On a Saturday afternoon last year, more than a dozen teenagers gathered in Denver to learn about naloxone, a medicinal nasal spray that can reverse an overdose of the synthetic drug fentanyl and other opioids.
An expert from Denver Health led the group in discussing which specific drugs are considered opioids and how to identify the telltale signs of an overdose, like clammy or cold skin, a limp body, and lips and fingernails that look purple or blue. The teens also learned how to administer the nasal spray, commonly known by the brand name Narcan, and then put their newfound knowledge to use practicing how exactly they would do it in the event of an emergency.
It’s scary stuff, but for many teens, it’s necessary knowledge in today’s world.
Suyash Shrestha, then a senior at Stargate School in Thornton, attended the event, but it wasn’t his first training. Shrestha spent much of his high school years trying to spread awareness about the concept of harm reduction to people his age. Harm reduction provides teenagers with honest information about drugs, along with advice for those who already use them about strategies for doing so more safely.
“Harm reduction is something that not a lot of teens or youth even think about or even know exists,” Shrestha said in an interview. “It ultimately creates that safer environment for the people who do need that information or do need those resources to come forward and get them… That’s why we should continue pushing for that type of curriculum or education.”
Discussions about naloxone and other harm reduction strategies are becoming more commonplace in Colorado classrooms, as teachers and institutions seek to educate students against the backdrop of sweeping state drug reform and an ongoing fentanyl crisis nationwide. However, this is hardly the norm.
Drug education, once ubiquitous in schools through the D.A.R.E. program, has struggled to find its footing in recent decades, even as changing cultural attitudes prompted marijuana legalization in many states across the country. In Colorado, a lack of consensus about approach and the logistical challenges of implementing curriculum have led to a patchwork of strategies where local control — which leaves it up to individual districts to decide the specifics of their health curricula — is the only standard.
The Denver Post is publishing a three-part series exploring why drug education has been slow to keep pace with the legalization of drugs like cannabis and psilocybin, and the ubiquity of deadlier substances like opioids. In the wake of the “Just Say No” movement of the 1980s and ’90s and a subsequent opioid epidemic, many local educators and organizations are embracing new philosophies about how to equip kids with the tools and information they need to lead successful lives.
Experts say drug education needs to be a more holistic endeavor — one that sees educators, community leaders, parents and youth working together to address the underlying causes of drug use and support healthier outcomes. For a generation of kids who have the world’s information at their fingertips, effective education must ditch fear tactics and instead rely on factual information presented honestly and transparently, they say, so that youth can make their own informed decisions.
As a member of the Rise Above Colorado’s Teen Action Council and Northglenn’s Youth Commission, Shrestha’s passion stems from hearing personal stories of Coloradans overdosing on synthetic opioids and from wanting to help anyone who might find themselves in a similar situation. After he first learned there was a medication that could literally save lives, Shrestha thought everyone deserved to know about it, including teens and other students.
Carrying naloxone was one way Shrestha saw he could potentially make a difference, and by teaching others to do so, he hoped to inspire his peers to be part of something meaningful — so that ultimately they make fewer harmful personal choices.
From ‘Just Say No’ to ‘just say nothing’
Putting trust into the hands of school students is a stark departure from historical norms. Traditionally, Americans have relied on school-based curricula and fear-based educational campaigns that aim to scare kids straight.
Stigmatizing drug and alcohol use as a black-and-white moral issue has a long legacy in the U.S., said Steve Sussman, professor of population and public health sciences at the University of Southern California. In the late 1800s and early 1900s, books such as “Safe Counsel, or, Practical Eugenics” and “Searchlights on Health” advocated bettering oneself and society by embracing purity, resisting temptation and finding a suitable partner.
The books, which were influential at the time, depicted two life paths for young men and women: They either grow up to be honest, decent citizens or, conversely, end up becoming degenerates depending on their life choices. For example, if boys decided to study and embrace purity, they would grow up to be honorable and venerable. However, if they choose to smoke cigarettes and drink alcohol, they would become moral and physical wrecks.
“There was nothing in between,” Sussman said. “For females, you’d either go the route of becoming a good mom, or you could end up going on the road to coquetry.”
Moral judgments like these became part of the school curriculum in the late 19th century, as the temperance movement gained momentum toward its goal of total abstinence. By 1901, the Woman’s Christian Temperance Union had successfully lobbied every state in the union to mandate its Scientific Temperance Instruction in schools. The curriculum — which it’s worth noting was criticized by scientists at the time — asserted alcohol was “a dangerous and seductive poison” and promoted total abstinence as the only solution for mental, moral and physical well-being.
Scientific Temperance Instruction waned after Prohibition ended in 1933, but fear tactics remained a hallmark of campaigns to combat drug use and abuse.
In 1936, the film “Reefer Madness” warned parents about the dangers of marijuana, a “frightful assassin of our youth” more threatening than opium, morphine and heroin. Three decades later, in 1963, that narrative persisted when a presidential commission called for an educational campaign to warn teenagers that “although the use of a drug may be a temporary means of escape from the world about him, in the long run these drugs will destroy him and all that he aspires to.”
The most famous effort, though, is D.A.R.E., or Drug Abuse Resistance Education. Started in 1983 as a partnership between the Los Angeles Police Department and the Los Angeles Unified School District, it leveraged uniformed officers lecturing classrooms about various substances they saw on the job.
The goal was to teach kids to “Just Say No” to drugs, gangs, violence and peer pressure, echoing the country’s first lady at the time, Nancy Reagan. And it caught on quickly with the adults in power.
By 1994, D.A.R.E. was the most widely used school-based prevention program, reaching an estimated 5.5 million fifth graders in more than 60% of the nation’s school districts that year alone, according to the U.S. Department of Justice. The program continued to grow, and by 2009, it appeared in 75% of U.S. school districts.
Despite its popularity, though, studies showed that D.A.R.E. wasn’t effective and that program participants were just as likely to use drugs as non-participants. In some cases, it had the opposite of its intended effect.
After developing a new curriculum in the early aughts, called Take Charge of Your Life, researchers at the University of Akron in Ohio found that seventh graders and ninth graders who went through the program from 2001 to 2006 experienced higher rates of cigarette and alcohol use by 11th grade compared to a control group, and there was no reported change in active marijuana use. One positive effect was that seventh graders who used marijuana at the time they went through the program were less likely to continue doing so by 11th grade, the study found. In response to criticism, D.A.R.E. America retooled its curriculum for elementary and middle school students, starting in 2009.
D.A.R.E. still exists today, though curricula focus more on social-emotional learning and “helping kids learn to make healthy and safe decisions for a better life,” said regional director Dennis Osborn. Core lessons no longer include information about specific drugs, he added, though there are specialized units dedicated to vaping, fentanyl/opioids and marijuana.
About 2,000 law enforcement agencies currently participate in the program compared to around 7,500 at its height, according to Frank Pegueros, CEO of D.A.R.E America.
However controversial the content, D.A.R.E. provided the infrastructure, training and standardization necessary for drug education to proliferate widely. When that structure began to be dismantled in the 2010s, though, school-based drug education faltered, effectively leaving the generation of kids that followed to navigate the waters on their own.
“We went from ‘Just Say No’ to ‘just say nothing,’” said Rhana Hashemi, a social psychology researcher at Stanford University and founder of Know Drugs, which helps schools implement harm reduction education programs.
At the same time, a lethal substance was gaining traction. From 1999 to 2023, approximately 806,000 people died from an opioid overdose, with a significant increase in the number of deaths attributable to illegally made fentanyl and fentanyl analogs saturating the illicit drug supply over the course of the last decade, according to the Centers for Disease Control. Overdose fatalities involving synthetic opioids (excluding methadone) increased from 3,105 in 2013 to 72,776 in 2023, accounting for 91.7% of all opioid-related deaths that year, the CDC reported.
The widespread tragedy galvanized parents and politicians, who realized the pervasive “just say nothing” culture wasn’t cutting it.
Making their own decisions
The reason D.A.R.E. didn’t work, Hashemi said, is because of a cognitive dissonance between the messaging and what kids saw in real life. Warnings about the negative outcomes like overdoses, “brain rot” and addiction simply didn’t resonate. That paradox persists in prevention-focused social media campaigns today, according to a study Hashemi published in 2024.
“It’s a similar thing that’s happening now online, where our PSAs are still stuck in an abstinence-only mindset emphasizing these very serious consequences. But those messages are coming up alongside kids having fun and glamorizing their use,” Hashemi said.
That’s why Hashemi and other experts advocate providing teenagers with honest information about drugs and safer use strategies, known as harm reduction. “I would define it as both a set of strategies and knowledge, but also a philosophical attitude in how we should address things,” she said. “Our goal is not net sum prevention of use, it’s prevention of harms.”
For example, it’s helpful to know that a single serving of alcohol varies depending on whether you’re drinking beer, wine or liquor. That way, if young people choose to drink, they have a better understanding of how much they’re consuming.
“Young people are going to make their own decisions,” said Marsha Rosenbaum, a sociologist and harm reduction expert. “So we need to acknowledge that even if we don’t like the decisions they’re making.”
Rosenbaum helped introduce parents to the idea of harm reduction through a series of booklets entitled “Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education,” the first of which was released in 1999. Harm reduction was something of a taboo topic in the ‘90s, she said. And in many ways, it still is today.
Luke Niforatos, executive vice president of advocacy organization Smart Approaches to Marijuana, believes that harm reduction has gone too far in normalizing substance use and abuse, and that it often sends the wrong message to America’s youth. While he supports making naloxone more accessible, other safer use initiatives, like supervised needle injection sites, do little to help drug users get treatment or work toward recovery, he said.
Conversations about beverages’ specific alcohol content, marijuana edible standard dosing and onset times, and the potentially therapeutic benefit of things like cannabidiol should be the responsibility of parents — not schools — Niforatos added.
“I understand there has to be some level of teaching in the schools, but you have to be really careful about that line because, at the end of the day, it quickly traverses over the line into teaching someone how to use instead of educating them,” he said. “I think the message needs to start with ‘do not use’ and then support that message with evidence.”
Rosenbaum and other advocates dispute that characterization. Abstinence is part of harm reduction — in fact, it’s the safest strategy of them all, she said. But presenting critical information about drugs in a nonjudgmental tone opens the door for trust building with kids and ultimately empowers them to make more informed choices, supporters say.
In a sign that public attitudes are changing, Rosenbaum turned “Safety First” into a comprehensive drug education and intervention school curriculum in 2017. It was subsequently acquired and revised by Stanford University’s REACH Lab in 2023, and is now available for schools to use for free. With lessons about cannabis, hallucinogens, e-cigarettes, opioids and more, public health experts hope Safety First can help set a new standard for evidence-based classroom instruction. The second lesson in the curriculum provides an introduction to harm reduction.
More than 629 schools across at least 46 states have used the curriculum, including schools within 15 Colorado districts, said Bonnie Halpern-Felsher, director of the REACH Lab. She estimates Safety First has reached more than 50,000 students, though it may be more than that since the curriculum is available for free online.
In broader efforts to prevent opioid deaths, naloxone has become widely available nationwide at hospitals, schools and even vending machines without a prescription. In Colorado, social media campaigns encourage young adults to “keep the party safe” by carrying the overdose reversal medication and testing their drugs for fentanyl.
Hashemi is encouraged by this shift, but she believes harm reduction needs to expand both beyond opioids and beyond the classroom. She hopes momentum continues and drug education addresses other prominent issues teens are dealing with, such as nicotine addiction and bad trips from psychedelics. She also wants to see social media campaigns, public service announcements and other digital campaigns reach kids online, where they already spend a lot of time. (A 2024 study suggests video and computer games are cost-effective interventions to explore.)
“When you expose the kids themselves to harm reduction education, they run with it,” Hashemi added. “But if we do not use fentanyl as a Trojan horse to do harm reduction around all drugs, this moment is going to sort of pass us, and we’re not going to be giving kids the comprehensive education that they’ve always deserved.”
This series was reported with support of the Ferriss-UC Berkeley Psychedelic Journalism Fellowship.