Strategies for Overcoming the Opioid Epidemic in Schools and Communities
Grace Westermann in conversation with Jennifer Loeffler-Cobia, Justice and Public Health Policy and Practice Director at WestEd
Jennifer Loeffler-Cobia:
If we are to successfully implement these five strategies around education, around treatment, around collaborative efforts, around policy reform, right, if we think about this comprehensively around the system, five years from now, we could very well witness a transformed system where collaboration amongst schools, communities, law enforcement, public health treatment providers is seamless and highly effective. That’s what we want is a seamless kind of continuity of care.
Grace Westermann:
Welcome to Leading Voices, a podcast brought to you by WestEd, a national, non-partisan research, development, and service agency. This podcast highlights WestEd’s leading voices, shaping innovations and applying rigorous research in ways that help reduce opportunity gaps and build communities where all can thrive. I’m Grace Westermann, and I’ll be your host.
Today we turn our attention to a crisis that touches every corner of our nation, the opioid epidemic. While overdose deaths have recently declined, we’re still losing more than 50,000 people a year to opioids and will remain in an epidemic unless we sustain and strengthen the efforts that are working, efforts that require schools, communities, health systems, law enforcement, policymakers, and families to work together towards sustainable solutions. Our guest Dr. Jennifer Loeffler-Cobia is the Justice and Public Health Policy and Practice director at WestEd’s Justice & Prevention Research Center and an adjunct professor at the Bovard College at the University of Southern California.
With over 20 years of experience at the intersection of justice, prevention, and public health, she’s a national expert in multi-sector, evidence-based strategies that translate research into actionable solutions to reduce recidivism, violence, and substance misuse. At WestEd, she leads research and evaluation projects on juvenile and adult justice, substance misuse prevention, violence prevention, and public health. Jen, it’s great to see you. Thanks so much for being here.
Jennifer Loeffler-Cobia:
Thanks, Grace. It’s great to be here, and thanks for inviting me.
Grace Westermann:
So, Jen and her team have developed five strategies for addressing the nation’s opioid epidemic. These five strategies focus on supporting safe schools and communities. Jen, can you give us an overview of the five strategies your team has developed to address the epidemic before we dive into each one?
Jennifer Loeffler-Cobia:
Yeah. So what I want to talk about, so there’s really five kind of buckets that I like to talk about when we think about encompassing or addressing the opioid epidemic effectively, and I want to really hone in on that word “effectively” because it really takes a comprehensive approach. We can’t just do one thing without the other.
So the first one is education and prevention programs, and it’s really about spreading awareness and knowledge, developing workshops, school programs, campaigns. It’s really that information dissemination. The second is access to treatment and recovery services, right? We really want to ensure that we have a comprehensive care approach in terms of our treatment and our recovery services. So that includes medical treatment, mental health services, rehabilitation, healthcare, housing, employment, all of the things that kind of encompass or go with that comprehensive care.
The third kind of bucket area is that integrated treatment and justice diversion programs, right? Like I just was talking about, we want to really have that comprehensive care in our treatment and recovery, and we want to make sure that we have those justice diversion programs, too, to really help with rehabilitation and accountability rather than just a punitive or punishment.
And then the fourth bucket is really creating that community engagement support, building that strong support network, building networks in the communities, fostering collaboration, and really encouraging that kind of collective effort in combating this overdose epidemic.
And then the fifth kind of bucket, what I call our policy and our legislation, right? We can do all of this great implementation, but if we don’t have effective policy and a legislation to go… to support what we’re doing in our communities and within our schools, we have to make sure that we advocate for supportive legal frameworks to make sure we have that support, whether it’s through funding, other resources, so forth, and we need to make sure we’re working with policymakers within that comprehensive strategy.
Grace Westermann:
You mentioned education and prevention as that first pillar. And since we know youth are especially vulnerable, with nearly one in seven high school students reporting prescription opioid misuse and the highest rates of opioid misuse being among 18- to 25-year-olds, can you share what’s driving opioid misuse among young people and how schools and communities can respond?
Jennifer Loeffler-Cobia:
Yeah, absolutely. So we live in a society right now where we’re constantly connected, we’re constantly on our phones, we’re constantly on our computers, we’re constantly looking at the news, 24-hour cycle news, right? And this creates a lot of stress, a lot of anxiety. It can even create depression. We’re also getting lack of correct information as well that can really cause this stress, this anxiety, sometimes depression.
And when we think about our schools, sometimes we don’t have the adequate mental health resources within our schools to address this, and that’s where most of the kids spend our daily time is in schools. So how can we better support schools to address some of these mental health issues?
And when we’re thinking about kids, like I said, stress, anxiety, and some depression, those are the mental health issues that we’re seeing within kids that can then lead to substance use because they’re self-medicating, they’re trying to overcome some of these mental health issues. They often turn to different substance use like opioids. So that’s one of those root causes.
The other is family dynamics and the environment which our kids are raised in, right? Some of the kids are really having a high level of exposure, especially with prescription drugs within our families, whether it’s a brother or sister, maybe even a mother or father, maybe a more distant cousin, uncle, aunt. They just have greater access to it.
And then access and availability. We might have a family member who’s been hurt, so then they have some kind of an opioid for pain management. And then if we can’t get access to prescriptions anymore, because we’ve really ramped down on the use of prescription opioids, we go to the streets. So we see a lot more kids, youth, families, parents going to the streets to feed that substance use disorder or that addiction.
And we have lack of parental guidance. So parents are often not educated in this area, so how then can they educate their kids with accurate information? And again, lack of education and awareness, limited understanding of the dangers of opioid misuse. “If it’s a prescription, therefore, it must be okay” is kind of the general attitude, but that’s not always the case. And so, just because we have a prescription opioid doesn’t necessarily mean that it can’t be abused.
We also are seeing peer pressure. I mean, that’s kind of a cliche that we always talk about. “Oh, peer pressure.” But it really is a thing, right? And we are seeing more and more of it. So those are just five of those different root causes that we’re seeing in terms of how kids are engaging more and more with opioids, fentanyl, other drugs.
Grace Westermann:
So addressing those root causes is the first step. But if opioid overdose does happen, schools and communities need ways to respond right away. And one tool that gets a lot of attention is naloxone. What do you see as the biggest challenges and opportunities in making life-saving interventions like naloxone more available in schools and community spaces?
Jennifer Loeffler-Cobia:
Well, before we talk about some of the challenges, let’s talk about what naloxone is because there’s a lot of misinformation out there about NARCAN, that’s their regular name, or naloxone, which is the generic name, and it really is a life-saving medication. What it does, it’s an antagonist, and it rapidly reverses the opioid overdose. So it binds to what we call opioid receptors in our brains. It literally blocks the effects.
So if a youth is overdosing and it’s an opioid overdose, that naloxone given either through injectable or nasal spray immediately reverses the overdose because it blocks those receptors. So it is actually an amazing drug, and it’s used in emergency settings to make sure that that overdose is prevented.
What I encourage folks to do, anyone can be trained in providing naloxone, either injectable, you don’t have to be a nurse or an MD to do an injectable, you just need to be trained, or the nasal spray, which is usually easiest, and it’s also easiest to keep with you. It really has shown to reverse the overdose statistics that we’re seeing.
Some of the challenges, however, that we’re seeing in terms of just really responding to the overdose epidemic is we still have a stigma and an awareness problem. We have to think about folks with substance use disorders. It’s a disease like any other disease that we’re seeing, right? It’s a disease just like diabetes. It’s a disease just like cardiovascular disease.
When we have folks that have a substance use disorder on opioids, it literally has a chemical change in our brains to where our bodies are saying, “I have to have this to breathe,” basically. And until we can kind of restructure that chemical imbalance that the opioid has created, they’re going to continue to have that substance use disorder.
There are medications out there, medical-assisted treatments like buprenorphine, other drugs that can help bring down that substance use disorder, help control it, help get the person through the withdrawals of the opioid so that then they can get into treatment and then further into sustained recovery. So we’re treating a disease with a medication, but the stigma around that still remains. So we have to think about how do we really create awareness, create education around substance use disorder to really help combat this opioid epidemic.
Financial resources and constraints, right? There’s limited funding for… I just talked about naloxone, other medical-assisted treatment for further recovery. Naloxone is that short-term overdose prevention. But then once we save their life, we have to then further work with them in medical-assisted treatment to help sustain that recovery, but that costs money, so there needs to be funding.
Policy barriers, and I’ll get into a little bit more about that here in a minute, but we need to just make sure that our policies are really supporting naloxone, supporting medical-assisted treatment, getting money into the schools to do prevention work, prevention and education within the schools, and really making sure that we are providing resources around culture and language barriers.
We’ve got diverse culture and perceptions in terms of drug use and recovery, and we want to make sure that we are communicating and doing outreach that impacts all different cultures or we’re going to really miss the boat. We also need to make sure that our rural areas are getting resources. They’re often overlooked, and it does create a barrier through infrastructure to get folks in rural areas to resources. So we need to always keep that in mind, accessibility and infrastructure as well.
Grace Westermann:
What are the impacts on rural communities versus more urban communities? How are rural folks impacted by the epidemic differently?
Jennifer Loeffler-Cobia:
Yeah, absolutely. And it goes to lack of resources. In our urban areas and our cities, we have access to resources, we have access to funding to support those resources. And so you’re going to see… If we think about this idea of naloxone to prevent overdoses, we’ve got a lot of resources within our urban and our cities to do training, to provide the funding to get naloxone into people’s pockets so that they can carry it with them, right? We don’t have those same resources in rural areas.
So we just have to really make sure that our kids in rural areas and our youth and families, that we are providing the resources, providing the education, and providing that awareness and that understanding because we do continue to see that rural area have high rates of overdoses per capita.
Grace Westermann:
Beyond emergency responses and life-saving interventions, what are some of the first steps leaders can take to build responsive community-based recovery programs?
Jennifer Loeffler-Cobia:
So some of the first steps I think that folks could really engage in terms of building community-based recovery programs are, one, find your champions. Find the folks within the community that can be a real champion for naloxone, a champion for education and awareness. And then use those champions within your communities to build coalitions. And the coalitions need to have representation of your entire system.
So think about all of the folks or organizations or people that is trying to go into some kind of intervention or treatment. Who are they going to interact with in the system? They might interact with law enforcement. They might interact with mental health, housing, employment, healthcare, public health, education. So think of the folks within the system that kids and youth and families, that they’re going to interact with to try to get to that sustained recovery. And build a coalition of that system to help identify, okay, what resources system-wide, not just at the organization level, but system-wide, what resources do we have as a system? And where are the gaps in our resources? And how do we fill those gaps? And how do we share resources? And how do we prevent duplication of resources?
So really starting to create… Use those champions within your system to create that coalition, and then start having those conversations as a system of how we can share resources, identify gaps in resources, and better support these youth and families in our communities. So those would be, if we’re thinking just… And especially about infrastructure and accessibility to resources, those would be some of the first steps that I would do. Find your champion, build a coalition, and then learn how to work together as a coalition within your community.
Grace Westermann:
Okay. So we’ve talked about what schools and communities can do on the ground, but lasting change often depends on the policies that support those efforts. From your perspective, what policy and legislative strategies are most effective in expanding access to addiction treatment and overdose prevention?
Jennifer Loeffler-Cobia:
There’s a hundred different policies that we could talk about, some that help, some that hinder the work that we’re trying to do in saving lives, essentially. But just some of the things that come into mind, I’ll go over a few here.
And this one’s kind of a no-brainer, but we need to increase funding and resources. We have to have policies… As I just talked about, having your champion, building your coalition, that takes funding and resources. Being able to distribute naloxone, do training, and then get that in the hands of folks to be able to use it, that takes funding and resources. So we’ve got to make sure that our policymakers understand that, they understand evidence-based practices in addressing the overdose epidemic and making sure that then they can take that while they’re having the policy discussions and developing and implementing and passing policy.
Funding and resources: Allocate sustained funding. It has to be for prevention, has to be for treatment, it has to be for recovery. We can’t do one without the other. so making sure that we really have those funding and resources built into our policies.
Insurance companies: Making sure that Medicaid and insurance coverage has been expanded to address treatment and recovery services. I even would argue that insurance companies need to do better at prevention services as well. So thinking about innovative ways that insurance companies and their policies can better interact with prevention because prevention is really where it’s at.
We want to prevent overdoses before it ever even has an opportunity to happen, right? So where can our policies provide better resources for prevention, especially in the schools? Schools is where it starts because that’s where our kids are during the day, that’s where we can get the education, the awareness, and the information. So think about policies around prevention.
Integration of services. So again, I go back to that coalition of the system. How can our policies better support funding and resources for integrated services? So we’re not just saying if somebody has a substance use disorder, oh, we’re just going to send them to counseling. That’s part of it, that treatment, that counseling, but that person may need help with housing; they may need help with employment; they may need help with further education; they may need help with family dynamics; they may need healthcare.
And then just a couple more. Criminal justice reform. Criminal justice, that organization or that piece of the system can’t do it all by themselves. And the first thing that we think of if we have a youth, especially in our schools, that maybe let’s say they bring contraband into the schools or they have the substance with them, or maybe they’re high or using while at school, the first reaction is to get the criminal justice system involved, to charge them. And we really need to think about the impact of that. Is that the best first step?
And so a lot of times we want to think about policies that support diversion programs. We want to help support treatment programs for youth before we enter them into the criminal justice system. So how can we really work with the criminal justice system to reform it, to better support those with substance use disorders?
Grace Westermann:
Yeah. And I want to unpack that a little bit. Those diversion programs like drug courts give people facing non-violent substance-related charges a chance at long-term treatment under court supervision instead of jail time, which is important because incarceration alone often makes addiction worse and raises the risk of overdose and repeat offenses. So how do these programs strike that balance between holding people accountable and showing compassion so they can move toward long-term recovery?
Jennifer Loeffler-Cobia:
Absolutely. And when I talk about diversion programs, I’m definitely not talking about not holding people accountable. But we have to find that balance because at some point, let’s say folks do come into our criminal justice system, at some point they’re going to return back to their families, their communities, their employment, their school, whatever it might be. We want them to be successful. So where’s that balance in providing accountability for their behavior and their actions, but also providing them the treatment so that they can be successful and better members of our communities when they return?
So we think about justice diversion programs, for instance, like drug courts and treatment initiatives. So they’re designed to provide those alternatives to traditional prosecution and incarceration, particularly for those individuals that are struggling with substance misuse or have a substance use disorder. These programs really, like I said, they balance that accountability and that treatment by using evidence-based practice assessments and personalized treatment plans. They offer access to comprehensive services like I mentioned before, counseling, mental health support, and education.
And by really implementing this structured oversight with incentives and sanctions and partnering with community organizations and focusing on rehabilitation and that personal growth, what happens is they really foster that environment that’s conducive with recovery. So we haven’t taken any accountability away from it. We’re just not solely focused on the accountability and the punishment piece. We are balancing it out with that treatment to help provide that better recovery down the road.
And we also want to think about trainings that incorporate trauma-informed care and programs that are regularly evaluating their outcomes because in the spirit of accountability, we want to make sure that the programs that we provide and put folks with substance use disorders, youth and adults, we want to make sure that they’re good, number one, evidence-based, and two, that we’re getting the outcomes that we want.
And when we don’t get the outcomes, then we need to make enhancements or changes or calibrations to our programs; we want to make them better. So it’s really making sure that we have that long-term recovery in mind as we’re working with folks with substance use disorder.
Grace Westermann:
In your work, you said that real progress against the opioid epidemic depends on breaking down silos. And you touched on this when you mentioned building coalitions with schools, law enforcement, public health, treatment providers, and community members all at the table. So what are some of the biggest barriers that keep these groups from working together?
Jennifer Loeffler-Cobia:
I do a lot of work in systems thinking, systems approaches, and not just with the opioid overdose epidemic but in other public health areas. Really thinking about how a system works together rather than in silos is one of the better approaches that we can do to provide services, especially to this vulnerable population. But guess what? It’s hard. It’s hard to do. Collaboration, you wouldn’t think it is hard, but it is hard to do, and that’s why we don’t do it very well within our communities.
It’s much easier for the criminal justice system to go do their thing, do law enforcement, arrest somebody, convict them, put them in jail. That’s kind of the easier path for law enforcement. Public health is over here doing education awareness work on their end. Doctors, medical doctors are providing prescriptions, they’re providing awareness, they’re doing their thing. And we’re all kind of working in these silos.
How do we then come together and start talking about resources, start talking about shared resources, start talking about how do we change policies together as a system? That takes a lot more resources, it takes a lot more time, and it takes that collaboration spirit and that commitment. And we don’t do this. And the reasons why is because we have fragmented communication channels. We don’t have communication channels that are consistent with, one, data, using data and understanding data and really using it to support our decisions as a collaborative effort.
Grace Westermann:
Could you talk a bit more about that? What kinds of data need to come together to make planning more effective?
Jennifer Loeffler-Cobia:
I would look at our, one, overdose data, not only just the number of overdoses that we have in our community but where are they happening? Who are they happening to? Where’s our vulnerable populations? When are they happening? And we need to then look at that as a system and start talking about, okay, if we have a cluster of overdoses happening in one area or one community, why? And use that coalition or that systems approach to start asking the questions, why is this happening and who’s this happening to?
And then start thinking about, with that coalition and that system, where are the resources? Is this in a rural area that we talked about earlier? Is this in an urban area but we have lack of law enforcement here, we have lack of mental health resources, we have lack of naloxone training? We need to use the data to start asking the questions of why.
And a lot of times what folks will do, especially in coalitions if we have a collaborative effort, they’ll just look at the descriptive statistics across the board and they’ll be like, “Oh, you know what? Our overdoses are increasing. Our overdoses are decreasing.” And they’ll kind of leave it at that. But then they don’t start to ask why.
Why are we getting a decrease? If we’re getting a decrease in overdoses, we want to continue to do what we’re doing, so what is it that we’re doing? And we need to ask those questions. If we’re showing an increase in a certain community, why? Why is that happening? And it’s not just one piece of the system that can solve the problem. It can’t just be the criminal justice system. It can’t just be the medical system on its own. It can’t just be the education piece. We have to work together to determine why is this happening and how do we solve it together. So that’s just one really general way of looking at data.
Whenever I’m working with a coalition or a community system, I’m always teaching them in data to ask the questions. Why are we seeing this? And is it the outcome that we desired? And if it is, keep doing what we’re doing. If it’s not, we need to figure out what we need to calibrate and what we need to change.
Grace Westermann:
When these groups do come together in coalitions, what are the first things they need to focus on to make the coalition work?
Jennifer Loeffler-Cobia:
The first thing I’m going to say is data. I’m going to come back to data. Learning how to look at data in a meaningful way, but it starts with data. So use data to start asking those questions, start brainstorming, training.
Once you have your coalition together, you can’t assume that everybody knows what naloxone is, what medical-assisted treatment is. What are the best evidence-based practices to address the opioid overdose epidemic? What are the best practices to create awareness campaigns if we’re thinking about prevention? So bring in folks, subject-matter experts within your coalition that can help train. And then that also sparks questions, that also sparks brainstorming, that also sparks innovation within your coalition.
Grace Westermann:
I know there are barriers we’ve just discussed that can make collaboration tough but not impossible. So let’s imagine the opposite for a moment. If the strategies you discussed today were put into place and working together the way they should, what would things look like five years from now? What would be different for youth, families, and communities?
Jennifer Loeffler-Cobia:
So this study… I’m just going to talk about a certain study that was done, I think it was about 2017, 2018. And what this study looked at, the researchers at that time, so almost 10 years ago, looked and said, “We want to do a predictive study that said if we continue on the path that we’re on in terms of siloed approaches, the policies that we currently have in terms of addressing the opioid overdose epidemic, where are we going to be in five years?” So that was about ’24, ’25, so about where we are today.
And what they found in their predictive study that said if we continue on the same trajectory, in five years, we are going to see our overdoses increase tenfold. That was their predictive study back five, six, seven years ago. Now we’re here, and what we’re seeing is that predictive study really coming true.
Yes, we’ve done certain things in siloed… Let me give you an example. Back, oh gosh, maybe 10, 15 years ago when we really started seeing this overdose epidemic really take shape and start increasing and we saw a lot of folks losing their loved ones from the epidemic, what we did was we said, okay, we’ve got to capture, we’ve got to really hone in on medical doctors, we’ve got to hone in on prescriptions, on prescribing pain meds.
Because if we do that, and we stop the prescriptions of OxyContin and other different opioids, then we’re going to not have these overdoses that we have. And so that was where the focus was, was on that medical doctor, that medical profession and prescription, and really training medical doctors about the effects of OxyContin.
So that was great, right? We honed in on one piece of the system with the medical side, and we saw these prescriptions coming down. We saw a decrease in prescriptions. Well, what happened was is that was great. We saw statistically that prescriptions were coming down, but we weren’t seeing overdoses come down. Why? Because all we did is we took the supply away from those that now have a substance use disorder. This was in all age groups, all race, genders across the board.
And so where do those folks go if they already have a substance use disorder and addiction? They can’t get it from their doctor. They’re going to go to the streets. So now we have a criminal justice issue. We have a homeless issue. We have other issues. We have an unemployment issue. We have now exasperated the problem into the system because we first solely focused on one piece of the system.
So in thinking about that, and we think about these five strategies that I’ve mentioned, if we are to successfully implement these five strategies around education, around treatment, around collaborative efforts, around policy reform, if we think about this comprehensively around the system, five years from now, we could very well witness a transformed system where collaboration amongst schools, communities, that law enforcement, public health, treatment providers is seamless and highly effective. That’s what we want is a seamless continuity of care.
So, youth will benefit and their families and our communities will benefit from this kind of comprehensive education that empowers them with the knowledge and the resilience against this opioid misuse. Families will experience increased support and resources, including readily accessible treatment, services, and education workshops. Communities will thrive through robust engagement initiatives that foster solidarity and productive substance misuse prevention.
We’ll reduce that stigma that we talked about and create that environment where recovery and support are prioritized rather than demonized, and breaking down those barriers to treatment and intervention. And then overall, just thinking about a coordinated system with those integrated systems, we will share goals, we’ll align policies, and will lead to really significantly lower rates of opioid misuse and that healthier, more informed community, really providing that hope to pathways for sustainable change.
Grace Westermann:
Well said. And I hope we can get there. Do you have any last thoughts for our listeners before we wrap up?
Jennifer Loeffler-Cobia:
Oh, sure. We’ve lost millions and millions to this opioid overdose epidemic. And I’m not immune to it. I’ve lost a mother and a sister to this epidemic over the years. That’s why I do the work that I do is because I’m not just doing this as my profession. I’m doing this also because I’m passionate about the work. Because if I could’ve saved their lives, that would’ve been amazing. So I want to save as many lives as we can.
And I want us to think about, for every statistic, we’ve lost millions of loved ones to this epidemic, so every statistic, there’s a person that’s behind that statistic. And every person, there’s a story. And these stories encompass journeys through pain, addiction, attempts at recovery. Right? Sometimes it takes more than one. It comes with socioeconomic struggles that are all intertwined now with the substance use disorder or misuse.
So, really recognizing that the human stories behind the data highlights the urgent need for our compassionate, personalized responses, comprehensive support systems to address this really complex public health issue. And each narrative adds depth to the understanding of the crisis and really underscores the importance of the empathy and the action to foster healing and prevention. So we just really need to come together, collaborate, share resources, use data to make better data-driven decisions, and really make sure that in five years from now, we’re saving more lives. At the end of the day, that’s what’s most important; saving lives.
Grace Westermann:
I really appreciate the way you brought us back to the human side of this epidemic. And something that you said to me in the past has stuck with me. You said that the opioid epidemic doesn’t discriminate; it impacts every demographic and crosses every economic line. And I think that’s a powerful reminder but also a call to action. So for our listeners who want to stay connected with your work or even partner with you, where’s the best place to find you online?
Jennifer Loeffler-Cobia:
Yeah, absolutely. And thank you for all of the work that you’ve been doing to really help support this complex public health issue. You can go and learn more about our work at WestEd’s Justice & Prevention Research Center at jprc.wested.org. There’s lots of information about the different public health issues and areas that we target. And then within that page, there’s specific information about the opioid overdose epidemic with our contact information and just some of the different research evaluation capacity-building resources that we can provide.
Grace Westermann:
Great. Thanks so much. And Jen, thanks for being on the program. I really appreciate the work you’re doing to support communities on the front lines of this epidemic. And thank you to our listeners for joining us today.
Before we close, if you or someone you love is struggling with substance abuse, you’re not alone. The Substance Abuse and Mental Health Services Administration Helpline is available 24/7 at 1-800-662-HELP for free and confidential support.
You can find this and past episodes of the Leading Voices Podcast online at wested.org/leadingvoicespodcast or on Apple Podcasts, YouTube Music, Pandora, iHeart, and Spotify.
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