Mim Shafer, head of the health department at Mission High School in San Francisco, and a teacher of three health classes, was disappointed with the school district鈥檚 drug-prevention curriculum. She felt it was stuck in a 鈥淛ust Say No鈥� model from the 1980鈥檚, failed to acknowledge the differences between types of drugs, and didn鈥檛 prepare teenagers for real life scenarios in which drug use occurs.

鈥淲e teach a really radical sexual health curriculum, we have this awesome, body-positive way we teach nutrition,鈥� she says. 鈥淗ow come it鈥檚 in a district where we鈥檙e accessing all this radical, engaging curriculum that our drug and alcohol unit is like, please just don鈥檛 do this?鈥�

In 2019, Shafer was asked if she wanted to volunteer her class for an experimental curriculum 鈥� one that went beyond prevention and taught teens how to minimize the harm of drug use, including recognizing an overdose and administering naloxone. She jumped at the chance.

Two years since the pilot ended, Shafer is still teaching the curriculum and says her students find it more engaging. 鈥淚t鈥檚 very conversation-based, and I think there鈥檚 a lot of very cool ways that students get to sort of follow other interests,鈥� she says, including student projects looking at the war on drugs, looking at state-by-state zero tolerance laws and exploring drug myths.

Beginning in 2019, five schools in the San Francisco Unified School District became among the first in the nation to adopt a drug curriculum for teenagers based on the principle of harm reduction. The 15-lesson curriculum, 鈥�: Real Drug Education For Teens,鈥� was published by the non-profit Drug Policy Alliance and, after incorporating feedback from the 2019 SFUSD pilot, was published for free on its website.

The curriculum was designed as an antidote to abstinence-based and preventive curricula popularized in the 1980鈥檚 and which still proliferate. Rather than 鈥渏ust saying no,鈥� Safety First focuses on the history of drug policy, the physical and social effects of different drugs on the brain, and potential consequences for use, covering alcohol, illicit and prescription drugs, as well as casually used drugs like caffeine. It also teaches kids how to independently research drugs.

While the curriculum advises teenagers that abstinence from drugs is the safest approach, it advises students on minimizing potential negative effects. It also provides historical background about the war on drugs and its disparate impact on mostly poor Black and Latino communities.

The designer of the curriculum, Marsha Rosenbaum, is a long-time executive at Drug Policy Alliance, and lessons extend on the themes of , written as a letter to her son upon entering high school. In the letter Rosenbaum tells her son that rather than trying to scare him into not using drugs she would, 鈥渢ell you a little about what I have learned, hoping this will lead you to make wise choices.鈥�

She began developing 鈥淪afety First鈥� into a full classroom lesson plan in 2016. DPA piloted the curriculum in a single classroom at Bard High School in New York in 2018 and in Spring of 2019 it was piloted at five schools in SFUSD.

Sasha Simon, who has overseen the Safety First curriculum since 2017 and now works for DPA as a consultant, says that SFUSD was chosen because the school already has a less punitive drug policy, directing students to outside resources instead of penalizing them for drug use. The five schools Simon and DPA chose for the pilot were also chosen for their racial diversity and because many students were low-income, in contrast to the student body of their first successful pilot at Bard High School, whose students are whiter and more affluent.

Simon says the district was taking a financial risk by opting into Safety First; In California, it鈥檚 easier for schools to adopt drug curricula with an abstinence or prevention-centered approach, because the programs are eligible for state grants. Through the state鈥檚 , California鈥檚 county offices of education received $. Simon says that while SFUSD鈥檚 prior curriculum was eligible for this funding, Safety First is not.

Cheryl Nelson, a teacher on special assignment in SFUSD who was a liaison between Drug Policy Alliance and the district, says she spoke to many teachers who were frustrated with the district鈥檚 previous drug curriculum. (Nelson added she was not speaking as a representative of the school district but rather speaking to her personal experience with drug education curricula.)

鈥淭eachers would say to me, I鈥檓 lying to the students, so much of the drug curriculum asks teachers to stand there and not implement best practices,鈥� she says. 鈥淚t felt not true, judgmental, archaic,鈥� she says of the curriculum.

Steven Sussbaum, a researcher who was the creator of SFUSD鈥檚 previous drug curriculum, 鈥淭owards No Drug Abuse,鈥� or TND for short, defended the curriculum to Next City, saying it had shown preventive effects for hard drug use in 7 of 7 randomized controlled trials between the years 1992-2012. He says that the program has remained timely because the effects are replicated over a long period of time.

鈥淲e do revise the TND curriculum slightly to keep up with the times, either regarding information on our website or in the manual to the extent that we maintain the evidence-base,鈥� Sussbaum wrote in an e-mail.

While searching for funding to write a new drug curriculum, Nelson was put in touch with Rosenbaum at DPA, who was developing the Safety First lesson plan. Nelson offered feedback, and DPA eventually asked her about piloting the program in SFUSD schools.

Erin Hiltbrand Hall was one of the teachers Nelson reached out to about teaching Safety First in 2019. She teaches at Balboa High School, where the student body is about 50 percent Asian-American, 30 percent Latinx and over 60 percent qualify for free or reduced lunch, a program for low-income households. 鈥淚t was always kind of difficult to find something that was relevant to students that didn鈥檛 contribute to stigma,鈥� she says.

(Sussbaum, who developed the TND curriculum, told Next City he is 鈥渘ot blind to addiction stigma concerns,鈥� and sent a study he authored this year on addiction stigma.)

Hall says Safety First was more relevant to her students than the old curriculum. 鈥淲e鈥檙e certainly not encouraging teenagers to use drugs, but there鈥檚 the reality that people are curious and they try and do things for a number of reasons,鈥� Hall says. 鈥淚f we can provide teenagers with factual information where they can make the best decision for them and their body, I think that鈥檚 fantastic.鈥�

Shafer, at Mission High School, says the students have wildly different reactions to the curriculum. Her students are 90 percent students of color, about 50 percent of whom are Latinx, and 80 percent are eligible for free and reduced lunch.

鈥淭hirty 14 year olds have very different life experiences and very different levels of familiarity,鈥� she says of a typical class. 鈥淭here鈥檚 definitely kids who talk about narcan, talk about fentanyl right away,鈥� Shafer says. 鈥淭here鈥檚 kids who are like, 鈥榙rugs are bad so I鈥檓 just not going to use them.鈥欌�� She says the students would also integrate pop culture into the conversations, like the year the students related the lessons back to the Netflix show 13 Reasons Why.

While abstinence-based and preventive approaches are still the norm in high schools, even the dominant drug prevention campaign of the 1980鈥檚 has had to shift focus to a less rigid approach after . Drug Abuse Resistance Education, or D.A.R.E, a once ubiquitous program from the era that partnered with police departments, recently , still aimed at preventing drug use, although it is now more interactive than before.

D.A.R.E. opposes marijuana legalization, and classes are still led by police officers, despite criticism that this approach is inappropriate in schools where teenagers have had negative experiences with the criminal justice system.

In an e-mail, Ashley Frazier, Director of Curriculum at D.A.R.E., , saying it 鈥渋s not an abstinence program, and does not require or suggest the pledging of any oaths, to police officers or anyone else,鈥� a reference to a claim made on DPA鈥檚 website.

To claims that D.A.R.E. is out of touch, Frazier says, 鈥渨hat seems out of touch is the idea that all kids experiment with drugs, which is not borne out by any large sample data. Most kids don鈥檛 use drugs.鈥� She says that most D.A.R.E. participants are fifth graders, and 鈥淚t just isn鈥檛 a great audience for harm reduction efforts. Those are better aimed at population (sic) who are experiencing or at high risk of experiencing substance use disorder.鈥� A request for data on how many D.A.R.E. participants are teenagers was not returned, but there are lesson plans on the D.A.R.E. website for middle school and high school students.

Frazier says that rather than abstinence, D.A.R.E. is now aimed at, 鈥渓earning to assess their context, identify potential risk, weigh the potential for negative consequences, and make decisions that align with the future they want.鈥�

But Simon says many health curricula have changed their branding yet still aren鈥檛 thinking past prevention. 鈥淢ost health education policies are written with abstinence in mind, or minimally with prevention in mind, or preventing at all costs,鈥� she says. 鈥淓ven if that鈥檚 not what鈥檚 directly stated, that is absolutely the goal.鈥�

Simon says that the focus on decision-making that D.A.R.E. has recently adopted is limited, as the only decision students are prepared for is to say no. 鈥淚f you鈥檙e looking for a million ways to say no, what happens when they say yes?鈥� Simon asks.

Safety First doesn鈥檛 use prevention as a metric. Instead, it focuses instead on drug knowledge and critical thinking, and says an evaluation showed students鈥� media literacy had improved; teens were less likely to believe that only one online resource was enough to understand the use of a drug, Simon says.

Shafer says the focus on research skills is one of the salient points of Safety First. 鈥淭hey know to vet articles when they find them,鈥� she says. Shafer鈥檚 students also have a personal connection to the material, as Marsha Rosenbaum鈥檚 now adult son, Johnny, leads a surf club at the high school. Rosenbaum made a visit to the school to talk more about the letter she wrote to her son twenty years ago.

And Shafer says she hasn鈥檛 gotten pushback from parents. 鈥淚 haven鈥檛 heard much from parents other than the standard, I鈥檓 so glad you鈥檙e talking to them about this,鈥� she says.

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