Narcan reverses opioid overdose. College campuses could use more of it : Shots

In the summer of 2020, Monica Vera-Schubert talked to NPR about her long struggle to get insurance coverage for her son Bobby’s addiction treatment. They’d recently prevailed, he was getting sober, and Vera-Schubert, a single mom, expressed immense gratitude.

“My son is alive; I appreciate every moment I have with him,” she said.

In the years that followed, Bobby became a devoted student, got into his dream school of UCLA, and sometimes joined his pharmacist mom as an activist, giving talks and warning others of the dangers of prescription-drug abuse.

“I always tell him, ‘Bobby, I’m so proud of you,’” Vera-Schubert said at the time. Bobby would respond, “Mom, I’m so proud of you.”

That was four years ago.

This spring, Vera-Schubert reached out again, saying Bobby had relapsed. On April 12, a roommate found him slumped over his desk in his dorm, apparently overdosed from fake Xanax pills laced with fentanyl. Bobby Schubert was 29.

Deadly trend

The Schuberts’ tragedy speaks to the need for greater public health response to overdoses, including on college campuses. The overdose death rate among young adults ages 18 to 24 spiked 34% in just five years between 2018 and 2022, according to data provided to NPR from the CDC. The trend largely is driven by cheap and potent opioids like fentanyl infiltrating a variety of street drugs and fake pills resembling treatments for anxiety, or ADHD.

In short, casual or even inadvertent drug use is now far riskier, killing a broader range of people — many of whom may not even realize they’re ingesting opioids. Yet public health advocates say too few colleges have specific plans to address overdose prevention on campus — either through mandatory overdose training, broad distribution of overdose-reversal medication, or chemical drug testing strips that check for the presence of fentanyl.

Shrouded in shame

A big reason for that lack of action is a lack of data, says Christina Freibott, a researcher at Boston University. “There’s nothing that tracks, specifically, college campuses,” she says. “They are not always aware of the cause of student death. If it was an overdose or something else.” Medical privacy often shields that information, she says. And even if students are revived from an overdose, for example, they’re very unlikely to report the incident to school officials.

Overdoses are shrouded in secrecy and shame, says Monica Vera-Schubert. That devastating night, as she stood outside her son’s dorm and wailed over her son’s body, she felt shunned; no one from UCLA, the police, or medical examiner spoke to, or consoled her. “My son passed away, there in the dorms on the university, and nobody wants to say anything.”

A few weeks later, as Vera-Schubert reconstructed a timeline of the final moments of Bobby’s life, her grief turned to torment, as she realized one thing might’ve changed everything: “The dorm that my son is at: Was there Narcan there? No.”

Narcan — a brand of the medication naloxone — can fully reverse opioid overdose if administered quickly, often as a nasal spray. California’s Campus Opioid Safety Act took effect last year, requiring most state and community colleges to provide education and free naloxone to students. UCLA officials say the school is compliant.

Nevertheless, in the 10 minutes it took paramedics to arrive after Bobby was found, Monica Vera-Schubert says no one near him had access to naloxone. She was later told there was none in the building.

“For 10 minutes, maybe more, my son just laid there; there was no Narcan,” Schubert says. “My son just laid there. Would he still be here? Maybe.”

Blinders on?

Naloxone itself is inexpensive and harmless; it has no effect on anyone not overdosing. But some college administrators worry that making naloxone very visible on campus might tarnish their image: What will prospective parents think? Does it appear to condone drug use?

“Of course, you don’t think it’s a problem until you have to put a student in a body bag,” says Susan Murphy, who was in that position when she was assistant dean of the pharmacy school at the University of Charleston, West Virginia. That loss, and others, prompted her to leave academia five years ago to head the West Virginia Drug Intervention Institute, which provides overdose education and distributes kits with training videos to schools and bus systems.

She says even as the risks mount, many college administrators remain willfully blind. “That lack of reporting data allows people to continue to put blinders on,” she says.

Murphy says some colleges do understand the urgency — including all colleges in her home state of West Virginia. “We had some really brave college presidents who said, ‘I don’t care what the perception is, this has to happen,’” she says.

The most proactive among schools are devising some of their own solutions. Some use their own pharmacy school students, for example, to train other students to recognize overdose and administer naloxone. Others — including Virginia Tech, University of Georgia, and colleges and universities across West Virginia — hang boxes containing free naloxone and how-to videos in place like libraries and dorms, alongside first-aid kits and fire extinguishers. Some even distribute fentanyl test strips, so students can test their drugs before using them.

That includes places like UCLA. Officials there declined an interview, but said in an emailed statement that it provides free naloxone and fentanyl test kits at more than 20 locations on campus, including at residence halls. It said it plans to expand the availability of those this month, before school resumes.

That wasn’t enough to put naloxone within arm’s reach when Bobby Schubert needed it.

His mother says she met with school officials the month after his death, telling them she found no naloxone visible anywhere on campus, including in her son’s old dorm. “My son might still be alive if there were changes made,” Vera-Schubert says she told them.

In recovery and ready to help

Proximity to naloxone is critical, says Preston Quigley, whose high school years passed in a blur of drug use and some perilously close brushes with opioid overdose.

“It’s kind of like drowning, but you don’t know it,” says Quigley, of how overdose can feel. Quigley is now 26, three years sober, and a social work major at West Virginia University. He’s had friends who needed naloxone to revive them. “If Narcan wasn’t available, we were shaking, slapping, doing whatever we could to keep that person awake,” he says.

Quigley, who is active in his college recovery community, says in the years since he got sober, fentanyl has made drug use only scarier: A student might take a pill from a friend, thinking it’s a late-night study aid, then wind up dead. “That for me is where the difference I think lies, and where a lot of the danger lies for the college population,” he says.

“The students know”

But expecting schools themselves to accept and adopt overdose prevention takes too long, says Theo Krzywicki, a former paramedic in long-term recovery who founded a group called End Overdose. The group works directly with students, bypassing school administrations to distribute naloxone and provide training. So far, it has 28 chapters, with a backlog of students at 75 other schools looking to start new ones.

“I think that answers how big of a problem it is: The students know,” Krzywicki says of the large number of new student applicants. “That’s why we focus on working with the students, because the students are more motivated to make change, typically, than the campuses.”

He says too few of the public-health efforts speak to the realities young people face; the old “Just Say No” anti-drug campaigns have no relevance, especially considering fentanyl lurks invisibly in so many places. Education, he says, is most effective when it comes from peers who understand.

“When you have one person that understands the community and culture and can provide the information at a level that people not only understand but receive— that’s the biggest part — you can really make a lot of progress,” Krzywicki says.

Trauma for the witnesses, too

Peer-to-peer training can also be a critical source of emotional support for bystanders — including students who’ve tried to revive unresponsive roommates or friends.

“People are very aware that this is a huge problem that is threatening our generation,” says Madeleine Ward, who lost a middle-school friend to overdose. She says that experience leaves terrifying scars. “I feel like I was very, very aware of the fact that fentanyl in particular is a very big issue and something that I needed to look out for, for myself and for my friends.”

Yet her freshman year at UCLA, Ward says everyone around her seemed wholly unprepared.. “When I got to college, it was very scary because I didn’t feel like that many people knew what Narcan was, or that many people were scared about taking drugs that were laced with fentanyl.”

So Ward co-founded an End Overdose chapter at her school, giving out naloxone and educating peers to recognize signs of overdose. “After every single training we have, so many people have been really deeply impacted by overdose and overdose loss.” (Ward coincidentally lived on the same campus as Bobby Schubert, but did not know him and was not aware of his death.)

Ward, who graduated in May, says things are starting to change on campus. In one of her last classes, a professor asked for a show of hands of people who were carrying naloxone with them. About 50 in a lecture hall of 200 students raised their hands, Ward says, “which was huge to me because I didn’t know a single person who carried Narcan freshman year.” That, she says, means everyone is safer.

Photography by Mette Lampcov. Photo editing by Katie Hayes Luke.