Medical Marijuana Update

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According to the National Institutes of Health, people have used marijuana, or cannabis, to treat their ailments for at least 3,000 years. However, the Food and Drug Administration have not deemed marijuana safe or effective in the treatment of any medical condition, although cannabidiol, a substance that is present in marijuana, received approval in June 2018 as a treatment for some types of epilepsy.

This tension, between a widespread belief that marijuana is an effective treatment for a wide assortment of ailments and a lack of scientific knowledge on its effects, has been somewhat exacerbated in recent times by a drive toward legalization.

Twenty-nine states plus the District of Columbia have now made marijuana available for medical — and, in some states, recreational — purposes.

A recent study published in the journal Addiction also found that use of marijuana is increasing sharply across the United States, although this rise may not be linked to the legalization of marijuana in participating states. Nevertheless, this rise in use is prompting major public health concerns.

In this article, we look at the scientific evidence weighing the medical benefits of marijuana against its associated health risks in an attempt to answer this simple question: is marijuana good or bad?

What are the medical benefits of marijuana?

Over the years, research has yielded results to suggest that marijuana may be of benefit in the treatment of some conditions. These are listed below.

Chronic pain

Last year, a large review from the National Academies of Sciences, Engineering, and Medicine assessed more than 10,000 scientific studies on the medical benefits and adverse effects of marijuana.

One area that the report looked closely at was the use of medical marijuana to treat chronic pain. Chronic pain is a leading cause of disability, affecting more than 25 million adults in the U.S.

The review found that marijuana, or products containing cannabinoids — which are the active ingredients in marijuana, or other compounds that act on the same receptors in the brain as marijuana — are effective at relieving chronic pain.

Alcoholism and drug addiction

Another comprehensive review of evidence, published last year in the journal Clinical Psychology Review, revealed that using marijuana may help people with alcohol or opioid dependencies to fight their addictions.

But this finding may be contentious; the National Academies of Sciences review suggests that marijuana use actually drives increased risk for abusing, and becoming dependent on, other substances.

Also, the more that someone uses marijuana, the more likely they are to develop a problem with using marijuana. Individuals who began using the drug at a young age are also known to be at increased risk of developing a problem with marijuana use.

Depression, post-traumatic stress disorder, and social anxiety

The review published in Clinical Psychology Review assessed all published scientific literature that investigated the use of marijuana to treat symptoms of mental illness.

Evidence to date suggests that marijuana could help to treat some mental health conditions.

Its authors found some evidence supporting the use of marijuana to relieve depression and post-traumatic stress disorder symptoms.

That being said, they caution that marijuana is not an appropriate treatment for some other mental health conditions, such as bipolar disorder and psychosis.

The review indicates that there is some evidence to suggest that marijuana might alleviate symptoms of social anxiety, but again, this is contradicted by the National Academies of Sciences, Engineering, and Medicine review, which instead found that regular users of marijuana may actually be at increased risk of social anxiety.

Cancer

Evidence suggests that oral cannabinoids are effective against nausea and vomiting caused by chemotherapy, and some small studies have found that smoked marijuana may also help to alleviate these symptoms.

Some studies on cancer cells suggest that cannabinoids may either slow down the growth of or kill some types of cancer. However, early studies that tested this hypothesis in humans revealed that although cannabinoids are a safe treatment, they are not effective at controlling or curing cancer.

Multiple sclerosis

The short-term use of oral cannabinoids may improve symptoms of spasticity among people with multiple sclerosis, but the positive effects have been found to be modest.

Epilepsy

In June 2018, the Food and Drug Administration (FDA) approved the use of a medication containing cannabidiol (CBD) to treat two rare, severe, and specific types of epilepsy — called Lennox-Gastaut syndrome and Dravet syndrome — that are difficult to control with other types of medication. This CBD-based drug is known as Epidiolex.

CBD is one of many substances that occurs in cannabis. It is not psychoactive. The drug for treating these conditions involves a purified form of CBD. The approval was based on the findings of research and clinical trials.

A study published in 2017 found that the use of CBD resulted in far fewer seizures among children with Dravet syndrome, compared with a placebo.

Dravet syndrome seizures are prolonged, repetitive, and potentially lethal. In fact, 1 in 5 children with Dravet syndrome do not reach the age of 20 years.

In the study, 120 children and teenagers with Dravet syndrome, all of whom were aged between 2 and 18, were randomly assigned to receive an oral CBD solution or a placebo for 14 weeks, along with their usual medication.

Research indicates that marijuana could help to treat epilepsy.

The researchers found that the children who received the CBD solution went from having around 12 seizures per month to an average of six seizures per month. Three children receiving CBD did not experience any seizures at all.

Children who received the placebo also saw a reduction in seizures, but this was slight — their average number of seizures went down from 15 each month before the study to 14 seizures per month during the study.

The researchers say that this 39 percent reduction in seizure occurrence provides strong evidence that the compound can help people living with Dravet syndrome, and that their paper has the first rigorous scientific data to demonstrate this.

However, the study also found a high rate of side effects linked to CBD. More than 9 in 10 of the children treated with CBD experienced side effects — most commonly vomiting, fatigue, and fever.

The patient information leaflet for Epidiolex warns of side effects such as liver damage, sedation, and thoughts of suicide.

What are the health risks of marijuana?

At the other end of the spectrum is the plethora of studies that have found negative associations between marijuana use and health. They are listed below.

Mental health problems

Daily marijuana use is believed to exacerbate existing symptoms of bipolar disorder among people who have this mental health problem. However, the National Academies of Sciences, Engineering, and Medicine report suggests that among people with no history of the condition, there is only limited evidence of a link between marijuana use and developing bipolar disorder.

Moderate evidence suggests that regular marijuana users are more likely to experience suicidal thoughts, and there is a small increased risk of depression among marijuana users.

Marijuana use is likely to increase risk of psychosis, including schizophrenia. But a curious finding among people with schizophrenia and other psychoses is that a history of marijuana use is linked with improved performance on tests assessing learning and memory.

Testicular cancer

Although there is no evidence to suggest any link between using marijuana and an increased risk for most cancers, the National Academies of Sciences did find some evidence to suggest an increased risk for the slow-growing seminoma subtype of testicular cancer.

Respiratory disease

Regular marijuana smoking is linked to increased risk of chronic cough, but “it is unclear” whether smoking marijuana worsens lung function or increases the risk of chronic obstructive pulmonary disease or asthma.

A 2014 study that explored the relationship between marijuana use and lung disease suggested that it was plausible that smoking marijuana could contribute to lung cancer, though it has been difficult to conclusively link the two.

The authors of that study — published in the journal Current Opinion in Pulmonary Medicine — conclude:

“There is unequivocal evidence that habitual or regular marijuana smoking is not harmless. A caution against regular heavy marijuana usage is prudent.”

“The medicinal use of marijuana is likely not harmful to lungs in low cumulative doses,” they add, “but the dose limit needs to be defined. Recreational use is not the same as medicinal use and should be discouraged.”

So, is marijuana good or bad for your health?

There is evidence that demonstrates both the harms and health benefits of marijuana. Yet despite the emergence over the past couple of years of very comprehensive, up-to-date reviews of the scientific studies evaluating the benefits and harms of the drug, it’s clear that more research is needed to fully determine the public health implications of rising marijuana use.

More research is needed to confirm the harms and benefits of marijuana use.

Many scientists and health bodies — including the American Cancer Society (ACS) — support the need for further scientific research on the use of marijuana and cannabinoids to treat medical conditions.

However, there is an obstacle to this: marijuana is classed as a Schedule I controlled substance by the Drug Enforcement Administration, which deters the study of marijuana and cannabinoids through its imposition of strict conditions on the researchers working in this area.

If you happen to live in a state where medical use of marijuana is legal, you and your doctor will need to carefully consider these factors and how they relate to your illness and health history before using this drug.

For instance, while there is some evidence to support the use for marijuana for pain relief, you should certainly avoid marijuana if you have a history of mental health problems.

The Risks of Meth Usage

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Methamphetamine (meth) is a powerful, highly addictive drug that causes devastating health effects, and sometimes death, even on the first try.

Meth is easy to get addicted to and hard to recover from. Meth is a dangerous, synthetic, stimulant drug often used in combination with other substances that can be smoked, injected, snorted, or taken orally. Someone using meth may experience a temporary sense of heightened euphoria, alertness, and energy. But using meth changes how the brain works and speeds up the body’s systems to dangerous, and sometimes lethal, levels—increasing heart rate, blood pressure, body temperature, and respiratory rate. Chronic meth users also experience anxiety, confusion, insomnia, paranoia, aggression, visual and auditory hallucinations, mood disturbances, and delusions.

The Rise of Meth Use in the United States

The number of fatal overdoses involving meth has more than tripled (PDF | 336 KB) between 2011 and 2016, according to the CDC. Use is also on the rise between 2016-2018 for most age groups. In 2018, more than 106,000 adults aged 26 or older used meth—a 43 percent increase over the previous year.

Short-term Effects of Meth

Even taking small amounts of meth, or just trying it once, can cause harmful health effects, including:

  • Increased blood pressure and body temperature
  • Faster breathing
  • Rapid or irregular heartbeat
  • Loss of appetite, disturbed sleep patterns, or nausea
  • Bizarre, erratic, aggressive, irritable, or violent behavior

Long-term Health Risks of Meth

Chronic meth use leads to many damaging, long-term health effects, even when users stop taking meth, including:

  • Permanent damage to the heart and brain
  • High blood pressure leading to heart attacks, strokes, and death
  • Liver, kidney, and lung damage
  • Anxiety, confusion, or insomnia
  • Paranoia, hallucinations, mood disturbances, delusions, or violent behavior (psychotic symptoms can sometimes last for months or years after quitting meth)
  • Intense itching, causing skin sores from scratching
  • Severe dental problems (“meth mouth”)

Need Help?

With the right treatment plan, recovery is possible. If you, or someone you know, needs help with a substance use disorder, including meth use, call SAMHSA’s National Helpline at 1-800-662-HELP (4357) or TTY: 1-800-487-4889, or use SAMHSA’s Behavioral Health Treatment Services Locator to get help.

How to Use Naloxone to Reverse Opioid Overdose and Save Lives

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NALOXONE SAVES LIVES

A variety of drugs and drug combinations carry the risk of fatal overdose. Emergency protocol for any suspected overdose includes calling 911. However, in the case of opioids, which includes heroin and prescription pain medications like Vicodin, OxyContin and Percocet, naloxone (also known by the brand name Narcan) can reverse an overdose, potentially saving a loved one’s life.

What Puts One at Risk for Overdose?

Anyone using opioids, whether for recreational purposes or otherwise, can be at risk for overdose. Other risk factors include:

  • Using or taking drugs alone
  • Mixing opioids with other drugs like alcohol, benzodiazepines (e.g., Xanax and Ativan) and prescription stimulants (e.g., cocaine and Adderall)
  • Having lower tolerance due to recent detox/drug treatment, incarceration or illness
  • Not knowing what drugs one is consuming (e.g. using heroin cut with fentanyl)

Know the Signs of an Overdose

An overdose can happen when the amount ingested causes suppressed breathing in a way that oxygen can’t reach vital organs, and the body begins to shut down. It’s important to note that an overdose can occur anywhere from 20 minutes to 2 full hours after drug use. Signs of an overdose include:

  • Face is clammy to touch and has lost color
  • Blue lips and fingertips
  • Non-responsive to his/her name or a firm sternum rub using the knuckles
  • Slow or erratic breathing, or no breathing at all
  • Deep snoring or a gurgling sound (i.e. what would be described as a “death rattle”)
  • Heartbeat is slow or has stopped

What To Do if You Suspect an Overdose

1. Call 911

If you suspect an overdose and your loved one is unresponsive, call 911. If you must leave the person alone to make the call, put them in the recovery position — on their side with the bottom arm under the head and top leg crossed over the body (see image below). This is to avoid aspiration if he or she vomits. Give the address or location and as much information as you can (i.e., unconscious, not breathing, drugs used if known, etc.).

how to administer auto-injector naloxone for opioid overdose
2. Administer Naloxone

Note that naloxone is only effective in the case of an opioid overdose. However, if you are unsure of the substance(s) involved, it’s best to err on the side of caution and administer it. Naloxone is not known to cause any harm in the case of a non-overdose.

3. Conduct Rescue Breathing

If the person has labored breathing or is not breathing at all, it is vital to conduct rescue breathing. Tilt the head back, pinch the nose closed and give one slow breath every 5 seconds until the person resumes breathing on their own or until the paramedics arrive. Watch to see that their chest rises and falls with each breath.

4. Comfort and Support

Once the person is breathing on their own, place them in the recovery position until paramedics arrive. Comfort the person as he or she may be confused, upset and going through withdrawal (feeling sick from a lack of opioids if their body is dependent on them) when revived. Do not allow him or her to use drugs.

5. Aftermath of an Overdose

Once your loved one has been stabilized, this may be an opportunity to suggest detox and treatment. Contact the Partnership for Drug free Kids free Parent Helpline at 1-855-378-4373 to speak with a trained counselor and begin getting the help your family needs.

How to Administer Naloxone

Naloxone is administered as a nasal spray or via injection, depending on which of the following devices it has been prepared for and packaged with.

1. Evzio auto-injector

With U.S. Food and Drug Administration (FDA) approval in 2014, this was the first auto-injector approved for non-clinical settings. The auto-injector administers a single dose of naloxone with a retractable needle, avoiding accidental needles sticks and any additional assembly. To use, place the black end against the middle of the person’s outer thigh, through clothing (pants, jeans, etc.) if necessary, then press firmly and hold in place for 5 seconds. For extra reassurance, the device has a voice recording that provides step-by-step instructions as you go, including letting you know once it’s OK to stop applying pressure and remove from the person’s thigh.

2. Narcan Nasal Spray

Narcan Nasal Spray is the most recent FDA approved naloxone product. It is very easy to use. There is nothing to assemble and each package comes with two devices prefilled with a single dose each. Simply hold the device with your thumb on the bottom and your first and middle fingers on either side of the nozzle. Gently insert the nozzle into one nostril until your fingers on either side of the nozzle are against the bottom of the person’s nose. Once in place, press the plunger firmly to spray the entire dose of Narcan into one nostril. There is no need to spray into both nostrils.

3. Injection via syringe

Injecting into the muscle of the upper thigh or upper arm with a syringe is also a very common way to administer naloxone. Many naloxone kits come with a syringe and a vial or a pre-filled cartridge of naloxone. The shot can be administered through clothes.

Talk to your pharmacist about the proper dose for naloxone. 0.4 mg/mL is commonly recommended. A second dose of 0.4 mg/mL is sometimes needed, however, if the first dose does not reverse the overdose and restore breathing.

Frequently Asked Questions

Where can I get naloxone?
In addition to some independent drugstores, Walgreen’s, CVS, Rite Aid, Target and Wal-Mart are providing naloxone in many states through their pharmacies without requiring a prescription. You can also find training programs and naloxone here.

Will naloxone help if the person overdosed on drugs other than opioids?
No, it only works to reverse an overdose involving opioids.

If I don’t know what the person used, should I administer naloxone anyway?
Yes, naloxone is a very safe drug and will not adversely impact someone who has overdosed on other drugs or alcohol.

I’ve heard friends say that a cold shower, coffee or other stimulants can help with an overdose. Should I try that?
No, if someone is in respiratory distress the best course of action is to call 911 and administer naloxone along with rescue breathing.

If the person begins breathing on their own after giving them naloxone, why should I bother calling 911?
Naloxone only last for 30 to 90 minutes so it’s possible that the person could go into respiratory arrest again due to the opioids still in their system. Medical professionals can help provide the necessary treatment to prevent respiratory failure.

I’ve heard that fentanyl is so powerful that 1 or 2 doses of naloxone may not be enough. Is that true?
Yes, overdoses involving fentanyl may require repeated administrations of naloxone to restore breathing.

My son is in rehab and I expect that he will be committed to recovery when he gets out, so why do I need to get a naloxone kit?
The relapse rate associated with opioid use has been estimated to be as high as 90 percent. 1 As a precautionary measure, it’s important to have naloxone in the home. Just as you don’t anticipate having a fire, you probably have a smoke detector in the home – this is the same kind of precautionary measure that you hope you never have to use.

Won’t the person who overdosed be arrested for possession and potentially other charges if 911 is called and the police arrive?
Many states have passed overdose prevention laws, which support treatment instead of arrests. Check your state’s laws.

What legal protections are there for the person administering the naloxone so that if something goes wrong, they aren’t held responsible?
Most states have passed Good Samaritan Laws for the protection of the person administering the naloxone. Check your state’s laws.

If I don’t have any naloxone and someone has overdosed, what should I do?
Call 911 and perform rescue breathing until the paramedics arrive.

What’s the price and availability of Naloxone?
Price and availability vary. However, some formulations, including the most expensive, are increasingly covered by insurance policies. In some states, insurers still only cover naloxone for patients — people who are taking/using opioids. In other states, insurance will also cover naloxone for third parties (e.g. concerned family or community members). Contact your insurer, pharmacist or Health Department to find out what is covered in your state.

Even when insurance is not available, some manufacturers will provide naloxone at no charge for people who cannot purchase it through insurance or other means if requested by their physician. Contact the manufacturer’s website – such as Evzio or Narcan – for information on these programs.

Does naloxone expire?
There is an expiration date on naloxone, however research indicates that it can be effective well beyond the expiration date on packaging; in some cases months and years later. The safest practice is to get a replacement (setting a reminder on your phone’s calendar) but in the case of an emergency, it’s better to use an expired dose than to not administer anything.

Will naloxone go bad if it is stored in a place that’s too hot or cold?
Yes, check the packaging to see what temperature range is recommended. Generally, room temperature is advised.

If I keep naloxone in the house, won’t my child think that he or she can use more drugs because there’s an antidote available?
There are no studies that indicate increased usage due to having naloxone available. Think of having Naloxone around as you would a first-aid kit. It’s always best to err on the safe side and be prepared in case of emergency.

5 Ways to Process the Death of a Friend in 12-Step Recovery

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1) Respect the Spiritual Principle of Anonymity

The 12th Tradition of Alcoholics Anonymous states: “Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities.” The majority of 12-step fellowships have adopted this tradition. In the digital age of mobile technologies and the internet, anonymity needs to be respected beyond the original boundaries of “press, radio, and films.” 

Although many people, including myself, are quite open about sobriety on social media, others are strict about maintaining anonymity. When a sober friend dies, you may be tempted to post a tribute on their Facebook page, letting the world know that they died sober. Resist the temptation. By taking such an action, you could be violating their anonymity, and revealing something to family or co-workers that they would prefer to have kept anonymous. Also, don’t automatically assume you know all the details, which brings us to number 2.

2) Never Presuppose a Relapse or Speculate on Causality

Sadly, people in recovery sometimes return to drug and alcohol use, and sometimes it results in death. However, when a sober friend dies, until you know for sure from a medical report or similar legitimate source, you shouldn’t speculate on whether or not they relapsed. Such speculation is nothing more than gossip, even if you don’t intend it to be. As Aesop wrote in a fable and Thumper later adopted as his motto, “If you can’t say anything nice, then don’t say anything at all.” 

Even if someone did die as a result of a relapse, do not act like the “wise” sage. It’s not your job to use that knowledge to warn others. Such an attitude raises you above the emotional reality and places your sobriety on a pedestal. And imagine if you are wrong. Then, not only have you damaged a sober friend’s legacy, you have hurt yourself by telling such a story. In these cases, better safe and kind than sorry and foolish. As a member of a 12-step fellowship, I don’t want to point fingers or take other people’s inventories. I don’t want judgment to consume my capacity for love and empathy. 

Instead, focus on the good: What was special about your friend?

3) Be Cautious and Respectful When Speaking to the Family

If you meet a sober friend’s family at a memorial service or funeral organized by them, make sure ahead of time that it’s okay to discuss your friend’s sobriety. Many people remain anonymous even within their own families. They also have friends and co-workers who know nothing about what happened in the past. 

It’s not your job to enlighten everyone about what a great speaker or sponsor your friend was. You will likely end up creating confusion and uncertainty. And if your friend did not disclose his or her participation in a 12-step program, you could be adding to the family’s already-heavy emotional burden. 

If you believe the family may not be aware of a sober friend’s 12-step participation, then come up with a story about how you knew each other. Maybe a book club, a favorite activity, or a past introduction through mutual friends. 

It’s easy to take the focus off of you by talking positively about your friend. You can tell people what a good person he or she was and how much you enjoyed their sense of humor. With my friend who died recently, his family knew about his sobriety and celebrated it. At the same time, people who knew him from 12-step fellowships talked about his business acumen, his lovely smile, and his joking personality. It was not hard to find topics to discuss that were outside of the 12-step context. 

4) Set Up a Separate Memorial for the 12-Step Fellowship to Mourn and Celebrate a Sober Friend

Although it makes sense to attend the family’s funeral or memorial service to show your support by being present, it’s a good idea to set up a separate memorial service as well. This second service can focus on your sober friend’s 12-step community. Often there will be a meeting before this kind of memorial service. Then, in the service, people will openly talk about the person’s role in the fellowship, and what gifts he or she brought to the program. The meeting and the service should both be open so that anyone can attend. When you publicize this event, be careful not to use social media in such a way that violates anonymity. In most cases, word-of-mouth at meetings and personal one-on-one communications should be enough to raise awareness. 

5) Celebrate the Positive and Maintain a Loving Legacy

Once a sober friend is gone, the best way to process that loss is to celebrate the positive. Rather than focusing on the loss, talk about what that person gave to others and their memorable qualities. My sober friend always made a point to offer a seat next to him to newcomers. He made everyone feel welcome. Today, I do my best to maintain that loving legacy by doing what he did. I keep his smile and his love alive by going outside of my comfort zone, following his example, and acting as he did. 

As alcoholics and addicts in 12-step fellowships, we are vulnerable to our character defects, and sometimes end up relapsing as a result of them. The process of getting sober is about progress and not perfection, and we make mistakes and fall back into deeply entrenched negative patterns of behavior. The death of a sober friend reminds us of the real, lasting value of our sobriety. We can celebrate the positive while we grieve the loss. We recommit not only to our recovery, but also to practicing the principles that reflect the best qualities of our departed friend. 

Latest Federal Data on “Deaths, of Despair”

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Here you go folks. The Federal Governments latest study on deaths by alcohol, drugs and suicide. It’s a long document but, a good read full of eye opening info. Just click the following link to be taken directly to the document.

https://wellbeingtrust.org/wp-content/uploads/2019/06/TFAH-2019-YoundAdult-Pain-Brief-FnlRv.pdf

You Can Help Reduce the Opioid Crisis

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You’ve probably heard a lot about our country’s opioid crisis. Stories about it are everywhere: online, in the news, and on social media. You may even personally know a friend or a family member who has been affected.

In the past, when it came to drug deals, the media painted a picture of drug abusers getting an opioid “fix,” during shady transactions. But it’s become clear that very often, people get opioids in a far less ominous way: They take them from someone’s house. The fact is, there’s a staggering amount of prescription opioids in the medicine cabinets and other storage places in households all over America.

When initially taking these drugs, some people may think of this as a form of innocent experimenting, but sadly, many of the next victims you’ll read or hear about—or even know personally—will have died from an overdose of opioids they took from someone else’s prescription bottle.

You can help reduce the impact of this opioid crisis. Here’s how:

  • Tell your friends who may want to experiment in this way that prescription opioids can be just as dangerous as heroin.
  • Tell your parents and family members that it’s not a good idea to keep unused, unwanted, or expired opioids around the house “just in case” they’re needed for pain. The risk is just way too high!

How many prescription opioids are out there? In 2016, retail pharmacies dispensed more than 214 million first-time or refill opioid prescriptions. As many as 9 out of every 10 of these patients report not finishing what has been prescribed to them. That’s a lot of leftover opioid prescription bottles—and every one of them has the potential to kill.

The U.S. Food and Drug Administration (FDA) has developed a simple infographic to walk through the process step by step for drug disposal. Contrary to what a lot of people think, it’s okay to flush the opioids on the FDA’s “flush list” down the toilet. We need to get them out of our homes.

Today, teens are taking on important new leadership roles when it comes to public health topics. Use that same energy to step up and lead another way: Make sure your house is free of unwanted, unused, and expired opioids. Encourage your friends to do the same and let them know that using other people’s opioids can be deadly.

Teens can play a big role in this effort. We, and especially your friends and family, need your help!