National Back To School Month: Youth Mental Health & Drug Use

Editorial Team

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Across the U.S., from preschool kids to college teenagers, American students will be heading back to school as another new academic year begins. Sadly, not all of our schools’ youngsters will be needing the latest school gear, the latest tech, and everything else necessary for academic success in 2021, as for some, the knock-on effects of the coronavirus pandemic hit their mental health way harder than their parents or their friends imagined, and for others, their recreational substance use suddenly turned too deadly.

In 2021, the reality is school attendance numbers in many state cities and towns will be slightly down, and many usual names won’t be read out during the morning register – perhaps left only to be formally spoken during a memorial at a later date.

A clear sign of this potentially tragic outcome for many of our U.S. children and teenagers was the huge rise in hospital visits seen in spring of 2020, when, according to National Syndromic Surveillance Program (NSSP) data from the Centers of Disease Control & Prevention (CDC), the number of children’s mental health-related ED visits increased significantly and remained elevated through to October of last year.

For children aged 5-11, ED visits for mental health issues increased by 24%, and for those aged 12-17, they increased by 31%.

First Lesson of the Day: Sammy Chapman (2005-2021)

One young teenager who won’t be going back to school with their friends is Samuel Berman Chapman, the 16-year-old son of Dr. Laura Berman, an American TV host, and relationship therapist.

On Sunday, February 7th of this year, Dr. Berman found her teenage son dead on his bedroom floor, his life tragically ended by an accidental overdose after buying what he believed were prescription drugs through the social media platform Snapchat. Unfortunately, the drugs (currently thought to be either counterfeit Xanax or Percocet tablets) were laced with the potent synthetic opioid fentanyl, the man-made opioid found in the majority of the record number of drug overdose deaths in 2020.

The sad fate of Sammy, as he preferred to be called, is not a common occurrence, although, worryingly for parents and guardians across the nation, it is definitely becoming more and more common. Since the arrival of the coronavirus pandemic in the U.S., many young Americans are regularly, and often unknowingly, putting their lives in danger by experimenting with the use of illicit drugs.

However, because of the pandemic, the drug supply has changed significantly, and much of it now contains fentanyl or a similar opioid substance or derivation, including counterfeit prescription medications (like the fake ones that took Sammy’s life) and other hard drugs, such as cocaine and methamphetamine.

My beautiful boy is gone. 16 years old. Sheltering at home. A drug dealer connected with him on Snapchat and gave him fentanyl-laced Xanax or Percocet (toxicology will tell) and he overdosed in his room. We watched him so closely. Straight A student. Getting ready for college. Experimentation gone bad.” – Dr. Laura Berman (February 8, 2021, via Instagram)

And all it took was a couple of text messages to “the right people” on a social media app like Snapchat (or Instagram, for that matter). Sammy didn’t even need to leave the house – the lethal tablets were delivered directly to the family home.

In direct response to Sammy’s death, the Drug Enforcement Agency (DEA) stated, “DEA Chicago, through cyber investigations, is committed to disrupting and dismantling drug networks that exploit the Internet to distribute illegal drugs, including fraudulent and counterfeit prescription drugs – to adults and children, alike. [The] DEA encourages parents and caregivers to talk with their children about the dangers of drug abuse and the misuse of prescription drugs, emphasizing the immediate potential of overdose death. Tips about websites or individuals selling drugs via social media may be shared anonymously to dea.gov/submit-tip.”

It’s an agonizingly painful and extremely hard lesson to be learned by any parent or guardian, that’s for sure.

teen mental health school

Not Every Child or Teenager Going “Back To School”

Even though the general consensus in the U.S. is for children to return to school this fall, how they actually do that in a safe and appropriate way is yet another bone of contention in a nation divided along political lines and by the pro-vaccine / anti-vaccine and the pro-mask / anti-mask demographics, to name but a couple of reasons.

Here we are, nearly a year and a half into this global pandemic, and there is no accepted agreement at any level on how best to keep our school kids (and their teachers) safe. The U.S. is currently in a situation where changing federal guidance is being challenged by state governors who are now literally creating laws against it. For example, here in Arizona, Phoenix school officials have announced this week they will require masks, defying both state law and Arizona Republican Gov. Doug Ducey.

The Pandemic’s Various Effects on Children’s Behavioral Health

Up until the manifestation of the Delta variant, the coronavirus had pretty much left the kids alone (apart from a small number of exceptional cases). However, it has been merrily playing havoc with their minds, and our children’s mental well-being has suffered because of it. This is predominantly because children live in a world where almost everything is out of their control in the first place.

Therefore, kids can be impacted significantly when their usual routine – the normal things they trust will happen, as they have always done – is suddenly disrupted or fundamentally altered.

Increased Depression, Anxiety & Other Mental Health Issues

Although the pandemic has created a plethora of study data for medical scientists and researchers to analyze, when it comes to children’s mental health, much of it is, frankly, disturbing. In one study, published in JAMA Pediatrics, researchers examined a sample group of 2,330 Chinese schoolchildren for signs of emotional distress. The children, at that point, had been locked down for around 33 days. Even after just a month, 22.6% of them reported depressive symptoms and 18.9% were experiencing anxiety.

Furthermore, it’s not just the normal and expected effects of school lockdowns and social isolation that can pose problems for a child’s mental wellbeing – a suffering economy can have similar effects, too. In one pre-pandemic study, for example, an economy in trouble will have a direct effect on mental health, particularly for children.

Economic Decline = Mental Health Decline

In a 2018 paper, published in Health Economics, Ezra Golberstein, a University of Minnesota health policy researcher, studied economic conditions in the U.S. from 2001 to 2013, and found that a 5% increase in the national unemployment rate led to a huge 35% to 50% increase in “clinically meaningful childhood mental-health problems.” Golberstein recently stated, “When the economy is in a bad place, kids’ mental health gets worse. This time is going to be much worse because it’s also a pandemic.”

Mental Health Decline = Huge Increases in Youth ER Visits

Finally, according to their white paper on “The Impact of COVID-19 on Pediatric Mental Health,” FAIR Health reported mental health services for teenagers (aged 13-18) accounted for a much greater proportion of all their medical claims than usual, particularly in March and April 2020.

Using data derived and collated from over 32 billion private healthcare claim records from January to November 2020, compared to the same months in 2019, here are their main findings:

  • Overall Mental Health: During March and April 2020, mental health claims for individuals aged 13-18 approximately doubled over the same months in the previous year.
  • Intentional Self-Harm: Claims for intentional self-harm (as a percentage of all medical claims)  in the same 13-18 age group increased 90.71% in March 2020, compared to March 2019, and in April, the increase was higher – 99.83%. In the northeastern U.S., the increase was phenomenal – a 333.93% increase in intentional self-harm claims.
  • Overdoses & Substance Use Disorders (SUDs): Claims for overdoses for teenagers aged 13-18, increased 94.91% in March, and 119.31% in April 2020. Additionally, claims for SUDs also increased – 64.64% in March and 62.69% in April of last year.
  • Mental Health Disorders: Again for the age group 13-18, in April 2020, claims for generalized anxiety disorder increased 93.6%, claims for major depressive disorder claims increased 83.9%, and adjustment disorder* claims rose 89.7% (adjustment disorder is defined as an emotional or behavioral reaction to a stressful event or change, with symptoms of both depression and anxiety).

back to school month

Different Kids, Different Responses

In addition to more findings like these, there’s another factor to consider – kids are different to each other, as adults are, and the coronavirus pandemic will affect them differently, too.

The impact on a child’s sense of safety depends on the extent to which the family is affected. If there is a loss or if the family has a drastic change in their economic consequences, this event would shape the children’s view of the world.” – Roxane Cohen Silver, University of California social psychologist

Additionally, another variable factor is whether a child originally came into the pandemic with a pre-existing mental health disorder or a substance use problem, or another behavioral issue. The most recent pre-pandemic data from the CDC states:

  • 7.1% of all U.S. children (aged 3-17) have been diagnosed with anxiety
  • An additional 3.2% suffer from depression
  • 7.4% have diagnosed behavior problems
  • 9.4% suffer from attention deficit hyperactivity disorder (ADHD)

An analysis of data conducted again by Golberstein found that of the number of children who were receiving any kind of mental health therapy and other services, 57% received part of it in their school setting, and 35% received all of these services at school.

Kids, COVID-19, Substance Use & Overdoses

Did you know that the U.S. opioid crisis has resulted in nearly 9,000 deaths of children and teenagers from opioid overdoses in the past 20 years – a rate that has actually tripled during that time period? Furthermore, did you know that the arrival of synthetic opioids has resulted in an increased mortality rate of 2,925% in this age group?

Addiction experts agree that pandemic-related strains on an individual’s mental health, like economic stress, loneliness, and general anxiety, are a major driver for the increase in substance use and fatal overdoses seen in 2020. Unfortunately, this applies to kids, too.

As this stress increases, people, including children, may have fewer ways to manage it. For example, activities that promote resilience, like physical activity and spending time with friends, have been difficult to do for children with school closures and stay-at-home orders, which can lead some kids to either start using drugs, use them more often or use them in greater amounts.

Like young Sammy Chapman mentioned previously, some kids don’t need to leave their house to access illicit drugs. In fact (and this is the dangerous reality in present-day America), some kids can access potent opioids and other prescription medicines just by simply opening the family medicine cabinet

The Lethal Poisons Lurking in Your Family Medicine Cabinet

According to the latest of the CDC’s National Health Statistics Reports – Number 162, dated August 5, 2021 – in 2019, 22.1% of U.S. adults with chronic pain (1 in 5) had used a prescription opioid in the previous 3 months, and the highest prevalence was seen among adults aged 45-64 years at 25.9% – more than a quarter in that age demographic.

That’s a potentially huge number of opioid medications sitting in unlocked bathroom cabinets across the entire nation, with easy access for any member of the family household.

In fact, there are simply so many of these unused opioids medications, as well as other central nervous system depressants and other prescriptions in the U.S., an accurate estimate is virtually impossible. However, here’s an indication of the massive scale of this problem:

  • In 2017, U.S. retail pharmacies dispensed more than 191 million opioid prescriptions to almost 60 million patients (either as first-time prescriptions or refills).
  • As many as 90% of these patients reported not finishing what was prescribed to them.
  • During that same year, 47,600 people died from an overdose involving opioids.
  • According to data from the National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration (SAMHSA), half of the people who misused prescription opioids got them from a friend or family member.

[INSERT VIDEO: https://www.youtube.com/watch?v=2kAklblMi24&t=16s and

ADD the following title:]

How to Safely Dispose of Unused or Expired Medicine

U.S. Food & Drug Administration

mental heal for young adults

Advice for Parents: Be Proactive

Unfortunately, the decline in our children’s mental health will not stop until the pandemic itself finally grinds to a resounding halt. For parents, this means just one objective – mitigation, and the best way of mitigating the numerous pandemic effects on the growing mind of a young person is to provide as much social support to the child as possible.

The Importance of Your Child’s Social Support

Social support can be defined as a child’s support network that can be relied on, and turned to in times of real need, regardless of whether it is perceived or actual. Additionally, social support is seen by child psychology experts as a vital element for youngsters to build healthy and solid relationships with both family and friends, and to establish a strong level of psychological health for the child.

The reverse situation is, therefore, one of poor social support, and this has been shown to directly lead to anxiety, loneliness, and an altered brain function, and an increased risk of substance use and addiction, cardiovascular disease, depression, and suicide.

High levels of social support provide and encourages: 

  • Emotional support, essential when an individual is stressed or lonely
  • Instrumental support, a proactive form of support such as helping with tasks, and
  • Informational support, which can provide guidance, advice, information, and even mentoring.
  • Healthy choices and behaviors, good coping mechanisms, and improved motivation

As a parent, you are in the best position to help both facilitate and strengthen your child’s social support network as they return to school, and once they are settled back into the school routine. 

Is Your Child Experiencing a Mental Health Crisis?

Prior to returning to the more normal routine of going to school, children have had many worries during the pandemic, such as whether they will see their friends and wider family, go to school, or get sick themselves. However, parents face challenges, too, so it may be the case that a parent is unable to fully address their children’s emotional needs, for one reason or another.

Occasionally, the first the parent will know something is seriously wrong may be as their child enters a period of mental health crisis. If this is the case with your child, here is a list of “immediate response” contacts depending on the situation you are facing:

Children in Crisis: Immediate Response Resources for Parents

  • National Suicide Prevention Lifeline: Call 1-800-273-8255. The National Suicide Prevention Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. 
  • Crisis Text Line: Text MHA to 741741 and you’ll be connected to a trained Crisis Counselor. Crisis Text Line provides free, text-based support 24/7.
  • The Trevor Project: Call 1-866-488-7386 or text START to 678678. A national 24-hour, toll-free confidential suicide hotline for LGBTQ youth.
  • National Domestic Violence Hotline: For any victims and survivors who need support, call 1-800-799-7233 or 1-800-799-7233 for TTY, or if you’re unable to speak safely, you can log onto thehotline.org or text LOVEIS to 22522.
  • StrongHearts Native Helpline: Call 1-844-762-8483. The StrongHearts Native Helpline is a confidential and anonymous culturally appropriate domestic violence and dating violence helpline for Native Americans, available every day from 7 a.m. to 10 p.m. CT. 
  • The National Sexual Assault Telephone Hotline: Call 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.
  • The Partnership for Drug-free Kids Helpline: Call 1-855-378-4373 if you are having difficulty accessing support for your family, or a loved one struggling with addiction faces care or treatment challenges resulting from COVID-19 circumstances, the Partnership for Drug-free Kids’ specialists can guide you. Support is available in English and Spanish, from 9:00 am-midnight ET weekdays and noon-5:00pm ET on weekends. 

Important: In the event of a suspected drug overdose, parents should call 911 immediately. Additionally, even if the child experiencing an overdose wakes up or appears to have improved significantly after one or two doses of naloxone, emergency medical assistance is still necessary.

What is Naloxone?

Naloxone – a common brand name is Narcan – is an opioid overdose reversal medication available for free in most U.S. states; for example, here in Arizona, it is available from Arizona’s 

Department of Health Services. Furthermore, if you believe your child may be using opioids or has access to the drug, it is definitely advisable to acquire naloxone to keep at home in the event of such an emergency.

External Sources:

  1. Centers of Disease Control & Prevention (CDC): National Syndromic Surveillance Program (NSSP) report “Mental Health-Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic – January 1-October 17, 2020. November 2020. Available at CDC.gov.
  2. Drug Enforcement Agency (DEA): Submit a Tip. August 2021. Available at DEA.gov.
  3. JAMA Pediatrics: “Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China.” April 2020. Available at JAMANetwork.com.
  4. U.S. National Library of Medicine: “How Do Economic Downturns Affect the Mental Health of Children? Evidence from the National Health Interview Survey.” August 2019. Available at NLM.NIH.gov.
  5. FAIR Health: “The Impact of COVID-19 on Pediatric Mental Health.” March 2021. Available at FAIRHealth.org.
  6. JAMA Pediatrics: “US National Trends in Pediatric Deaths From Prescription and Illicit Opioids, 1999-2016.” December 2018. Available at JAMANetwork.com.
  7. American Psychological Association (APA): “Substance Use During the Pandemic.” March 2021. Available at APA.org.
  8. Centers of Disease Control & Prevention (CDC): National Health Statistics Reports – Number 162. August 2021. Available at CDC.gov.
  9. Substance Abuse and Mental Health Services Administration (SAMHSA): “How People Obtain the Prescription Pain Relievers They Misuse.” January 2017. Available at SAMHSA.gov.
  10. U.S. Food & Drug Administration (FDA): “How to Safely Dispose of Unused or Expired Medicine” via YouTube (Video). September 2020. Available at Youtube.com.
  11. U.S. Food & Drug Administration (FDA): FDA Launches Public Education Campaign to Encourage Safe Removal of Unused Opioid Pain Medicines from Homes. April 2019. Available at FDA.gov.

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WRITTEN BY GERARD BULLEN
AUGUST 6, 2021

Gerard has been writing exclusively for the U.S. substance addiction treatment industry for many years, providing a range of medically-reviewed work, including white papers, long-form, and short-form content articles, and blog posts for accredited addiction treatment centers. A member of the American Medical Writers Association, Gerard’s specific focus is substance addiction (an area that has impacted Gerard’s personal life in several ways), and he is particularly drawn to the topics of professional, evidence-based treatment, new and alternative therapies, and enabling readers to find their own sustainable, long-term recovery. Gerard lives and works in Maryland, U.S., he’s happily married, and a proud father. His interests include hiking with the family, reading fiction (from the classics to virtually all of the current NYT bestseller list), American and British film classics, and his beloved dogs, Toby and Coco, both rescued from the local pound.

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