A new network of college students is hoping to ward off a terrifying prospect: Discovering a friend, blue lipped with shallow breathing, dying from an opioid overdose.
Students at the University of Texas at Austin began learning to use naloxone, the medication often known by the brand name Narcan that rapidly reverses an overdose, more than a year ago.
But this semester, the peer-to-peer network of students and faculty training one another plans to expand to the University of Houston and Texas A&M University at Kingsville.
The goal is to give students naloxone and teach them how to use it, so that they can save a life if they encounter a peer showing symptoms of an overdose. The new training comes even as many Texas public universities lack written policies on naloxone distribution, though the state has made the drug available over the counter thanks to 2015 legislation.
Supporters of the program compare the availability of Narcan to fire extinguishers or automated external defibrillators that are mainstays of campus and other buildings.
“The majority of the doses are likely going to go unused — that’s a good thing,” said Lucas Hill, a UT-Austin pharmacy professor who directs a program called Operation Naloxone that UH students plan to expand into Houston this semester. “Most fire extinguishers get tossed out without being used. This is similar.”
Opioid abuse in Texas hasn’t resulted in the overwhelming frequency of overdose deaths seen in West Virginia, Pennsylvania or New Hampshire, according to the Centers for Disease Control and Prevention.
But recent rises are statistically significant, CDC data show. In 2015, 2,588 people overdosed from drugs in Texas, the center said, and the figure rose to 2,831 in 2016. Harris County had between 14 and 15.9 deaths from drug poisoning per 100,000 residents in 2016, slightly higher than most other Texas counties, according to the CDC. That figure has increased since 2010.
Four percent of Texas college students misused opioids in 2017, including codeine, according to the state’s Health and Human Services Department.
Despite this, and despite state law passed by the Legislature in 2015 to increase the availability of the drug, at least 24 of 35 four-year Texas public universities do not have written policies related to the distribution of naloxone, according to a Houston Chronicle review of university policies from open records requests.
Texas A&M and Rice University allow EMS and student health services to use naloxone when needed, university representatives said.
At least 50 A&M medical and nursing staff members were trained this fall for the first time to treat overdosing students, and EMS staff have long carried naloxone, said Martha Dannenbaum, who directs A&M’s student health services.
“We felt as a medical organization that it was best for us to ensure that everyone who might encounter this within our facility be trained,” Dannenbaum said. “Drug use, misuse and abuse exists everywhere. It’s not just the homeless population or the poor, it’s everyone from the highest administrative areas to young people that are functional.”
Hill said it’s difficult to know how widespread the issue is on Texas campuses, as families often keep overdoses private.
Joy Alonzo, a clinical assistant pharmacy professor at A&M’s health science center, said she hopes networks like Operation Naloxone get ahead of the issue before deaths in Texas spike.
But she acknowledges that pushback is possible as some perceive naloxone is enabling an addiction.
Some critics, including Mike Gimbel — a former “drug czar” for Baltimore County, Md., who now talks to college athletes about drug use — say addicts will simply overdose again without long-term treatment.
Gimbel, a former heroin addict who has been clean for more than 40 years, praises Narcan as a “miracle drug” but said distributing naloxone to friends and family of addicts is an expensive “quick-fix solution.”
Alonzo said this idea is naive, as there are already too few treatment facilities in the state.
Also, a person needs to be alive to move to long-term care, she added. “I can’t treat somebody who’s dead.”
Trainings at UT-Austin started in small groups. Residence advisers — supervisors of each floor of UT-Austin dorms — received one-hour training sessions on how to respond to opioid overdoses with naloxone.
They asked key questions: Can you give someone too much? If you take this with other drugs, what happens? And they learned that they would have 24-7 access to naloxone in each residential facility.
Then, Hill said, he began training pharmacy students to lead their own overdose prevention training sessions. About 300 students in pharmacy, medicine and social work have received this training, he said, and they have taught more than 600 people in student and community groups to use naloxone.
Hill and instructors distribute naloxone, which is funded by grants and donations, at these sessions.
In the fall semester, Hill went to UH and trained dozens of pharmacy students, leaving behind 20 boxes of the drug to start outreach.
Goran Flajc, a UH doctoral pharmacy student, said his student organization is planning to train more students and distribute naloxone this semester.
They’ll start, he said, with meeting Cougars in Recovery, a support group for students who are recovering from addiction.
UH spokesman Mike Rosen said the university’s police chief reviews cases frequently and cannot remember the last overdose officers observed.
Flajc, of Houston, said peer-to-peer distribution and training sessions can make the information easier for students to absorb.
“It’s phrasing it in a way students understand, speaking to a population you’re a part of,” he said. “It helps. It’s less intimidating.”
David Persse, city of Houston EMS physician director, said the drug is relatively easy to administer and cannot do harm if it is mistakenly administered on someone who is not overdosing.
“There’s really not a problem putting it in the hands of laypeople,” he said, noting, however, that the drug can be expensive.
Alonzo said putting the drug in students’ hands can save time — and potentially lives. The time that spans between an overdose and a student’s trip to a health center could prove fatal, she said.
Two Texas A&M at Kingsville students said they want Alonzo to train pharmacy students this semester. Then, the students hope to train resident advisers and others in early March.
“It’s an unfortunate problem to have, but it is a risk reduction strategy,” said third-year pharmacy student Austin Bridges, of The Woodlands. “And for now, it’s the best strategy we have in taking on this challenge.”
State law, campus policies
Anti-overdose drugs became more easily accessible in Texas after Gov. Greg Abbott signed into law Senate Bill 1462 in 2015. The bill allows for naloxone to be prescribed through a standing order to anyone at risk of overdose as well as family, friends or others in a position to assist those people, and a provision in the law allows nonprofits and other organizations to distribute the drug to people who may be able to use it to save lives.
It also indicates that people who act in good faith in deciding whether or not to prescribe or use the drug do not face criminal or civil liability. Not one lawmaker voted against the bill.
It’s a significant step as many college students indicate that they would not know how to help an overdosing peer. A survey commissioned by the Hazelden Betty Ford Institute for Recovery Advocacy and The Christie Foundation found that more than 37 percent of 1,200 college-age adults surveyed said they would not know where to go for help in event of an overdose.
Universities say known opioid overdoses are rare on their campuses. UH police officers do not carry naloxone with them, Rosen said, in part due to the infrequency.
Hill said that to his knowledge one dose of the drug has been opened from the dorm distribution sites. A University of Texas police officer withdrew the drug for a person who became responsive without needing it, he said.
At A&M, alcohol is still the biggest problem in drug misuse, said Mike Middleton, A&M’s EMS manager.
“New Hampshire, Virginia … that’s an epidemic,” he said. “Here on campus, we’re seeing alcohol and other types of abuse. It doesn’t mean it doesn’t happen here, (but) we don’t see it.”
Alec Mohr, a Texas A&M junior who leads a new Aggies in Recovery group, said A&M’s ability to distribute naloxone aren’t well known.
But he said he’s intrigued by the possibility of training students more widely, comparing the drug to defibrillators.
“If it’s something that simple,” he said, “I don’t see why people shouldn’t know how to use it.”
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