A few more things that you’ll find in that folder. Just again, food for thought. I did a micro lesson series for Red Ribbon Week a couple of years ago at the high school level. So during Red Ribbon Week, these are just, we’re talking five or six slides that essentially have an introduction of video and then turn and talk discussion questions, which were done during advisory period. So one of them was on vaping, the second was on fentanyl, and the third was on stress management. So those were really easy to deploy for some of the high schools in our local area.
The second is a three lesson series that my colleague Nadia Moya and I developed, which are standards aligned for middle school students. So it lays out what are opioids, what is fentanyl, then talks about stress management as well as managing peer influences. So that’s a three lesson series. And then the last one on the right was developed in concert with our Orange County Youth Council, which is a peer-to-peer presentation for high school students. That is a one session workshop. And again, all of these please take review, adapt as you see fit. I will know I put an asterisk there. They’re not quite yet, AB 2429 compliant because there are specific requirements that you’ll find in the ED code that those need to comply with. Alright, so that’s outreach and education. Again, I know you’ll be able to dive in there and grab all of those files, but if you ever have questions about what did you mean on this slide or what is that, please just reach out to me directly.
I’m happy to hop on a zoom. So the second priority is overdose response, right? And honestly, this is the one that I think a lot of people gravitate to across the community when we talk about how do we address illicit fentanyl. So let’s talk about what this looks like and what the policy changes are. So the first policy change to be aware of is that now we must allow students to and up to carry naloxone or test strips at school or doing school activities. That’s a new change. It is explicitly authorized, even if you haven’t updated the board policies yet. It is ed code as of January 1st. The second is that, so the comprehensive school safety plans that you might be familiar with for middle and high schools, they must now include an overdose response protocol. What are you going to do in that case?
And then finally, this is also a newer development. All of our county offices now have funding to procure store and distribute naloxone to all middle and high schools in our county. So we have funds earmarked for that. It’s not compulsory for the districts to take advantage of that, but we’re trying to distribute it far and wide. I’ll touch on that in a minute. So these are some of the policy updates, and again, you’ll be able to follow those sources back and dig into the ED code. Alright, so what have I been up to with overdose response strategies? So number one is staff professional development. So key, I have been all over the county. I’ve done district level, school level, all of our professional networks, local conferences for school-based mental health professionals, for counselors, everybody. Just trying to get the word out about what the issue is, inform them and provide resources.
I’ve also been working very closely in concert with our health department to support naloxone training and also naloxone policy and procedures. So getting districts connected with the Naloxone distribution project at the state. And then, now, obviously with that last bullet point, providing it directly to schools through opioid settlement funds. So we’re going to be rolling out a lot of that right now. We’re waiting on our pallet of Narcan to come in and we’re already laying the groundwork for how that distribution is going to look procedurally. Other things that we’ve been doing around overdose response strategies, I think it’s really important to direct students and families to no cost naloxone sources, although it is over the counter, it’s still around like 50 bucks, which is not great to tell students and families. Fortunately, we’re very blessed in Orange County to have a strong network of no-cost drop-in centers for narcan and naloxone.
So we publicize those very widely on our OCD website. And every time we have a workshop or we’re out at network meetings, so to make sure that as many as people as possible take advantage of that. In addition, we provide that information alongside counseling interventions. So when there’s an incident of student substance use, ensuring that that is included in the packet that goes out. And then finally, strengthening our outreach to groups who may be more likely to encounter fentanyl, such as those who are in marginalized groups that have typically higher rates of substance use. So students in foster care, students who are enrolled in our non-traditional or alternative schools. Alright, so the resources for overdose response. This looks very small on this one slide, but I’m assure you once you get into the folder, there is a lot. So the one on the left is basically your toolkit for compliance with that school safety plan requirement.
So I worked with a lot of my colleagues here at OCDE to develop this overdose response kit. So you go in that folder and it’ll have from start to finish pretty much all the pieces that you need from introducing the issue to what are your procedures and what do you need, what’s the poster that you can put up with the algorithm of how to respond to an overdose, what does the follow-up care and reentry look like? All of that stuff in there. So please take and edit that and use it as much as you’d like and let me know if you have questions. The second one is from the National Association of School Nurses, which is their naloxone toolkit, which also has some of those sample policies and different tools that you can use to implement the Naloxone on campus at your district. And then the last one there is my staff professional development slides. I did update the talking points, so you should be able to grab and go with that. But that’s essentially a 30 minute PD professional development workshop that you can provide for school staff that outlines the issue, engages them, and again, lets them know what’s their role as an educator in addressing this head on and what are some of the resources they can provide to students and families. So again, that’s all yours, please take it, use it, adapt it.
Alright, and the last priority that I’m going to talk about is access to care. And this is a tough one because we all know resources differ, capacity differs, and access to treatment is just a hurdle that continues to be an obstacle. So what are some of the policy updates that are related to this? Well, with AB 27 11, now across the state districts and schools are not allowed to suspend students for voluntarily disclosing substance use if the purpose of that is to seek services or support. So if a student comes forward and said, I need help with an addiction, they cannot be suspended for that. So that’s important and also sets the tone, I think, for the way that schools approach this issue. The second there is, the other part of SB 10 was that now we are encouraged to use an MTSS approach and restorative practices when responding to opioid misuse.
So that was just the intent of the legislature. I thought that was nice that they emphasized that. And so we’ll talk a little bit more about what does that look like. So here at OCDE, some of the ways that we’ve approached this, of course, establishing very strong partnerships with our school-based mental health programs, encouraging co screening. I think it’s a really important point to make that when students are being screened for substance use issues or for mental health concerns, that we’re also asking the other question, we know about the prevalence of co-occurring disorders. And then the last point there is identifying low cost substance use treatment programs, right? Again, we are fortunate, we have a very strong network of outpatient and intensive outpatient programs in Orange County for Medi-Cal beneficiaries. Unfortunately, there are a lot of treatment programs that are just not affordable. And we also want to avoid the perception of conflict of interest or endorsement, but we provide this information for all of our school and district staff so they can make those referrals efficiently.
And then lastly, for the final strategies here, alternatives to suspension. We have seen a groundswell of support for school discipline reform, some mandatory, some voluntary. This has been excellent because when we talk about substance use, there are so many reasons why punitive discipline does not make sense. And so we provide training to districts on how to do that, how to build support, and how to build guidelines for implementation. What are the programs that you can use for counseling interventions? And then that, which leads me to the second point there, which is we do host trainings on brief intervention strategies. So, for the actual school-based mental health and counselors who work with students, what are the protocols that they can use? How can they screen and then use motivational interviewing to hopefully drive behavior change? So this is a really huge area for us, and we’re really excited to continue to scale that up because this is an excellent pathway toward reaching substance use treatment out in the community.
Now, some of the resources that you’ll find in there, we have a lot more in my office that we’re just getting final approvals for. In fact, we’ve developed an alternatives to suspension to toolkit that has everything from start to finish from advocacy through communication on how to implement alternatives to suspension. So we will have that finalized within the next two weeks, actually. So it’s very exciting. But here’s just a sampling of some of the tools from that toolkit that are linked in the Google folder. So, we have an advocacy slide deck that lays out why suspension doesn’t make sense, and all of the ways that using a TS can be beneficial. That second one there is just a quick one pager on addressing some of those typical pushbacks. You might hear around a TS, like what happens to zero tolerance? What if it’s just nicotine?
Why isn’t this working yet? Why am I catching the same kid for the third time? So helping to respond to those in a thoughtful way. And that last piece, there is a guide on California Education Code and what it says about certain substance use related incidents. How much leeway and discretion do you have as an administrator? So again, this is just sampling of the tools from the toolkit, but I hope that you find ’em useful. And again, take, use ’em, adapt them. So I’m going to close with just some thoughts about service delivery and the framework that you use. I know that I ran through a lot of stuff and there are a lot of ways that you can address this issue and it can be a bit overwhelming. And like I said, we all wear hats. This opioid work for me is about 0.07 FTE, so I understand that we need to prioritize.
So let’s think about the way that we deliver these services. So this may look familiar to those of you who are very closely involved with MTSS. So there are different levels at which we intervene and provide support to students. So either directly at the top to students and families where we’re educating them, engaging them in youth development, doing some of that family outreach at the school level. We’re performing staff development, we’re giving out resources, we’re helping them make those program referrals at the district level. We assist with service coordination, help them with their program planning, particularly around alternatives to suspension. And then providing the policy support, whether it’s a TS or Naloxone implementation. And then at the county region and state level, just continuing to engage in professional learning opportunities like this one, collaborating with your regional partners and accessing some of those statewide resources.
So whatever your role is, and whether you’re at of county office, a district, if you are a community partner, we all have a part to play in this, and you can determine what makes sense for you based on your capacity. And then again, for those of you who are versed in MTSS, you’ll find this very familiar considering how you tier your supports at the universal level for all students. We’re talking about prevention lessons, campaigns, our outreach and resource fairs for some students who maybe require a little more intensified support, we have counseling interventions and naloxone education because we want to make sure that we’re ensuring their safety. And then for a few students who may have a higher level of need, again, making sure that we’re screening for substance use and making those referrals to substance use treatment.
Now, this is a big slide, don’t worry. This is not a vision test, and I’m not going to read through all of these bullet points, but I wanted to just lay this out here for you. These are the list of collaborative partners that I’ve had in this effort. And you’ll see some of them are pretty obvious, some of them may be less obvious. But, I encourage you to think about who in your community, who at your district, county office or school site has a shared interest in promoting student health and wellbeing. And, could support you in distributing your messaging and bringing you valuable insights, grounding you in what the community is actually experiencing and assisting you with reaching who you are trying to reach. So again, you’ll have access to this slide and you can see all of these different partners and think about how you can leverage those partnerships to get the word out.
Now, this is me and I know you’ll all get follow-up emails and things like that, but I will do want to drop this just in the chat. I think the more the merrier. I’m dropping my contact information in the chat. If you have any questions about anything I just sped through, please reach out to me directly. I’m here to help. This is really important to address. It’s affecting so many young people and adults, and I’m just an open book. So please, please reach out to me if you have questions with that. I think I’m right. Oh, good. I’m right on time. It’s a miracle. We are going to transition into a Q and A segment, so I’m going to go ahead and stop my share.
Jennifer Loeffler-Cobia:
Stephan, thank you so much for sharing all of those great resources. I know this has been a lot of information for our attendees, but again, like Stephan said, we are going to be here for office hours. And please feel free to put some questions in the Q and A that you have, and we’ll hopefully be able to get to them at the end of the session. But Stephan, thank you so much for sharing all of those great resources and all of the great work that you’re doing in your district. I really appreciated one of the quotes you said, if I can quote you, we all wear our hats. And then you showed the slide of all of the partners and all of the folks that we can work with within dealing with and addressing this epidemic. So I just want to kind of pick your brain a little bit about the work that you do, and the way that you approach some of the strategies that you talked about. So what are some of the challenges that you have faced in addressing kind of this illegal fentanyl overdose issue? And what are some of the lessons that you’ve learned along the way maybe with working with partners and other things?
Stephan Lambert:
Yeah, this has been a very unique issue. This has been an unprecedented thing. Overdoses on campus was not something I would think. And again, I’ve been in this for 17 years, so some of the things, I’ll just get ’em out. There are a lot of myths that persist around fentanyl, like touching fentanyl or trick or treating and things like that, that unfortunately get a lot of traction. And then we have to gently correct when we’re in those settings and we’re providing that information. So that’s been one aspect that we had to work around. I would say the second thing is a lot of people are interested in addressing this issue, so pervasive and affects so many things. So we have many folks who are interested in addressing it, and they have different approaches to it. So we have law enforcement, we have folks with lived experience, or unfortunately, those who have suffered a loss, we have treatment and recovery groups.
And so all of them have a different lens. And at times it can seem like we’re at odds with the way that we want to frame the issue with the language that we use. But I think it’s really important to identify, okay, what’s the role that this partner can play? How can we paint a holistic picture while still respecting and incorporating their perspective? Because we can do that in a way that welcomes them in and ensures that we’re providing the whole picture while leveraging their expertise as well. Now, the other thing too, sort of dovetailing from that is the idea of keeping things age appropriate. Because what happened, especially with the trick or treating thing, is folks are really like, oh, we need to address this at the elementary school level. But we have to always keep in mind the way that we educate high school students about this is different from the way we educate elementary school students for a reason. We’re not trying to induce curiosity. We don’t want to have the opposite effect of a counter effect. So, I would just encourage everyone, please review the health ed content standards for elementary age students, the way that we talk about medication misuse versus the way that we talk about illicit opioids in middle and high school.
Jennifer Loeffler-Cobia:
I love that. Thank you for sharing. I really appreciate you talking about, and again, kind of going back to the different hats that we wear. We can’t work on this epidemic in silos. We have to work in a system and work together because we’re all trying to address this and making sure we’re not duplicating resources or we’re identifying gaps in resources. And so I really appreciate you sharing that as well. And then also the myths, right? There’s a lot of myths out there. So it’s really good to, we all have to do our due diligence in understanding what is fact and what is myth so that we can then work within her communities in a meaningful way. So yeah, you talked a lot about policies as well within California, any of those different policies in different states. So I just want to know what’s some of the challenges that have kind of arisen in terms of implementing some of California’s new policies?
Stephan Lambert:
So it’s really, I don’t know that I would say challenges, just complications perhaps. So with the new ruling around students being able to carry naloxone on campus, there’ve been a lot of questions about, well, are we supposed to give it to the students that they carry it on campus? Are we supposed to train them? So there wasn’t anything in the ED code about that. So that’s raised a lot of questions about how do we avoid presenting new liabilities and things like that. And so that’s come up a bit with the AB 2429, which mandated that fentanyl education for those who have health class. It’s an interesting iteration of how sort of health education policy has been going where with California Health Youth Act and SB 224 mandating mental health education. There are certain things that all students have to get, and then there are certain things that just students with health class have to get, and it’s getting a little bit fragmented. And that does, for those of us who work in health education, we’re always a little reluctant, like, oh no, who’s this going to fall upon? And then what structures and funding exist to support this? So it’s really just more questions about how this rollout is going to work. So it remains to be seen.
And unfortunately or fortunately, that’s up to all of us that are working in the field. A policy is only as good as its implementation a lot of times. So it’s good to ask questions and really understand how can we implement in the best meaningful way that’s going to get us the outcomes that we want and overall lives. So really great insights there. So just last question I have for us to chat about is through all of this. Yes, obviously we’re in the middle of an overdose epidemic. We’ve got, I talked about numerous different opioids and opioids at the beginning of this session. We’re not just talking about fentanyl. There’s other things that we need to be aware of. So even with what we’re going through with this complex public health issue, I feel like there’s always lessons learned that we can find and put into positive change. So what kind of opportunities do you see that are emerging or have emerged in your school district that really creates that meaningful positive change?
Yeah, I will say that what fentanyl did is it did start a lot of conversation. This being all over the news and social media brought into the fold a lot of people who maybe weren’t even thinking wasn’t on their radar, substance use, prevention and health. I think this is a great opportunity to just further de-stigmatize addiction and treatment. We can increase the access to medication assisted treatment, we can strengthen our health education, make it clear we all need to talk about this. This isn’t a stick. This doesn’t have to be a stigmatized issue. And there’s also just new funding opportunities and ways to think about how we braid our structures. Like I mentioned, a lot of my work is tobacco use prevention. And so finding ways that we can leverage our contacts or share space with the tope programs to address opioids. And also some of the new funding structures like the Children and Youth Behavioral Health Initiative.
I did want to plug that to let them know. There’s a couple of things I just wanted to drop in the chat there. Our TUPE program is going to be hosting a mental health and TUPE webinar series, and our third session is going to be about the fee schedule and how that can be leveraged for supporting the health of our students related to substance use. And then Wellness Together had a great webinar and has a resource available as well about the fee schedule. I’m not an expert on the fee schedule, so I’d never pretend to be. But there are just increasing opportunities where we can make incremental differences in what we’re able to offer to students because again, this is an opportunity for us to take stock of, are we doing everything we can to keep this non-stigmatized and to break down the doors so that young people can thrive. So on that side of things, there are some positive aspects.
Jennifer Loeffler-Cobia:
I love that. I love the conversation. I love being able to have open conversations, like I said before, not working in silos that we’re reaching across different organizations, working together, collaborating. I’ve seen a lot of that starting to happen, and I really appreciate you talking about reducing the stigma. This is a substance use disorder, just like any other kind of disease or disorders that we’re dealing with. So thank you for all of your insights for answering the questions and just having the conversation. And I know that we’ll have office hours to be able to further the conversation with any folks that want to learn more about Narcan or training or how to distribute or the different policies and things. So feel free all of the attendees to reach out. Derek, I think we just have maybe one minute if there’s any lingering questions.
Derek Lowry:
Yeah, that was great. And I think we only have one minute, and then we need the five minutes to close and do a webinar poll. So I do want to note that we have office hours next week, and we’ve got several great questions. Please come to the office hours and we can answer those questions there. But maybe one question, will there be any funding for local education agencies regarding the new policy mandates?
Stephan Lambert:
So the ones that, there are some of them that have funding tied to it, like the naloxone distribution, but for most of them, I don’t think there were changes in funding that was supplied, which again becomes a structural issue of like, okay, well, who’s going to provide the PD and things like that. So unfortunately, I think, yeah, not that I know of for some of these policy mandates, but thankfully, as far as naloxone and test trips and things like that, they’re all available at no cost through the state.
Derek Lowry:
Okay, thank you. There’s some great questions here and I would just emphasize again, to come to the office hours next week to have them answered. I’m sorry that we couldn’t get to them all.
Jennifer Loeffler-Cobia:
Perfect.
Laura Buckner:
Yeah. And yes, I’ll share in just a second the slide that has the details of the office hour coming up. But I just wanted to first of all say thank you everyone for joining us today. Thank you, Derek and Jennifer, and especially Stephan for all of the resources and information that you all shared. There is going to be a very brief Zoom poll popping up soon. Please take a few minutes to let us know how we did. We hope we answered some of questions and provided some insights. And those resources. I just know Stephan, people are already accessing them and planning on using them. So thank you so much again for sharing those. As I mentioned in the beginning, this session was a part of a series of virtual sessions related to the Stronger Connections grant. These are available to all educators in California. And our next one will be on April 23rd.
And we’ll share strategies and perspectives on igniting youth engagement. And actually, it kind of pairs nicely with this session because one of the examples that will be shared, and that webinar is going to be a youth-driven effort to address and remediate with peers, other students in their district who have had drug use issues. And so you can see how this is happening with some youth engagement as well as among other examples, but that’s one of them that I think folks today might be particularly interested in attending that for. So mark your calendars. You’ll be receiving invites because we have your email addresses now that you’ve all registered for this one. And we’ll be letting you know when you can register, but that’ll be on April 23rd. I’ll mention again that this session was recorded, and we’ll send a notification to everyone here today once it’s posted.
In addition to links to the slides and all of the resources that were shared, these are the details of our office Hour. Again, that’s going to be on April 23rd. If you’d like to follow up with our presenters, please plan on attending, and everybody here today will receive a calendar invitation with the link to join that. It’ll be over Zoom, and please feel free to contact us. We have a CDE and a WestEd email set up to support Stronger Connections grantees and attendees of this session. You can feel free to email both of those and we’ll figure out the best way to respond. So again, please continue filling out that feedback poll. Derek, Jennifer, Stephan, thank you again for spending your time with us today. We really appreciate it and we hope everybody goes out and has a nice afternoon.
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