Early prevention programs for children could help end the opioid crisis

Reprinted from The Conversation Canada with permission

By Charlotte Waddell, Christine Schwartz, Jen Barican and Nicole L.A. Catherine

Children's Health Policy Centre, Simon Fraser University Faculty of Health Sciences 

Can a program for Grade 7 students help end the opioid crisis? The answer is yes, according to compelling research findings on school-based primary prevention interventions.

As noted by the Canadian Centre on Substance Use and Addiction, the opioid crisis is “a complex public health issue devastating the lives of many Canadians and their families who are experiencing accidental overdose or death from opioids.”

To address this crisis, many of Canada’s responses to the opioid crisis still focus downstream on adults, after problems have started or become entrenched. In contrast, primary prevention operates upstream in childhood — before most young people start engaging in substance use, misuse or experimentation.

As researchers concerned with helping children avoid opioid misuse, we conducted a systematic review of prevention programs designed for this purpose. We found two programs that stood out for their success in preventing opioid misuse. Both were delivered to children in middle school and tested using rigorous evaluation methods, namely, randomized controlled trials (RCTs).

Potentially life-saving interventions

The program Strengthening Families significantly reduced prescription opioid misuse among young people in Iowa and Pennsylvania, with benefits lasting up to 14 years after the program ended. The impact was also large, reducing misuse by 65 per cent.

Project PATHS, the other successful program which was delivered in Hong Kong, significantly reduced heroin use with benefits lasting up to two years later. And each time these programs prevented a young person from misusing opioids, they potentially saved a life.

Beyond intervening early, both of these successful programs shared other similarities. Children learned enduring skills such as resisting peer pressure, managing stress and cultivating positive friendships. Teaching multiple skills that children could apply throughout their development likely played a role in the programs’ long-term success — and likely contributed to other positive outcomes including reducing cannabis and ecstasy use.

Both program evaluations also highlighted the ability to reach very large numbers of children, using school delivery. These numbers were about 12,000 for Strengthening Families and about 8,000 for Project PATHS.

Reducing harms, distress, criminal activity

These numbers suggest that new Canadian school-based prevention efforts could potentially reach thousands of young people. With such a substantial population impact, these programs hold great promise to reduce many harms associated with the opioid crisis — including not only deaths but also criminal activity and distress for individuals misusing opioids and their families.

These two school-based programs have another significant feature adding to their appeal for delivery in Canada. Training for facilitators is very brief — only two days for Strengthening Families and three days for Project PATHS.

The short training time also helps reduce delivery costs, further increasing the appeal for policymakers and school administrators.