California would funnel $50 million into educating young people about the risks of opioids and fentanyl under Gov. Gavin Newsom's latest budget proposal, which comes as colleges are trying to make students aware of the dangers of those drugs.
Opioid overdoses nationwide have accelerated during the COVID-19 pandemic. The U.S. Centers for Disease Control and Prevention estimates that more than 100,000 Americans — and about 10,000 people in California — died of drug overdoses in the year ending in April 2021, a nationwide increase of 28.5% from the year before.
And opioid overdose deaths have been steadily increasing for years among Californians age 34 and under, more than tripling from 1999 to 2019, according to Kaiser Family Foundation data.
Fentanyl, a synthetic opioid, has led to overdose deaths on campuses in the last several years — a sophomore at Stanford University died from an accidental fentanyl overdose in 2020, as did three students at the University of Southern California in 2019.
Some California colleges have begun training students and staff in the use of naloxone, a medicine that can reverse overdoses and is frequently used under the brand name Narcan.
Increasing awareness among students could influence communities on a larger scale after they graduate, said Noel Vest, a postdoctoral fellow at Stanford University specializing in substance use disorders and recovery.
"We know that naloxone saves lives. And so, you know, especially among college-aged students, the more that we can get it in their hands, the more that we can help them understand how to effectively use it, the better as a society we are going to be," Vest said.
When asked whether Newsom's proposal would target college students, the California Department of Public Health said it would conduct research to craft the campaign and identify specific audiences and age ranges. The campaign would aim to reach both youths and adults, the department said in a statement to the CalMatters College Journalism Network, using social media, print and digital ads, and online toolkits.
The proposal is part of Newsom's $286.4 billion budget plan for the fiscal year that begins in July. Funding for the proposal comes from the massive settlement states reached with opioid makers.
Newsom released the plan on Jan. 10. It serves as a marker of his priorities and is still subject to negotiation with state lawmakers, who must approve a budget by mid-June.
A separate bill authored by Sen. Melissa Hurtado, a Central Valley Democrat, would require campus health centers to distribute naloxone. It passed the Senate last session but stalled in the Assembly.
Stanford University has already trained hundreds of graduate and undergraduate students to use the medicine over the last year, said Ralph Castro, director of the university's Office of Substance Use Programs.
Cal Poly San Luis Obispo offers free overdose prevention kits to students that include Narcan, and trains them on how to use it. And Fresno Pacific University has Narcan available at several places on campus, including in the health center and the athletics department.
Marissa Gonnering, a third-year resident adviser at Cal Poly, attended a Narcan training on campus. The process only took about 20 minutes and felt important, she said, because as an RA, she knew she could be the first person to reach the scene of an overdose.
She hasn't had to use Narcan yet, but said she feels safer knowing how to do so. The university should make sure students know it's available and distribute the kits widely, she said.
"I think it's super important to have that safety net if it's possible," Gonnering said. "But I think that if only a few people know about it, or have it, then it's… not as helpful."
Jarita Greyeyes, a fourth-year PhD student and member of Stanford's Graduate Student Council, is among those calling on the university to ensure that everyone on campus has access to Narcan and related training, and that the resources are widely publicized to students.
When Greyeyes sought out Narcan training on her own more than a year and a half ago, it required multiple conversations with care providers and pharmacists on campus, and she faced questions about why she wanted the medicine.
Greyeyes said the experience would have discouraged her, if she hadn't been so committed to being able to carry Narcan.
"As a person who loves and cares for people who use drugs, and who also has witnessed people in my own life struggle with substance use issues, I would never want to be in a situation in which someone mistakenly or in any way ingested a substance that could harm them and we weren't able to offer them care and assistance," Greyeyes said.
Colleges should make Narcan easily available — such as placing it in a bucket on the quad so students can walk by and anonymously grab it, said Aimee Moulin, a professor of emergency medicine and addiction medicine at the University of California, Davis.
The idea that having access to Narcan means people will use drugs more isn't true, she said.
"It is a myth that is out there that, I think, is tied to stigma related to drug use," Moulin said. "We've had these abstinence-only thoughts out there for a long time and universally they've been unsuccessful."
Instead, Moulin advocates for harm reduction: a set of public health strategies meant to mitigate the potential negative consequences of drug use. President Joe Biden's administration has touted the approach.
For Moulin, that means meeting drug users where they are, showing them healthier ways to use, and ultimately helping them get treatment.
The Department of Public Health said its campaign may include either prevention, harm-reduction messaging, or both, depending on the results of its research. Both approaches "are necessary to prevent and mitigate harm from opioids, including fentanyl," the department said.
Overdose prevention education should use compassionate language, never words that demonize people who use drugs, said Shannon Knox, the director of training and education at Community Health Project LA, which operates a syringe exchange and distributes free Narcan to Los Angeles County health care providers.
The education should also center safety measures: never using alone and always testing drugs before using a full amount, she said. Colleges should also communicate addiction treatments options to students, Knox said.
"We need to be funding the education because the lack of education has a lot to do with why people are dying. And it's really hard on people like me and my staff to hear about all the overdose deaths that are happening, when we know how limited the resources are," Knox said.
Kirsten Vinther, a health educator and prevention specialist at Cal Poly, said students need to feel safe to ask questions and receive straightforward responses.
"I have always been a proponent of honesty and awareness — be clear with the students that there are dangers inherent in the use of substances and show them the respect of honesty and the awareness that many of them have already made different decisions about their use — or will," Vinther said in an email.
In Narcan trainings, Vinther said it's also important to stress that the medicine won't always reverse an overdose, and can only reverse an overdose for a short period of time. The person receiving Narcan still needs immediate medical attention.
Colleges should also make sure students are aware of medical amnesty policies, said Jeremy Sharp, regional outreach director at Students for Sensible Drug Policy. Such policies can shield students from punishment if they seek medical help for an emergency related to drugs or alcohol.
The risk of taking drugs laced with fentanyl is upping the stakes. The rate of drug overdose deaths involving synthetic opioids, such as fentanyl and fentanyl analogs, increased 56% from 2019 to 2020, according to the CDC. Fentanyl analogs are chemically similar to fentanyl but require special toxicology testing to detect, the CDC says.
While doctors can prescribe fentanyl to patients with severe pain, most recent cases of fentanyl-related overdoses and deaths are linked to illegally made fentanyl that can be mixed with heroin and cocaine, sometimes without the user's knowledge, according to the CDC.
Fentanyl's many analogs mean those who use it don't know what to expect, Knox said. People who have used heroin for 20 or 30 years may use fentanyl once and overdose. Those people would die without access to Narcan to reverse the overdose, she said.
With fentanyl, "we're talking about a pretty different animal than we've ever seen," Knox said.
"The biggest shift I see is that while we are not only attempting to educate students about the dangers inherent in the use of substances they are knowingly ingesting, we now also need to educate them about substances that they may not necessarily be choosing to use," Cal Poly's Vinther said.
More funding and education will help, experts said.
"Every dorm room has a fire extinguisher in it. I mean, I would think that the best thing that you could do around this would be that every college housing unit has a place where they have Narcan," Vest said.
Forschen and Luna are fellows and Murphy is the private colleges team leader with the CalMatters College Journalism Network, a collaboration between CalMatters and student journalists from across California. This story and other higher education coverage are supported by the College Futures Foundation.