Reading Time: 9 minutes The debate on marijuana legalization continues: Here’s what we know about the pros and cons
Reading Time: 6 minutes By now, many of us probably know someone who’s been affected by opioid addiction. Learn how to spot the signs of an overdose and where to get help.
Rate this article and enter to win
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
- 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
See Where can I get help with opioid abuse or addiction? in the article.
Free, confidential, 24/7 helpline (English and Spanish): SAMHSA
Achilefu, A., Joshi, K., Meier, M., & McCarthy, L. H. (2017). Yoga and other meditative movement therapies to reduce chronic pain. Journal of the Oklahoma State Medical Association, 110(1), 14–16.
American College Health Association. (2016). American College Health Association-National College Health Assessment II: Reference Group Executive Summary, Spring 2016. Hanover, MD: American College Health Association; 2016.
Arnold, R. (2017). Fast Facts and Concepts #83. Why patients do not take their opioids. Palliative Care Network of Wisconsin. Retrieved from https://www.mypcnow.org/blank-aw14v
Back, S. E., Payne, R. L., Wahlquist, A. H., Carter, R. E., et al. (2011). Comparative profiles of men and women with opioid dependence: Results from a national multisite effectiveness trial. American Journal of Drug and Alcohol Abuse, 37(5), 313–323.
Brooner, R. K., King, V. L., & Kidorf, M. (1997). Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. JAMA Psychiatry, 54(1), 71–80.
Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
Centers for Disease Control and Prevention. (2012). Grand Rounds: Prescription drug overdoses—a US epidemic. Morbidity and Mortality Weekly Report, 61(1), 10–13.
Centers for Disease Control and Prevention. (2015). Today’s heroin epidemic infographics. Retrieved from https://www.cdc.gov/vitalsigns/heroin/infographic.html
Centers for Disease Control and Prevention. (2016). Increases in drug and opioid overdose deaths—United States, 2000–2014. Morbidity and Mortality Weekly Report Weekly, 64(50), 1378–82.
Centers for Disease Control and Prevention. (2016). Prescription opioid overdose data. Retrieved from https://www.cdc.gov/drugoverdose/data/overdose.html
Centers for Disease Control and Prevention. (2016). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics.
Centers for Disease Control and Prevention. (2017). Heroin overdose data. Retrieved from https://www.cdc.gov/drugoverdose/data/heroin.html
Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry, 71(7), 821–826.
Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. New England Journal of Medicine, 374(2), 154–163. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMra1508490#t=article
Coomber, R., & Sutton, C. (2006). Harm Reduction Digest 34: How quick to heroin dependence? Drug and Alcohol Review, 25(5), 463–471. Retrieved from https://onlinelibrary.wiley.com/doi/10.1080/09595230600883347/abstract
Darke, S. (2012). Pathways to heroin dependence: Time to re-appraise self-medication. Addiction, 108(4), 659–667.
Davis, C. (2016, March 1). “Over the counter” naloxone access, explained. The Network for Public Health Law. Retrieved from https://www.networkforphl.org/the_network_blog/2016/03/01/745/over_the_counter_naloxone_access_explained
Grattan, A., Sullivan, M. D., Saunders, K. W., Campbell, C. I., et al. (2012). Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substanceabuse. Annals of Family Medicine, 10(4), 304–311.
Jones, C. M., Baldwin, G. T., Manocchio, T., White, J. O., et al. (2016). Trends in methadone distribution for pain treatment, methadone diversion, and overdose deaths—United States, 2002–2014. Morbidity and Mortality Weekly Report, 65(26), 667–671.
Jones, C. M., Paulozzi, L. J., & Mack, K. A. (2014). Sources of prescription opioid pain relievers by frequency of past-year nonmedical use United States, 2008–2011. JAMA Internal Medicine, 174(5), 802–803.
Lankenau, S. E., Teti, M., Silva, K., Jackson Bloom, J., et al. (2012). Initiation into prescription opioid misuse amongst young injection drug users. International Journal of Drug Policy, 23(1), 37–44.
Ludden, J. (September 2, 2016). An even deadlier opioid, Carfentanil, is hitting the streets. National Public Radio. Retrieved from https://www.npr.org/sections/health-shots/2016/09/02/492108992/an-even-deadlier-opioid-carfentanil-is-hitting-the-streets
Mahoney, K. (2016, August 10). FDA supports greater access to naloxone to help reduce opioid overdose deaths. FDA Voice; US Food and Drug Administration. Retrieved from https://blogs.fda.gov/fdavoice/index.php/2016/08/fda-supports-greater-access-to-naloxone-to-help-reduce-opioid-overdose-deaths/
Miech, R., Johnston, L., O’Malley, P. M., Keyes, K. M., et al. (2015). Prescription opioids in adolescence and future opioid misuse. Pediatrics, 136(5), e1169–e1177.
National Institute on Drug Abuse. (2015). Prescription opioid use is a risk factor for heroin use. Retrieved from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use
National Institutes of Health. (2017, January). Overdose death rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Noble, M., Treadwell, J. R., Tregear, S. J., Coates, V. H., et al. (2010). Opioids for long-term treatment of noncancer pain. The Cochrane Collaboration. Retrieved from https://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain
Paulozzi, L. J., Budnitz, D. S., & Xi, Y. (2006). Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology of Drug Safety, 15(9), 618–627.
Popovich, N. (2016, May 25). A deadly crisis: Mapping the spread of America’s drug overdose epidemic. Guardian. Retrieved from https://www.theguardian.com/society/ng-interactive/2016/may/25/opioid-epidemic-overdose-deaths-map
Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. Mortality and Morbidity Weekly Report, 65(50–51), 1445–1452.
Schwartz, A. (2015, April 25). Michael Botticelli is a drug czar who knows addiction firsthand. New York Times. Retrieved from https://www.nytimes.com/2015/04/26/us/michael-botticelli-is-a-drug-czar-who-knows-addiction-firsthand.html?_r=0
Senate Caucus on International Narcotics Control Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. 13-4795. Rockville, MD: SAMHSA, 2013.
Stobbe, M. (2016, December 9). A grim tally soars: More than 50,000 overdose deaths in US. STAT. Retrieved from https://www.statnews.com/2016/12/09/opoid-overdose-deaths-us/
Szalavitz, M. (2016, May 10). Opioid addiction is a huge problem, but pain prescriptions are not the cause. Scientific American. Retrieved from https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
Utah Department of Health. (2016). Prescription opioid deaths. Retrieved from https://health.utah.gov/vipp/pdf/RxDrugs/PDODeaths2015.pdf
Volkow, N. D. (2014, May 14). America’s addiction to opioids: Heroin and prescription drug abuse. National Institute of Drug Abuse. Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse
Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., et al. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Journal of Pain, 156(4), 569–576.
Whalen, J., & Spegele, B. (2016, June 23). The Chinese connection fueling America’s fentanyl crisis. Wall Street Journal. Retrieved from https://www.wsj.com/articles/the-chinese-connection-fueling-americas-fentanyl-crisis-1466618934.
White, P. F. (2017, March). What are the advantages of non-opioid analgesic techniques in the management of acute and chronic pain? Expert Opinions in Pharmacotherapeutics, 18(4), 329–333.
Whitworth, M. (2015, October 22). Can you really become addicted to a drug after just one hit? Vice. Retrieved from https://www.vice.com/en_us/article/reasons-why-you-cant-get-addicted-to-drugs-after-one-hit
Yokell, M. A., Delgado, M. K., Zaller, N. D., Wang, N. E., et al. (2014, December). Presentation of prescription and nonprescription opioid overdoses to US emergency departments. JAMA Internal Medicine, 174(12), 2034–2037. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1918924
The science of drinking: How to make it work better for you
If you choose to drink alcohol, you’re likely familiar with the relaxed, chatty buzz that may come early in the evening—and the slump that sometimes follows (the tiredness, the nausea, maybe the fear of what you posted online). If you’re drinking in school, you can learn how to get that buzz without the slump. For those who drink alcohol, this skill is key to a night—no, a lifetime—of positive experiences and few, if any, regrets.
What makes alcohol tricky to navigate? First, we need to understand how alcohol affects us—which in certain key respects is different from popular myth. With those basic concepts, we can choose to drink alcohol in ways that give us what we want from it.
Second, we all like to believe that we make our own choices, and to some extent, we do. But it’s complicated. A ton of research shows that our behavior, including what we drink, is highly dependent on what’s happening around us. In college, getting the alcohol buzz without the slump means grappling smartly with social dynamics, in addition to understanding the science of how alcohol affects us. This is especially relevant when you’re new to college, new to drinking, or both. (The minimum legal age for consuming alcohol in the US is 21.)
Why some alcohol can feel fun—and more alcohol doesn’t
Getting a buzz on
If you choose to drink alcohol, it may help you relax, socialize, and have fun—up to a point. Depending on what you drink, how much you drink, and how quickly or slowly you drink it, the alcohol level in your blood will rise to a certain level—let’s call it “peak buzz.”
For most people of average tolerance, peak buzz happens when your Blood Alcohol Content (BAC)—the concentration of alcohol in your bloodstream—approaches 0.06 percent. For most people, two to three drinks within an hour will have this effect. Some research indicates that 0.06 percent BAC is on the high side; you may find peak buzz comes at any point after 0.04 BAC.
After the buzz, the slump
Beyond that point—0.06 percent BAC—the enjoyable effects of alcohol decline and wear off. You may feel sleepy, flat, disconnected. You may get moody or sick, or make unwise decisions. From here, there’s no going back to peak buzz. Drinking more alcohol can only take you deeper into the slump and toward regret territory.
The science of the slump—and why you can’t get the buzz back
Explained by Dr. Jason Kilmer, associate professor of psychiatry and behavioral science, University of Washington:
“The biphasic aspect actually occurs within the brain. The brain center that inhibits our actions is the first to be affected (depressed) by alcohol. So without the inhibiting center the other areas somewhat go wild, and we feel uninhibited, etc. Later, the brain functions that allow us to act bolder and less shy also get depressed, and then we slump.” —Dr. Pierre-Paul Tellier, director of student health services at McGill University, Quebec
These buzz effects and slump effects in the chart are examples of how people may experience alcohol; the sequence of effects on each side of the chart is in no particular order.
The key to getting what you want from alcohol
Three questions to match your alcohol intake with peak buzz
What do I drink?
The amount of alcohol you consume depends partly on what you’re drinking. Alcoholic beverages vary enormously in their alcohol content.
What’s my usual serving size?
The amount of alcohol you consume also depends on the shape and size of your glass or cup. A standard serving size is unlikely to be whatever your new friend just ladled into that solo cup.
How to get the hang of serving sizes:
- Take bartending classes: Many campuses and community organizations offer classes in bartending and safe serving practices—often for free.
- Practice measuring and pouring, so you know what 5 oz. wine (for example) looks like in a red solo cup. Remember:
- Red solo cups come in different sizes.
- The lines on red solo cups are not reliable measures of serving size.
The same size beverage can look very different depending on the size and shape of the cup or glass.
How long will I be out for?
Think about pacing your drinking. Most people take about one hour to metabolize one standard drink. If you’ll be out for, say, four hours, and you plan to have three alcoholic drinks, you may decide to have one alcoholic drink per hour for the first three hours.
Pregaming—drinking before you go out—means you hit peak buzz earlier. If you keep drinking, your mood declines earlier too.
How to estimate your Blood Alcohol Content
BAC calculators and charts help you estimate the number of standard drinks you can consume before your BAC reaches peak buzz (0.06 percent).
Woman (155 lb, 5’7″): 3 standard drinks in 3 hours
Man (155 lb, 5’7″): 3 ½ standard drinks in 3 hours
BAC charts and calculators are useful but limited tools:
- They estimate how much alcohol someone of your body type and sex can typically drink before experiencing certain effects (positive and negative).
They do not account for various other factors that may influence your alcohol tolerance (e.g., age, health, fatigue, medications, food consumed, and whether or not the environment is familiar).
You may need to adjust the BAC percentage to account for the amount of time you’re drinking.
Effective tools and tips for having fun and staying in control
Jason Kilmer, PhD, associate professor of psychiatry and behavioral science, University of Washington; assistant director of health and wellness for alcohol and other drug education, Division of Student Life, University of Washington.
Joan Masters, MEd, senior coordinator, Partners in Prevention, University of Missouri Wellness Resource Center; area consultant, The BACCHUS Network.
Ann Quinn-Zobeck, PhD, former senior director of BACCHUS initiatives and training, NASPA - Student Affairs Professionals in Higher Education (peer education initiatives addressing collegiate health issues at US colleges).
Pierre-Paul Tellier, MD, director of student health services, McGill University, Quebec.
Ryan Travia, MEd, associate dean of students for wellness, Babson College, Massachusetts; founding director, Office of Alcohol & Other Drug Services (AODS), Harvard University.
American College Health Association. American College Health Association–National College Health Assessment II: Reference Group Undergraduates Executive Summary Fall 2015. Hanover, MD: American College Health Association; 2016.
Borsari, B., & Carey, K. B. (2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13, 391–424. Retrieved from https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.602.7429&rep=rep1&type=pdf
Borsari, B., & Carey, K. B. (2006). How the quality of peer relationships influences students’ alcohol use. Drug and Alcohol Review, 25(4), 361–370.
Crawford, L. A., & Novak, K. B. (2007). Resisting peer pressure: Characteristics associated with other-self discrepancies in college students’ levels of alcohol consumption. Journal of Alcohol and Drug Education, 51(1), 35–62.
Harrington, N. G. (1997). Strategies used by college students to persuade peers to drink. Southern Communication Journal, 62(3), 229–242. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10417949709373057?journalCode=rsjc20
Kilmer, J., Cronce, J. M., & Logan, D. E. (2014). “Seems I’m not alone at being alone:” Contributing factors and interventions for drinking games in the college setting. The American Journal of Drug and Alcohol Abuse, 40(5), 411–414.
Neighbors, C., Lee, C. M., Lewis, M. A., Fossos, N., & Larimer, M. E. (2007). Are social norms the best predictor of outcomes among heavy-drinking college students? Journal of Studies on Alcohol and Drugs, 68, 556–565.
Neighbors, C., Jensen, M., Tidwell, J., Walter, T., Fossos, N., & Lewis, M. A. (2011). Social-norms interventions for light and nondrinking students. Group Processes & Intergroup Relations, 14(5), 651-669. doi: 10.1177/1368430210398014
Palmeri, J. M. (2016). Peer pressure and alcohol use among college students. Applied Psychology Opus, NYU Steinhardt. Retrieved from https://steinhardt.nyu.edu/appsych/opus/issues/2011/fall/peer
Perkins, H. W., Linkenbach, J. W., Lewis, M. A., & Neighbors, C. (2010). Effectiveness of social norms media marketing in reducing drinking and driving: A statewide campaign. Addictive Behaviors, 35, 866–874.
Seigel, S. (2011). The four-loko effect. Perspectives on Psychological Science, 6(4), 357–362.
Student Health 101 survey, July 2016.
Turner, J., Perkins, H.W., & Bauerle, J. (2008). Declining negative consequences related to alcohol misuse among students exposed to social norms marketing intervention on a college campus. Journal of American College Health, 57, 85−93.
Wechsler, H., Nelson, T. E., Lee, J. E., Seibring, M., Lewis, C., & Keeling, R. P. (2003). Perception and reality: A national evaluation of social norms marketing interventions to reduce college students’ heavy alcohol use. Journal of Studies on Alcohol, 64, 484–494.