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What do you know about opioid abuse and addiction? Take our quiz to see how your knowledge compares to other students’, and find answers to questions like these:

• Is it risky to take prescription pain meds?
• Who’s at risk for addiction?
• How rare is opioid abuse among college students?
• Does opioid overdose reversal always work?

The US is experiencing a brutal opioid epidemic. In 2015, 33,000 Americans died from overdoses involving prescription painkillers, heroin, and synthetic opioids, according to the National Institutes of Health. Many opioid overdoses can be reversed with timely medical treatment, however—someday, you may be in a position to save a life. This brief guide shows you how.

The illicit use of heroin and prescription painkillers is rare among college students. Yet this epidemic is affecting demographics that were previously considered relatively immune to drug crises. “My freshman year of college, my older sister went to rehab for heroin addiction. People from all ethnicities and social classes are struggling with opioid addiction,” says a third-year undergraduate at Saint Louis University, Missouri.

In this article, “opioid” covers heroin, prescription painkillers, and synthetic opioids sold on the street. For info on getting help with abuse and addiction, see Get help or find out more.

What to do if someone may have overdosed: Call 911 immediately

• Act quickly: Most deaths occur one to three hours after the overdose, so you have a window for intervention.
• Get medical help: When people survive an overdose, it is because professional help was available. You do not need to be sure the person has overdosed on opioids (or any other substance) before calling 911. Calling 911 usually ensures quicker medical help than taking the victim to the hospital yourself.
• Tell the 911 dispatcher: Let them know if the person’s breathing has slowed or stopped and if they are unresponsive. Give the dispatcher the exact location.
• Be aware of Good Samaritan laws: In most states, people who seek help with a suspected overdose are immune from drug-related criminal charges under Good Samaritan laws (also known as 911 Immunity Laws). Your college may have similar policies (sometimes called medical amnesty). For information about your state, see Get help or find out more.

What does an opioid overdose look like?

» The signs of opioid overdose include:

• Small pupils
• Droopy arms and legs, and the inability to stand or walk
• Itching
• Slurred speech
• Shallow and uneven breathing
• Being unresponsive
• Loss of consciousness

» As the window for intervening narrows, signs include:

• Pale face
• Blue lips
• Gurgling chest sounds

Could I be at risk for opioid abuse?

Opioid addiction is difficult to treat. Avoiding illicit drug use is the safest strategy. Here’s how to look out for yourself:

• If you are using a prescription opioid medication that was not prescribed to you, seek help.
• If you are using an opioid medication prescribed to you, be self-aware about your reasons: Opioid medications are prescribed for long-term pain associated with various medical issues or for short-term pain control after surgery or an injury. If you are using opioids for other reasons—e.g., to get high or buzzed—seek help.
• If you are using opioids for pain relief, and your pain is becoming more difficult to control, discuss that with your physician immediately.
• If you have a family history of drug abuse/addiction and need medication for short-term pain, consider asking your physician for a pain medication other than opioids. Having a family history of drug abuse/addiction puts you at a higher risk for abuse/addiction.
• If you are abusing opioids or may be addicted, you will need support with your recovery. See Get help or find out more (below).

Where can I get help with opioid abuse or addiction?

• Ask your physician or other health care provider for a referral to an addiction specialist.
• If you have health insurance, check the insurance company website for addiction specialists covered by your plan.
• Ask at your student health center, counseling center, place of worship, or community center about addiction assistance.
• Call your local hospital for help finding medical professionals with addiction expertise.
• Look at community directories or online for a specialist in your area: Make sure the person is licensed or certified in mental or behavioral health, or is a licensed counselor in social work or professional counseling.
• Try Narcotics Anonymous for local, free, anonymous support groups.
• Many detox centers offer free initial consultations.
• For more key info and resources, see Get help or find out more (below).

What are the options for accessing reversal treatment?

Many opioid overdoses can be reversed with treatment. The opioid reversal medications naloxone and naltrexone can be delivered via a nasal spray, by injection, or intravenously. These reversal drugs (or antidotes) are also known by various brand names (e.g., Narcan®).

Naloxone treatment can be accessed in several ways:

• At hospital emergency rooms
• Via police departments and paramedics (ambulance responders), after calling 911
• Via some fire departments
• In most states, via some trained laypeople (not medical professionals) who may have a history of opioid abuse or family members who are abusing opioids
• Some states allow pharmacies to dispense naloxone to people meeting certain criteria without a physician’s direct involvement (this is often reported as over-the-counter availability, although that term is technically incorrect)

What exactly does “unresponsive” mean?

Here’s what being unresponsive looks like, according to the Harm Reduction Coalition:

• Not answering to their name
• Not responding to information they may not want to hear (e.g., “I’m going to call 911”)
• Not responding to physical stimulation (e.g., rubbing your knuckles into their sternum, the place in the middle of their chest where the ribs meet, or pinching their earlobes)
• If the person wakes up but their breathing seems shallow or their chest feels tight, call 911 anyway
  

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Assignments accumulating? Exams coming up? Halfway through this semester, you may be wondering how you’ll make it all happen. As a pharmacologist on a large campus, I routinely talk to students about how they grapple with this, and hear their conversations about strategies for success. Maybe your oversize coffee goes everywhere you go. Perhaps your friend bought some funky herbal product that claims to help with mental performance. Maybe your roommate hit up their ADHD classmate for a dose of Ritalin.

It’s possible that certain products may help you stay alert, think straight, and meet a deadline. Trying these substances may or may not work out as planned. Sometimes students tell me that they wanted to be more alert and took something that instead gave them a tremor, dry mouth, and insomnia. What went wrong? Did they waste their money? Could they have harmed their health? Good questions. If you consider using anything—even large amounts of caffeine—you need to know how that substance may affect you and how to manage or minimize the risks.

Using substances to enhance your focus or brainpower:

No drug makes you smarter
No medication, treatment, herbal product, street drug, or other substance has been shown to improve intelligence or enhance cognition in people with healthy brains.

ADHD medications don’t provide an intellectual advantage
Drugs prescribed for students with attention or learning issues help level the playing field, addressing the factors that could hold those students back. They may temporarily improve alertness. They do not boost intelligence or grades.

Energy drinks are no more effective than coffee
Energy and related products derive their “oomph” from the added caffeine (and, in many products, lots of added sugar).

Most herbal supplements offer little or no benefit
These products are not regulated and may be misleadingly labeled. The “natural” claim is often dubious, and products labeled this way can be risky. As a rule, I see the “non-drug” label that is required by law (a statement that the product has not been evaluated by the FDA and is not intended to treat a disease) as an admission that the product carries little, if any, benefit.

If you choose to use: Four things you need to know

1  Using any substance means accepting some risk

All drug use carries some risk. This is true whether the substance is legal or illegal, whether it is prescribed or available over-the-counter, and whether it is socially acceptable or socially stigmatized. When medical providers recommend a course of treatment, they consider your state of health and balance the possible risks of the drug against its possible benefits. If you self-medicate, you may not be aware of those risks or adequately factor them in.

2  It’s on you to know exactly what the substance is and whether it can potentially generate the effect you want
Ever known someone to take a drug and then wonder why it did the opposite of what they desired, or it produced icky side effects? Maybe they took the wrong dose or were given the wrong drug. Maybe this was not the right drug for that user’s individual biology (even though it seemed to work for their friend). Or maybe the drug wasn’t even designed to improve alertness—which would be like taking Valium for pain (Valium has no pain-relieving properties). Even well-intentioned friends are unlikely to be reliable sources of info.

3  It’s on you to be careful about dosing

It is not true that if a little bit of a drug is good, more must be better. That’s a dangerous approach to any medication.

4  It’s on you to anticipate any negative effects on your functioning and figure out how to manage and minimize those

Using drugs or substances can affect how you feel and function in the next few days. “There is no free lunch. You can steal from Peter to pay Paul only so far,” says Steve Lux, a former health educator at Northern Illinois University. “Using stimulants might help you stay up and get the paper done, but you’ll be depleted the next day.”

You can anticipate those effects. “If you’re going to burn through the nights during your exams, make sure that for one to two weeks beforehand, you are getting good sleep, eating well, and taking care of yourself,” Lux says.

Note: No amount of rest or self-care can mitigate the side effects of drugs.

Considering using any of these?

What they do, how they work, and what you need to know

Who’s using what in college?

Caffeine use is common among students, and sizable minorities of students have used energy drinks and other high-dose caffeinated substances, surveys show. The vast majority of students have not used prescription “study drugs” that were not prescribed for them.

Most students are not misusing stimulants
In a national, anonymous survey of more than 80,000 college students, 88 percent said that in the past 12 months they had not used a prescription drug that wasn’t prescribed to them (National College Health Assessment, Spring 2016). Of the minority who had chosen to use medications that weren’t prescribed for them, stimulants were the most common (7 percent had used).

In a recent survey by SH101, here’s what students reported about their lifetime use of substances that they hoped would improve their alertness or performance:

Why some students wouldn’t use again
In each substance category in the chart below, around one in three students who had used this type of substance said they would not use it again. Most students who did not intend to use again cited concerns about how the substance(s) might affect their general well-being. Some said their use was a one-off event (e.g., to help them complete a single assignment). Some did not care for the side effects. Some were concerned about possible long-term consequences: “[Adderall] definitely increased my ability to focus, but I turned away from it because it was obviously habit forming,” said a third-year student at Ridgewater College, Minnesota.

Source: SH101 survey, October 2016, 1,000+ respondents (not representative of students nationally)

What are the legal, professional, and academic implications of misusing prescription drugs?

Anyone who illegally accesses, uses, or distributes prescription drugs is violating federal law, and likely state law and your school’s code of conduct. Unauthorized possession of scheduled, non-narcotic substances (such as stimulant medications) is at minimum a misdemeanor. Possession of scheduled narcotics (such as methadone or Percocet) is more serious. You may be subject to federal and state charges and penalties, and/or college sanctions. A criminal record may limit your future employment prospects, damage your reputation, and threaten your college career and scholarships. Colleges can enact sanctions against students for crimes committed on and off campus; these can include academic probation, fines, rescinding scholarships, or expulsion.

“Doctor shopping” This means visiting multiple physicians with the goal of obtaining several prescriptions for the same or similar medications, and/or using more than one pharmacy to fill these prescriptions.

• The laws vary by state, but you will likely be red flagged by the Drug Enforcement Administration.
• If this happens, your name will be entered into a database and shared with all physicians and pharmacies, preventing you from obtaining and filling more than one prescription for certain medications.
• You may end up reliant on one source for prescribing and dispensing drugs.
• Your access to drugs you need when you need them may be reduced long-term; for example, when a “doctor shopper” is injured in a car accident, it may be harder for them to get prescribed pain relief medications.

Falsifying symptoms Pretending you have certain symptoms can get you barred from seeing some physicians.

Tampering with prescription forms Doing this with the intention to get drugs is a felony, punishable by fines and jail. It would likely result in fewer physicians and pharmacies being willing to help you in a time of real need.

Use of prescription substances without a prescription Legal penalties are based on the type of substance, when, and how you were caught (for example, whether you were possessing the drug or using it), and how much of the substance you obtained. Possession is often charged as a misdemeanor. Having large amounts of a substance implies that you intend to distribute it, resulting in heavier charges and penalties.

Giving away or selling your medication This is called “drug diversion,” and it’s a felony. Giving a drug away is considered the same as selling it for cash. People caught selling (or buying) diverted drugs may face fines or jail, and have to attend mandatory treatment for drug abuse, as these penalties vary by state.

Student perspective
“I had a friend actually go to prison for this. Even though it was a misdemeanor, he had to do six months.”
—Fourth-year student, Ashford University (online)

“Many of my (mostly guy) friends have asked me for some Ritalin, but once they discovered I was unwilling to partake in that illegal activity, they stopped asking.”
—Third-year undergraduate, Gonzaga University, Washington

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