Citizen Cartwright

When one pill can kill, and what to do about it

My thanks to the reader who sent me this Rolling Stone special report titled "Inside Snapchat’s teen opioid crisis.” And my thanks to a young person who lost a friend to fentanyl, for their suggestions on how to prevent deaths.

"Between 2019 and 2021, the number of teen deaths from fentanyl tripled — and the driver of that plague, per the cops and feds I talked to, was fake pills sold online,” says Rolling Stone. "Phony opioids that looked like Oxycontins but were cut with fentanyl, not oxycodone; bogus Xanax but with fentanyl, not alprazolam, on board. Name any pharmaceutical with a foothold on campus — Adderall, Valium, Suboxone, what-have-you — and it was instantly available via social media and delivered to your door like Papa John’s.

"The folks compounding those pills weren’t pharm-school grads. They were cartel adjuncts or lost-soul dropouts with a storage unit and a pill press. And whether their fentanyl came from Mexico or directly from China, they were everywhere and nowhere at once: invisible on the street but ubiquitous online; and many were hawking poison disguised as pharma drugs over Snapchat.

Snapchat was effectively a safe space for dealers, says Rolling Stone: "All forensics vanished within 24 hours, wiped clean by the delete function of the app. That wasn’t a bug but a feature of Snap, the code choice that sent its fortunes soaring and marked it out from its social media rivals. On TikTok and Instagram, your DMs and photos largely lived till you deleted them, one by one. On Snap, it was the reverse: Everything turned to smoke unless you manually saved it to your account."

"To be fair, other platforms hosted millions of kids, too, and were beset by dealers and their pills,” says Rolling Stone. "And consider the sheer scale of Snap’s safety challenge: Each day, 5 billion posts are exchanged by its users, or more than 2 million a minute. But crimes done on TikTok left durable tracks for law enforcement to follow. On Snap, the trail was faint and short-lived. According to multiple law-enforcement sources, between 2019 and late 2022 — the years of inquiry in this story — that vanishing ink was a stone wall for cops, and a boon to Snap’s criminal users. Dealers plastered menus of their pills and prices on their public-­facing Stories page. They posted up in places where kids hung out and pinned menus to their Snap Map tabs. Up popped the profiles of Snap users nearby — and an easy way to tell kids from cops.”

The Social Media Victims Law Center is suing Snapchat on behalf of fentanyl victims’ families.

Parents who have lost teens to fentanyl-laced drugs are among those lobbying for The Kids Online Safety Act, a bill that would require social media, gaming and messaging apps to limit features that could heighten depression or bullying or lead to sexual exploitation, says The New York Times.

"The bill, which has the greatest momentum of any broad tech industry legislation in years, would also require the tech services to turn on the highest privacy and safety settings by default for users under 17 and let youths opt out of some features that can lead to compulsive use,” the Times says.

The take of the young person I talked to: "While it's true that Snapchat’s default setting is for messages to disappear, Instagram has an easily toggled 'vanish mode' that achieves the same with text and photos. Other common platforms offer similar modes as well.”

They told me: "Accepting that ‘just say no' as a premise might not always be effective, I’d suggest getting Narcan for your kid and encouraging them and their friends to have it on them. Even if they’re not in danger of fentanyl exposure themselves, remind them that even routine drug users can die from first use of fentanyl if they don’t know it’s cut into the drug they’re taking. Narcan can save the life of their friend or a stranger if they see them responding negatively to a drug. Also, if you administer it without need (i.e. you think they’ve taken fentanyl but they haven’t), Narcan won’t harm them, so you’re not in danger of 'making it worse' to try it just in case."  

Also, this young person tells me that people who buy drugs can buy test kits for fentanyl. Here is an explainer of the testing process, by the New York City government.

Narcan (naloxone) is free in D.C. Here is the link.

And here is the link for the federal Drug Enforcement Administration’s fentanyl awareness resources.

Private equity’s increasing role in caring for our most vulnerable

We’ve already talked about the role of private equity in assisted living facilities, nursing homes, hospices, hospitals (you may recall the series of articles in 2022 by KHN, since renamed KFF Health News). 

 

Now, each of the top five for-profit child care chains — KinderCare, Learning Care Group, the Goddard School, Primrose Schools and Bright Horizons — is controlled by private-equity funds, and private-equity-backed centers have 10 to 12 percent of the market, says The Atlantic.

 

I recently discovered that private equity also is in psychotherapy.

 

And physical therapy.

 

And the care of children with autism.

 

The Atlantic article reminds us of some of the problems of the private equity business model, according to the book "Plunder: Private Equity's Plan to Pillage America,” by Brendan Ballou, former special counsel for private equity at the Justice Department:

 

— Private equity buys a business with the intention of flipping it for a profit, not long-term sustainability, meaning it's trying to maximize value in the short term and is less likely to invest in staff or facilities. 

 

— It tends to load businesses with debt and a lot of fees. 

 

— Its business structure insulates private equity firms from liability.

 

I’m always grateful when someone who points out a problem also recommends solutions, as Ballou does in his book. I’ve been meaning to summarize them here.

This Valentine’s Day, a tip to feel calm, cozy

As you know, I work as an academic tutor and coach for children and teens. Much of my work is helping them deal with anxiety.

 

In a class I take that trains therapists and coaches, I recently learned about the book "Resilience: Powerful Practices for Bouncing Back from Disappointment, Difficulty, and Even Disaster,” by Linda Graham, a marriage and family therapist.

 

The book contains more than 130 exercises to help people survive and thrive, no matter what.

 

So for this Valentine’s Day, in these anxious times, here is a very simple tool Graham describes as “portable equilibrium,” that’s powerful enough to calm a panic attack in less than a minute:

 

— Put your hand on your heart and breathe in a sense of safety or goodness.

 

— Remember one moment when you felt safe or loved by another human or a pet.

 

— Feel those feelings for 20 to 30 seconds.

 

— Repeat this practice many times a day at first, “to strengthen the neural circuitry that remembers this pattern.”

 

"Remembering a moment of feeling safe, loved, and cherished by another person or pet activates the social vagus, reassuring you that indeed you are safe, you belong, and you are welcomed,” Graham says. "Your blood pressure decreases, and your heart rate stabilizes. You return to the sense of safety that comes from a feeling of connection and belonging with safe others, even when you are alone.”

 

She suggests practicing this exercise whenever you feel the first sign of an upset. With practice, it will enable you to avert a difficult emotional reaction before it hijacks you. 

 

At a minimum, she suggests practicing it five times a day for a week to train your brain in this new response to any difficult moment.

KHN: 'With polio’s return, here’s what back-to-schoolers need to know'

"As polio appears again decades after it was considered eliminated in the U.S., Americans unfamiliar with the dreaded disease need a primer on protecting themselves and their young children — many of whom are emerging from the trauma of the covid-19 pandemic,” says Kaiser Health News.

 

Why is polio back?

 

Violent conflict, the spread of conspiracy theories, vaccine skepticism, inadequate funding and political will, and poor-quality vaccination efforts have slowed progress toward eradication, but before the coronavirus pandemic, the world had gotten very close to eradicating polio, KHN says. During the pandemic, childhood immunizations, including polio vaccinations, dipped in the United States and around the world.

Boys should start school a year later than girls

So says Richard Reeves, a senior fellow at the Brookings Institution, in an article in The Atlantic adapted from his forthcoming book, "Of Boys and Men: Why the Modern Male Is Struggling, Why It Matters, and What to Do About It.”

 

Here is an excerpt of his excerpt:

 

“The fact that boys mature later than girls is one known to every parent, and certainly to every teacher,” Reeves says. "According to a Rand survey, teachers are three times more likely to delay entry for their own sons than their own daughters. The maturity gap is now demonstrated conclusively by neuroscience: Brain development follows a different trajectory for boys than it does for girls. But this fact is entirely ignored in broader education policy, even as boys fall further behind girls in the classroom.

 

“On almost every measure of educational success from pre-K to postgrad, boys and young men now lag well behind their female classmates," he says. "The trend is so pronounced that it can result only from structural problems. Affluent parents and elite schools are tackling the issue by giving boys more time. But in fact it is boys from poorer backgrounds who struggle the most in the classroom, and these boys, who could benefit most from the gift of time, are the ones least likely to receive it. Public schools usually follow an industrial model, enrolling children automatically based on their birth date. Administrators in the public system rarely have the luxury of conversations with parents about school readiness.

 

“But public-school kids should have the same opportunities as private-school kids, and public-school officials should be able to have those conversations. As a matter of policy, the public schools that aren’t already flexible about school start should be made so — and I believe that, as the default, all states and school districts should enroll boys a year later than girls.

 

“A proposal to give a boost to boys may sound odd to some, given the inequities that many girls and women still face. But I am betting on our ability to think two thoughts at once. There is much still to be done to promote female representation in politics and corporate leadership, for example. But as to education, boys and men are the ones who need the most help. And it’s not an issue only for them. When schools fail boys, those boys grow into men lacking the skills to flourish in the workplace, to be strong partners, or to be good providers for their children. Giving boys the gift of time will help create a better society not just for men, but for women and children too.

 

“In the span of just a few decades, girls and women have not only caught up with boys and men in the classroom — they have blown right past them. Half a century ago, the landmark Title IX law was passed to promote gender equality in higher education. At the time, there was a gap of 13 percentage points in the proportion of bachelor’s degrees going to men compared with women. Today, the gender gap is a little wider — 15 percentage points as of 2019 — but the other way around. For every three female college students, there are only about two men. The trend worsened during the pandemic. College enrollment as a whole declined in 2020 — but that decline was seven times greater for male than for female students.

 

"It’s hard for some people to get their head around the idea that in many areas of life, and above all in education, boys and men are now the ones who need the most help. We have a National Coalition for Women and Girls in Education, but no equivalent for men. Thousands of academic scholarships are aimed at young women, almost none at young men. This lag is understandable, given the dizzying speed with which the gender gap has reversed. But we can start to address this new gap — right now, at the very beginning of the educational journey — simply by giving boys an extra year to mature."

 

As you know, readers, I tutor children and teens. I agree with Reeves.

Apple’s plan to scan iPhones for images of child sexual abuse

I ran this AP article in last Friday’s “in the news.” My thanks to the reader who has sent me this analysis from technology blogger John Gruber.

 

A letter to Apple from security experts, privacy advocates and others saying the plan "introduces a backdoor that threatens to undermine fundamental privacy protections for all users of Apple products,” has gotten thousands of signatures, says The Verge.

 

Apple said on Monday it will refuse any government demands to expand its new photo-scanning technology beyond the current plan of using it only to detect child sexual abuse material, Ars Technica reports.

 

Here is more on the issue, from CNET.

Childhood trauma is a public health issue, and what can be done

At least five of the top 10 causes of death in America are associated with what the CDC calls adverse childhood experiences.

 

And preventing those traumatic experiences could reduce adult depression by as much as 44 percent, the CDC says.

 

Sixty percent of adults across the country have experienced at least one type of adverse childhood experience, according to the report.

 

Those experiences include violence, abuse, or neglect and having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance misuse, mental health problems, or instability because of parental separation.

In the CDC's first-ever analysis of the issue, researchers analyzed 2015-2017 data from more than 144,000 adults in 25 states. The findings were published Nov. 5 in a Vital Signs report.

 

What I particularly like about the CDC’s report is that it doesn’t just point out the problem, it discusses what can be done to prevent and respond to child trauma and who can do it — from healthcare providers to employers to states and communities to each of us.

 

Supportive, nurturing relationships and environments for both children and families are at the heart of prevention, according to the report.

 

Positive childhood experiences and relationships are known to buffer against the stress of trauma and strengthen resilience, says Dr. Anne Schuchat, the CDC’s principal deputy director. 

 

"It might be a parent, it might be a teacher, it might be a neighbor, but having a stable, reliable person in your life can help you at that individual level with resilience,” says Schuchat. "That stability and nurturing will help you when you have a stress or a difficult problem [because you] have an outlet and a reliable way to process it and seek help if you need to.”

Helicopter parenting your dog or cat

When something I come across during my middle-of-the-night news searches makes me laugh out loud, I want to share it with you.

 

So:

 

You know the trend toward pet owners being reconceptualized as pet parents. 

 

Well, in apparently the same way people have used baby monitors, pet cams now enable pet parents to monitor their pets — and more.

 

Wi-Fi-enabled cameras now come with features to entertain pets, including treat-dispensers, laser-pointing games and two-way audio that lets you hear and talk to your pet remotely, reports The New York Times. One device offers two-way video, so your pet can see you. It’s all controlled by your smartphone.

 

PetChatz HD, at $300, has live video-streaming, motion-detection alerts, two-way audio, a built-in treat dispenser and an LCD screen so your pet can see you.

 

For $99 more, you can buy a PawCall button that enables your pet to get in touch with you. A light on the paw-shaped button tells the animal when you’re available, and he or she then can press the button to dispense a treat and send you a text to initiate a call.

 

The Times reporter who tested this with her dog writes: “After repeating these steps 10 times and then taking a break and doing it all over again a couple of hours later, Rocket still hadn’t gotten the hang of it. He had eaten a lot of treats, though.”

 

My imagination is running away with thoughts of what a smart and enthusiastic pet might do with this device.

Can our kids be trusted with their own lives?

As I’ve mentioned, I tutor kids. And I’d like to alert you to a new book by neuropsychologist Dr. Bill Stixrud — who trained me to be a tutor — and Ned Johnson, founder of PrepMatters tutoring service: “The Self-Driven Child: The Science and Sense of Giving Your Kids More Control Over Their Lives.”

The book’s essential point is that it’s a parent's job to be a consultant for their child, who is the (age-appropriate) decision maker for his or her own life.

Why should children make their own decisions?

“Over the last 60 years, study after study has found that a healthy sense of control goes hand in hand with virtually all the positive outcomes we want for our children. Perceived control, the confidence that we can direct the course of our life through our own efforts — is associated with better physical health, less use of drugs and alcohol, and greater longevity, as well as with lower stress, positive emotional well-being, greater internal motivation and ability to control one’s behavior, improved academic performance, and enhanced career success.” p. 12

Why should parents be "consultants?"

“When we say we want children and teens to make their own decisions as much as possible, what we really want is for them to make informed decisions. It’s our responsibility as parents to give the information and the perspective that we have — and that they lack — in order to enable them to make the best possible choices. Once properly informed, kids usually do make good decisions for themselves — and their decisions are almost always as good as or better than our own.” p. 55

But what if things go “wrong?”

Bill writes: “I realized within six months of leaving Berkeley that flunking out was the best thing that could have happened to me. So often, when it feels like everything is going wrong, things are just being reorganized in helpful ways that we could never anticipate.” p. 311

For me, this book does indeed make sense, as its title promises. Certainly the “worst” moments of my own life have been my greatest teachers. And learning as a parent that my role was to provide information but to limit unsolicited advice has enabled my daughter and me to be cozily close. In contrast, my own parents micromanaged me into youthful depression and adult estrangement.

Among the other topics in this heavily researched book: why parents should be a “non anxious presence” and how to do it, why downtime is important, dealing with technology, navigating learning differences, assessing whether one’s teen is ready for college, and alternative routes if they aren’t.

 

Here is an interview with Bill on the book, from Scientific American.

 

And an article by Bill and Ned in Big Think.

Teens' smartphones making them 'seriously unhappy'

The smartphone has radically changed every aspect of teens’ lives, from the nature of their social interactions to their mental health, says Jean Twenge, a professor of psychology at San Diego State University and author of "Generation Me" and “iGen,” in the September issue of The Atlantic.

More comfortable in their bedrooms than in a car or at a party, today’s teens are physically safer than teens ever have been, she says.

Psychologically, though, the generation she calls iGen is more vulnerable than Millennials were: Rates of teen depression and suicide have skyrocketed since 2011.

"It’s not an exaggeration to describe iGen as being on the brink of the worst mental-health crisis in decades,” Twenge says. "Much of this deterioration can be traced to their phones.”

The allure of independence, so powerful to previous generations, holds less sway over today’s teens, who are less likely to leave the house without their parents, says Twenge. Twelfth-graders in 2015 were going out less often than eighth-graders did as recently as 2009.

In a variety of behaviors — drinking, dating, spending time unsupervised — 18-year-olds now act more like 15-year-olds used to, and 15-year-olds more like 13-year-olds, she says.

Why are teens waiting longer to take on the responsibilities and the pleasures of adulthood? In an information economy that rewards higher education more than early work history, parents may be inclined to encourage their kids to stay home and study rather than to get a part-time job, says Twenge. Teens seem to be content with this homebody arrangement — not because they’re so studious, but because their social life is lived on their phone, she says.

Teens who spend more time than average on screen activities are more likely to be unhappy than those who spend less time, and those who spend more time than average on nonscreen activities are more likely to be happy, Twenge says, citing The Monitoring the Future survey, funded by the National Institute on Drug Abuse.

Despite all their power to link kids day and night, social media also exacerbate the age-old teen concern about being left out, says Twenge.

"The correlations between depression and smartphone use are strong enough to suggest that more parents should be telling their kids to put down their phone,” Twenge says.

And, given the increasing addiction to smartphones among people of every age, I imagine a likely response from teens would be to suggest that their parents put down their own phones.