Our students are easily buying alcohol using fake ids and are shoplifting alcohol from stores and pharmacies. One of the more popular spots to shoplift liquor are the CVS Pharmacies (especially in the Bon Air in Greenbrae and Redhill in San Anselmo shopping centers).
The best way for stores to prevent shoplifting is to lock up hard liquor in cases yet typically only the most expensive liquor is locked.
Contact CVS! Please take a moment to contact Nicholas Beardsley through his assistant Cortney Mesenbrinksmith, at 707-762-0133 and/or email firstname.lastname@example.org and ask that all hard liquor be capped or locked in storage cases - the way Rite Aid does!
The next best deterrent is to apply plastic "caps" to liquor which sound an alarm and prevent it from being opened.
A way to prevent successful use of fake ids (which are often out-of-state licenses in different names) is for stores to ask for a second form of id (such as an ATM or credit card).
Be the Influence, together with local coalitions (the Twin Cities Coalition for Healthy Youth and the Ross Valley Healthy Community Collaborative) has attempted, without success, to work with CVS' District Manager by advocating for stronger security and deterrents. If you are in a store which has uncapped or unlocked hard liquor, talk to the manager to make your voice heard - or contact email@example.com with the name of the store and we will do so!
Please discuss with your child that shoplifting and using fake ids are crimes with serious legal consequences.
GENERAL PARENTING TIPS: HOW TO HELP PREVENT TEEN ALCOHOL AND OTHER DRUG USE OVER THE SUMMER MONTHS AND BEYOND
Parents are their Teens Most Important Influence.
As we've stated before, the BTI program is premised on the simple fact that parents have a lot more influence with their teens than they think they do. Parents are still their teens' number one influence.
It is further based on research that shows that increased “supervision”, an “engaged” parenting style and “modeling” healthy behavior by parents with respect to their own alcohol and drug use can all positively impact teen behavior and help delay early experimentation and use.
While you may not want to be a hovering parent, now is the time to "lean in" as a parent, especially during the freshman and sophomore years. Below are tips to pick and choose from, depending on your teen's age, temperament, maturity level and proven trustworthiness.
They are pointers from our newsletter last August that bear repeating.
• Be Wary of Parties with Older Teens and Sleepovers. Parents of younger teens (especially rising freshman and sophomores) should say "not yet" or otherwise discourage their teens from attending large parties or those with teens from more senior grades. The world of a 14-15 year old is very different from that of a 17-18 year old. Additionally, parents are often absent from these parties, the parties are loosely supervised or worse, drinking and other drug use is tolerated. Similarly, parents should be wary about last minute sleepover requests and should use the BTI Parent List to reach out to the hosting parents.
• Know Where Your Teen is Going and With Whom, Especially if Driving. Consider using "Find My Friends", Life 360 (which shows a history of where your teen has been, not just where your teen is at the moment) or other app on your phones to verify your teen's whereabouts. This also applies to where your teen is during the day. Also know who your teen is driving with. Get to know your teens' friends and their parents by reaching out to them and using the BTI Parent List.
• Do not enable your new teen driver with a "provisional" restricted drivers license to drive other teens or allow your teen to be driven by a new teen driver. Under the law, new drivers should not be driving friends until they have had their license for one year. New drivers with friends in the car greatly increases the risk of an accident and can result in substantial liability. Say no to your teen getting a ride with a new driver, even if it makes life more convenient for you as a parent. Get to know your teens' friends and their parents by reaching out to them and using the BTI Parent List.
• Trust your Teen ... to be a Teen! Teen brains are wired for risk taking. A common refrain of teens to parents is "You don't trust me!" The response? "We trust you to be a teenager" or "we don't necessarily trust all your friends"!
• Set a Reasonable Curfew and Check-Ins. There is no reason for teens to be allowed out at all hours of the night. Local curfew laws are at 11 pm and the CHP strictly enforces this curfew and issues citations when teens have their "provisional" drivers license. For rising freshman and sophomore parents, think about what time is okay for a senior to come home at night. Then count backwards for curfews. Realize that every year, you will want to move your teen's curfew a little later to reward good behavior and acknowledge growing maturity and freedom. If you start 9th grade with a midnight curfew, you will soon find yourself in trouble. Regarding check-ins, having some face-to-face contact is best and a phone conversation is even better than texting. Trust ... but verify such as through a landline, Find My Friends, Life 360 or similar app.
• Be Aware of Local Social Host Ordinance Laws and Use Law Enforcement as Support. Social Host Ordinances throughout Marin hold parents strictly and financially accountable for underage drinking in their homes. Some local police departments publish press releases about social host violations with your street named and if your teen is 18 yeas old or over, your family may be identified by name. If you are leaving your house unattended for the evening or leaving town overnight, take precautions to ensure your house won’t become "The Party Spot". Never hesitate to contact police for help if a party gets out of control. Local police also can be contacted for drive-by "vacation checks".
• "Teen Proof" Your Home. Reduce easy access to alcohol, marijuana and prescription drugs by "teen proofing" your home and locking up or otherwise securing or keeping track of any alcohol and other drugs. Don't make it easy for your teen to experiment with or use alcohol or other drugs - even if you think it is an inevitable "rite of passage".
• Hidden Stashes and Fake Id's. Periodically check for hidden alcohol, marijuana and other drugs or paraphernalia as well as “fake id’s”, all of which can be found in bedrooms, cars and wallets. Fake Id's are easy to obtain online and usually come in pairs. If you find one and destroy it, chances are a second one is around.
• Know the Difference Between Experimentation and Use/Abuse. Experimentation is trying alcohol or another drug once or maybe twice. More than that is "using", which can escalate into "abusing". The "worst" drug out there is the one that your teen experiments with and likes.
• Have Regular Discussions about these Topics with Your Teen. If you have not been talking about the hard stuff (drugs, birth control, sex, consent), this is the time to start. If you have been talking about these issues, double down. Talk early and often. Every family has its own mores and values and your teen should know them. Over time they may discard some of what you say, ignore your rules and defy you but they should never be unclear about both your values and rules. Agree to the rules ahead of time - no alcohol or other drugs, or smoking. Be present, ask open ended questions and listen to what they say. Be mindful of the language you use and make positive remarks about your teen's behavior outnumber any negative comments ("catch them being good".)
• Establish Consequences if your Teen Violates Your Agreements. Be a parent and not a pal. Local law enforcement officers often comment that when called, parents seem more concerned with the legal ramifications than on disciplining their teens. Set consequences which have a connection to the behavior or rule violation.
• Give a Goodbye Reminder, Hello Hug or Good Night Kiss. Be around when they leave for a night out, perhaps with a reminder of your rules and consequences. This will also ensure there is no "pre-gaming" at your home. After a teen's night out, parents should stay up to greet their child, look them in the eye and give them a hello hug or good night kiss (and a discreet sniff) when they come home. Have a conversation with them and try not to be asleep or out on the town yourself when they arrive.
• Establish a Safe Ride/"No Questions Asked" Policy and an "Exit" Plan. Tell your teen that they can always call you for a safe ride home and there will be "no questions asked" -- and then perhaps ask the next morning. Review excuses that your teen can use to exit a risky situation, e.g., "my parents will kill me" or "I have to get up early in the morning". Consider writing a letter such as the one posted at http://www.huffingtonpost.com/kathy-radigan/an-open-letter-to-my-teenage-son-aboutdrinking_b_5609429.html
• Postpone or Keep Track of Uber, Lyft or Taxi Rides. While certainly safer than driving drunk or drugged, these forms of transportation enable excessive levels of drinking and other drug use. Don't allow them for younger teens without driver's licenses if you are able to be driving them. For older teens who are driving, keep track of how frequently your teen is using them. Frequent use may well indicate abuse.
• Don't Place Absolute Trust in Designated Drivers. Our California Healthy Kids Survey (CHKS) results show that too many so-called designated drivers drive are simply less drunk or high than their passengers (28% of Tam District's 11th graders admit to driving under the influence or being a passenger in a car with a driver under the influence). Moreover, many kids have the mistaken belief that driving stoned is slower and safer than driving drunk. Both are dangerous.
• Stay Away from Party Buses. Just say "no" to this one outside of Prom as there are significant risks to party buses. Party buses enable extreme levels of partying. Last summer in Marin, police intercepted a typical party bus loaded with young teens and copious amounts alcohol, marijuana and prescription drugs. Read about it here. Note that this party bus incident was not an isolated one but rather was typical of buses rented for birthday parties, New Year's Eve and Prom. Marin County's Superintendent of Schools Mary Jane Burke and Sheriff Robert Doyle said it best in their response to the incident: party buses are bad news. This opinion piece cites our BTI program and also has several excellent common sense suggestions that parents may use before allowing their teens to participate in social activities.
• Be Mindful about Your Own Use: Model Responsibility and Moderation in Your Own Behavior. As stated before, this may be the most important tip of all. While the BTI Commitment is about parenting teens and not policing adults, consider limiting your alcohol intake when around your teens (and younger kids). A glass or two with a meal isn't a parenting crime. Yet, when hosting or attending a child-related event, keep it alcohol free. Never drive while under the influence. If your kids are going out, you may have to be sober to pick them up. Remember that while your teens may pretend not to hear you - they are listening and are watching your actions and are eager to point out your hypocrisies!
Summer is a time for travel, working summer jobs, attending camps and other programs, and taking a break from it all by sleeping in and hanging out at the beach. But for some teens, summer means they will start using alcohol, marijuana or other drugs for the first time.
Each year, the National Survey on Drug Use and Health asks preteen and teenage students (ages 12-18) to report the year and month they first used a substance. The results of this survey reveal that summer is most definitely a time for experimentation.
Key findings include:
• First use of alcohol peaks in June and July (and also in December).
• First use of marijuana, tobacco (vapes, cigarettes, cigars and smokeless tobacco), and inhalers peak in June and July. The same holds true for college students.
A 2015 study from the Substance Abuse and Mental Health Services Administration (SAMHSA) found similar results. Marijuana use and underage drinking peak in June. Not so coincidentally, data from the National Highway Traffic Safety Administration reveal that during May, June, July, and August, nearly twice as many teens die in highway crashes every day when compared to the rest of the year.
Youthful drinking also contributes to injuries and deaths during other popular summertime activities, such as boating and swimming. For example, the Centers for Disease Control and Prevention reports that alcohol use is a factor in up to 70 percent of adult and adolescent deaths associated with water recreation, almost a quarter of emergency department visits for drowning, and about one in five reported boating deaths.
As summer approaches, it is important for parents to be aware of summer temptations among high school and college students and to take positive steps to prevent experimentation, which can lead to regular use. SAMHSA advises parents to find activities and events that provide appealing alternatives for teens and to reinforce messages about the risks involved with using alcohol and drugs year-round, while consistently restricting access to these substances.
During the summer months in the Bay Area there is a party every night in some place. Monitor your teens' whereabouts, reach out to other parents using the Be the Influence Parent List, impose curfews and set consequences for breaking the rules you set in accordance with your family values.
Although parents may feel tempted to take a summer time break from all the monitoring, parenting is a 24-7 job. Remember -- be a parent and not a pal!
Notification of Police Departments of Vacation Plans
Did you know that your local police department will collect information on your vacation plans? This may help ensure that you won't be liable under Social Host Ordinance Laws in case there are any parties at your home during your absence. Consider calling your local police department and alerting them to any vacation plans you may have!
Unfortunately, our students are easily buying alcohol using fake ids and are shoplifting alcohol from stores and pharmacies. Fake ids are of high quality these days and alcohol is often easily accessible. The best way for stores to prevent shoplifting is to lock up hard liquor in cases yet typically only the most expensive liquor is locked. The next best deterrent is to apply plastic "caps" to liquor which sound an alarm and prevent it from being opened (although there are ways to get around this). A way to prevent successful use of fake ids (which are often out-of-state licenses in different names) is for stores to ask for a second form of id (such as an ATM or credit card).
Some of the more popular spots to shoplift liquor in Marin include the CVS Pharmacies (especially in the Bon Air in Greenbrae and Redhill in San Anselmo shopping centers), and Safeway and Lucky grocery stores.
Be the Influence, together with local coalitions (the Twin Cities Coalition for Healthy Youth and the Ross Valley Healthy Community Collaborative) is working with the managers of these and other stores and advocating for stronger security and deterrents. If you are in a store which has uncapped or unlocked hard liquor, talk to the manager to make your voice heard or contact firstname.lastname@example.org with the name of the store and we will do so.
Please discuss with your child that shoplifting and using fake ids are crimes with serious legal consequences.
Prom is always an exciting and special time. Proms at our schools are typically held in fun venues in San Francisco. Although Proms are held off campus, students and parents should be aware that all rules and restrictions for alcohol and drug use at school apply. Students and parents also should be aware that buses, backpacks and purses have been searched at some of our schools’ Proms and students have been suspended for possession of alcohol or other drugs or for being under the influence. Additionally, random breathalyzer tests have been administered at some Proms.
To make Prom safe and fun, we urge parents to take steps before and after Prom, including knowing in advance the whereabouts of your students for pre- and post-Prom parties, checking in with your teen post-Prom, contacting the hosting parents to ensure that their parties will be supervised and alcohol and drug free, imposing reasonable curfews and not renting hotel rooms for post-Prom parties. Special precautions should be taken for transportation to and from Prom, as discussed below.
Be Mindful about Your Own Use. Consider holding an alcohol-free pre-Prom party. The party should be about the teens dressed in their finery with photographs being taken, not alcohol being consumed by the parents. Save any imbibing for after the teens have left!
Binge drinking and other drug use often takes place on “Party Buses”, especially after Prom. Although several deaths led to legislation in California regulating party buses effective January 2013, unscrupulous bus companies and drivers continue to ignore current legal protections and safe practices. A recent example of this occurred last summer when police intercepted a party bus loaded with young teens and copious amounts of alcohol as well as marijuana and prescription drugs. With roughly 30 teens on board, there were 30 bottles of hard liquor and a case of hard lemonade. This incident was not an isolated incident as party buses rented for Prom as well as New Year’s Eve and birthday parties throughout the year often involve binge drinking and other drug use.
As Superintendent of Marin County Schools Mary Jane Burke recently wrote to all schools:
“This time of year in particular, as prom and graduation season approaches, kids are more likely to want to “go big” with party buses and hosting social engagements in celebration of these milestones. I urge parents to get involved with the planning of these events and require responsible chaperones. Inform your teens that the party bus rental comes with a responsible adult on board; a party is allowable but only with attentive adults present. Establish clear rules and boundaries for your teen when they are with friends. Establish a level of trust and be clear that if your child violates that trust, there will be consequences.”
California law actually requires that a chaperone over the age of 25 years be present on these buses. Accordingly, at least one adult should be present on the buses going to - and returning from - Prom. Binge drinking and other drug use particularly take place post-Prom when the buses are essentially parties on wheels. Other examples of precautions to prevent alcohol and drug use include requiring that any backpacks be placed in the cabin under the bus (and stay there until the kids disembark), feeling or searching the backpacks for alcohol and drug paraphernalia and requiring signed waivers by each passenger. As required by California law, if the driver becomes aware of any alcohol or drug use by minors, the bus company is obligated by law to immediately terminate their services. That means parents may have to retrieve their kids wherever the bus has stopped.
Additionally parents who sign party bus contracts are often on the hook for hundreds of dollars in fees (often contracts charge a set amount per pile of vomit) and other damage incurred.
Regarding post-Prom parties (also called kick-backs which are smaller gatherings than huge parties), some parents generally “look the other way” with respect to alcohol and marijuana use. An NIH paper published in July 2014 examined 22 studies on the issue of parents providing alcohol or youth or providing a place to party. The paper concluded that “there is little research evidence to support the notion that it is even possible to ‘teach’ children to drink responsibly.” The paper quoted three studies and found that:
“Parents might believe they are keeping their children and their children’s friends safe by allowing them to drink in their home. This is not the case. Adolescents who attend parties where parents supply alcohol are at increased risk for heavy episodic drinking, alcohol related problems and drinking and driving”. The same applies to other drug use. The premise that parents are keeping their teens “safe” when they provide a place to party and look the other way on alcohol and drug use by their teens, albeit well-intentioned, is a false one.
If you are going to host a Post-Prom party, we advise taking the precautions outlined at http://www.tamdistrict.org/cms/lib8/CA01000875/Centricity/Domain/146/070329-teenparties.pdf
In addition, consider contacting the parents (a group email is easy), clearly setting forth your rules, requiring that backpacks and purses be left at the doorway and not allowing in and out privileges. Another suggested practice is to require any teens who are driving (though most take Uber) to leave their keys with you and then to check in with you before they leave.
Social Host Ordinances. These local laws hold a parent liable for parties or gatherings when alcohol is consumed by minors. It doesn’t have to be a big party - a “gathering” is defined in some jurisdictions as involving one or more minors.
Social host ordinances are strictly enforced in most jurisdictions with some towns issuing press releases of citations such as Larkspur, Corte Madera, San Anselmo, Fairfax, Greenbrae and Kentfield. Recently, Tiburon and Belvedere also adopted new “zero tolerance” policies towards underage drinking and social hosting.
The terminology in this fast changing landscape can be confusing with so many new products coming out on the market. Some of the most common terms for the electronic vaping devices we are discussing are e-cigarettes, e-hookahs, vapes or vape pens.
For a list of all the terminology associated with vaping, see https://www.e-cigarette-forum.com/forum/threads/electronic-cigarette-terminology-and-slang.285856/
For purposes of this discussion, we will use the term “e-cigarettes”.
An alarming number of young people who have never used conventional cigarettes are now using electronic vaping devices. Center for Disease Control numbers indicate that between 2011-2013,
e-cigarette use among youth doubled. Between 2013-2014, vaping among middle and high school students tripled.
According to the 2015-16 California Healthy Kids Survey, in the Tamalpais High School District, 23% of 9th graders and 45% of 11th graders have used electronic cigarettes or other vaping devices (use within the past 30 days is 10% for 9th graders and 13% for 11th graders).
E-cigarettes are easy to hide and can be virtually odorless, with very little "smoke" emitted that dissipates quickly. Because it can be hard to detect, vaping is occurring on school premises. This year, “JULLING”, as discussed below, has become especially popular at our high schools.
E-cigarettes with Nicotine
An e-cigarette is a handheld battery operated device which heats a flavored liquid (“e-liquid or e-juice”) which then creates an aerosol that is inhaled by the user and emitted into the environment. It is incorrect to refer to this emission as a vapor because it contains many chemicals and particulate matter. Particulate matter is a mixture of extremely small solid and liquid particles suspended in air. Many of the chemicals and particulate matter that are emitted are hazardous.
The e-liquid is usually made of nicotine, propylene glycol and flavorings. The exact composition varies from product to product. Some e-cigarettes are disposable and others are rechargeable and refillable. There are more than 7,000 marketed flavors, from tobacco to cherry.
The invention of the modern e-cigarette is usually credited to a Chinese pharmacist. E-Cigarettes began flooding U.S. markets in 2006 and 2007. Most e-cigarettes are still made in China. Today there are hundreds of brands of e-cigarettes with global sales in excess of $7 billion. The number of e-cigarettes sold has increased every year. As of 2015, 80% of all e-cigarette sales in convenience stores were products made by tobacco companies. Customized devices are also commonly made with components sold online and in vaping stores.
Toxins. Although it is generally agreed that e-cigarettes expose users to fewer chemicals than tobacco, e-cigarettes do not emit only water vapor, as the makers would have you believe. Harmful chemicals such as nicotine, formaldehyde, carbonyls, metals (including chromium, nickel, tin, silver, cadmium, mercury and aluminum) and organic volatile compounds have been identified. Particulate matter, especially from the heavy metals is potentially damaging to the lungs. Tests have found that e-cigarette liquid and aerosol can contain higher levels of metals than regular cigarettes. Because e-cigarettes are relatively new, the long term effects of e-cigarettes are unknown. Also, some e-cigarettes that have claimed to be nicotine-free actually do have nicotine.
Second hand exposure. The long term effects of second hand exposure also are unknown at this time. The chemicals in these e-cigarette aerosols remain in the environment, re-emit for varying periods of time and also are capable of reacting with other chemicals to create additional substances known to be carcinogenic.
Lack of Regulation and Approval as a “Quit Device”. E-cigarettes have been unregulated until recently. In August 2017, the FDA extended its regulatory powers to include e-cigarettes so regulation has just begun. The FDA has not approved e-cigarettes as a device for quitting tobacco and several studies have indicated that e-cigarettes use actually is linked to lower odds of quitting.
What do E-Cigarettes look like? E-cigarettes come in a multitude of sizes and shapes. The main components are a mouthpiece, a cartridge (tank), a heating element/atomizer, a microprocessor, a battery and a possible LED light at the end. E-cigarettes have quickly evolved. The first generation e-cigarettes look like tobacco cigarettes (with variations in size) and are so called “cigalikes”. The second generation e-cigarettes are larger and look less like tobacco cigarettes. The third generation devices include mechanical mods (devices or attachments) and variable voltage devices. The fourth generation devices include “sub ohm tanks” and temperature control devices. The power source is the biggest component of an e-cigarette which is frequently a rechargeable lithium-ion battery. These lithium batteries have been known to overheat or explode. Also, some liquid cartridges can leak when handled.
Nicotine is Addictive. Nicotine is an incredibly powerful addictive drug, no matter how it is used. It is one of the most addictive known substances on a level comparable to heroin and cocaine. It stimulates the regions of the cortex associated with reward, pleasure and reducing anxiety. The nicotine content in e-cigarettes is more than adequate to sustain nicotine dependence. Some people get addicted in just a few weeks. Others develop cravings over several months.
When nicotine intake stops, withdrawal symptoms include cravings for nicotine, anger/irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger or weight gain and difficulty concentrating.
Youth More Susceptible. Youthful experimentation with e-cigarettes can lead to lifelong addiction. The younger the child is when they start using nicotine, the more likely they’ll be addicted. Youth are sensitive to nicotine and can become dependent easier than adults.
Although, as mentioned above, e-cigarettes have not been around for enough time for longitudinal studies about the long term health effects, we do know much about the effects of nicotine. Because of nicotine addiction, about three out of four teen cigarette smokers end up smoking into adulthood. Teens who use e-cigarettes are more inclined to become smokers than those who do not. The majority of young people who vape also smoke cigarettes and use hookahs which are discussed below.
Early cardiovascular damage is seen in most young cigarette smokers; those most sensitive die at relatively early ages. Among youth who persist in cigarette smoking, one third will die prematurely from smoking. Teens who smoke are not only immediately short of breath, they may end up as adults with lungs that will never grow to full capacity. Such damage is permanent and increases the risk of chronic obstructive pulmonary disease (COPD). COPD is a debilitating, progressive disease which can not be reversed; when developed at very young age (in ‘30s) it eventually becomes an end stage lung disease.
Marketing to Youth. Big tobacco markets e-cigarettes to young people with strategies including cartoon characters and candy flavors. The devices come in designs and in colors that are attractive to young people. Candy fruit and alcohol flavors add to the appeal. Multiple websites share various tricks and tips for users. The industry also encourages the myth that smoking makes you thin, an especially appealing message to young girls.
JUULING (pronounced “jeweling”) recently has become popular at Bay Area high schools. A JUULE is a vaping device that looks less like an e-cigarette or pen and more like a flash drive or cell phone. It is a rectangular prism with a hole for a capsule which also acts as a mouthpiece at one end. It has a charging dock that plugs into a USB port.
Of concern is that JUULs can accomodate an especially high nicotine strength which is more addictive. This is because of its use of nicotine salts found in the tobacco leaf rather than free-base nicotine and its juice chemistry and delivery system. Introduced with four flavors: tobacco, mint, fruit and creme brulee, more flavors are being added. A JUUL package with four flavors and a charger sells for $49.99 with free delivery.
Dripping. One in four high school students who have used e-cigarettes also have tried this dangerous vaping method. Dripping involves dropping e-cigarette liquid onto the hot coils of a device to produce a thicker more flavorful smoke and stronger throat hit. It may expose users to higher levels of nicotine and to harmful non-nicotine toxins such as formaldehyde, a known carcinogen. See
Vaping with Marijuana
There is also a multitude of personal vaping devices for marijuana: desk top vaporizers (which are not portable or discreet), portable vaporizers (which are usually small enough to fit in a pocket and are used for vaporizing dry herbs), vaporizer pens (mostly for wax and oil concentrates versus dry herbs) and e-cigarettes (mostly for vape juices). Vaping e-liquids (also known as tinctures) combine a flavor and a concentrate with pre-filled tincture cartridges. With less smell, vaping liquids is more discreet than burning herbs.
E-cigarettes also can easily be modified into an electronic pipe (e-blunt or e-joint). If dry herbs are used, a dry herb cartridge attachment is used. If vaping is in the form of THC concentrate (hash oil, wax, budder, BHO, full-melts), a concentrate cartridge or a glass globe attachment is used.
Those most likely to vaporize marijuana with e-cigarettes include males and younger students. According to a 2015 survey by Yale University published in Pediatrics, approximately 27% of high school e-cigarette users have used electronic devices for products containing THC (marijuana, honey oil, dabs, etc.). Dual use (of marijuana and tobacco) is common and initial use of any of these products increases the likelihood of future use of another.
Marijuana smoke contains more chemicals and a greater amount of carcinogens than tobacco smoke according to the American Lung Association. For a comprehensive discussion about the health risks of marijuana use by teens, see our October newsletter at http://eepurl.com/chCv4n.
Combining Nicotine and Marijuana. Gaining in popularity is a “Spliff” which is a cigarette rolled with a mixture of tobacco and marijuana. This mixture produces its own high: tobacco increases the vaporization efficiency creating more available THC (the active ingredient of marijuana) so that the user feels the effects of marijuana more quickly. This results in a special kind of head rush with the tobacco stimulating adrenaline production.
A hookah is a water pipe - a single or multi-stemmed instrument for vaporizing and smoking flavored tobacco or sometimes marijuana. The vapor or smoke is passed through a water basin (often glass) before inhalation.
While many hookah smokers consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks as cigarettes. Hookah smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke. Due to the mode of smoking - including the frequency of puffing, depth of inhalation and length of the smoking session, hookah smokers absorb higher concentrations of the toxins found in cigarette smoke.
Hookah smoke contains multiple toxic chemicals that come from the burning of the charcoal, tobacco and flavorings. Hookah smokers inhale many chemicals that can cause cancer (oral, lung, stomach, esophagus and gastric), clogged arteries, heart disease, lung disease (impaired pulmonary function, chronic bronchitis and emphysema), decreased fertility and other health problems. Hookah smoking increases the amount of carbon monoxide in a person’s body to eight times their normal level.
Compared to smoking one cigarette, a single hookah session exposes users to more carbon dioxide and similar levels of nicotine.
A typical hour long hookah smoking session involves 200 puffs while smoking an average cigarette involves 20 puffs. A typical hookah session delivers 1.7 times the nicotine dose of one cigarette and the nicotine absorption rate in daily waterpipe users is equivalent to smoking 10 cigarettes per day.
Second hand smoke. Second hand smoke from hookahs poses a serious risk for nonsmokers because it contains smoke not only from the tobacco but also from the heat source (e.g., charcoal) used in the hookah. Second hand smoke from hookahs contains significant amounts of carbon dioxide, aldehydes, ultrafine particles and respirable particulate matter (particles small enough to enter the lungs). Studies have found that the concentrations of particulate matter in the air of hookah bars were in the unhealthy to hazardous range according to EPA standards. The air in hookah bars also contains significant amounts of toxic chemicals that are greater than for cigarettes.
Addiction to and dependence on hookah. Many hookah smokers, especially frequent users, have urges to smoke and show withdrawal symptoms after not smoking for some time; thus it can be difficult to quit. The signs and symptoms of addiction and dependence are very similar to the signs of cigarette addiction.
“420” is coming up. April 20th has evolved into an unofficial “holiday” for some which is observed by smoking or otherwise consuming marijuana. The day has become a global event.
How did this global phenomenon start? It all began in Marin at San Rafael HS years ago.
Read about the history of 420 at www.en.wikipedia.org/wiki/420_cannabis_culture).
Our high school students in prior years have reported their classmates getting high multiple times throughout this day beginning at 12:01 am and continuing through 11:59 pm, as well as coming to class high. If you suspect your teen is inclined to get high, we advise that you know your teens’ whereabouts, ensure that they are at school and are supervised after school, and discuss disciplinary consequences at school and at home and the health risks of teen use of marijuana.
The term “420” also has become code for a time to get high not only on April 20th but throughout the year.
The vast majority of Marin teens do not abuse prescription or so called “hard” drugs. California Healthy Kids Survey (“CHKS”) results for 2015-16 show past month use of these drugs by Tamalpais High School District 11th grade teens to be in the single digits (although lifetime use is higher in the double digits).
Yet there are disturbing increases in use, especially with respect to prescription drugs, and the consequences for those who abuse these drugs are harsh. Over the past 15 years, drug related ER visits and deaths in Marin have tripled. Teen and adult drug related deaths in Marin occur at shocking rates.
From 2012 to 2013, there was one accidental overdose death every two weeks in Marin. The year 2016 was a particularly deadly one, with more drug related deaths of young Marin males than in previous years. These deaths often resulted from a combination of alcohol and other drugs or the abuse of multiple drugs at the same time (called “polysubstance abuse”).
For this reason, Marin County’s Public Health Officer, Dr. Matt Willis, who has a child at Drake High School, has called drug use in Marin “an ongoing public health crisis.” For an alarming article about the magnitude of this problem, read “A Dangerous Game” at http://marinmagazine.com/September-2016/Dangerous-Game/.
Prescription (Rx) Drug Abuse
ADDERALL, RITALIN and Other ADHD Drug Abuse. Adderall and Ritalin are two popular drugs which are used primarily to treat the symptoms of attention-deficit hyperactivity disorder (“ADHD”). Other ADHD drugs include Dexedrine, Focalin, Vyvanse and Concerta. Adderall, normally referred to as “Addies”, is the most commonly abused of these drugs and is a combination of amphetamine (known as “speed” or “uppers”) and dextroamphetamine. Ritalin is also abused and is a methylphenidate, which has similar effects to amphetamines.
Stimulant Classification. These drugs are classified as central nervous system stimulants, which means they speed up and heighten certain bodily processes. Those who have been diagnosed properly as having ADHD and take these drugs feel a calming, centering effect.
Abuse is Common. Yet, increasing numbers of teens and young adults who don’t have ADHD inaccurately believe that taking these drugs will help improve their ability to maintain focus and productivity while studying, taking tests, working or participating in sports. Some take these drugs recreationally. For those users, taking these drugs feels just like taking speed - legal speed.
Adderall and Ritalin abuse is becoming ubiquitous in high schools and college environments. For a Redwood High School Bark article on the use of Adderall by students, go to www.redwoodbark.org/2012/11/students-turn-to-drugs-to-enhance-test-performance.
Side Effects. Common symptoms of Adderall abuse include dry mouth, headache, hoarseness, nausea, digestive issues, reduced appetite, anxiety, restlessness, insomnia, irritability, excessive fatigue, pounding or fast heartbeat and shortness of breath. Ritalin abuse runs the risk of similar negative side effects.
Dangerous Consequences. With long-term or high dose abuse, the symptoms can compound and lead to even more dangerous effects. These include weakness or numbness in the arms or legs, dizziness, slowed or difficult speech, chest pain, hives or rashes, changes in vision, aggressive behavior, paranoia, mania and seizures. Since these are stimulants, serious cardiovascular complications include increased heart rate, increased body temperature to dangerous levels, heart attacks, cardiac arrest or strokes.
Symptoms of Overdose. These include panic attack, hyperventilation, cardiac rhythm abnormalities, hallucinations, uncontrollable tremors, profound confusion or delirium, vertigo, loss of consciousness and coma.
Post-effect Crash. Like Cocaine or any other stimulant, the “up feeling” from Adderall and Ritalin is followed by a crash, a feeling of fatigue, depression and decreased alertness. This can lead to additional abuse to obtain the high.
Tolerance, Dependency and Addiction. Unprescribed abuse of Adderall can be very addictive. Long-term abuse can lead to increased tolerance. Often, as use increases, it becomes impossible to ever recreate the initial high. This can lead to dependency, which in turn can lead to addiction. Over time, the resulting increase in dopamine activity can because subtle brain changes that reinforce drug behavior to the point of being quite difficult to reverse on one’s own.
An interview that highlights why teens are more susceptible to addiction is at http://www.npr.org/sections/health-shots/2015/01/28/381622350/why-teens-are-impulsive-addiction-prone-and-should-protect-their-brains
Short versus Long-term Use. On a short-term basis, non-ADHD users may stay up all night, read more and finish more problems, or work harder, but on a long-term basis, sleep/wake cycles are interrupted and the drugs do not improve one’s ability to learn or work. Non-ADHD users are learning or working in an “altered state” which is called “state dependent learning”. Someone who studies or works in an altered state may not remember the information when he or she returns to a non-altered state.
As Dr. Jan Maisel, a Greenbrae pediatrician has stated, “if someone stays up all night, whether assisted by a medicine or not, and does all this work and then goes off to take a test on this work or make a presentation, if they haven’t slept sufficient hours, they are much less able to put the work that they did into their long-term memory”. Studies show that students who abuse Adderall and Ritalin are more likely to have lower grades than students who do not abuse the substance.
Easy Access. A 2016 survey among 18-28 year olds found that roughly 63% obtained these drugs from friends, 18% from classmates and 20% from family.
Using for Recreational Purposes or Combining with Alcohol. Popping ADHD drugs with alcohol keeps users awake for more partying as these drugs counter the depressive effects of alcohol. The euphoria and happiness from these drugs, as well as reportedly better and more frequent sex, can lead to recreational abuse at parties and nightclubs.
Gateway drug. Unprescribed Adderall, Ritalin and other ADHD drugs are becoming known as gateway drugs to Cocaine, Ecstasy, Heroin and Methamphetamine (“meth”), especially when those drugs are cheaper. Meth and Adderall are almost chemical siblings - the methyl group simply allows the Meth to race through the body and hit harder. After that, meth breaks down and metabolizes into amphetamine. Meth and amphetamine cause the same side effects, same potential for overdose and same risk of physical dependence and addiction.
Research done at UC Berkeley identified a relationship between ADHD and use of stimulants in childhood and dependence on other stimulants in adulthood. According to another study, adolescent rats given repeated doses of Ritalin were more likely to self-administer Cocaine.
Slang Terms. These include Kiddy Cocaine, Truckdrivers, Uppers, Speed, Double Trouble, Christmas trees, Skippy, Jif, Bennies, Beans, Black Beauties, Roses, Hearts, Crosses, LA Turnaround, Addies (for Adderall) and Rittys, Rits (for Ritalin).
Prevention. A critical part of prevention is to inform your child that there is no association documented between ADHD drug abuse and increased study abilities or intelligence. The more you speak with your child about the dangers of drug use, the less likely your child will abuse drugs. If your child is prescribed ADHD drugs, monitor their use to ensure that the drugs are not being diverted to others.
XANAX and Other Drugs Used to Treat Anxiety.
Drugs such as Xanax, Valium, Klonopin, Ativan, Halcion and Restoril are in a category of drugs called Benzodiazepines (“Benzos”) and are typically prescribed to treat patients suffering from anxiety and panic disorders. They also aid sleep and are prescribed for other reasons, e.g., Klonopin and Valium are also anti-seizure drugs. Benzos are central nervous system depressants, slowing down aspects of mental and physical health. They are highly addictive if taken over a prolonged period or in large quantities. It is important to remember that teens and young adults are more susceptible to addiction because of their developing brains.
Xanax. This is perhaps the most commonly abused Benzo and is the trade name of the prescription medication Alprazolam. Street names include Xannies/Zannies, Handlebars/Bars or Blue Footballs. Xanax bars are becoming increasingly common in Marin high schools, are 2 milligrams, shaped like a bar and divided into quarters.
Signs of abuse. These include, sleepiness, lethargy, lacking in motivation to engage in normal activities of daily life, slurred speech, monotone voice, appearing distracted, agoraphobia (not wanting to leave the house) and reclusiveness (avoiding other people). Benzos are known to slow down respiratory rates which alone can be dangerous as breathing slows. But when mixed with alcohol, another depressant (not uncommon among teens and young adults), their combined effect can lead to serious injury, coma or death.
After long term use, individuals may become even more reclusive, agoraphobic and scared of people, behaving more strangely, and have twitching eyes and a tense neck.
Slang terms. These include Candy, Downers, Downs, Chill Pills, Tranks, Tranqs, Totem Poles, Sleeping Pills, French Fries, Blues, Z-bar and Bricks.Mixing Benzos with Alcohol. Combining Benzos with alcohol is especially dangerous. Since both substances are depressants, that can greatly relax muscles and bring the central nervous system to a crawl, which can result in unconsciousness, coma or death. A slang term for a mix of prescription drugs with alcohol is “recipe”.
Opioids are a class of drugs that include the illicit drug Heroin, as well as regular prescription (Rx) pain relievers such as Oxycodone (OxyContin and Percocet), Hydrocodone (Vicodin, Lortab), Codeine, Morphine, Methadone, Fentanyl and others.
Opioids are one of the most abused drugs in the U.S. and they are easy to get ahold of, readily prescribed and are very addictive - a dangerous combination. Of particular concern is that opioids can cause measurable symptoms of addiction in less than three days!
The 2014 National Survey on Drug use and Health has estimated that there were 4.3 million non-medical users of pain relievers in the U.S. in 2014, a population second only in size to marijuana users.
The U.S. is in the midst of an opioid epidemic. Drug overdoses today are the leading cause of accidental deaths in the U.S. - more than car crashes and gun deaths combined - and opioids are driving this epidemic. The CDC announced in December 2016 that more people died from drug overdoses in 2015 than in any other year on record and 60% of those deaths came from opioids. This is a uniquely American issue. While Americans comprise less than 5% of the world’s populace, we consume 80% of the world’s opioids and 99% of the world’s Hydrocodone and Oxycodone.
PRESCRIPTION (Rx) OPIOIDS. In 2014, more young adults died from prescription drug (mostly opioid) deaths, than overdoses from any other drug, including heroin and cocaine combined, including many more needing emergency room treatments.
Nearly a half million teens (aged 12-17 years old) used prescription painkillers non-medically for the first time in 2014. These drugs are easily accessible from family or friends’ medicine cabinets. The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994-2007.
As stated above, in the Tamalpais HS Union District, 24% of 11th grade teens surveyed used prescription pain killers or other prescription stimulants, according to the 2015-16 CHKS survey. Most teens do not believe that painkillers are dangerous, because they are prescribed by a doctor and are not illegal. The terms “pharming” or “pharm party” refer to swapping or sharing Rx drugs. The term “trail mix” or “skittles” refers to mixing various prescription drugs at pharm parties. Fortunately, pharm parties are not common in our Marin high schools.
Opioids bind to the brain’s opioid receptors. Once attached, they initiate a cascade of neurochemical activity which signals a massive influx of dopamine. The signals sent to the brain block pain, slow breathing and have a general calming and antidepressant effect.
Signs of Misuse. These include constricted, small pupils (pinprick or pinpoint in size), noticeable euphoria (feeling high), marked sedation, intermittent nodding off or loss of consciousness, respiratory depression (shallow or slow breathing), nausea, vomiting, constipation, and analgesia (feeling no pain). Withdrawal symptoms can mimic flu symptoms.
Slang terms. These include Hillbilly Heroin, Kickers, Oxy, OC, Oxycotton, Cotton or being Jammed (Oxycodone) and Jerry Rice (80mg tabs), Percs, Percodans (Percocet), Vic, Vikings, Vikes, Watson-377 (Vicodin) and Happy Pills and Big Boys.
Mixing Alcohol and Opioid Painkillers. As with Benzos, both alcohol and opioid painkillers are central nervous system depressants. When combined, these substances can have a catastrophic interplay. Concurrent use can hasten an overdose due to a synergy in respiratory depression. While alcohol alone can have harmful effects on the liver, the risk of liver damage is severe as many painkillers also contain acetaminophen.
Gateway to Heroin. Four out of five new heroin users started out by misusing prescription painkillers.
HEROIN. Although rare, heroin use unfortunately exists in Marin County and in our high schools. With over 1 million heroin users in the U.S., heroin-related deaths are skyrocketing, made possible in part by the cheap supply of heroin, easy availability and Fentanyl-infused heroin (which is 50 times more potent than heroin.) Many of these deaths are also attributable to new government manufacturing requirements that make opioid prescription pills more difficult to crush and inject into the bloodstream. These factors have made prescription drug users shift to heroin.
Heroin deaths rose 23% in 2015 and were higher than gun deaths. Over the past several years, heroin has resulted in too many tragic deaths of Marin teens and young adults.
Signs of Use. After a “fix” or after smoking heroin, a heroin user will look “stoned”. Signs of use are very small pupils, glassy looking eyes (light colored eyes can turn bright blue), difficulty in keeping eyes open (appearing as nodding off - called “goofing off”), inability to finish sentences, slurred speech, shallow breathing, scratching, excessive smoking, loose facial muscles, blood stains on clothes from using needles, bloody tissues, track marks on hands, arms and legs, long sleeves in warm weather to hide track marks.
Slang Terms. These include H, Horse, Smack, Junk, Dope, White Horse, China White, Skunk, Skag, Helldust, Brown Sugar, Thunder, Chiva and Chasing the Dragon. Kryptonite refers to marijuana with heroin.
What is most alarming is that prescription pills are sometimes being laced with fentanyl and other synthetic opiates and these counterfeit drugs are extremely deadly. (Remember, fentanyl is 50 times more potent than heroin - a legal dose is approximately 2 milligrams). This has been occurring since 2013-14 and there is a new and ongoing Fentanyl crisis (the first was in 2006 with fentanyl infused heroin).
Motivated by enormous profits, traffickers are exploiting high consumer demand for prescription medications by producing inexpensive, fraudulent prescription pills containing fentanyl. Counterfeit pills containing fentanyl are smuggled into the U.S. from Mexico and Canada and clandestine pill press operations also occur in the U.S., with China as the primary source. Traffickers usually purchase powdered fentanyl and pill presses from China to create counterfeit pills to supply illicit U.S drug markets. The pills are manufactured to look like Vicodin, Percocet, Xanax and other prescription pills. See https://www.dea.gov/docs/Counterfeit%20Prescription%20Pills.pdf.
COLD AND COUGH MEDICATIONS (Coricidin pills, Robitussin Cough Syrup). In October 2015, five students at Tamalpais and Drake high school overdosed in one week after taking large doses of cold and cough medicine, known as “Triple C”. When taken in large quantities, these drugs cause a high that produces hallucinations and a sense of dissociation. The primary ingredient is dextromethorphan or DXM, which can create psychotic results.
Signs of use are dilated pupils, vomiting and poor motor control. Use can result in seizures, coma and death.
Another dangerous version of cough syrup contains Codeine and Promethazine, which is prescribed, but can be abused easily. Known as “Purple Drank”, it is often mixed with soda and is attributed to the loss of at least one Marin youth.
Slang terms. DXM abuse is also referred to as Triple C, skittles or robotripping. Codeine with Robitussin is called Cody, Captain Cody, Schoolboy or Tuss.
According to the 2015-16 CHKS results, 10% of 11th graders in the Tam High School District reported using Ecstasy, LSD or other psychedelics at least once in their lifetime (the question was not broken out for MDMA, Ecstasy, Molly and LSD). Cocaine lifetime use was 5% of 11th graders surveyed.
MDMA, ECSTASY and MOLLY.
MDMA is perceived as benign compared to other drugs such as cocaine or hallucinogens such as LSD. It is a synthetic drug, that alters mood and perception (awareness of surrounding objects and conditions). It is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth and distorted sensory and time perception.
MDMA was initially popular in the nightclub scene and at all-night dance parties (“raves”). Today, the drug affects a broader range of people who more commonly call the drug Ecstasy or Molly, a relative of Ecstasy. It still is considered a “party drug” and is popular at nightclubs, outdoor music festivals, concerts, large parties and interactive, high-energy environments. For an article in the student-run Redwood High School newspaper, the Bark, on the drugs used in the club scene, including Molly, go to http://redwoodbark.org/2014/04/peace-love-unity-and-raves/.
MDMA is usually taken as a capsule or tablet, though some swallow it in liquid form or snort the powder. Once consumed, it takes about 15 minutes to enter the bloodstream and the brain, producing almost instant feelings of euphoria and closeness, while diminishing a user’s anxieties. The effects can last anywhere from three to six hours. Many users take a second dose as the effects of the first dose begin to fade or they take more than one pill at a time to enhance their experience.
Effect on the Brain. MDMA increases the activity of three brain chemicals: Dopamine (which causes a surge in euphoria and increased energy/activity), Norepinephrine (which increases heart rate and blood pressure) and Serotonin (which affects mood, appetite, sleep and other functions.) It also triggers hormones that affect sexual arousal and trust. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by users.
Other health effects. High doses of MDMA can affect the body’s ability to regulate temperature. This can lead to a spike in body temperature which can result in hyperthermia. That can occasionally result in liver, kidney or heart failure or even death. When taken in overcrowded, overheated environments such as a music venue, MDMA also can lead to severe dehydration which can lead to overheating, convulsing or seizing. Finally, because MDMA promotes trust and closeness, its use can encourage unsafe sexual behavior.
Molly. After Ecstasy earned a bad reputation in the 1990’s, the drug was rebranded and Molly, with its seemingly sweet and innocent name, appeared on the scene. Slang for “molecular”, Molly refers to the supposedly “pure” crystalline powder form of MDMA, usually sold in capsules for about $40 per 100-milligram pill. This is a marketing ploy.
Molly users often actually get other drugs such as synthetic cathinones (“bath salts”), cocaine, ketamine (found in horse tranquilizers), methamphetamine, heroin, PCP or over-the-counter cough medicine, caffeine and even rat poison. These substances can be instead of MDMA or in addition to MDMA. They can be extremely dangerous because the person does not know what they are taking. They are also harmful when combined with pure MDMA. And as with other drugs, combining Molly with alcohol, marijuana or other drugs is especially risky.
Taking Molly is like playing a game of Russian Roulette. The DEA says that only 13% of the Molly seized in New York state over the last four years actually contained any MDMA and even then it often was mixed with other drugs. Molly is often manufactured in countries such as China, where the ingredients can be mixed in unsanitary places like toilet bowls and bathtubs. No one knows the truth as to how each batch of Molly is prepared.
In a six year span, emergency room visits related to the use of Ecstasy, MDMA and Molly rose by 128% among those under the age of 21. Since 2013, there has been an extensive string of Molly deaths and overdoses throughout the country. Horror stories abound of young adults taking one dose and dying almost instantaneously from Molly.It is tragic that Molly is used amongst teens and young adults today who are simply looking for a “good” time. Molly is marketed to teens who are first-time drug users as well as rave and electronic dance music fans who may think they are getting MDMA. Molly is also popularized in rap lyrics and pop culture.
Signs of Use. Symptoms include hyperactivity, unusual confidence, jerky movements, inability to sleep, talkativeness, grinding or chattering teeth, very large pupils, sweating, thirst, lack of appetite, staring, “spittin” cotton (spit is like a cotton ball). The comedown can be depression, fear, listlessness, apathy, muscle aches, cramps and mood swings. Not everyone who uses this drug shows all of these symptoms.
Use of Lollipops, Pacifiers and Gum. As these drugs speed up activity in the central nervous system, the excess adrenaline causes users to grind their teeth and clench their jaw or their teeth to chatter. This is why users often suck on lollipops or pacifiers or chew a lot of gum when using Molly, Ecstasy or MDMA.