How higher education can step up to help fight America’s worsening drug epidemic
In 2015, opioid drugs claimed the lives of more than 32,000 individuals in the U.S. — an average of 91 people a day, according to the Centers for Disease Control and Prevention (CDC). That same year, a survey of students at eight colleges and universities conducted by The Ohio State University (OSU) found that one in 10 undergraduates had used prescription painkillers for nonmedical reasons. Additionally, 68 percent of respondents said they had intentionally misused these drugs on more than one occasion, and 13 percent reported doing so at least 40 times.
As the opioid epidemic continues to worsen — overdose deaths increased by 19 percent in 2016, according to recent preliminary data from The New York Times — many states and communities are taking action by enforcing strict regulations on prescribers, distributing free doses of the overdose treatment drug Naloxone, and mandating prevention programs in K-12 schools. However, some experts are concerned that the higher education community isn’t doing enough to address the prevalence of opioid abuse and addiction among college students.
Kenneth Hale, PhD, an OSU pharmacy professor and associate director of the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery (HECAOD), says he firmly believes that most schools aren’t prepared to provide adequate prevention and treatment programs. “I think the urgency of the opioid dilemma hasn’t sunk in for colleges as much as it needs to because they’ve got bigger problems to address with alcohol and binge drinking,” he explains. “But there is potential for great harm when drug overdose is the leading cause of death for people under 50 and we have 10 percent of students misusing prescription opioid medications.”
While Hale says colleges and universities should continue to focus primarily on the rampant problem of alcohol abuse, he believes they do a disservice to students by dedicating few, if any, resources for prescription drug abuse prevention, especially as most individuals who misuse medications begin doing so between the ages of 18 and 25. “I think we have an opportunity and an obligation to help educate students at this age about how to use medication safely so they can be better healthcare consumers in general and help avoid problems like the opioid epidemic in particular,” says Hale.
To address these issues, the OSU College of Pharmacy created the website Generation Rx, which provides free, age-appropriate materials for K-12 students to senior citizens on teaching prescription drug safety. “As someone who has worked in student affairs and as a pharmacist, [Generation Rx] seemed like the right thing to do in terms of trying to establish resources to help solve the opioid problem, which was becoming one of our most serious public health dilemmas,” Hale explains.
The website features a page dedicated solely to higher education, called Generation Rx University, which has downloadable materials such as campus flyers and educational videos designed to teach students about general medication safety and the dangers of prescription stimulants and opioid painkillers. It also provides resources for student groups, residence halls, campus health clinics, and other campus organizations to host an opioid awareness program that educates on how to use painkillers responsibly after an injury and how to help someone who is experiencing an overdose. Generation Rx University is sponsored by OSU and the Cardinal Health Foundation, which currently offers grants to help fraternities and sororities host opioid awareness events.
In addition to prevention programs, Hale says colleges should focus on harm reduction for students who may already be abusing or addicted to prescription painkillers. He believes that schools should ensure that Naloxone is easily accessible so that students are prepared for situations, like campus parties, where people may be misusing opioids or combining them with alcohol, which increases the risk of overdose. Hale says OSU offers Naloxone through its campus health clinic without a prescription.
“I think most schools are probably one overdose away from realizing that they need to do more — more to get Naloxone in people’s hands and more to raise awareness that this crisis is not just something that’s happening across the U.S.; it’s happening on college campuses,” says Amy Boyd Austin, director of the Catamount Recovery Program at the University of Vermont (UVM).
Last year, Austin says that 60 percent of students who participated in Catamount had a history of opioid abuse. As a collegiate recovery program (CRP), Catamount provides an on-campus space and resources, such as 12-step meetings, wellness programs, and trained support staff, for students struggling with substance abuse disorders. Launched in 2010, the program originally had five participants. By 2016, it had roughly 30 — which Austin largely attributes to the nationwide rise in opioid use.
Individuals who have a history of substance abuse must be diligent about maintaining their sobriety, which can be extremely difficult in a college environment where alcohol and drug use are prevalent at many social events, says Austin. As such, students in recovery often feel isolated and may drop out of school in order to avoid the pressures of a campus setting. Being part of a CRP provides these individuals with a community of supportive peers as well as trained and dedicated staff members who understand what it’s like to have a “recovery identity” and feel like an overlooked and often-stigmatized member of society.
“Recovery is a big deal with the opioid situation because using one time could result in an overdose,” Austin says. “Most people are doing everything they can to protect their recovery, and that usually means finding something like a CRP where there’s a community of people supportive of their recovery identity.”
By dedicating funding and resources to recovery, Austin believes schools can help change the stigma around addiction that prevents many people from seeking help. “It is up to university leadership from the very top to look at this as a public health crisis … and to embrace that a recovery community is a positive addition to any campus,” she says. “Having a CRP changes the whole campus climate around recovery identity and can really go a long way in helping break through the unconscious biases that people have regarding substance abuse disorders.”
An investigative report by PBS News estimates that 150 colleges and universities in the U.S. offer CRPs, and a growing number now have substance-free or recovery-centered housing. In 2015, for example, New Jersey Gov. Chris Christie passed a law requiring that most higher education institutions in the state offer sober dorms after New Jersey experienced a 215 percent increase in opioid deaths in just five years.
In Vermont, the number of heroin- and fentanyl-related deaths nearly doubled between 2015 and 2016, according to a report from the state’s health department. And Austin says it is extremely common for students who develop prescription opioid dependencies to turn to stronger, more lethal drugs.
“I think many people see experimentation with substances in college as normal, and taking a pill doesn’t seem like that negative of a behavior,” she explains. “When someone gets hooked on opioids as pills and then for whatever reason can’t afford them or access them anymore, and heroin is cheap and available, that’s when they end up crossing that line they probably never thought they’d cross.”
Jessica Higgs, MD, a physician at Bradley University, says she doesn’t think college students are that different from the general population. “Most people caught up with this epidemic did so by accident, either because of prescription pain medication or experimenting with other drugs that led to opioids, which may have been cheaper or more accessible,” she says.
As a board member for the American College Health Association (ACHA), Higgs leads the ACHA Task Force for Opioid Prescribing in College Health. ACHA created the task force recognizing that colleges aren’t immune to the national crisis. Research findings from the organization have shown that the younger people are exposed to such medications, the more likely they are to become addicted.
In 2016, the task force issued guidelines for college healthcare professionals to follow when providing prescription painkillers, such as only issuing small doses and screening patients for substance abuse problems. “Our first approach is to only use these medications when they are appropriate and necessary and to only give the patient what is needed instead of a script for 30 pills when they may only need six,” Higgs says.
Hale agrees that college healthcare providers have a responsibility to reduce the availability of opioids on college campuses. And campus medical clinics, as well as healthcare providers nationwide, are becoming increasingly sensitive to the dangers of overprescribing such medications, he says.
Phillip Anderson, PharmD, who serves as manager of OSU’s Wilce Student Health Center Pharmacy, says that the university’s physicians and pharmacists have been vigilant about minimizing the amount of prescription painkillers dispensed on campus because of the prevalence of overdose deaths in the surrounding community. Ohio has been the state hardest hit by the opioid crisis in terms of the number of deaths, he explains, which is why the state lifted restrictions on Naloxone two years ago so that the drug could be purchased without a prescription. Since that time, OSU Student Health Services has offered Naloxone kits, which each contain two doses.
“We felt the need to do our part and not ignore the students or faculty … who may be struggling with this issue,” says Anderson. “Often, the person who purchases a kit is the caregiver or friend of someone who has an addiction problem, and they are worried.”
When someone purchases Naloxone, Anderson or another pharmacist takes that person to a private consultation room to train him or her on how to recognize the signs of an overdose and how to dispense the drug via injection or nasal spray. In addition, pharmacy staff have done outreach on campus, such as talking to students in residence halls about what to do in case of an overdose. They also trained OSU’s police department after it received a grant to purchase Naloxone kits for its roughly 60 officers to use if needed. Anderson is unaware of any officers having to respond to an overdose on campus, and he says the pharmacy has sold very few kits.
He believes that the most important factor in battling the opioid crisis is educating students and providing life-saving treatment. “All we can do is be open about this problem and offer to help,” he says.
Beyond the traditional college campus, medical and pharmacy schools are now tackling the issue by requiring a more rigorous curriculum and training around prescription painkillers to prepare future healthcare providers. “One of my colleagues was just telling our students,” says Hale, “that this is the biggest, most important medication issue of our time.”●
Mariah Bohanon is a senior staff writer for INSIGHT Into Diversity. For more information, visit generationrx.org.