Improved counselling for young people to dispel the myth that opioids are harmless

In Denmark, pain-relieving opioids and anti-anxiety benzodiazepines can be bought relatively easily and cheaply through social media, kiosks or friends and acquaintances. At the same time, there are signs that the use of these highly addictive substances is spreading in some youth environments. This development has led the Danish Health Authority to emphasise the importance of municipalities focusing on local prevention efforts.

In a new report, the Criminological Observatory at the University of Copenhagen makes seven recommendations on what the City of Copenhagen - and other stakeholders - should focus on in their efforts to combat the use of opioids and benzodiazepines among young people.

The report points to seven needs/recommendations:

1. Increasing knowledge in youth education programmes about different municipal services
2. Mandatory and proactive drug counsellors in secondary schools
3. Greater recognition and support for carers
4. Non-reportable counselling services for young people with substance misuse problems
5. National knowledge bank with local knowledge exchange
6. Eye-level awareness campaign through the 'right' communication channels
7. Mapping of medication practices related to opioids and benzodiazepines

The report is based on a major survey of young people in the capital, commissioned by the City of Copenhagen's Health and Care Administration. It describes how illicit opioids and benzodiazepines or prescription drugs such as Oxycontin, Dolol and Xanax are used by young people to combat social anxiety, restlessness and agitation.

"The use of drugs can be invisible because they are used in the bedroom at home and do not smell or cause noisy behaviour. This is one of the reasons why there is probably a large number of unreported cases. We therefore lack knowledge about the contexts in which young people use drugs, why they do so and how they themselves view their use," says Henrik Vigh, professor and head of the Criminological Observatory at the Department of Anthropology.

We can see that some young people don't perceive opioids and benzodiazepines as hard drugs because they are prescription drugs in pill form and are therefore perceived as 'safe'.

"This study sheds light on the actual behaviour of young people and the environments in which drugs are used. This is a prerequisite for more effective prevention".

The study includes several hundred interviews with young people conducted on the streets, in cafés, bars, venues, etc. According to project lead Jacob Fischer Møller, this has provided new insights into young people's views on drugs.

"For example, we can see that some young people don't perceive opioids and benzodiazepines as hard drugs because they are prescription drugs in pill form and are therefore perceived as 'safe'. Young people talk about opioids and benzodiazepines and know what they are, but many get their knowledge from rappers who romanticise the drugs rather than from the authorities. The question is: who do we prefer to inform young people?" he says.

Targeted and anonymous counselling

The report recommends more targeted information and counselling for young people. At the same time, it rejects the fear that more information and counselling, for example in secondary schools, will automatically lead to increased drug use.

"Young people are already familiar with drugs. A much bigger challenge is that powerful addictive drugs are widely available and so cheap that pills are often sold in sheets. This makes the path to addiction much shorter. That's why we recommend that youth education programmes and authorities provide better information on the subject. In particular, to avoid dangerous mixing with alcohol, for example, and to counteract misconceptions about the drugs," says Jacob Fischer Møller.

The report also points to the current reporting requirement as a concrete barrier. Today, drug abuse by minors has to be reported to the authorities, and their parents are then involved. For some young people, not least some Danes from ethnic minorities, this is so shameful that it can deter them from seeking help.

"It is therefore also a question of creating counselling services for young people, for example in their education programmes, where it is possible to be anonymous," says Jacob Fischer Møller.

Dissatisfaction leads to abuse

The report emphasises that opioid and benzodiazepine use takes place in communities that feel exclusive and inclusive, thus attracting and retaining the young person as a drug user. Drug communities can therefore be a major barrier to recovery from addiction.

There is a lack of well-being among some young people that needs to be considered in prevention work.

At the same time, the report highlights discontent as the main reason why young people turn to drugs in the first place. Typically, young people use opioids and benzodiazepines as a form of self-medication to cope with stress and anxiety about performance or fitting in with their own and others' expectations. As one of the counsellors puts it in the report: "Discontent comes before 'addiction'.

According to Henrik Vigh, this means that young people's drug use should not be seen as an isolated problem. It is a societal challenge.

"Fortunately, Denmark and Europe do not have the same opioid crisis as the US, where the spread of fentanyl in particular has led to many thousands of deaths. Here at the Criminological Observatory, we are very concerned about early warning signs, and there is a lack of well-being among some young people that needs to be considered in prevention work. As the report recommends, we need to work in several directions at the same time.

Download the report: Target group analysis of young people's use of illicit opioids and benzodiazepines in Copenhagen (in Danish only).