Countermeasures Season 2 Episode 5 Podcast Transcript: Preparing Students for Opioid Emergencies
[00:00:02] Bella Grumet I think when you’re directing harm reduction efforts toward college students and students of this generation, I think one of the things that makes us so successful is our peer-to-peer modeling, because we’re the generation of D.A.R.E., where I have been signing drug free pledges since I was in the first grade and didn’t really know what a drug was. So I think people in that generation kind of have a kneejerk reaction to any sort of harm reduction or drug focused efforts because they think they’re being judged and are being told to do something. But we really value kind of meeting people where they are and saying you’re you’re an adult, you’re going to do what you’re going to do, but please listen to us and how to do it safely.
[00:00:48] Narrator This is Countermeasures, brought to you by Emergent, maker of NARCAN® Nasal Spray. Join us as we explore the shifting complex world of the opioid crisis. Today, opioid overdose is the leading cause of accidental death for so many families, loved ones and friends behind these lives lost. This season will continue to explore some of the communities hit the hardest by the crisis, from prisons and construction sites to schools and elderly care, we will hear from changemakers offering a new way forward. At colleges nationwide, each new school year, students eagerly move into dorms and select their classes. For many, college is a time of firsts. The first time living on their own. The first time meeting so many people at once. And for some, the first time they will experiment with illicit substances. Coming from a diverse range of educational backgrounds, when it comes to drugs and alcohol, many students don’t know the dangers of accidental overdose or why accepting a pill to help them study harder or be more social has the potential to end their lives. In this episode, we speak with college students, researchers and educators about how to make campuses safer for everyone. The Carolina Harm Reduction Union, or CHRU, is a peer-to-peer student-run, faculty-monitored harm reduction organization that provides education and harm reduction materials at the University of North Carolina at Chapel Hill.
[00:02:25] Riley Sullivan My name is Riley Sullivan. I’m the Executive Director and co-founder of the Carolina Harm Reduction Union, and I’m also a senior at the University of North Carolina at Chapel Hill.
[00:02:37] Bella Grumet My name is Bella Grumet. I’m a senior at the University of North Carolina at Chapel Hill studying neuroscience, and I am the Director of Communications for the Carolina Harm Reduction Union.
[00:02:47] Kathleen Ready I’m Kathleen Ready. And I’m Director of Education and kind of volunteer coordination with the Carolina Harm Reduction Union.
[00:02:57] Bella Grumet One of the reasons getting involved in this organization was important to me is I was actually touched by a loss we had due to an accidental opioid poisoning related to a student on our campus and in the past years was three alumni and students overdosing on an opioid related to UNC’s campus. And so I just really saw a need to get education and awareness out to the student population to prevent another tragedy.
[00:03:24] Narrator Members of CHRU saw the need for education on their campus, as well as the importance of peer-to-peer education.
[00:03:32] Kathleen Ready We do a lot of different educational presentations as well as actual distribution and handing out of naloxone and fentanyl testing strips. And one of the great things about at least UNC and just like the general community is, there are so many different groups of people with different interests and different background knowledge. It’s like we’ve presented two groups of people that are EMTs and we’ve also presented to Greek life in different cultural groups, and each of them have different interests and kind of baseline knowledge. So we create tailor presentations that are tailored to what they think is important for whoever is in the organization to learn about. So do we do a lot of that and working with groups of students and people in the community and as well as distribute naloxone. So every week we have we put a table on campus for a couple of hours and hand out naloxone and Fentanyl testing strips and train the kids who come to the table how to use these resources and how to spot an overdose and what to do if you’re ever put in that situation. Just generally raise awareness on campus.
[00:04:40] Narrator Administrators are key in supporting students. Alexis Drakatos at the University of Oregon, oversees substance misuse prevention services. She says the student perspective, like the one brought by Riley, Bella and Kathleen, is crucial.
[00:04:56] Alexis Drakatos The student perspective of our work is really important, and we do have I’d say our efforts are primarily student led or student inspired. And so within my team, I do have a staff, a staff of students. We have about five or six, I’d say, that are peer, we call them substance abuse prevention peer educators. And so their role is really helping develop education and leading a lot of our workshops, doing outreach and things of that sort. So it’s really important to us to bring in students and have them be that, be that face. And also they’re the ones that are amongst their peers. They know they’re on the ground seeing what’s happening, seeing the types of questions. And so that allows us to really involve students, one, because their perspective is so important, but also when it comes to the actual moments where we’re educating a group of students, having that peer to peer model we find just allows to meet students where they’re at. But I think it also allows for just a comfort as being able to ask questions that they may be less willing to ask if I’m in the room or other professional staff are in the room. And so I think it really allows for a healthy balance.
[00:06:08] Narrator Cori Hammond is the Director of Prevention Services at Partnership to End Addiction, a national nonprofit with a mission to transform how addiction is addressed by empowering families, advancing effective care, shaping public policy, and trying to help change the culture. Cori says that most overdoses in the college age demographic occur because people don’t realize they are taking an opioid.
[00:06:32] Cori Hammond The risk factors for this college age group, the risks are similar to what we see in adolescents, in some ways. The the prefrontal cortex of the brain, which is that part of the brain that’s responsible for critical thinking and risk management that’s not fully developed in the late teens and early 20s. And so because of this college age people are more likely to take risks just in general. Sensation seeking, like, in males peaks at age 19, which is conveniently freshman year for most of them. But that’s common risk factors for all substances, specifically for opioid overdoses. We think about unintentional overdoses due to mostly fake pills for this age. So the overwhelming majority of young people who have a fentanyl or an opioid overdose, they didn’t mean to take fentanyl. They, you know, the overwhelming majority of them are not addicted to opioids. They thought they were taking a legitimate pharmaceutical pill that they bought from a pal or they’re taking a bump of cocaine, not realizing that fentanyl or any of these other ultra potent synthetic opioids were present in what they were taking. So that’s the main risk on college campuses. And, you know, college students are under a lot of pressure, you know, pressure to make good grades, attend class, be social, be involved and figure out their life plan, which is all part of the whole experience of college. But it’s really stressful. So it’s understandable that they could be tempted by a lot of different substances to help cope with all of that, you know, things like amphetamines that they think are going to help them stay up to study, you know, cocaine or MDMA that they think is going to make them social or fun at this party, Xanax, that they think is going to help them relax when they’re anxious. And, you know, they may be getting these substances from someone that they trust completely, but who is that person getting substances from? So we know that the illicit drug market is not safe and these fake pills can be like they can’t be identified just by looking at them. And so these are the situations that we know put college students at risk for an accidental overdose.
[00:08:58] Narrator At the University of Oregon, incoming students are required to complete online training that includes education about fake pills.
[00:09:07] Alexis Drakatos We do have students from all over the world. And so it is important to recognize that the education that our students may be coming in with specific to alcohol and other drugs is going to look really different just depending on the state, the country that they’re coming from, even the community and then even the individual school and what their K-12 education might have looked like. So we want to try to have a baseline education for all our students to educate them on specific campus policies, state policies, and maybe even in some cases, federal regulations. So the baseline education for incoming students is we utilize the so online prevention, especially knowing that we have such a large incoming class of students. And so our students, during their first term or quarter on campus, they’re required to complete some online modules that focus on alcohol, cannabis, prescription medication. And then we also focus on Title IX and some other sexual assault, consent and consent education. And so all students are required to complete those modules. We also do require students when they come for orientation, freshman or first year student orientation. We have them go through an in-person workshop that’s led by students.
[00:10:28] Narrator Certain groups of students are at higher risk of substance misuse. And Alexis emphasizes the importance of reaching and educating these groups.
[00:10:37] Alexis Drakatos How we go about educating specific communities or assessing maybe trends or levels of risk within specific communities on campus. I think areas that we do spend a great deal of our time in the three that come to mind immediately would be fraternity and sorority life. And so we recognize that their data shows and I think even anecdotally you will see that I think students that are engaged in fraternities where you guys might be at utilize substances at greater rates than non-fraternity and sorority life peers. They’re also at greater risk for other other harmful behaviors as well. And so that’s a really important group for us to be working with and having targeted education towards. And we also like to focus on athletics and so working broadly with our athletic teams. And then I think the other I’d say is working with incoming or first freshman year students as well. And so what that education might look like as much as possible is involving students from those populations and that education. So, for example, a fraternity sorority life, part of my role is overseeing we call it the Safety Wellness Board here on campus. And so it’s we have members that are all in fraternities and sororities that lead this board. And so we have staff that are working with these students that are peer leaders. And then those are the students that are leading education to the greater fraternity sorority life community. So again, it’s that model of having student leaders involved saying, okay, what do we need to talk about? What are the trends you’re seeing? What do we need to do to address these things? And so having that support to help them tailor education for those students.
[00:12:24] Cori Hammond In general, we know students are at a higher risk of substance use disorders during college if they binge drink, if their peers use if they’re a member of a fraternity or sorority, and if they kind of believe that substances are super harmful. We also know that female students are more than twice as likely as male peers to seek out stimulants for non-medical use, which puts them at higher risk of coming into contact with laced or fake pills. Bisexual women, for instance, are at an increased risk for opioid misuse and opioid use disorder. We know in general that students who are struggling with low GPAs or have difficulty in socializing are more likely to use opioids than their peers. Prescription opioid misuse is highest among students who report psychological distress or depression or suicidal thoughts.
[00:13:22] Narrator As you’ve heard, conversations about prevention for college students are changing. Students are calling for open, nonjudgmental conversations rather than scare tactics.
[00:13:33] Bella Grumet So I think when you’re directing harm reduction efforts towards college students and students of this generation, it’s really I think one of the things that makes us so successful is our peer-to-peer modeling, because we’re the generation of D.A.R.E. where I was signing drug free pledges since I was in the first grade and didn’t really know what a drug was. So I think people in that generation kind of have a kneejerk reaction to any sort of harm reduction or drug focused efforts because they think they’re being judged and they think they’re being told to do something. But we really value kind of meeting people where they are and saying, you’re like, you’re an adult. You’re going to do what you’re going to do, but please listen to us and how to do it safely. And I’ve gotten a lot of feedback from people on how they’re so much more open and willing to listen to a peer talk to them because they know they’re not being judged. They know it’s not some message being forced at them. It’s someone on their in their circle, on their level, like meeting them where they are, that’s coming from a place of just wanting to help and not to judge.
[00:14:39] Riley Sullivan I won the D.A.R.E. essay contest in fifth grade and reflecting on that curriculum that I’ve had to go through my entire childhood and to college it’s largely corny and you make everything seem like the worst thing in the world. And even recall a video of like some dude dressed up as Mario saying, if you do drugs, you go to hell before you die. And it kind of brings us to this point where it’s almost like The Boy Who Cried Wolf, when there’s something that is actually incredibly harmful, we’re less likely to listen because we’ve been programed to kind of ignore some of that messaging.
[00:15:24] Narrator Another important element in this shifting conversation has been about dispelling the myth that it’s normal to use substances in college.
[00:15:33] Cori Hammond The conversation around prevention has changed a lot. You know, we’re doing a lot of work to try to dispel some of the myths and misconceptions about substance use in young adults and adolescents. A big one is this idea that substance use as a teen or a young adult is an inevitable part of life, that it’s a rite of passage. It’s something that everyone does, and that’s something that we know is just not true. For high schoolers, for instance, the number of total abstainers, those who have never used any substances at all is increasing year after year. Like last year, 30 percent of high school seniors said that they had never used any substance before, and that’s including alcohol and nicotine. For 18 to 20 year olds, which is a big subset of the college population, only about 35 percent said that they had used any illegal substance in the past year. And there was a recent systematic review of all of these different studies that found the prevalence of prescription opioid misuse on college campuses is generally below 10 percent. So this is certainly not something that everyone is doing. And talking about substance use, like everyone’s doing, it just really normalizes it unnecessarily. So instead of focusing so much on the negatives, like don’t do this, it’s bad for you. Prevention is really trying to focus on the positives, like this idea that most of your peers aren’t using substances. We’re definitely moving away from that just say no approach. And it’s been a slow shift. Like over over the last century, we’ve had a shift in the way that the medical community in the scientific community thinks about addiction. So first we had what could be called like a moral model, this idea that people believed drug addiction was a moral failing. And if you just have enough willpower, you can overcome it. And then we kind of moved to something that would be called like a biomedical model, where we realized the role that genetics and biology play in substance use and addiction, learning how addiction is a progressive brain disease. And finally, we realized that even that was kind of too reductive. And it’s not just biology. And so we landed on a much more comprehensive model, which most would call the bio psychosocial model. So taking into account biology, psychology, the socio economics and all of these cultural factors contribute to someone’s risk and should be taken into account for both prevention and treatment. And so that shift in understanding mirrored the way that we have shifted in prevention too. So first we used scare tactics meant to terrify kids, to not try drugs, and then we moved into kind of just psycho education. And if we just teach them the facts, then they’ll be able to say no. And it wasn’t until the 90s or so that we saw a significant shift towards evidence-based programs. And then finally later, a shift in this more comprehensive approach took hold. And so once we’re thinking comprehensively about someone’s risk landscape, their biology, psychology, socioeconomic status, culture, it becomes really obvious why just teaching kids to say no is not enough.
[00:19:13] Narrator The CHRU team has seen that students are very responsive to open and honest conversations about prevention and harm reduction.
[00:19:21] Bella Grumet I’ve actually been really moved by how positive the response has been. I have people coming up to me and public being like, it’s the naloxone girl. And then that kind of sparks conversation of them, asking more questions, asking for more resources, asking for us to come back and present to their new members of their organizations. And I think what’s been really important to me is it’s generated a conversation around the naloxone and around opioid overdoses that has been absent. And the absence of that conversation was causing people to die. Because I think in college, there’s kind of a you can sweep it off mentality to a lot of things that go on. And I think getting this conversation started has made people take a critical lens to what’s going on in their lives. And the hope is that if there is ever an emergency situation, instead of hoping someone will sleep it off. They’ll know the signs, they’ll know the symptoms, they’ll know to call 911, which has been what has been missing in the cause of some of the recent deaths we’ve experienced in our campus network.
[00:20:26] Kathleen Ready And to kind of add on to that, not only are students super receptive and excited to get the resources themselves and have us present. There also as the person who’s in charge of volunteers, very excited to become involved themselves. Like I trained two kids this morning and I have like ten more than I’m going to train this weekend. Everyone on campus is excited about it and they too want to help spread the word and communicate to the people they know.
[00:20:54] Riley Sullivan I’m like constantly surprised with the things that happen around our work with CHRU. And like our first couple of weeks trying to start this thing out. It’s as somebody pointed us in the right direction to get mass quantities in naloxone, which I didn’t even know would be a possibility. And then we get offered to go on like NPR, and then people are listening to us. And it’s obviously been incredible to watch and see people like Bella come on and Kathleen.
[00:21:29] Narrator Another important element of modern harm reduction and prevention is understanding the intersection of substance use and other factors like mental health. This is taken into account on the University of Oregon campus.
[00:21:41] Alexis Drakatos In general, substances are can be used as a way to cope with whether it’s stress, if it’s stress of academics and trying to get everything done and managing things. And so maybe we know prescription stimulant misuse on college campuses in particular is, you know, as a as a as an issue that we see on campuses. And so whether it’s stress of just try academic performance and trying to do as many as much as possible and perform well. But then also on the other side, we know that our most college campuses, I would say, are seeing increased rates of students feeling, having anxiety, having depression. And so and I think that using substances to cope is not something we just on campuses, but I think in society those things coexist. And so recognizing that those things are real, that these intersections are real and we know that they’re happening, that’s something that I think a lot of our work and collaborations on campus really target, is how can we help students identify maybe when they are when maybe substance use isn’t something they’re just doing recreationally, but it is turning into more of a crutch or a tool to help them cope. So offering trainings and information, just normalizing that it’s okay to be stressed, it’s normal to be stressed, it’s normal, you know, mental health and all these things are normal. But then how can you and also asking and seeking support is normal and really important as well. And so resources that that are available on our campus and I would imagine other campuses have similar might look different, but there’s lots of similarities.
[00:23:19] Narrator While progress has been made, stigma still plays a role in conversations about substance use.
[00:23:25] Cori Hammond As much progress as we’ve made in normalizing talking about addiction and mental health disorders, they are still stigmatized. A huge part of what we call secondary prevention is learning to get help when you need it before things get worse. And it’s understandably hard for young people to say, I have a problem and I need help. It’s tough to admit that you’re having difficulty with substances or difficulties with your mental health and opening yourself up to judgment from adults or your peers. You know, in college age students, they’re probably wondering like, what are what are my professors going to think? What will my parents think when I have to drop out? When in actuality we know how common this is and that there is effective support and treatment out there. And stigma in harm reduction is still a massive problem. You know, many people take an abstinence only approach to drug use, thinking, you know, my child’s never going to use drugs. Why would I ever have a discussion with them about how to use them safely. Which is very reminiscent of my child’s never going to have sex, so why would I ever talk to them about contraception, which is problematic in so many ways. And so we really need to break through that way of thinking. You know, young people are are dying and we have access to tools that can save them. We want adolescence and college to be a time where kids can make risky decisions and learn and grow from them. And in today’s world, we need harm reduction to do that. The alternative is that a young person can make one poor decision and their life is over.
[00:25:19] Narrator While there is still lots of room to grow, conversations about prevention and harm reduction on college campuses have come a long way. Student led initiatives like the CHRU administrators like Alexis and educators and researchers like Cori are all doing their part to prevent accidental overdose on campuses and educate college students about the risks associated with substances. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to help address public health challenges like the opioid crisis, visit emergentbiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.