FALLBACK STRATEGY FOR TEENS WHO SAY YES TO DRUGS

The recent death of a 14-year-old girl from Belmont who had taken the drug
ecstasy has shocked and surprised the Bay Area. Especially disturbing is
that, in the opinion of San Mateo County coroner Robert Foucrault, Irma
Perez's life could have been saved with professional intervention.

According to the paramedic's report, Perez had taken an excessive dose -
three "Valentine ecstasy" pills - and possibly alcohol and/or other drugs
as well. While her two friends suffered no ill effects, Perez had an
extremely rare reaction. She experienced what emergency physician Dr. Karl
Sporer calls "serotonin syndrome": rapid heart rate, high blood pressure,
high fever and agitation.

Because adverse reactions are so rare with ecstasy, what caused Perez's
idiosyncratic response? Did the pills contain adulterants? Did Perez have a
pre-existing condition that made her especially vulnerable, such as a
cardiac arrhythmia? Was she dehydrated or did she drink too much water,
causing dramatic drops in sodium levels? We don't know the answers to these
questions yet, but it is hoped the coroner will issue his report soon and
make it public.

As a drug educator, I agree with Belmont-Redwood Shores Superintendent John
McIntosh that in this "teachable moment" we must provide information to
both parents and teenagers. At this critical juncture we need to be very
careful about what we say so we can win back the confidence of young
people. After more than two decades of exaggerations about drugs in
general, and a recent scandal leading to the retraction of "brain damage"
claims about ecstasy, adults have lost a great deal of credibility with teens.

Our task is to replace exaggeration and scare tactics with balanced,
science-based information. In a perfect world, teenagers would "just say
no" to alcohol and other drugs. But after abstinence-only messages,
reinforced by increasing zero-tolerance policies (such as expulsion from
school and arrest), the National Institute on Drug Abuse survey,
"Monitoring the Future," found that in 2003, more than 45 percent of
eighth-graders had tried alcohol, 17 percent had tried marijuana and 3
percent had tried ecstasy. Missing from our educational efforts is a
fallback strategy of harm reduction for those teens who, like Perez and her
friends, say "yes" despite our efforts.

In addition to providing sound information about alcohol and other drugs,
young people should learn to recognize signs of distress and know that they
can and must get help. This was not what happened in Perez's case. For five
hours her friends tried on their own to help, using makeshift methods, such
as giving her a bath. Perez finally lapsed into the coma from which she
never recovered.

Sadly, the experience of Perez's friends is not uncommon. They realized
something was wrong and got scared, knowing they would "get into trouble"
if the police came. In their naivete, they hoped she would simply come out
of it. This scenario is played out all too often, because it's possible to
overdose on almost any substance, especially alcohol, the most popular drug
among young people.

Many in law enforcement, such as Commander Trisha Sanchez of the San Mateo
County Narcotics Task Force, agree that the message we send our teens
should be clear. The use of alcohol and other drugs is a poor choice, but
if you do experiment and there is a problem, you will not be punished by
calling for help.

As a parent, I understand that providing "harm reduction" information can
be uncomfortable. We worry that acknowledging the possibility that
teenagers might experiment will send the message that we condone the use of
alcohol and other drugs and that this message will, in fact, open the door.

The reality, however, is that as a society we regularly medicate and imbibe
with a variety of legal and illegal substances, so the door is already
open. Our job is to keep our kids alive, even if they're not completely
drug free.