Before the overdose, Griffin Hoffmann was a sophom*ore, about to lead his Portland, Ore., high school's tennis team. Sienna Vaughn was a junior in Plano, Texas, who participated in Girl Scouts and cheerleading. Laird Ramirez was 17 years old living near Charlotte and competing on his high school's wrestling team. He was rarely seen without his skateboard.
The teens thought they were taking prescription pills for pain and relaxation, drugs like Valium or Percocet, that they bought from friends or from social media. But the pills they took were counterfeits – they hadn't come from a pharmacy and it turned out they contained fentanyl, a potent, often deadly, synthetic opioid. Just 2 milligrams can kill you.
Griffin, Sienna and Laird's deaths are part of a grim crisis happening all across the country. Their stories, taken from local news reports, are among the dozens NPR reviewed, and they illustrate a new challenge for schools this fall.
"[Fentanyl's] infiltration into schools is certainly something that cannot be ignored," says Alberto Carvalho, the superintendent of the Los Angeles Unified School District. LAUSD is one of the largest districts to stock naloxone, a medicine that reverses opioid overdoses, throughout its schools.
"We cannot close our eyes. We cannot look the other way," he says.
Fentanyl was involved in the vast majority of all teen overdose deaths – 84% – in 2021, and the problem has been growing. According to the Centers for Disease Control and Prevention, fentanyl-related adolescent overdose deaths nearly tripled from 2019 to 2021. And nearly a quarter of those deaths involved counterfeit pills that weren't prescribed by a doctor.
Lauren Tanz, an epidemiologist who studies overdose prevention at the CDC, says a number of factors contributed to these alarming numbers.
"The combination of more easily available drugs – particularly highly potent drugs like fentanyl that are available via social media and through counterfeit pills – and a mental health crisis among adolescents that was exacerbated during the COVID-19 pandemic is resulting in an increase in overdose deaths among kids."
This academic year, education leaders are grappling with how to approach a drug use crisis unlike any they've seen before.
"If our students are having contact with these substances, considering the devastating implications and consequences," says Carvalho, "then we need to be active participants in the solution, and not necessarily shy away from it or punt it to somebody else because it falls outside of the realm of traditional education."
Schools can't do it alone
It's happening all across the country – from Tennessee to Texas; from Maryland to Oregon. In some cases, a single high school or school district has seen multiple fentanyl overdose deaths. School buildings have posters in the hallways memorializing students who have died. Social media posts and back-to-school messages from school staff include warnings and pleas to turn in pills students have bought online, "no questions asked."
In addition to stocking naloxone – often known by the brand name Narcan – schools have revamped their drug awareness and prevention programs. Some are promoting the use of test strips to help identify if a pill contains fentanyl, although the small paper tests can still be considered drug paraphernalia and are illegal in several states.
But Becky Pringle, president of the National Education Association, the nation's largest teachers union, warns schools are just one piece of the puzzle.
"We can't possibly do this alone. This is not a school crisis. This is a community crisis," says the former middle school teacher.
"So it's not just educators in schools. It's parents and families. It's the communities themselves. It's every level of government. We have to come together. Too often, the ills of society find the way to our schoolhouse doors, but the resources of society don't follow them."
There are multiple bipartisan pieces of federal legislation aimed at supporting schools in dealing with fentanyl, including one proposed bill that would give money to schools to stock naloxone and train teachers and nurses in updated drug education.
Mourning families are often leading the charge
Some families of students who have died have been frustrated with how schools are responding or say schools could do more. Of the 20 largest districts in the country, only five confirmed to NPR that they stocked naloxone in all of their schools last school year. And in schools across the country, drug education is ad-hoc, not standardized and oftentimes outdated. The 2021 National Survey of Drug Use and Health found only about 60% of surveyed 12-17-year-olds self-reported that they saw or heard drug or alcohol prevention messaging in school.
Avery Kalafatas, an 18-year-old from the Bay Area, says she knew nearly nothing about fentanyl until it killed her cousin, Aidan Mullin. He was like an older brother to Kalafatas; the two shared a love of the outdoors and camping. Mullin had an interest in agriculture, and a fondness for growing peppers and playing the guitar.
In November of 2020, Mullin, then 18, took what he thought was a Percocet. It contained a lethal dose of fentanyl. His death was a devastating blow.
"And it took me a while in my grieving process to obviously get past the shock and the sadness of it. But in that process, I was honestly pretty angry that this wasn't talked about more," she says.
Kalafatas began to educate herself about the synthetic opioid.
"As I became more aware of it through my cousin's death, I really saw a big need for more education, both among parents, and especially teens."
Kalafatas founded the nonprofit Project 1 Life with a mission to educate adolescents and foster youth-led conversations about fentanyl, the deadly and frighteningly ubiquitous opioid found in so many counterfeit pills. "This isn't like the drug crisis we were dealing with 20 years ago, it's a completely different ballgame," Kalafatas says.
A different ballgame because many students aren't intentionally seeking out the deadly drug they're overdosing on.
Ed Ternan, a father from Pasadena, Calif., runs the nonprofit Song for Charlie with his wife, Mary. They use social media to inform teens about fentanyl-laced counterfeit prescription pills.
He says the growing fentanyl crisis requires a new approach to how families and educators talk to students about drugs.
"We need to revive drug education in America. In a way, we need to Narcan drug education – we need to breathe life into it, bring it back," Ternan says.
He says they've learned from consulting with experts in youth mental health and drug education that the "just say no" message of the past isn't an effective way to communicate with teenagers. Instead, they craft fact-based messages they hope teenagers will actually pay attention to.
Rather than focus on "Don't do drugs, they might harm you," Song for Charlie's messaging is: "You're getting ripped off. These dealers advertising on social media do not care. They don't know you, they're not your friend, and they are lying to you about what they're selling you," Ternan explains.
That's what happened to Ternan's youngest son, Charlie.
"He was very much the calming influence...in our family," he says. "A very steady, level-headed guy with more of a subtle, dry sense of humor."
In May 2020, Charlie was on his college campus in northern California. He was weeks away from graduation, and was prepping for a job interview. He was also in pain. Ternan says his son had recently undergone back surgery.
Charlie purchased what he thought was a Percocet off of Snapchat. It contained fentanyl.
"He actually took it a couple hours before he was supposed to have a job interview on the phone," Ternan says. "And so he died very quickly in his room at his frat house waiting for the phone to ring at about four o'clock on a Thursday afternoon."
After his son's death, Ternan says most of the information about fentanyl he could find was buried on government websites and in a smattering of news articles.
"You can put that information in those places for the next 10 years, and Charlie and his friends would never have seen it because that's not where they are."
Where they are is on social media. Ternan and his wife funneled their grief into action; they founded their nonprofit and partnered with social media platforms to disseminate information about fentanyl.
Ternan says their messages also appeal to teenagers' strong social bonds. He's learned that telling teens to warn their friends about fentanyl is more powerful than stoking fear of their own harm.
This kind of awareness could save lives. The latest research from the CDC found there were bystanders present at two thirds of teen overdose deaths. Tanz, the CDC researcher, sees this as a potential opportunity for intervention and education.
"These are people that were nearby who could have intervened or responded to the overdose," she says. "It means we can educate family and friends to recognize warning signs ... and that might improve bystander response and prevent deaths."
Peer-to-peer conversations have also been central to Kalafatas' efforts at Project 1 Life. "Hearing it from someone that's not an adult, parent, or teacher... makes it much more real," she says.
"I think the Fentanyl crisis is an inflection point in our national conversation about drugs," Ternan explains. "It's forced us to look in the mirror and acknowledge our shortcomings and say we got to do better."
Both Kalafatas and Ternan want schools to use some of the lessons they've learned to educate students. With schools also struggling to address mental health, learning loss and so many other challenges, they say it's been an uphill battle.
But they also say it's a necessary one. Schools have the potential to reach millions of kids if they decide to talk to and teach students about the dangers of fentanyl.
"Having these conversations, and having them right, can be the difference between life and death," Kalafatas says.
Reported and written by: Elissa Nadworny and Lee V. Gaines
Reporting contributed by: Sequoia Carrillo
Edited by: Nicole Cohen
Visual design and development by: LA Johnson
Copyright 2023 NPR. To see more, visit https://www.npr.org.
