Naloxone on College Campuses
Substance use among teens and young adults in the United States has stabilized in recent years, with the overdose death rate down and lower than among other age groups. However, risks remain—especially in the era of potent synthetic opioids like fentanyl. Nearly 6,000 people under 25 died of a drug overdose in 2023.
With approximately 18 million students currently enrolled in U.S. colleges and universities, college campuses represent a place where overdose prevention strategies can help reduce these deaths. Many universities have implemented on-campus naloxone distribution programs to reduce the risks associated with substance use and improve student safety. Here, we will describe some of these programs and explain what policymakers can learn from such efforts.
Substance Use Among College Students
Substance use among college students is common—over 22 percent have used an illicit substance in the past month, with about 12 percent reporting nonmedical use of prescription drugs. And although rates vary by study, estimates indicate that up to 20 percent of college students have misused prescription opioids.
As with adults, young people who use substances do so for various reasons including curiosity, recreation, productivity and performance, coping with physical or emotional pain, or because they have a substance use disorder. From fentanyl to counterfeit prescription pills, most of these substances are purchased on the illicit market, where they are subject to fluctuating potency and ever-changing contaminants. Additionally, due to a lack of transparency in this space, people often have no idea what they are actually putting into their bodies. These factors increase the risk for overdose and fatality, rendering even casual experimentation dangerous.
Why Naloxone Is Important
Naloxone is a medication that rapidly reverses an opioid overdose by restoring normal breathing when someone’s breathing has slowed or stopped. It is safe, easy to administer as a nasal spray or intramuscular injection, and has no effect if opioids are not present. This makes it a low-risk and highly effective lifesaving intervention that layperson bystanders can use in emergencies.
Given the dangers associated with the current illicit drug supply, widespread access to naloxone is essential. Because layperson bystanders are the individuals most likely to be present during an overdose, programs that get the medication into the hands of target populations are particularly important. Health departments and harm reduction organizations often distribute naloxone at no cost, and all states have expanded pharmacy-based access through standing orders, pharmacist prescribing, or other means. The U.S. Food and Drug Administration approved the medication for over-the-counter sales in 2023. These programs and policies work together to improve naloxone access by filling gaps and removing barriers, which differ from person to person. Some individuals do not know how or where to access the medication, while others lack the funds to purchase it over the counter. Many also fear potential stigma from talking to a pharmacist or medical provider about it.
University Naloxone Distribution Programs
Colleges and universities across the United States have prioritized expanding naloxone access on campus. Approaches vary, from installing vending machines to distributing free kits through student health centers to equipping campus police with the medication. These programs reflect a shift toward making naloxone visible and available in high-traffic campus settings rather than limiting access to medical offices alone.
For these programs to be effective, they must be supported by state policy or public health initiatives— and many are. Most states have laws improving naloxone access either by reducing liability for rescuers (i.e., Good Samaritan laws) or by removing barriers for community members to obtain the medication. These policies are associated with reductions in opioid overdose mortality and make campus distribution programs possible.
But distribution only goes so far, even when supported by strong policy. People are less likely to act as rescuers if they cannot recognize an overdose or feel ill-equipped to administer naloxone, and research suggests that most college students do not possess these skills. Fortunately, pairing overdose education with naloxone distribution increases overdose-survival rates by increasing the likelihood that a layperson bystander will respond.
Consequently, some universities have launched initiatives that include both naloxone distribution and training or integrate it into bigger harm reduction efforts and messages. For example, the University of California Los Angeles’ Narcan Distribution Project provides free naloxone kits to students and staff at multiple campus locations including student activity centers, administrative buildings, and education departments. The program also promotes safe and effective use by teaching students how to recognize an overdose and administer the medication. Similarly, New York’s Colgate University provides campus-wide overdose response education in addition to distributing naloxone.
Conclusion and Policy Takeaways
Programs that distribute naloxone to laypeople are effective because they get lifesaving medication directly into the hands of the people most likely to witness an overdose: community members, especially the friends and families of people who use drugs. However, they are only one part of what must be a more comprehensive approach, both on and off campus.
Naloxone distribution is most effective when it takes place in an environment in which policies increase community access and encourage administration. This includes protecting layperson responders from prosecution and liability as well as maintaining low-cost access for individuals who cannot afford to purchase naloxone over the counter.
To better improve uptake and overdose response, programs targeting college students and other layperson responders should incorporate education and training on identifying an overdose and administering naloxone. This increases the likelihood that those willing to respond are able to do so in a timely and competent manner.
Finally, campus-based naloxone distribution programs reach more people and are more cost-effective in jurisdictions that allow for the distribution and administration of expired naloxone. Because it is still safe and effective, encouraging its use saves programs money and labor. Extending access and liability protections to cover expired naloxone will also benefit program logistics and budgets.
While campus-based naloxone distribution can be an important tool in stemming the U.S. overdose crisis, it requires smart policy—paired with widespread education—to be effective.