As a result of strong consumer advocacy, Massachusetts is now the first state in the nation to take the sensible step of verbally screening all middle and high school students for drug and alcohol problems. Governor Charlie Baker recently signed into law a landmark bill on the opioid epidemic that includes the school screening requirement. Other states across the country would be wise to follow suit. Our young people need the protection of this public health approach that focuses on preventing addiction before it starts.

Ninety percent of people who develop an addiction to drugs or alcohol started using in their teens. The new law, called the Substance Abuse Treatment, Education, and Prevention (STEP) Act, requires school nurses to screen all students in two grades using a validated questionnaire and follow-up. The specific grades in middle and high school will be decided by each school district. By conducting open, non-judgmental conversations with students, school nurses will encourage healthy choices and provide supportive, factual information. If needed, young people will be referred for additional counseling.  

The law takes statewide an effective strategy for screening and early intervention that Massachusetts piloted from 2013-2015 with over 3,000 public school students in grades 7-9. About 10 percent of those screened received brief counseling because they reported using alcohol or drugs, and 3 percent were referred to treatment. School nurses in the seven pilot school districts continue to have conversations with students every day about substance use. In the past year, over 100 school districts have requested training and support from the state to begin verbal screening of middle and high school students.

Health advocates, the recovery community, researchers, nurses, school officials and state policymakers made the case to Massachusetts lawmakers that screening young people is a critical element in addressing the misuse of pain pills and growing use of heroin that killed nearly 1,200 people in Massachusetts in 2014 and is taking the lives of more than 100 people per day nationally.

 “There was a lot of deliberation and redrafting as new concerns, insights, and perspectives were brought to light, and the final language is stronger for it,” according to Courtney Chelo, manager for the Addictions Free Futures project, which led the advocacy.

In the early stages of the bill development, there was a misunderstanding of the screening process. Some policymakers and members of the public mistook the verbal screening for drug testing. Through a swift response and education efforts, advocates clarified that students would simply be asked a few questions. Advocates demonstrated a mock screening for legislators to illustrate exactly how the screening would be conducted.

Concerns were also raised about confidentiality and parental consent. Advocates and policymakers worked together to ensure students or parents can opt the student out of this screening. Language was also included in the bill to ensure that information disclosed by students will remain confidential unless the sharing of information is authorized by the student or parent/guardian, or is needed to address an immediate medical emergency.

The results serve as a model other states can add to their own initiatives to fight the opioid epidemic. As Mary McGeown, President and CEO of the Massachusetts Society for the Prevention of Cruelty to Children remarked, “Supporting youth to make healthy decisions and getting them help if they need it is the best way to prevent addiction and all of its devastating consequences. The positive impact of this effort will be felt for generations to come.”  

The Addiction Free Futures Project is part of True Talk: Power of Prevention, supported by Community Catalyst and the Conrad N. Hilton Foundation. Additional support for the Addiction Free Futures Project is provided by the Peter and Elizabeth C. Tower Foundation. The project is promoting prevention and early intervention for youth substance use disorders.

This guest blog was co-authored by Courtney Chelo, Behavioral Health Project Manager at the Massachusetts Society for the Prevention of Cruelty to Children and the Children’s Mental Health Campaign.