After examining 15-year-old Janie, I sat down to chat. “We’re going to discuss some things I talk about with everyone,” I said. Then I asked Janie what she thought of a methamphetamine arrest that had just taken place at her high school. Janie just laughed, but when I asked whether anyone had ever offered her meth, she sighed and glanced at the floor. “Well, yes …” she admitted.

It turned out that Janie had been offered meth while hanging out at a friend’s house after a football game. She told me she’d taken the drug into the bathroom and flushed it down the toilet. When I asked why she hadn’t simply refused it in the first place, Janie said she hadn’t wanted to “seem like an idiot.”

That was my cue. I commended Janie for not ingesting the meth, but then I used role-play to show her how she could say no to drugs — and other risky behavior — in the future. I had Janie pretend to offer me meth; when she did, I said, “No, that’s not something I’m interested in.” If she were older, I might also have suggested, “I can’t. I’m driving tonight.”

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As Janie was getting ready to leave, she gave me a hug and said that next time someone did “something stupid” like offering her drugs, she’d be able to stand up for herself. That made my day.

Meth is a big problem. In 2003, the National Survey on Drug Use and Health reported that 12.3 million Americans aged 12 and older had used meth at least once. In Phoenix in 2005, 54% of incarcerated adults reported meth use.

These are scary statistics, but I think NPs and PAs can help stem this destructive tide. We have access to teens during regular sports physicals and well-child visits, and we can use that time to their advantage. There’s already evidence that anticipatory guidance — talking about things that could happen and how to prevent them — can help adolescents avoid smoking, pregnancy, and sexually transmitted diseases (STDs). My experience shows that such guidance can prevent meth abuse as well. Here’s what I suggest:

• Schedule 30-to 40-minute visits. After each exam, spend some time discussing drug abuse, and then wrap up the visit by reviewing safety issues, such as STD and pregnancy prevention and the importance of using seatbelts. I usually begin these talks when kids are 12. However, if I know that a family member has a drug problem, I start as early as age 8 or 10.

• Be straightforward, not judgmental. Coming down hard on adolescents closes off communication. I find that they’ll usually be more open when you approach them honestly and respectfully.

• Let them know you know the score. To show a teen I’m not clueless, I ask, “When have you been offered drugs?” If he says he has, I ask whether he’s taken meth in the past six months. I also ask how often he’s used meth and whether he’s discussed it with a parent or other adult. When I believe that a teen is at great risk or may already be addicted to meth, a local behavioral health emergency hotline helps me get the teen into treatment.

• Keep current to jump-start conversations. Bring up recent news stories about meth busts in your area to start tricky conversations.

Teens like Janie say my interventions help. One mom even said she overheard her daughter tell her younger brother how to say no to drugs. By spending an extra 10-20 minutes a year with our adolescent patients, I believe we can slow the meth epidemic — one teenager at a time.

Angela Golden, RN, MNEd, CNS, is a family nurse practitioner and assistant clinical professor of nursing at Northern Arizona University in Flagstaff.