Student Well-Being Q&A

Adolescent Overdose Deaths Are Rising. A District Has a Staffer Dedicated to Fighting Them

By Caitlynn Peetz — October 13, 2023 7 min read
Tight cropped photo of a book bag, stack of books, and pill bottle tipped on it's side with pills spilled out.
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Mary Stevens-Krogh has a big—and unique—job as the district coordinator of substance use supports for Portland Public Schools.

In Oregon’s largest city, Stevens-Krogh is responsible for managing the logistics of the district’s response to student drug use, at a time when overdose deaths are on the rise nationally.

Monthly overdose deaths among people aged 10 to 19 years old increased 109 percent between July and December 2019 to July to December 2021, according to the Centers for Disease Control and Prevention. Deaths involving illicitly manufactured fentanyl increased by 182 percent during that same time period.

The increase poses a complex problem for districts, which are tasked with figuring out how to prevent drug use among students, address infractions given that drug use is prohibited on school campuses, and provide support to the community when tragedy strikes.

Stevens-Krogh’s position focusing specifically on substance use is uncommon. School districts more commonly have health directors who focus more generally on student wellness—a position that Portland schools also have.

In an interview with Education Week, Stevens-Krogh talked about her job, the prevalence of adolescent drug use nationally, and offered advice for districts as they work to combat the problem. This interview has been edited for length and clarity.

What exactly are the responsibilities of your role, and where did the idea for your position come from?

My role is really focused on the coordination of substance use supports for students, as opposed to the delivery of services. I supervise three certified alcohol and drug counselors, and manage funds to work with contractors to provide and expand services in the district. I also do a lot with developing and implementing discipline policy around drug and alcohol supports. And I’m kind of the face of the district around substance-related issues, both good things like prevention efforts and also when we have tragedies. Oftentimes, people are looking to me to respond to that stuff.

Mary Stevens-Krogh

The idea for the position came from a senior administrator we had at the time who has since left the district, who had a real passion for the delivery of substance use supports. In her role, she was seeing that the efforts weren’t cohesive. Some things were happening in health classes, there was a smattering of discipline things in other departments, and there weren’t really any supports or partnerships with community-based organizations.

So her vision was that there would be one person that would work to address those gaps, coordinate, and expand on all of these things.

I have never found a peer [with the same position in other school districts]. When I’ve been lucky enough to go to national conferences, I’ve found a couple of drug and alcohol counselors that are employed by school districts, but I’ve never found anybody else in a coordination or administrative role.

How prevalent are adolescent drug use and deaths now, compared to previous years?

I think an important piece of context is that I don’t think either nationally or in Oregon adolescent substance use is up. It’s been steady for a long time, but where you see the increase is that overdose deaths are up. That is tied directly to the presence of fentanyl in the drug supply and people either seeking it out or using it by accident because it has totally infiltrated the illicit drug market.

It’s important to note that the overall leading cause of death right now for 18- to 45-year-olds is overdoses. It’s more than car accidents.

My one word of caution is you have to be careful because percentages of overdose deaths are terrifying when you see them, and some text or headline says there’s been a 500 percent increase. But if, for example, you had one minor who died one year and then five the next, that’s a 400 percent increase, but it’s not 400 kids. So, whenever possible, ask for more context if you see a number that’s particularly shocking.

What are some of the most impactful initiatives you’ve worked on in Portland schools?

We redid the district’s drug and alcohol policy. We revised it to be the “healthy substance-free learning environment policy,” and we really focused on what we did want to see, which is students and adults—everybody in the building—being healthy.

The most important piece of that policy that we redid is, now our primary response to substance use violations is connecting kids with interventions, education, and supports. It’s not enough to just say, “This is not acceptable and here’s your punishment.” You’ve got to have something to refer students to.

How important is the approach of offering services and education as opposed to discipline?

It’s everything. By and large, the primary form of discipline for drug and alcohol violations is out-of-school discipline. Out-of-school discipline for drug and alcohol violations is especially problematic because then we’re setting students up to have more unstructured, unsupervised time to use, instead of pulling them in closer and connecting them with supports.

One of our biggest interventions is, PPS has a long-standing six hours of psychoeducation that we offer to families that have the lowest-level drug and alcohol violation. So basically the first time kids get in trouble, they get referred to this class called Insight. And I manage that, and it’s four classes. Each is 90 minutes long, and students have to come with a parent or a caring adult. And it’s, you know, we’re doing activities, we’re giving a lot of baseline information. We’re talking about the substances that both most often trip students up, and we also now talk about fentanyl because it’s so dangerous. And then we talk about skills around refusal, how to ask for help if you need it, decision-making risk, and protective factors.

How effective has your work been? Are you seeing tangible impacts in your schools?

We have 41,000 students, and then we have about 400 to 450 that have a low-level drug and alcohol violation every year. And then from that group of students, the group that goes on to get in trouble again is less than 100. And then the group that goes on to get in trouble a third time is really small, probably about 20. So I think the thing that we’re seeing is that education and linkages to supports work.

It’s tricky because schools are in communities, so as long as substance use is an issue in the community—and it’s a big issue in the Portland community—that’s going to impact our students. So the things that we control are the supports that we offer once kids are in our buildings.

See Also

Joe Solomon, co-director of Charleston-based Solutions Oriented Addiction Response, holds a dose of the opioid overdose reversal drug Narcan at the Unitarian Universalist Congregation of Charleston in Charleston, W.Va., on Sept. 6, 2022. He and other organizers were preparing for the third annual "Save a Life" day event where thousands of doses of Narcan were distributed throughout all of West Virginia's 55 counties.
A dose of the opioid overdose reversal drug Narcan is shown here.
Leah Willingham/AP

What advice do you have for other district leaders who are faced with this problem?

In education, we’re all enamored with the MTSS (multi-tiered system of supports) triangle.

I love thinking about tier one interventions for substance use, because that is really where you have the most impact. So, focus on comprehensive health education for all students.

Think about skills-based health education where you’re not saying, “You won’t ever be in this situation,” but teaching them how to navigate it once there—what decisionmaking skills are you using for yourself when you’re in these hard situations?

Then, do some strategic planning about how you’re going to address this throughout the school year. Make a plan to talk about drug and alcohol supports once a month in your school newsletter, then figure out what you want to talk about each month and just keep it part of the conversation consistently.

Most districts don’t have a me, so find your community partner you can invite in when you need extra help. Figure out who that is and nurture that relationship.

I think that type of planning can take schools a really long way.

What else do districts need to fight this issue, from either the state or federal level?

I think one of the things that gets missed a lot is adolescent drug and alcohol treatment often gets placed outside of schools. That in and of itself is an automatic barrier for students accessing it.

Any time we can think about and fund partnerships between health authorities and school districts so that kids can access some of those services during the school day, we’re setting ourselves and our kids up for success.

The more barriers that a family has—if English isn’t their first language, if they don’t have a car, if the parent works odd hours—the harder it’s going to be for them to access treatment in the community. Anything we can do to fund treatment in schools, because the kids are already there, is really effective programming.

See Also

Vials of Naloxone opioid overdose medication.
iStock/Getty

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