As the opioid epidemic has escalated around the nation, colleges and universities have been spared the brunt of it. Opioid addiction and overdoses are more rare on campuses than among young adults in the general population. But schools are not immune to the problem, and they're growing increasingly concerned about how to keep students safe.
One of the first things colleges have started to do is to beef up awareness and prevention programs. As part of freshman orientation, students routinely now get a quick primer on the dangers of opioids, how to recognize an overdose, and how to save someone from dying with a dose of Narcan, the drug known generically as Naloxone.
In recent years, many schools have started making Narcan available through health services, and campus police. Now, a small but growing number of schools are beginning to distribute the drug more broadly.
At Bridgewater State University, in southeastern Massachusetts, campus police Detective Sergeant Robert McEvoy points out the "Opioid Overdose Kit" --marked with bright red stickers hanging on the wall in the lobby of an academic building.
It's one of 60 kits that have been added to existing defibrillator boxes all over campus. More than a dozen more kits hang in their own boxes in all BSU parking lots and on all floors of a campus garage. They each contain two doses of Narcan nosespray, and they're all free for the taking.
"We felt it was on the university to provide these," says McEvoy, "because it's a life-saving drug and we're in the midst of epidemic that affects everybody."
BSU is located in what McEvoy calls the epicenter of the opioid crisis in Massachusetts. So he says kits were deliberately meant to be accessible to the public outside the BSU community as well. On campus McEvoy says he sees opioids "regularly." In 2016, he says a student fatally overdosed in a dorm. And earlier this year, he says, another student died from an overdose off campus.
But he says plans to distribute the Narcan around campus predate those overdoses. And since launching the project last fall, more than a thousand people have been trained to administer it.
"It's really simple," McEvoy says, demonstrating with a small bottle that looks like any nosespray you'd buy at the drugstore. "You just put the tip into the nostril, press the plunger, and that's it."
Happy to be at a school that offers help
Indeed, talking to random students on campus, it didn't take long to find some who've been through the training.
"Yeah, I'm prepared. I'm ready," says junior Isaiah Roseman, a resident advisor. "It's easier than CPR, honestly. It's just [squirt] and you're done."
RAs are not required to administer the drug, but they are all trained and are encouraged to step in if necessary. "Personally, I feel it's my moral obligation to help someone who has overdosed. It could honestly save a life," says Roseman.
"I'm just happy to go to a school that has this," says sophomore Nick Vicente. "We're all human. If someone does something wrong, it's nice to know the school is looking out for students."
It's not just about the relatively small number of students who may be heroin users, Vicente says. But it's also important for the many who are using other street drugs like cocaine, which is sometimes laced with opioids like fentanyl, often unbeknownst to users.
"Honestly, I feel like a lot of kids are worried," says Vicente. "because that's when problems can definitely happen and then overdose can definitely be reality."
Beyond Narcan, student users need support
But others see it as a little more complicated.
"I think it's good to make Narcan available. But it's a really tricky situation," says another student from a different university, who says he spent about ten years battling addiction. He asked not to be identified to avoid harming future job prospects.
He says what started as drinking and smoking in high school, became a bad heroin habit through his college years. He dropped out and failed out multiple times, and overdosed twice. But he says that was before schools were set up to recognize or support students with drug addictions.
"I think they had their heads in the sand," he says. "They didn't want to acknowledge the problem. But I mean, it was probably blatantly obvious, honestly. I was pretty bad."
Now, one and a half years sober, he's enrolled in a new school, and works in a "campus recovery center," the likes of which barely existed even a few years ago.
His school has also just started giving free Narcan to students, but only if they ask for it.
He worries many users (or their friends) would be too afraid of letting campus authorities know who they are. "For me, it would be a fear of attracting attention and getting in trouble," he says.
But now on the other side, as the one trying to offer help to others, he also sees the downside to leaving Narcan out for people to just help themselves, anonymously.
"The con to that is that you have no way of offering them further help. The only way that we can help them, is if we know who it is," he says.
Parents need to step up
It's just one of many issues colleges need to grapple with as they work out best practices. But meantime, some say parents parents need to step in a play a larger role themselves.
"Unfortunately, colleges haven't really caught up with the opioid crisis, and I think parents need to take it into their own hands," says Jillian Bauer-Reese, Assistant Professor in the Department of Journalism at Temple University, where two students died of opioid overdoses last year.
Bauer-Reese says when kids leave for college, parents should send them off with a little care package, of Narcan, and fentanyl testing strips.
"It's time for parents to step up," she says. "Just like they would send [their kids] with condoms, to encourage them to have safer sex, they can create a safer drug use kit for them too. It's just something they can have if their plan was to try those drugs, to make that drug use safer."
Critics worry that might send kids the wrong message, and give them a false sense of security about using such dangerous drugs, and might even encourage more drug use. But Bauer-Reese dismisses such concerns.
"I don't think that if your student was planning on staying home on Friday night, studying for their exam, that having fentanyl strips in their drawer is going to be calling their name to go out and buy drugs, and try them," she says.
Is it worth the investment?
A separate question is whether such of broad-based strategies — distributing Narcan to everyone indiscriminately - are worth the investment, especially for schools with scarce resources.
Narcan costs upwards of 40 dollars a dose, and emergency kits are usually stocked with two, just in case.
At Bridgewater State University, none of the kits put out last year have been taken yet.
And in the two years since the University Of Texas at Austin launched a similar initiative, several kits placed off campus have been successfully used, but all those placed on campus remain untouched, according to Lucas Hill, a clinical assistant professor at UT's College of Pharmacy and the Director of Operation Naloxone.
"This is at least one data point that says [placing kits all around campus] may be not be cost effective," he says. "Maybe on-campus is not the hot spot."
Hill is now considering targeting kits more narrowly, for example at convenience stores and bars.
But, he cautions, naloxone alone is not the answer. Colleges also need to beef up treatment and recovery programs. Preventing an overdose death, he says, is not the same thing as curing addiction.
AUDIE CORNISH, HOST:
Opioid deaths are thought to be rare on college campuses. But since the opioid epidemic, young adults are now among those at high risk for overdose, so some schools aren't taking chances. NPR's Tovia Smith reports on the new effort to keep students safe.
TOVIA SMITH, BYLINE: One of the first things colleges are doing is teaching students to recognize an opioid overdose and what to do.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED ACTOR #1: (As character) Is he sleeping?
UNIDENTIFIED ACTOR #2: (As character) He's not waking up.
UNIDENTIFIED ACTOR #1: (As character) No, there's a needle in his arm. Taylor?
UNIDENTIFIED ACTOR #2: (As character) His lips are blue.
SMITH: Ohio University is using this video dramatization...
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED ACTOR #2: (As character) Come on, Taylor.
UNIDENTIFIED ACTOR #1: (As character) He must have overdosed.
UNIDENTIFIED ACTOR #2: (As character) Do you have Narcan?
SMITH: ...To show how Narcan, the drug known generically as naloxone, can reverse an overdose.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED ACTOR #2: (As character) He's starting to wake up.
UNIDENTIFIED ACTOR #3: (As Taylor) Where are we?
SMITH: Ohio University is one of many schools that make Narcan available through health services and campus police. Several other schools are starting to distribute the drug more broadly.
(SOUNDBITE OF DOOR OPENING)
ROBERT MCEVOY: As you can see, right at the main entrance, we have the AED cabinet.
SMITH: At Bridgewater State University south of Boston, campus police detective Sergeant Robert McEvoy points out one of 60 defibrillator boxes on campus that are now also stocked with little bottles of Narcan nose spray, all clearly labeled in red as opioid overdose kits and all free for the taking.
MCEVOY: We felt that it was on the university to provide these because it's a life-saving drug, and we're in the midst of an epidemic that affects everybody.
SMITH: Shortly after a student died of an overdose in 2016, police put Narcan in every dorm and parking lot and trained more than a thousand people to administer it.
MCEVOY: All you would do is you peel this back. You would hold it like this, put the tip into the patient's nostril.
ISAIAH ROSEMAN: About three-quarters an inch down into their nasal passage. And then you just give it one spray, and then you're done.
SMITH: That's junior Isaiah Roseman, one of the resident advisers who've been trained.
ROSEMAN: Yeah, I'm prepared. I'm ready. And I think personally I feel like it's my moral obligation to help someone who has overdosed. It could honestly save another person's life.
SMITH: Students like Nick Vicente say it's comforting not just for the small number of people who may be heroin users but also everyone using other street drugs like cocaine, which is sometimes laced with opioids like fentanyl unbeknownst to users.
NICK VICENTE: Honestly I feel like a lot of kids are worried 'cause that's when problems can definitely happen and then overdose can definitely be a reality.
UNIDENTIFIED STUDENT: I think it's good to make Narcan available, but it's a really tricky situation.
SMITH: This student from a different university says he spent about 10 years battling addiction. He asked not to be identified to avoid harming future job prospects. During his college years, he says he overdosed twice and kept failing classes. But he says that was before schools were set up to recognize or support students with drug addictions.
UNIDENTIFIED STUDENT: They didn't want to acknowledge the problem. Like, everything's fine at our school. But, (laughter) I mean, it was probably blatantly obvious, honestly. I was - it was pretty bad.
SMITH: Now, one and a half years sober, he's back in a new school and works in a campus recovery center the likes of which barely existed even a few years ago. His school has also just started giving free Narcan to students but only if they ask for it. He worries many users or their friends would be too afraid to do that. But he says he also sees the downside to just leaving it out for people to take anonymously.
UNIDENTIFIED STUDENT: The con to that is you have no way of offering them further help. The only way that we can help them is if we know who it is.
SMITH: As colleges struggle to work out best practices, some say parents can't afford to just stand by and wait.
JILLIAN BAUER-REESE: Unfortunately colleges haven't really caught up. And I think parents need to take it into their own hands.
SMITH: Jillian Bauer-Reese teaches at Temple University, where two students died of overdoses last year. She says when kids head off to college, parents should send them with Narcan as well as fentanyl testing strips.
BAUER-REESE: Just like they would send them with condoms to encourage them to have safer sex, they can create, like, a safer drug use kit for them too.
SMITH: She dismisses concerns that it may actually encourage more drug use.
BAUER-REESE: Like, I don't think that if your, you know, student was planning on studying for their exam that having fentanyl (laughter) testing strips in their drawer is going to be calling their name to go out and buy drugs and try them.
SMITH: But others question such broad-based strategies, especially for schools with scarce resources. Even with school discounts, Narcan runs about $75 for two doses. Emergency kits contain two just in case. At Bridgewater State University, none of the kits put out last year have been taken yet. And in the two years since the University of Texas at Austin launched a similar initiative, several kits placed off campus have been successfully used. But program director Lucas Hill says all those on campus remain untouched.
LUCAS HILL: This is at least one data point that says that may not be cost-effective. And so we'll see. Maybe on campus is not the hotspot.
SMITH: Hill's now considering placing kits instead at convenience stores and bars. But he cautions naloxone alone is not the answer. Colleges also need to beef up treatment and recovery programs. Preventing an overdose death, he says, is not the same thing as curing addiction. Tovia Smith, NPR News. Transcript provided by NPR, Copyright NPR.