Four teenagers take turns reading steadily from a teleprompter. Their message is as simple as their videos’ black and white color scheme: With fentanyl, there is no second chance. 

“Look, I’m not here to preach. But you need to be aware of a serious issue,” begins one of now seven public safety announcements written and produced by Arizona’s Tempe Union High School District students. 

In a conversational tone aimed at their Gen Z peers, the students calmly walk through party scenarios and life saving information about fentanyl, the synthetic opioid responsible for over . As little as two grains of salt, approximately 2 mg, are lethal. The size of a pencil tip.

What began last fall as a marketing club project has since become a nationally-recognized, peer to peer called “No Second Chance,” led by four students from two Tempe schools.

Students traversed Arizona and the country, leading local parent workshops and competing in an international competition to quickly spread the word about , commonly laced recreational and counterfeit prescription drugs, and Naloxone or Narcan, the overdose reversal medication. 

The federal Drug Enforcement Administration has just — one of two projects in the country to be recognized for their prevention work.

Students behind the campaign were motivated by the silence on the deadly trend that has claimed the lives of thousands of teens throughout their state. 

“There’s this entire world underneath our feet,” Corona del Sol high school senior Jaia Neal told ĂŰĚŇÓ°ĘÓ. “And yet I don’t hear any of it on social media, or from any of my friends or parents or anything. It’s like, what is happening? How are people not freaking out that so many people are dying from this?”

A sobering released last year revealed that among 10 to 19 year olds, fentanyl-related overdose deaths increased 182% from 2019 to 2021. Two thirds of them were not alone when they overdosed. 

Nearly all deaths were unintentional — of synthetic opioid deaths from 2021 were ruled a suicide. 

Such was the case for Ethan Dukes, 16. His mother, Shari, did not know why her early riser did not wake up one Saturday until the autopsy results came in.

In a way, No Second Chances’ campaign story begins with Ethan, the track athlete with dreams of being a parent and lawyer.

“One pill can kill — I always say one pill does kill. One pill flipped my entire world around,” his mother, lifetime district administrator and local prevention advocate Shari Dukes said. 

He had gone to bed early, by 10:15, after coming home from a party Friday night. At the time, February of 2019, fentanyl was not on her nor the district’s radar. 

Shari told her family’s experience, and frustration over schools’ silence for over two years after Ethan’s death, to the school board and an old colleague, Tempe Union’s social emotional wellness director, Ron Denne Jr. 

“I thought, if I don’t know and I’m so involved, then there’s got to be all these other folks. Your kid can’t go to bed one day and not wake up the next,” Dukes said. 

Denne pitched their community relations team and Corona del Sol’s marketing club advisor — and students took the torch.

No Second Chance has been meeting and presenting with family survivors, and National Guard and DEA drug trafficking teams. Their videos have been screened during video announcements at high schools within the district. Later this basketball season, some will make an appearance on the Phoenix Suns’ jumbotron. 

For those who’ve been doing prevention work for years, the campaign is exactly what’s been missing: how to reach young people effectively.

In the few months since students wrote and recorded PSAs, the landscape has already shifted. The amount of counterfeit pills containing lethal doses has risen from four in ten to seven in ten, the DEA reports. 

Teens are most commonly accessing fentanyl unknowingly from social media or secondhand from friends who have. Looking for prescription drugs, youth find laced, counterfeit Oxycodone, known as blue M30 pills, Percocet or Xanax.

“People don’t know what they don’t know… we want them to understand that there are bad people that are using social media platforms to sell drugs,” said National Guard Sergeant Tommy Morga, who helps lead the Arizona Counter Drug Task Force. 

Compounding concerns, fentanyl is hard to accurately test for. Drugs are mixed unevenly; scraping one side of a pill may yield a false negative. Some THC vapes are impossible to take apart. 

Just six years ago, fentanyl was a rarity outside of medicinal use as an anesthetic particularly for cancer patients. But the drug, 50 to 100 times more powerful than morphine, has ravaged parts of the country, particularly border areas, like Tempe Union’s , one of the nation’s most populous.

In Texas alone, have sought to authorize Narcan and emergency training for educators and schools. California last month, requiring school safety plans include opioid training. In , advocates are pushing for harm reduction approaches like Tempe Union’s, instead of abstinence or zero tolerance messaging. 

Almost immediately after the PSAs debuted at Tempe Union’s high schools, emails from teachers rolled in: thank you for showing these, my brother died of an overdose; my cousin is addicted. 

Today, 10 doses of Narcan are available at five locations at each high school. Buses are stocked. About 50 students and 250 staff have been trained to administer it, including all nurses, security guards and transportation teams. QR codes to make confidential counselor appointments are posted throughout campuses. The districts’ teachers can access free counseling through Talkspace and longterm support via .Ěý

At Corona del Sol, Neal never crossed paths with Ethan, four years her elder. But while presenting at a DEA teen academy meeting, she revealed her link to him, trading confidence for pained frustration. 

How could they walk the same halls, have the same teachers, and not know Ethan died from fentanyl poisoning?

“How did we not know,” Neal asked, “how close it is to us?”

Now, new national data unveil one factor that could be exacerbating the crisis: a record increase in sexual violence.

Nearly 1 in 5 teen girls experienced sexual violence in 2021, forced to kiss or touch someone in their life, according to the the Centers for Disease Control and Prevention’s released Monday.

A startling 14%, more than 1 in 10, were forced to have sex against their will, according to the report which compiled responses from 17,000 young people surveyed in the fall of 2021. The violence is up 20% since 2017.Ěý

The CDC conducts the survey every other year, though Monday’s report is the first to capture pandemic-era trends. And while there are bright spots — bullying and use of illicit drugs are down overall — the recent findings are grim.

In 2021, at least 18% of girls experienced some form of sexual violence — forced to touch or kiss someone in their life. And while the rate of girls forced to have sex in particular had remained pretty constant for the last 10 years, in the two year period from 2019 to 2021, it jumped from 11% to 14%.Ěý

“This is truly alarming,” said Kathleen Ethier, director of the CDC’s division of adolescent and school health. “For every 10 teenage girls you know, at least one of them, and probably more, has been raped. This tragedy cannot continue.”

Nearly 1 in 3 girls also seriously considered suicide. One quarter of girls and 37% of lesbian, gay or queer youth made suicide plans. Thirteen percent of girls attempted it, the highest numbers in a decade, roughly double the rate for boys.Ěý

While increases in suicidal ideation can be seen across many demographics, Black and Native or Indigenous students remain significantly more likely to attempt and are the students most impacted by housing insecurity.

“America’s teen girls are engulfed in a growing wave of sadness, violence and trauma,” said Debra Houry, chief medical officer for the CDC, during a press briefing Monday.Ěý

“These data are hard to hear and should result in action,” Houry said. “As a parent to a teenage girl, I am heartbroken.”

Research confirms adolescents who are forced to kiss, touch or have sex with people against their will are symptoms of depression, anxiety and post-traumatic stress. In children, this can manifest in a number of ways, including withdrawal from friends or social activities, difficulty sleeping, poor , self-harm, substance abuse and suicidal ideation.

Houry said while this report did not look at the connections between sexual violence and the increase in depression and suicidality, prior research has shown “sexual violence is associated with mental health issues, substance use and also long-term health consequences.” 

Girls are also 5% more likely than boys to misuse prescription opioids and more likely to have tried illicit drugs like cocaine, inhalants, heroin, methamphetamines, hallucinogens, or ecstasy, according to the report 

Nearly half of all high schoolers are “persistently sad or hopeless,” the report found, symptoms used as a proxy to measure depression. Numbers are notably higher for girls, queer youth and students of color.Ěý

The feelings, particularly when they are the result of sexual violence, hold the power to have lifelong impacts: “young people who feel hopeless about their future are more likely to engage in behaviors that put them at risk for HIV, STDs, and unintended pregnancy,” the report states. 

Only about half of teens, according to the 2021 findings, used a condom the last time they had sex. And only 5% were screened for STIs within the last year.

Yet many of the challenges facing young people today, Houry added, are in fact “preventable.”

can revamp health curricula to educate young people about sexual consent and managing emotions; encourage school-based clubs like Gay Straight Alliances; and increase mental health training for teachers, peers and staff. 

Healthy relationship and bystander training programs like Green Dot can reduce harm and stigma in talking about sexual or romantic violence, CDC officials said. 

The CDC and advocates also encouraged families to look for warning associated with suicide and regularly ask young people about their feelings or concerns. 

“I wish my family knew these resources and what to look for earlier,” national PTA President Anna King tearfully said during the media briefing. King lost a niece to suicide nearly five years ago.Ěý

“These conversations will help parents learn how to help their child and figure out what’s going on emotionally, building their ability to cope with life’s stressors and show them their feelings matter,” King said. “It also helps them to understand that they’re not alone.”

If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline. Additional resources are available at . For LGBTQ mental health support, you can contact The Trevor Project’s toll-free support line at 866-488-7386.