Barriers to Awareness for Overdose Prevention Among College Students: The Role of Stigma and Accessibility of University-Based Resources

Background and Purpose: Existing literature documenting levels of knowledge for opioid overdose response among college students is mixed and limited. Recent studies have highlighted the negative impact of stigma among young adult populations in engaging resources for overdose prevention and harm reduction. However, there remains a gap in understanding the experience of college students and how stigma influences levels of knowledge and awareness for overdose prevention. The purpose of this study was to uncover 1) the level of knowledge for overdose prevention held by college students and 2) how stigma influences knowledge and awareness for overdose prevention among college students.

Methods: A mixed methods protocol was conducted to determine levels of knowledge and awareness for overdose prevention and how stigma influences knowledge and awareness for overdose prevention. A survey was administered to N = 352 college students assessing opioid overdose response knowledge. The survey sample was predominantly female (61% female; 35% male; 4% non-binary/other), Asian (50% Asian; 35% White; 10% Black or African American; 5% Other), Non-Hispanic (75% Non-Hispanic/Latinx; 25% Hispanic/Latinx), and Freshman (44% Freshman; 25% Sophomore; 17% Junior; 11% Senior; 3% Graduate student). Descriptive analyses were conducted on survey subscales and items.

Additionally, 5 focus groups were held with N = 32 college students who had direct and/or proximal experience(s) with overdose to uncover how stigma influences student awareness for overdose prevention and campus-based resources. This sample was predominantly female (63% female; 28% male; 9% non-binary/other), White (69% White; 28% Asian; 9% Black or African American; Other 6%), Hispanic (59% Hispanic/Latinx; 41% Non-Hispanic/Latinx), and Sophomore (28% Sophomore; 25% Freshman; 22% Junior; 22% Senior; 3% Graduate student). Focus group transcripts were systematically coded and analyzed for themes related to stigma and barriers to awareness for overdose response knowledge via NVivo 14. Participants were recruited via snowball sampling, departmental listservs, word of mouth, social media, and flyers.

Findings: Survey findings demonstrated that college students possessed low levels of knowledge in opioid overdose response and only a minority of students had received training in how to administer naloxone (10.5%), knew where to access naloxone distribution on their campus (23.5%), and/or would feel comfortable administering naloxone if they needed to respond to an opioid overdose (32%). Findings from focus groups indicated that cultural stigma towards substance use at the individual- and university-level prevents students from (1) feeling comfortable to speak openly about proximal and direct experiences with overdose and (2) accessing campus-based resources for overdose prevention. Additionally, students felt that the resources offered by their university were insufficient in creating knowledge and awareness for overdose prevention due to existing resources being inaccessible and not well-advertised to the general student population.

Conclusions and Implications: Findings highlight gaps in adequate preparedness for college students in responding to opioid overdose and highlight stigma as a key barrier towards improving awareness and knowledge levels. Public awareness initiatives towards reducing stigma and improving knowledge for overdose prevention led by universities and student-led organizations should be undertaken in order to better prepare college students for overdose response.