As the devastating effects of the current opioid crisis continues to make its way to our nation's colleges and universities, college listservs and blog posts have been active with discussions about whether or not Narcan TM should be made broadly available on campus.
Narcan TMis the trade name for Naloxone, an FDA approved medication for the emergency treatment of known or suspected opioid overdose. Opioids include substances such as heroin and prescription pain pills like morphine, codeine, oxycodone, and Vicodin: the cause of an unprecedented increase in deaths among 15 to 24-year-olds since 2010.
Naloxone is a life-saving substance, but is not without controversy, and that is especially true on college campuses. Similar to other public health campaigns such as needle exchange programs to prevent the spread of HIV, availability of Naloxone has generated much debate but little consensus. Most administrators are comfortable discussing how to intervene in the case of an alcohol overdose, but opiate overdose is unfamiliar, even uncomfortable, territory.
Once a school is ready to embark on a decision-making process regarding Naloxone, there are some key questions that can be asked to help guide the conversation. The questions that follow are not intended to present or suggest a specific course of action, but to encourage dialogue about a topic that many schools are hesitant to discuss and in many cases, even acknowledge.
It is difficult to know exactly the impact that drug overdose is having on the college population since federal law doesn't require schools to report drug-related deaths unless they are deemed criminal. We do know there is an increased risk of overdose for specific demographics, including veterans, so the more universities can educate themselves about the issue broadly, the better they will be able to understand their own population. That said, schools cannot make an informed decision about the use of Naloxone until they have assessed the scope of the problem on their own campus. This is especially important when determining who may be best suited to carry and administer Naloxone, should an institution decide to move forward with such a process.
Naloxone does not cause harm to someone who may be overdosing on something other than opiates. This, in addition to ease of administration (via nasal spray), is one of the main reasons it is so appealing. As with most medications, however, the FDA has noted potential side effects of Naloxone, the most serious of which are acute withdrawal symptoms caused by the abrupt reversal of the opioids effects in people who are physically dependent or use opioids on a regular basis. This is why most schools that utilize Naloxone require medical intervention immediately following its administration. It may also be worthwhile to consider mandated counseling for the individual who experienced the overdose. These types of institutional safety nets can help to assuage concerns that may arise regarding safety and are ultimately no different than requiring interventions for those who experience an alcohol overdose.
Naloxone averages about $37.50 a dose and while that is a small price to pay for a life-saving intervention, communities across the country have found that it can add up quickly. In one small town, Middleton, Ohio, paramedics have responded to 598 overdoses between January and June of this year, demonstrating how the administration of Naloxone has cost the town upwards of $2 million yearly. Although campuses often operate as small cities, most are not comparable to Middleton or other high-risk communities. This is another reason why it is critical to collect institutional data that can help identify the extent of the problem on a given campus, particularly those located in parts of the country where overdose is most prevalent . If expense is truly a concern, a school might consider trying to offset the cost of purchasing Naloxone by reaching out to local agencies and national organizations such as the Clinton Foundation, which is working in collaboration with a pharmaceutical company to provide 40,000 doses of NarcanTM nasal spray to colleges across the country.
Many schools provide training for anyone on campus who wishes to carry and administer Naloxone, no questions asked. Whether or not students or staff acting in an official capacity may administer Naloxone must also be determined and has implications for policies and protocols around how, when, and in what settings individuals can intervene in a suspected opioid overdose. This includes a decision as to whether or not a school's amnesty policy extends to illicit drug overdose. Some schools have taken the position that student staff must follow the same protocol as they would an alcohol overdose and call 911 immediately if they suspect an opioid overdose. For other institutions, giving resident assistants the option of being trained to provide assistance via Naloxone may be a reasonable middle ground.
At the end of the day, this is the most important question to answer. While there is consensus among administrators about the risks of illicit drug use, there is a lack of consensus about what to do when it comes to effective prevention. In many cases, this ambivalence has led either to inaction or reaction to a specific issue such as availability of Naloxone.
Much of the uncertainty around creating effective programs and policies aimed at drug abuse has to do with a lack of understanding about what exactly we are trying to prevent. Add to that the negative stereotypes associated with illicit drug use and abuse and schools are challenged to come up with effective solutions that aren't limited in scope and impact.
Upon considering these questions, some schools may decide that use of Naloxone is an important part of their university's efforts to combat drug abuse. But if we really want to lessen the impact of overdose, campus administrators must work collaboratively to identify the most effective way to prevent it in the first place. If we are willing to ask questions about prevalence of illicit drug abuse, consider issues of student safety, and look at potential costs to the institution of using Naloxone, then shouldn't we do the same for prevention?