Quick Clips with Dr. Kilmer: 08. Framing Fentanyl for Parents

In this series we talk with Dr. Jason Kilmer, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. He specializes in the development, implementation, and evaluation of substance use prevention and intervention efforts on college campuses and among 18–25 year olds.   

While Dr. Kilmer focuses on college campuses, his insights are universal and particularly helpful for parents with teenagers of any age. Share these recordings with your parenting peers as you all navigate this exciting time in human development (ages 14–25) and work to help your kids navigate away from alcohol and other drugs.

This podcast is brought to you by the Substance Abuse and Mental Health Services Administration (SAMHSA). The views expressed here are not necessarily those of SAMHSA or the U.S. Department of Health and Human Services. For questions or comments about this podcast, please contact WhatParentsAreSaying@gmail.com. 

Transcript

Quick Clips with Dr. Kilmer: 08. Framing Fentanyl for Parents

[00:00:00] Debbie: Welcome to Quick Clips with Dr. Kilmer. Today we're talking about fentanyl. What do we need to understand as parents, especially with kids in college where. It's feeling a little scary that our kids are leaving our homes, even if it's not college and maybe encountering this drug. And how can we prepare them?

[00:00:27] What do we need to think? 

[00:00:30] Dr. Kilmer: I don't wanna, uh, know if I, knock on wood, if it'll actually loudly come across for your, your listeners. So I will quietly knock on wood. As I say, the good news is on college campuses for the, the overwhelming majority. Don't set out and say, I'm gonna go use fentanyl tonight.

[00:00:44] That's not something that students are choosing, making the choice to do the intentional use of this very deadly substance is, fortunately, I mercifully a very low frequency behavior. And certainly if there are people using opiates and they are making that choice, it can be a dangerous, uh, and, and frankly, very, very lethal, um, behavior to engage in.

[00:01:08] Some schools have gone out of their way to make sure that people. Know that if there is an overdose, Narcan, Naloxone can be used to reverse an opiate overdose, and so they make sure that people know that if you have a friend that uses opiates, be prepared in case, God forbid there's an overdose and there's something that can actually be done.

[00:01:27] Now what's what can be unfortunately, more likely is the accidental ingestion of something where someone says, Hey, I got this. Adderall, I put it in quotes because maybe it's not Adderall, maybe it's something that's a, a fake pill where when it's actually analyzed, it can have impurities in it, including adulterants, meaning other drugs like fentanyl.

[00:01:51] And what does that mean then? Most of the research that we've seen suggests that students don't start substance use with, I'm gonna go take a pill. It often starts with alcohol or with cannabis slash marijuana use. I was a principal investigator on a study where we looked at interventions to address the non-medical use of prescription A DH, ADHD stimulants.

[00:02:13] What did we hear? Quote. Everyone takes Adderall at finals. What did we learn? No, they don't. It was a gross misperception. The overwhelming majority of students never take stimulant non-medically. Those that did, we tried to do a deeper dive into what were we seeing? What we found is compared to students that did not take stimulants non-medically, those that did the overwhelming majority use cannabis, the overwhelming majority drank in a heavy episodic, or in quotes, binge way.

[00:02:45] The overwhelming majority were skipping classes. It was more of a symptom of a lot of other stuff's going on for the student. There's some research to think that if you really want non-medical use of prescriptions, prescription stimulants to go down, do what you can to reduce cannabis use, and here's why.

[00:03:03] One of the most well-established findings that we have about cannabis use is that it causes decreases in attention, concentration, and memory. I can explain that research if that's of interest, but just know that that's been clearly documented. If someone's using cannabis, what that means is they're probably gonna struggle with attention, concentration of memory.

[00:03:23] So if they're struggling with those things, they might be more likely to say, I wanna try and take something to address what I'm perceiving as an attention issue. We have seen so many people seek a diagnosis of or prescription for A DHD, who also report marijuana use. What the clinicians who meet with them are asking them to do is call time out in their cannabis use to try and disentangle what might actually be an underlying attention issue versus literally the side effect of their substance use.

[00:03:54] This is my long-winded way of saying that if you can keep cannabis use from happening or if you can reduce cannabis, use the likelihood of a student. Developing an attention, concentration or memory decrease that then leads to seeking non-medical use of prescription stimulants will go down. And if we can decrease students seeking stimulants non-medically, we can likely have an impact on reducing the likelihood of an accidental overdose.

[00:04:23] Debbie: That is encouraging that there's some answers and some perspective and some things as a parent to watch or notice. 

[00:04:31] Dr. Kilmer: Mm-hmm. 

[00:04:32] Debbie: Along these lines, how direct would you encourage parents to be? In talking to their kids about fentanyl and accidental overdose. But 

[00:04:45] Dr. Kilmer: what's useful? I think they can be direct. Yeah, I think they can be direct.

[00:04:48] And I think that the main thing to understand is in our field we have a long conversation about the fact that we know that scare tactic, key kind of approaches don't work. But what do you do when the reality is super, super scary? Yeah. The data are what the data are and, um, the data are, this is a very, very scary substance.

[00:05:04] So. Not delivering any warning in a scary way or in a scare T way if you do this, this terrible thing's gonna happen. But making very, very clear that the truth is if you do this, this is what could happen. And that's terrifying. And so I just gave an example of how reducing cannabis use could reduce the likelihood of accidental or, or, or seeking.

[00:05:29] Uh, something that could be laced with something. I have a colleague, Dr. Christine Lee, who's done research and shows that when students drink decisions about should I try something else, become more likely when they've been drinking. A student that says, I would never take a pill that I don't know what's in it, or I would never use blank, might become more likely to use blink when they're intoxicated.

[00:05:51] So what does that mean? Efforts to reduce drinking or even high risk drinking. We'll have an impact on decision making and if you can have an impact on decision making, the likelihood of taking people, taking things that could be risky starts to go down as well. I think that there is complete reason to make sure we're doing what we can around prevention related to Fentanyl and other opiates, and what I hope I'm making clear is that what you do about alcohol use, what you do about cannabis use will pay dividends on the likelihood of people using those other substances as well.

[00:06:24] Debbie: Thank you, Dr. Kilmer. Really helpful. Thank you. You appreciate it.