When a Manchester police officer arrived on the scene, the middle-school age boy was calm.
His mother, shut in the bathroom, had just overdosed on heroin, and he had been doing his homework in the kitchen when someone who lives with the family opened the bathroom door. She had fallen out, unconscious.
The boy told the officer: “I see my mom passed out like that all the time.”
“Imagine living as a child, not knowing if your mom’s going to be dead, passed out, every day,” says Lt. Nicole Ledoux, a detective who oversees the juvenile and domestic violence and heard the details from the officer who had been on the scene.
For many children around the United States, it is not a situation that is left to the imagination. They are members of Generation Heroin – youths who have grown up among epidemic use of opioids in some corners of America and have seen their own drug overdose rates more than triple in 17 states since 2001.
In Rhode Island, for example, all middle schools must be stocked with naloxone, a drug that can reverse potentially fatal problems related to overdoses. A survey of 81 middle school nurses found that 43 percent said students were abusing opioids, the Associated Press reports. Fifteen of the nurses had to call 911 at least once because of such drugs.
Here in New Hampshire, kids in Manchester come across dirty needles on the sidewalk as they walk to school. The fire department holds events in middle schools to show students how naloxone is administered in a crisis.
The need, say activists and public health experts, is to get more parents and teens into recovery and kids who witness addiction into counseling. Most children and teens, of course, never become users, yet the scope of the problem is such that young people themselves are standing up to be part of the solution.
They’re joining the “all hands on deck” approach to reversing the crisis. And they may help lead a broader cultural shift – from a crackdown approach that stigmatizes users to greater compassion. For these kids, after all, the users are friends and fathers, troubled 20-somethings to straight-A high school students.
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At Brandywine Heights High School in Berks County, Pa., a student collapsed right in the classroom.
She had gotten heroin from another student in the bathroom before class started. By the time the paramedics were rushing her to the hospital, the school was on lockdown.
Over the previous few years, the county had lost six young adults to overdoses. The student herself had been through rehab successfully. She had been doing so well that the superintendent included her on a committee to choose an assistant principal.
“She really was doing a phenomenal job, turning herself around,” says Andrew Potteiger, superintendent of Brandywine Heights Area School District.
The girl survived, he says, “but it was a very scary situation.”
In listening to students after the incident last spring, what became clear to Mr. Potteiger right away was that they weren’t bogged down by judgment of her. Nor had they given in to a fatalistic sense that their peers were doomed to become addicted.
“It wasn’t animosity. It wasn’t, ‘Oh, we’re a terrible school,’ ” he recalls. “It was, ‘How can we help?’ I was so proud of our students to be able to take that perspective and move forward.”
The desire to help is a defining characteristic for many young people dealing with heroin in the community, others say. But when addiction is as close as their own homes, the burden is worrying.
“The addiction is so strong and lethal that these kids are becoming parents to their parents,” says Sue Meagher, program director of Court Appointed Special Advocates of New Hampshire.
In Manchester, the police hired a child advocate and created a release form designed to get kids the help they need. Officers now ask parents or guardians to consider signing the form after a drug or domestic violence call. The form gives the department’s child advocate permission to follow up with them to connect the child to services.
The adults may not even realize that the kids need help, too. “It’s not that heroin addicts don’t love their kids,” says Ledoux, the police lieutenant, “but their priorities are off.”
In the first six months, officers have handed out 81 sheets, yielding 16 referrals of children who otherwise probably wouldn’t have gotten services. Another 23 cases are pending.
The need is urgent. A major study found that children who accumulate six or more “adverse childhood experiences” – traumas such as abuse or parental substance abuse – are 4,600 percent more likely to become intravenous drug users.
“Whatever we can do now to prevent that from happening is really important,” says Lara Quiroga, director of Project LAUNCH, which paired with the police on the new referral project.
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David Hedge has seen the ripples of heroin on the community firsthand. A counselor at McLaughlin Middle School in Manchester, Mr. Hedge meets regularly with a group of sixth- to eighth-graders affected by heroin use in their families.
On the Friday before spring break, he is standing before about 60 eighth-graders on bleachers in the dimly lit gymnasium. His talk is wide-ranging – from how smoking can affect lungs to how drunk-driving accidents can disfigure people. He illustrates the posts with graphic photos. But the message is singular: Addictions will ruin your life.
“Sometimes, after the first time, you’ve lost choice. You’ve become addicted. It only takes one time,” says Mr. Hedge. “People say, ‘Well, I’m only doing it to myself.’ No … you’re doing it to your friends, your family, because those are the people who care about you.”
Such talks have ramped up across Manchester in the past year. All high school and middle school students have had presentations on the spike in opioid and heroin overdoses.
For Detorron Grice, an eighth-grader at McLaughlin, the talks have made an impression. They make him “feel bad” for people who are addicted, and particularly for babies affected by mothers using drugs.
But his views are shaped by more than the good intentions of counselors and officials. They’re also shaped by what he’s seen.
One day at a friend’s house, he says, “we were fixing his little motorcycle, and there was a lady in the yard next to us doing it. So we told his mom, and she went over there, telling her, ‘I understand you do it, but don’t do it in front of my kids.’ ”
At some point later, he says, “the police raided that house.”
“I don’t want to end up like those people, but I can’t tell the future. You never know, you can always be in a situation and make the wrong choice.”
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For adults, that issue of choice often frames the debate. Does putting naxolone into schools or pharmacies normalize drug use, for example? When the Manchester school board recently voted on the issue, it was a split decision. Maine Gov. Paul LePage recently vetoed legislation that would have made naxolone available without a prescription.
But people who get hooked on painkillers or heroin or any other substance “aren’t bad people trying to get good. They are sick people trying to get well,” says Rebecca King, a school nurse in Delaware who co-authored a 2015 position paper by the National Association of School Nurses endorsing naloxone in schools.
For many children and teens, the instinct is not to apportion blame, but to do something.
When Ramsi Ross was a seventh-grader near the Brandywine Heights district in rural Pennsylvania, the boyfriend of one of her friend’s sisters died of an overdose.
Now, as a ninth-grader, she’s decided to take a stand.
“We’ve seen so many deaths from Berks County. People have really been like, ‘I just don’t want to get into this, because it’s so scary,’ ” she says. “People are … starting to open up and say, ‘This isn’t something I want to do.’ ”
Ramsi joined the high school chapter of Kutztown Strong – a community prevention effort – and has helped organize events for local kids. There was a “Dip and Dance” party at the pool as well as basketball tournaments and movies in the same park where people were known to go get high. The goal was simply to give teens something better to do.
They’ve started a monthly newsletter for elementary students, to get them thinking about good decisionmaking and talking with their parents. And for a health project, a group of high-school girls created a heroin-awareness campaign and took it to 8th-grade classrooms.
The resolve is spreading. Recently, middle-schoolers saw how much the Kutztown Strong teens were doing and decided to launch their own group. Meanwhile, the community came together to provide free after-school care for middle-schoolers at the YMCA.
At Brandywine Heights, Superintendent Potteiger says he can already see modest effects.
“Last year, I had at least three to four students that were using or had some kind of drug-related issues during the school day. This year I’ve had none,” he says. “You’re never going to get rid of the issue completely, but I’ve definitely seen a culture shift.”