A Teachable Moment

The recent death of a 14-year-old girl from Belmont, Calif. who had taken the drug ecstasy has shocked and surprised the San Francisco Bay Area, and people across the country.

Especially disturbing is that, in the opinion of the local coroner Robert Foucrault, Irma Perez's life could have been saved with professional intervention.

According to the paramedic's report, Perez had taken an excessive dose -- three "Valentine ecstasy" pills -- and possibly alcohol and/or other drugs as well. While her two friends suffered no ill effects, Perez had an extremely rare reaction. She experienced what emergency physician Dr. Karl Sporer calls "serotonin syndrome": rapid heart rate, high blood pressure, high fever and agitation.

Because adverse reactions are so rare with ecstasy, what caused Perez's idiosyncratic response? Did the pills contain adulterants? Did Perez have a pre-existing condition that made her especially vulnerable, such as a cardiac arrhythmia? Was she dehydrated or did she drink too much water, causing dramatic drops in sodium levels? We don't know the answers to these questions yet, but it is hoped the coroner will issue his report soon and make it public.

As a drug educator, I agree with Belmont-Redwood Shores California Superintendent John McIntosh that in this "teachable moment" we must provide information to both parents and teenagers. At this critical juncture, we need to be very careful about what we say so we can win back the confidence of young people. After more than two decades of exaggerations about drugs in general, and a recent scandal leading to the retraction of "brain damage" claims about ecstasy, adults have lost a great deal of credibility with teens.

Our task is to replace exaggeration and scare tactics with balanced, science-based information. In a perfect world, teenagers would "just say no" to alcohol and other drugs. But after abstinence-only messages, reinforced by increasing zero-tolerance policies (such as expulsion from school and arrest), the National Institute on Drug Abuse survey, "Monitoring the Future," found that in 2003, more than 45 percent of eighth-graders had tried alcohol, 17 percent had tried marijuana and 3 percent had tried ecstasy. Missing from our educational efforts is a fallback strategy of harm reduction for those teens that like Perez and her friends, say, "yes" despite our efforts.

In addition to providing sound information about alcohol and other drugs, young people should learn to recognize signs of distress and know that they can and must get help. This was not what happened in Perez's case. For five hours, her friends tried on their own to help, using makeshift methods, such as giving her a bath. Perez finally lapsed into the coma from which she never recovered.

Sadly, the experience of Perez's friends is not uncommon. They realized something was wrong and got scared, knowing they would "get into trouble" if the police came. In their naiveté, they hoped she would simply come out of it. This scenario is played out all too often, because it's possible to overdose on almost any substance, especially alcohol, the most popular drug among young people.

Many in law enforcement, such as Commander Trisha Sanchez of the San Mateo County Narcotics Task Force, agree that the message we send our teens should be clear. The use of alcohol and other drugs is a poor choice, but if you do experiment and there is a problem, you will not be punished by calling for help.

As a parent, I understand that providing "harm reduction" information can be uncomfortable. We worry that acknowledging the possibility that teenagers might experiment will send the message that we condone the use of alcohol and other drugs and that this message will, in fact, open the door.