Campus housing responds to the overdose crisis by focusing on both prevention and response.
By James A. Baumann
An unconscious person may not wake up, no matter how loudly their name is called or how much their body is rubbed and jostled. Their extremities or lips start to turn blue. Their breathing is shallow. Their pupils constrict to pinpoints and do not respond to light. Pale and clammy skin turns a bluish-purple or ashen color. Despite being unconscious, they make choking, gurgling, or snoring noises. These are signs of a person suffering an opioid overdose, signs that more and more college and university staff and students are being taught to recognize and respond to as these incidents remain near historically high rates.
The numbers behind the overdose epidemic have been startling. The Centers for Disease Control and Prevention noted that the overdose rate for those between 18 and 24 years old grew by 34% between 2018 and 2022. Meanwhile, a study published in JAMA Pediatrics found that while nearly 62% of students reported they would recognize at least one sign of an opioid overdose, only 30% knew what naloxone — an opioid antagonist that can reverse the effects of an overdose — was used for and fewer than 15% of them knew how to administer a dose of it.
Fortunately, there have been signs of improvement over the past year. An August report from the CDC noted that drug deaths had declined by approximately 10% over the previous 12 months, the most significant improvement they had recorded. In an interview with National Public Radio, Dr. Nora Volkow, head of the National Institute on Drug Abuse, said, “This is exciting. This looks real. This looks very, very real."
Some credit for that improvement can be given to the increased availability of naloxone nasal spray, which is also known by the brand name Narcan. In the wake of the Food and Drug Administration's decision in March 2023 to make the emergency treatment available over the counter without a prescription, a White House advisor said that the government hoped to see it available in “as many homes, workplaces, and communities as possible.”
Those communities increasingly include college and university campuses. For several years, campus security staff have carried naloxone doses and been trained to administer them when needed. As public awareness of opioid abuse and the prevalence of fentanyl, a synthetic opioid, being combined with other drugs has grown, naloxone has been made available to more students in more locations, including residence halls. In addition, more education and training is being offered to raise awareness not just about naloxone but also about preventative resources like fentanyl-detecting strips. “I think society as a whole has been rocked by the opioid crisis,” says Kirsten Carrier, assistant dean of campus life and director of residence life at Elon University. “Making life-saving devices available for something that is now widely seen as a public health concern has been much easier than it was even five years ago.”
Naloxone has been available on some campuses and in some residence halls for more than a decade, but it has not been widespread. It has become more available, however, as localized incidents and broader statistics forced awareness to grow and stigma to decrease. Additionally, introducing a version of naloxone delivered through a nasal spray rather than just in its injectable form – and educating people that it is not dangerous to give this to someone who has not used opioids – has broadened the number of people who can feel comfortable administering a dose. As opioid overdoses and fentanyl poisoning became recognized more as a public health issue than as isolated incidents, barriers have come down, though how colleges and universities have implemented overdose prevention efforts vary widely.
Carrier describes how several university departments at Elon have worked together to implement updated overdose prevention efforts. In the past, campus police had carried doses of Narcan with them, but this year the program was expanded by leveraging the ONEbox program. The kits, supplied by the West Virginia Drug Intervention Institute, provide a dose of Narcan, and when the box is opened, a 60-second video explaining how to administer a dose is shown. Leveraging funding from the student government association and with guidance from the dean of students’ office and the student wellness staff, the campus “was able to purchase automatic external defibrillator (AED) units to install in each Narcan location, and we installed both near an existing fire pull station as well so we could begin to create a one-stop for emergency needs in each of our eight residential areas,” Carrier explains.
At Elon, the dean’s office is responsible for checking the ONEbox locations weekly to ensure that the tag has not been broken and that doses have not expired. In addition, the risk management office checks them during the monthly AED reviews, and all residence life staff have been charged with reporting if the tag on a ONEbox is broken. “We're continuing to explore a ONEbox installation that would be accessible 24/7 for off-campus students, as the current boxes are all behind locked doors in each residential area. And we're exploring programming that would bring more Narcan doses for students to have as a just-in-case dose. The Narcan doses we have are more an immediate-need solution,” Carrier says.
In some cases, the push for increased education about and the availability of naloxone has been directed through legislative action. One of the most public responses came after a University of Victoria student overdosed in a residence hall in January 2024. By the time students returned for the next academic year, the province’s overdose prevention steering committee, created in response to the death, required that all 25 campuses in British Columbia have naloxone kits “readily available and accessible” to students. At Victoria, naloxone was placed in almost 90 locations across campus, including common areas on each floor. Residence hall staff were trained on their use, and education about them was ingrained into orientation for all students.
Additionally, British Columbia campuses, along with the Ministry of Post-Secondary Education and Future Skills, drafted a report to educate people about naloxone intervention and suggest practices to prevent overdose harm. Among the guidelines, it encourages both “static (e.g., stationary naloxone cabinets) and dynamic (e.g., naloxone kits carried by staff) options for use” and suggests placing them near automated external defibrillator units. Naloxone should be stored at room temperature and checked regularly to see if it has expired, and distribution cabinets should have tamper-evident features, “such as breakable glass or alarms.” And the report specifically singles out student housing, saying, “Consider distributing naloxone (including nasal naloxone) so that it is appropriately accessible within student housing (e.g., one kit per building or floor).”
In the United States, a number of state legislatures have crafted measures to combat overdose harm which requires campuses to take specific steps. For example, California’s Campus Opioid Safety Act, which went into effect on January 1, 2023, required public colleges and universities to provide education and information about opioid overdoses as part of orientation and to make opioid overdose reversal medication available on campus. Campuses can receive the medication and fentanyl test strips as part of the state’s Naloxone Distribution Project. While not required, the law encouraged the University of California system campuses to do the same.
At Occidental College, a private institution in Los Angeles, this year marked the second year of a partnership between the housing department and the Wellness Center's Health Promotions Office. Isaiah Thomas, assistant dean of students, explains that Wellness Center staff provide training to resident assistants each year, as well as general training to all students. Additionally, the center prepares Narcan kits that RAs can distribute to their residents or that students can pick up themselves.
A similar bill was passed in Washington aimed to provide both education and access to crucial supplies, such as naloxone and fentanyl test strips. Josh Gana, the University of Washington’s director of operations, notes that they have two housing desks that make naloxone available for self-serve. “At UW, our student health center is responsible for managing the distribution program, and our health prevention education program is responsible for the education program. Since funding was provided to build a program, complying with this law has been more straightforward than an unfunded regulation might have been.”
College and university student governments can also initiate efforts. Earlier this year, James Madison University’s Student Government Association approved resolutions that would increase naloxone’s availability on campus. Along with calling for annual training on the subject with fraternity and sorority risk management officers, it also encouraged having the campus’s ResQed student club (which focuses on safety and public health information) implement and monitor the placement of NaloxBox stations in the residence halls. Similarly, Texas Christian University (TCU) now has more than 200 Narcan stations across its campus, including in all the residence halls, as part of a collaborative effort among the university’s Student Government Association, Substance Use & Recovery Services office, Wellness Promotion office, and Student Affairs. As part of the program, resident assistants and hall directors regularly inspect the stations during their rounds and report when a box needs to be replaced.
The stations at TCU were provided by Windy City Cabinet. It is one of many businesses, like Overdosekits.com and others, that have responded to the growing need for accessible naloxone stations. The owner, Ken Alt, explains that the company found itself addressing this issue almost by accident. In 2017, an existing customer asked if it was possible to modify the boxes with breakable glass that were being sold as covers for fire alarm pulls. Now, the emergency kits and related products make up a significant portion of his business, selling to a variety of organizations on many campuses: fire, police, and campus safety departments; facility resources; intrafraternity councils; student health centers, and more.
Even in cases where the government may not mandate overdose prevention programs, those efforts can still benefit from partnerships with broader public health campaigns. The Ohio State University (OSU), for example, had offered naloxone for years, but they received a boost in 2020 when the campus became a Project DAWN (Deaths Avoided With Naloxone) site. The program, coordinated by the Ohio Department of Health, has more than 200 participants registered in the state to distribute naloxone and fentanyl test strips and to offer training. “I’ve been at OSU since 2015, and the efforts early on were very grassroots in the sense that small offices and groups would partner together and identify funds for one-time events and programming,” says Ahmed Hosni, assistant director of the student wellness center. “After becoming a Project DAWN site, efforts became more sustainable and consistent. I have provided technical assistance to many campuses around this topic, and sustainability and having staff effort to manage a dissemination program are often the biggest barriers I hear about. I would say that Project DAWN provided both of those things.”
A similar partnership is in effect at the University of Wisconsin-Madison, which is part of Wisconsin Voices for Recovery’s Nalox-ZONE Program, which provides more than 500 boxes across the state, including about two dozen on the Madison campus. Each Nalox-ZONE box features nasal naloxone, a CPR breathing barrier mask, and instructions written in both English and Spanish.
Zachary Cleland, assistant director of housing operations at the New Mexico Institute of Mining and Technology, explains that his campus hosts outside groups to provide training on how to administer the life-saving doses. “In my current town we have SCOPE (Socorro County Options, Prevention, and Education),” Cleland notes, a group that relies on grants to support their work offering training and providing free doses to the training participants, which has included RAs. “Knowing that administering it does not cause harm and that they could be saving a life, I think, is an important aspect of that training.”
Regardless of where the overdose prevention efforts begin, the campus housing department is a vital cog in the process. Hosni emphasizes the crucial role that the OSU housing office plays in prevention and response efforts. “Through partnering with us to get the messaging out to students about the program to making space available for us to do training, they are a critical part of our efforts to provide health education to students. They have even partnered with us to make training available to their residence hall staff who are interested and promote training to any student who is interested.”
At the Pace University Westchester campus in New York, the housing department is integral in supporting its harm-reduction approach. As RJ Halliday, a residence director, explains, “In New York, we're able to obtain fentanyl test strips free of charge, so we've been distributing them alongside condoms in our buildings. In my building, we specifically converted a drawer in our communal kitchens on each floor as a space where residents can get internal condoms, external condoms, and fentanyl test strips. On the front of the drawer are QR codes so that residents can learn how to use the items. There's also the number to our Counseling Center listed.”
Halliday clarifies that while the Pace RAs are trained to administer Narcan, they are not required to, as they are not medical professionals. “We have a strong nursing presence on our campus, so we discuss this the same way we do CPR for folks who are becoming health professionals or are already certified as EMTs. Our campus's Alcohol and Other Drugs Services specialist worked in emergency rooms and in a prison before being here, so he's done a great job taking the lead on a lot of this as well, including the Narcan trainings for our staff. He and I just hosted one for the residents in my building in the lead-up to Halloween. He's also helping us facilitate an Anonymous Q&A in the building where residents can submit any questions they have about drug use and harm reduction, so they can get accurate information.”
While the opioid crisis challenges campus communities and society at large, colleges and universities are taking critical steps to both prevent and respond to overdoses. In many ways, the effort and dedication are reminiscent of how campus housing and student affairs have responded to vital health and safety issues in the past. Larger campaigns and efforts often originate with other campus departments, but campus housing is a vital partner that can help with questions of logistics, monitoring, education, awareness, and crisis response. As campuses continue to take these steps together, they are creating safer spaces for their students.
James A. Baumann is editor of Talking Stick and the ACUHO-I Publications Director.
