Few college students know how to administer naloxone

 

Despite a steep rise in fentanyl-related overdose deaths among young people, a new study found that less than 15 percent of US college students are able to administer the life-saving medication to someone experiencing an overdose.

A majority of young adults are willing to come to the aid of someone experiencing an overdose, but few of them know how to administer naloxone, according to a new study by Boston University School of Public Health (BUSPH).

Published in the journal JAMA Pediatrics, the study examined opioid overdose knowledge among college students across the United States and found that less than 15 percent of the students surveyed knew how to administer naloxone, which can reverse the effects of opioids when it is provided quickly. 

The results also showed that only 30 percent of students understood what naloxone is used for. However, nearly 62 percent of students reported that they could identify at least one sign of an opioid overdose, and nearly 67 percent felt comfortable calling emergency services if they witnessed an overdose. 

The study is the first to examine this subject among adolescents and young adults. As fentanyl and other synthetic drugs drive a new wave of the opioid crisis in America—fentanyl-related fatal overdoses tripled among adolescents between 2019 and 2021—knowing how to administer this medication in an emergency can be a lifesaving skill.

“Our findings can serve as a starting point for understanding baseline levels of opioid overdose and naloxone knowledge among college students,” says study lead author Christina Freibott, a PhD candidate in health services research at BUSPH. With tailored approaches, “there are many different ways that campuses can increase student awareness of naloxone, such as combining opioid education with hands-on naloxone training, or having naloxone accessible to students on campus.”

Narcan, the nasal spray form of naloxone, is safe and effective, she adds. It is now available for purchase over the counter, with out-of-pocket costs ranging between $40-$80, depending on insurance coverage. “Having naloxone in your home or knowing where you can access it at school or work can save time in case of emergency,” Freibott says.

For the study, the researchers examined opioid overdose recognition, naloxone knowledge and use, and willingness to intervene during an overdose using data from the 2021-2022 Healthy Minds Study. The study is the largest and most comprehensive survey of mental health in higher education, administered annually to students at hundreds of US colleges and universities.

The responses also differed substantially by race/ethnicity, gender identity, and sexual orientation. For example, participants who identified as Alaska Native or Pacific Islander, transgender, or LGBTQ were more knowledgeable about naloxone than those who identified as other race/ethnicities, sexual orientations, or male or female genders, respectively. Alaska Native/Pacific Islander and female participants were better able to recognize an overdose than participants of other race/ethnicities and gender identities.

“Documenting the attitudes and knowledge of adolescents and young adults regarding opioid overdose prevention is a necessary first step for informing future public health approaches in school settings,” says study senior author Dr. Sarah Lipson, associate professor of health law, policy & management at BUSPH and principal investigator of the Healthy Minds Network, the organization that leads the Healthy Minds Study.

And while it is promising that two-thirds of students say they are willing to intervene during an overdose, that means that one-third of students are not—perhaps because of concerns about disciplinary repercussions at their school, the researchers say. 

“Some colleges, including Boston University, have a Good Samaritan Policy, which encourages students to call for help during a drug- or alcohol-related emergency without fear of disciplinary repercussions,” says Freibott. But other institutions, she says, may limit protections to the caller or to alcohol-only emergencies—or offer no protections at all—which can make students hesitant to call for help.

In future research, the team plans to track opioid overdose prevention policies at colleges and universities across the country and learn about any challenges that campus leaders face as they develop and implement prevention strategies. The new findings can especially help inform these efforts for colleges and universities in states with proposed legislation around opioid overdose prevention services on campus, such as California’s AB 1841 bill, says study coauthor Dr. Noel Vest, assistant professor of community health sciences at BUSPH. 

“These legislative actions will require schools to equip residential staff with the necessary training and resources to respond effectively to overdose emergencies but also empowers students to take action in critical situations,” Dr. Vest says. “We hope that this study can prioritize harm reduction, destigmatize seeking help for substance use issues, and foster a culture of care and support on college campuses.”