Opioid Harm Reduction on Campuses and the Policies That Make It Possible
Something remarkable is happening at the University of Arizona: Student leaders are ensuring that every fraternity has opioid harm reduction tools and skills at the ready. We spoke with Jason Love, outgoing vice president of risk management for the university’s Interfraternity Council, to learn more.
Opioid use is relatively low on university campuses. A 2023 survey found that only 0.6 percent of college students reported ever having used heroin, while only 3.2 percent reported ever having used prescription opioids non-medically. But the risks of overdose are real—both for students who intentionally consume illicit opioids, which are likely to be laced with the potent synthetic opioid fentanyl, and for students who consume other drugs, which could also be affected by fentanyl’s surge into our illicit drug supply. Fentanyl-driven overdose deaths are on the rise nationally, with a “nearly 7.5-fold increase from 2015 to 2021.”
That’s why, in 2022, Love joined fellow campus leaders to equip fraternities with the opioid overdose reversal medication naloxone and train members on how to recognize and reverse an overdose.
Today, every University of Arizona fraternity has a prominent red box containing two boxes of Narcan, a brand-name nasal-spray version of naloxone. University of Arizona Emergency Medical Services (UAEMS), a student-run paramedic organization, trains fraternity members on administering Narcan. UAEMS also distributes fentanyl test strips (FTS)—inexpensive strips of paper that let people test drugs for the presence of fentanyl before deciding if or how to consume them.
A combination of regulatory policies and state laws underpin this effort, highlighting where some states need to catch up and what lawmakers can do to help communities stay ahead of the curve.
2016: The Arizona Legislature passed a bipartisan law to protect people from civil or other damages if they administer naloxone to a person experiencing an overdose.
2018 and 2023: The Arizona Legislature passed a bipartisan Good Samaritan law to provide legal immunity for people who call for help for someone experiencing an overdose and are themselves in possession of drugs.
2021: The Arizona Legislature passed a bipartisan law to decriminalize FTS, which were previously defined as drug paraphernalia.
2023: The U.S. Food and Drug Administration approved over-the-counter (OTC) Narcan, making it easier for fraternities to purchase it directly using member dues. (For more on why OTC status is a step forward but not a panacea, see our R Street event “Is Over the Counter Enough? Getting Naloxone to the People Who Need It Most.”)
Luckily, most states have similar policy landscapes:
In recent years, a wave of states have decriminalized FTS, including Arkansas, Delaware, Florida, Hawai‛i, Illinois (effective January 2024), Kansas, Mississippi, Missouri, Montana, New Hampshire, New Mexico, Pennsylvania, South Dakota, Utah, Washington and Wisconsin.
All 50 states have laws that protect bystanders who administer naloxone.
Forty-seven states and Washington, D.C. have Good Samaritan laws similar to Arizona’s.
All 50 states and Washington, D.C. have some form of naloxone access law. These are often standing orders that allow individuals (and, in some cases, distributing organizations) to purchase the medication from behind the pharmacy counter without a prescription.
But there are a few holdouts. FTS distribution is risky for organizers in states and territories where they are still criminalized, including Idaho, Indiana, Iowa, North Dakota, Puerto Rico and Texas. (The Network for Public Health Law recently published a comprehensive survey on the legal status of drug-checking equipment in all 50 states.) Good Samaritan protections for 911 callers don’t exist in Kansas or Wyoming; Texas has a limited Good Samaritan law that leaves many bystanders vulnerable to prosecution.
Most states that have decriminalized FTS have done so by explicitly exempting them from existing drug paraphernalia laws, which criminalize a wide variety of items associated with illegal drugs—from cutting agents to pipes and syringes to any equipment used to test a controlled substance. But the reality of our drug supply points to a need to legalize drug-checking equipment for all illicit substances, thereby unlocking communities’ ability to meet the moment.
In many states where FTS are now decriminalized, all other drug-checking equipment is, by default, still classified as illegal paraphernalia. That includes test strips for xylazine (a veterinary tranquilizer present in a growing number of overdose cases) and the equipment and point-of-service checking that might detect nitazenes (synthetic opioids 10 to 20 times more potent than fentanyl). And as other substances emerge in the illicit drug supply, any tools developed to allow people to check for them would be illegal in many states from the moment they were made available to the public.
At Safer From Harm and the R Street Institute, we believe the government should not impede people’s ability to keep themselves safer from the potential harms of risky behaviors. The efforts of student leaders at the University of Arizona—and the public policy landscape that makes those efforts possible—paint a picture of just what we mean.
To learn more about the work these students are doing, contact Jason Love at arizonaifcriskmanagement@gmail.com.