At the University of North Carolina at Chapel Hill, three students stand behind a card table covered in naloxone injection kits. When a curious student leans in and asks what the kits are for, Caroline Clodfelter, one of the co-founders of the student group running the table, explains: "It will reverse an opioid overdose. ... So let's say you're going out to a frat — stick it in your pocket. It's easy to just have on you."

Nearly 600 miles away, at the State University of New York's Delhi campus, Rebecca Harrington, who works in student affairs, has also been tabling to prevent fentanyl overdoses. Her table, though, is full of colorful cups, a water jug and candies in zip-close bags — tools for her demonstration on how to use a fentanyl test strip. These test strips allow students to see whether a pill has been laced with the deadly synthetic opioid.

Test strips and naloxone are becoming more and more common on college campuses, and at least one health department has recommended they be added to school packing lists. For students who didn't bring their own, many campuses are handing them out at welcome fairs, orientation events or campus health centers.

Fentanyl was involved in the vast majority of teen overdose deaths in 2021, according to the Centers for Disease Control and Prevention. Nearly a quarter of those deaths involved counterfeit pills that weren't prescribed by a doctor. And the problem has been following teens onto college campuses.

Students may think they're taking pills like oxycodone, Xanax or Vicodin. Instead, those pills often have fentanyl in them, resulting in overdoses on campuses across the U.S., from Ohio to Colorado to Oregon. At UNC-Chapel Hill, three students died from fentanyl poisoning in just the last two years.

Handing out "an anti-funeral drug" at UNC-Chapel Hill

At one point this fall, UNC senior Riley Sullivan had more vials of naloxone in the closet of his off-campus apartment than even the local hospital keeps in stock.

Sullivan and Clodfelter are co-founders of the student-led Carolina Harm Reduction Union, the group behind that Chapel Hill tabling event.

He pulls out an orange to demonstrate how to use naloxone on someone who is overdosing, something he has had to do in the past. "You first pop the cap off of your vial," he says, breaking the sterile seal and pulling out the syringe. "It's kind of like opening string cheese almost." He loads the medicine and injects it into the orange. He says to be gentle.

"If you are in the position where you have had to give someone naloxone, they've almost died."

"Naloxone is what I call an anti-funeral drug," explains Nabarun Dasgupta, a research scientist at UNC-Chapel Hill's school of public health. He co-founded the nonprofit, Remedy Alliance/For the People, that supplied all that naloxone in Sullivan's closet.

"It's this perfect antidote that really saves people's lives."

Dasgupta has been worried about opioid overdoses on campus since 2005, when he was a Ph.D. student at UNC. He remembers telling his professors back then that he wanted to hand out naloxone to students. "They told me point blank that if I did that, I'd get kicked out of school," he recalls. He did it anyway.

At the time, Dasgupta believes, naloxone was seen as encouraging drug use. But things have changed. Many of today's college students were born during the opioid crisis and have personal experiences with it. The founders of Sullivan and Clodfelter's student group each have family and friends whose substance use has ranged from full-on addiction to occasional use at parties.

"Even like half a generation ago, we wouldn't have had that kind of lived experience among undergraduates," Dasgupta says.

Harrington, at SUNY Delhi, agrees this approach feels very different from the "don't do drugs" messaging a lot of people are familiar with. But research has found that this messaging alone doesn't work. Research also shows handing out harm-reduction tools — like test strips and overdose medication — doesn't lead to more drug use.

"Would it be great to magic-fairy-wand drug addiction away?" Of course, she says.

"But that's just not the reality of the culture we live in right now." Instead, she focuses on getting students the tools they need to stay safe.

A lifesaving science experiment at SUNY Delhi

As students approach Harrington's table on campus, she asks them to crush up a bit of candy — her stand-in for a pill they might have gotten from a friend or through social media. Harrington offers a selection of small items to smash it with — a rock, a bottle, a glass candle jar. Things you might find at a house party or in a dorm. She instructs the students to put the powder in a cup of water and swirl. The more powder you test, the better, she says. You need enough powder to cover Abraham Lincoln's hair on a penny, though many students will still want some left over if the pill is clean.

The final step: Dip the test strip in the mixture and look to see how many lines appear, similar to how a pregnancy test or a pool chlorine test works. For the tests she's handing out, two lines mean fentanyl has not been detected; one line means it has.

Practicing this at the table, Harrington says, has a big payoff.

"If you know how to use a [test strip], you'll be more likely to say, 'Wait a minute, friends. Before we do this thing, let's do a test strip. I have one. I know how to use it.' You're more likely to intervene because you've got that little bit of knowledge, that little bit of confidence."

At the end of the presentation, students can take a packet of test strips with them, and nearly everyone does.

Test strips are still considered drug paraphernalia in some states

Alexis Reice, a recent graduate of SUNY Oneonta, says a lot of her classmates came out of COVID-19 lockdown with more social anxiety and mental health issues. Self-medicating, via social media or friends of friends, is popular, but it can be dangerous, especially given the rise of counterfeit pills.

Test strips can be the difference between life and death.

"This is something you can just slip in your pocket, which is great," says Reice, who interned for the Office of Health Education on campus and gave out test strips. "It takes only a couple minutes at the most. It's really not that hard to do."

At Ohio State University, Caroline Ginder, a fourth-year biology student, does drug prevention outreach on campus, including giving out free test strips.

"It's been received a lot better than I even expected," she says. "Everyone that I've ever talked to has known about fentanyl test strips."

But it wasn't always that way. In fact, a handful of states — including Idaho, Iowa and Texas — still classify test strips as drug paraphernalia, policies left over from decades-old tough-on-crime drug laws.

But given the rise of overdoses, states are changing those laws. Ohio decriminalized test strips this year. Ginder says she includes that context in her presentations at Ohio State University.

"We do have students from all over the country, so it's important to let them know that, 'Yes, in Ohio you can have these [test trips], but you need to know about your own state's legislation.'"

Harrington, of SUNY Delhi, says test strips and overdose medication are part of a larger strategy on campus to make college students safer and reduce harm when they do use.

"Did one of the test strips I hand out stop an overdose? That would be awesome," she says. "I'll never know."

But she'd be satisfied giving just one person the confidence to use a test strip when that person might not have before. That would be enough to keep her mini science experiments going.

Edited by Nicole Cohen
Visual design and development by LA Johnson
Audio story produced by Lauren Migaki