At the end of 2021 I had the privilege of taking Dr. Amy Sullivan's class Uses and Abuses, exploring the history of substance use and abuse, prohibition, the “War on Drugs,” the addiction as a treatable disease versus a moral failing paradigm, and the recovery and harm reduction movement with a focus on the United States. One component of this class was naloxone (brand name Narcan) training done by Southside Harm Reduction. During this class period, we learned that every Automated External Defibrillator (AED) on campus also contained naloxone and that fentanyl test strips are available for free at the Hamre Center. Despite access to those resources, no student in our class knew of their presence on campus, much less how to use them, which felt deeply wrong to me. Macalester’s student body is not devoid of opioid use, nor is it exempt from experiencing overdose, and students should have the knowledge and resources to manage such instances. For me, this was a glaring blindspot in the school’s responsibility to ensure the safety and well being of its students that required action.

Every AED box on Macalester’s campus contains naloxone doses in an effort to increase harm reduction practices on campus and reduce the likelihood of opioid overdoses, yet the general student body is unaware of the naloxone in the AEDs, much less how to use it. We have provided students with fentanyl test strips yet have not properly educated students on what to do in the event of an overdose despite having resources on campus that can and do prevent overdoses. At a time during which overdose deaths have reached previously unseen levels, students at Macalester should know how to use naloxone and where to access it should it be needed (Baumgartner & Radley, 2022). Naloxone training and access is an act of care for our community as well as the community that we are privileged to exist within.

Naloxone drastically reduces death from overdose. A national study found that overdose deaths reduced by 14 percent in states after naloxone access laws were passed, and a naloxone distribution program based in Massachusetts was able to reduce overdose deaths in the 19 participating communities by 11 percent (McClellan et al., 2018; Walley et al., 201). Studies found that high rates of naloxone distribution among laypersons and emergency personnel can avert 21 percent of overdose deaths, with the majority as a direct result of layperson access to naloxone (Townsend et al., 2019).

So often, the tools used to address health concerns in Western medicine are purely curative, focused on “fixing” a patient, necessitating a perfect patient to fix. Harm Reduction, however, recognizes that people deserve care regardless of how “good” of a patient they are and that steps need to be taken to improve people’s quality of life regardless of other factors. It is both a political movement (Harm Reduction) and a set of practical strategies (harm reduction). Harm reduction focuses on the role that community care plays in health interventions and works to empower communities to reduce the negative consequences associated with drug use. As opioid use and overdoses increase across the country, harm reduction strategies are vital to maintaining the safety of our community. Work in public health policy often addresses problems on a large scale and provides resources only to those that fit the mold of the perfect victim and patient. Harm Reduction provides an alternative pathway to addressing health problems through community intervention and shared knowledge. It reminds us that public health policy can be personal and specific, able to address the needs of individuals while broadly improving the health and well being of the community. Its call for nonjudgemental and non-coercive provision of services to people who use drugs as well as the inherent respect and care required for all persons regardless of using status serves as a valuable reminder in all aspects of life, but especially for those who wish to enter healthcare as a provider. This project draws on the Harm Reduction philosophy through risk reduction efforts.

Clearly, training laypersons in naloxone use dramatically decreases the chance of death from an overdose. At Macalester, every first-year enters their first semester with a requirement to complete alcohol use and consent training modules online as well as attend the SEXY training and waste training presented to each dorm floor at the beginning of the year. These programs, while part of an education project, are public health projects at their core, focused on ensuring the safety of the Macalester student body and broader community. Although 3.9 percent of Macalester students self-report opioid use, far more use other drugs and the DEA reports that fentanyl is being mixed in with other drugs to increase potency. Additionally, Macalester has a responsibility as part of the larger community––in 2020, 678 people died in Minnesota alone, with over a quarter in the Twin Cities––as students engage through internships, volunteering, and experiencing the cities, making naloxone training necessary to student participation in the community. Professor Sullivan's naloxone training done in class has already led to a student administering naloxone and saving the life of a person overdosing on opioids. My project proposes an addition to the required first-year trainings, using a peer to peer method, in which students would be taught when to administer Narcan, how to do so, and where to find Narcan coupled with AED training. This demonstrates Macalester's commitment to the larger community as well as to equipping its students with the necessary safety skills as they enter a new phase in life. Additionally, I propose an anonymous Narcan request form that students can fill out in the mail room that allows for easy student access to naloxone. This project is a two step project, the first being my complete project proposal and the second being the implementation of the program which will be handed off to a fellow Macalester student currently interning at Southside Harm Reduction. These recommendations result from research into opioid death rates and public health community responses that have successfully lowered the rates of deaths from overdose.

The Harm Reduction principles have informed and continue to inform the way in which I care for myself, my friends and family, and the community to which I belong. Although this project will not be running before I graduate and timing has remained a challenge throughout this project, this project proposal will allow for a safer community while bolstering care and compassion between students. As I hand off this project, I know that Macalester has the tools to implement Narcan training and distribution and that this project will be taken up by Macalester students after me. Bringing harm reduction practice to Macalester College expands on the legacy of community care brought by the SEXY trainers and provides students with necessary resources to enter college and the community. This is an ongoing project and will continue to evolve after I graduate.

Baumgartner, J. C., & Radley, D. C. (2022, February 7). Overdose Deaths Surged in the First Half of 2021, Underscoring Urgent Need for Action [web log]. Retrieved from https://doi.org/10.26099/tmae-je82.

Townsend, T., et al. (2019). Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder and lay distribution in the United States. International Journal of Drug Policy.

Walley, A.Y., et al. (2013, January 30). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ, 2013. 346: p. f174-f174.

McClellan, C., et al. (2018). Opioid-overdose laws association with opioid use and overdose mortality. Addictive Behaviors. 86: p. 90-95.

Image Credits:

National Harm Reduction Coalition