As part of National Fentanyl Awareness Day on Tuesday, May 10, Stanford community members will be able to learn how to use Narcan (naloxone) to reverse opioid overdoses.
Educational materials and awareness building will be available starting at 10 a.m. Narcan will be distributed to those who complete the training, beginning at noon. Emergency responders also carry naloxone and are trained to administer it.
“Anyone, regardless of prior substance use, is at risk for an opioid overdose or fentanyl poisoning. It could be a friend, a neighbor, a classmate, a stranger,” said Vilina Mehta, Class of 2022, who is a harm reduction specialist at the Office of Substance Use Programs, Education & Resources (SUPER) and co-founder of the Stanford Campus Opioid Overdose Prevention Project (CO-OP).
Earlier in the opioid epidemic, many overdose deaths involved people who had become addicted and were taking increased doses. Today, it’s not uncommon for first-time drug purchasers to buy what they think is Percocet or Ecstasy online – only to die from a fentanyl overdose. This is particularly true for younger people — especially in Santa Clara County, where reporting shows that in 2020, the median age of people who died from fentanyl overdose was 26.
“Fentanyl contamination is becoming more and more of a widespread issue, and one pill can kill,” Mehta said. “My hope is that with more education and awareness, no more lives will be lost.”
Student-led education efforts
The May 10 training, which is a partnership between Stanford and Santa Clara County, is being co-organized by CO-OP, Perfusion, 5-SURE and the PEER student educators. CO-OP was founded by Mehta and fellow students Nicole Ticea and Max Moss after a student death from fentanyl in January 2020. Nearly 300 Stanford students have been trained in the past two years to use Narcan — and organizers hope to train many more at the event, which will take place at noon on White Plaza.
“We started CO-OP to eliminate opioid overdoses on campus by empowering members of our community with knowledge about the broader context of the opioid epidemic, substance use disorders, and the lifesaving opioid antagonist naloxone, or Narcan,” Mehta said. “We also provide free Narcan to everyone who attends our trainings.”
The trainings cover practical issues such as how to recognize and respond to an opioid overdose, as well as topics such as the neuroscience behind substance use disorders and context of the opioid epidemic.
“Many students are surprised by the biological model of substance use disorders — learning about how addiction literally changes one’s brain circuitry and is a disease rather than a choice,” Mehta said.
A growing epidemic
Fentanyl is a synthetic opioid that is up to 100 times more potent than morphine and can be manufactured cheaply. It is being cut into other street drugs and fake prescription pills, and a very small amount — the size of a sesame seed — can be deadly.
“We are seeing a huge influx of fentanyl here in the Bay Area,” said Ralph J. Castro, associate dean of students and director of SUPER.
Fentanyl has legitimate medical uses — it was first approved by the FDA in the 1960s for palliative care. But it needs to be used under a doctor’s supervision.
“There’s no quality control in the illicit market,” said Natalie Thomas, assistant dean of students and education and outreach manager for SUPER. “Even producers of illicit drugs who don’t intend to distribute fentanyl may share equipment with fentanyl producers, so small quantities of fentanyl can find their way into other drugs.”
The risk is particularly high for people who have never used opioids and thus have no tolerance to the drug, but anyone can be at risk regardless of prior use.
It is also getting harder to determine whether a pill that was obtained online is legitimate.
“The counterfeit pills that are circulating are looking much closer to the actual thing,” Thomas said, as shown on this U.S. Drug Enforcement Agency’s website.
One key element of the effort to eliminate opioid overdose deaths is naloxone (Narcan), an FDA-approved drug that temporarily reverses overdoses.
Narcan will not cause harm if it’s given to someone who isn’t overdosing. It’s a nasal spray that works by temporarily taking the place of opioids in opioid receptors in the brain. It is a prescription drug, but in California, it can be dispensed to anyone who has received basic training in its use under a standing order by the California Department of Public Health.
The Narcan training covers when and how to use Narcan — and also emphasizes the importance of calling 911 for any suspected overdose.
“Narcan is incredible – it will start to reverse the overdose,” Thomas said. “But it starts to wear off in 20 minutes, so the person still needs professional medical attention. Narcan is a stop-gap to keep somebody alive until EMS can arrive.”
In addition, not everyone who has symptoms is suffering from an opioid overdose. Alcohol, like fentanyl, is a central nervous system depressant, so severe alcohol poisoning can have similar effects.
“Narcan will only work for opioids, so if the person is overdosing from something else, it will not help them at all,” Thomas said. Other types of medical emergencies that are unrelated to drugs can also look like an overdose – another reason it’s important to call 911.
Everyone who attends the training receives Narcan at the end of it. The goal is to have as many people as possible on campus carry it and know how to use it.
“Every second counts in an opioid overdose,” Thomas said.
In addition to the training and events planned for May 10, Stanford offers other resources for learning about and dealing with opioid use.
SUPER provides educational workshops for campus groups about alcohol and other drugs, and it also gives incoming frosh online and in-person training about substance use and abuse. The Cardinal Recovery program offers resources for people with opioid use disorder and other addictions.
“We need a comprehensive and holistic approach to dealing with substance use and its related harms,” Castro said, “and SUPER is committed to using empirically proven strategies and developing novel solutions and programs.”