Story by Samuel Long
Graphic by Macon Porterfield
After Bella Grumet, a UNC-CH senior majoring in neuroscience, lost a close friend to an overdose last year, she was motivated to become an advocate for harm reduction strategies in hopes of preventing more drug-related deaths among college students.
Her friend was Elizabeth Grace Burton, a UNC-CH student who passed away last March in a Duke University dorm room with a mixture of alcohol, cocaine, and fentanyl in her system. The 19-year-old was an honors student, a Carolina Blue Scholar and a recently elected Director of Sisterhood in her sorority Zeta Tau Alpha before her death. She was an assured admit to the Kenan-Flagler Business School.
Burton’ is one of many who have died from accidental overdose in the past year. According to the Centers for Disease Control and Prevention, 51,435 people died due to unintentional drug overdose in 2022. 64.7% had at least one potential opportunity for prevention.
The United States Attorney’s Office for the Middle District of North Carolina announced Feb. 28 that Cye Frasier, 44, was sentenced to 29 years in federal prison and Carlisa Allen, 46, was sentenced to 28 years in federal prison for drug trafficking. Both dealers marketed themselves to college students as a source of narcotics, primarily cocaine, and knowingly distributed fentanyl, according to the sentencing announcement. They were linked to the deaths of Burton and Joshua Zinner, another college student who overdosed a day after Burton’s death.
But Grumet believes the outcome of Burton’s overdose could have been different.
“What struck me about the stories, once they came out, is there were so many opportunities for both bystanders and some of the medical personnel involved who could have administered naloxone and could have saved her life,” she said.
Grumet is a member of the Carolina Harm Reduction Union, an organization at UNC-CH whose mission is to educate students and campus organizations on how to properly administer naloxone, a medication used to rapidly reverse an opioid overdose.
Since naloxone binds to opioid receptors, it reverses and blocks the effects of heroin, morphine, fentanyl and oxycodone. This makes it a highly effective temporary treatment in the event of an accidental overdose. But because its effects don’t last long, it’s critical to obtain medical intervention as soon as possible after receiving the medicine.
Naloxone has no effect on a person who does not have opioids in their system, meaning there are no consequences if the medicine is used incorrectly. But it can cause withdrawal symptoms, which are important to watch out for.
The Carolina Harm Reduction Union teaches this information to students. They’ve found that generally, young people are taught to maintain abstinence from drugs and alcohol while growing up, which often makes education about these subjects taboo.
But Caroline Clodfelter, a co-founder of the Carolina Harm Reduction Union, said that realistically, alcohol and drug use is bound to happen. Teaching harm reduction, which lessens the negative social and physical consequences of substance use, is a better approach toward preventing deaths, she said.
Andrea Des Marais, a research program leader in the Duke University Population Health Sciences Department, said there is countless research showing the strategy works. Des Marais works with Duke’s Harm Reduction Research Collaboratory, which develops drug use interventions with harm reduction in mind.
“There’s funding at the NIH level to look more into how to implement harm reduction interventions and that sort of thing,” Des Marais said. “So yeah, this is a very evidence-based approach.”
There are many benefits of harm reduction, most noticeably a reduction of stigma toward people who use illegal drugs, Des Marais noted.
The practice paints people who struggle from substance use disorders as ordinary humans who need help and compassion. This increases their sense of accountability, teaches them how to help themselves through temptations and reduces their risk of harming themselves or others.
Clodfelter said she gets frustrated watching the public fight over who is responsible for deaths such as Burton’s, or whether universities should be more transparent about overdoses that occur on their campuses.
“How could her death not mean we need to change?” Clodfelter said. “How is it okay to sit here and say ‘let’s just keep telling people not to use’?”
Organizations around the Triangle are working to implement harm reduction in the state.
“I think one of the biggest foundations of our collaboratory is the underlying philosophy that it’s not our job to stop people from using drugs,” Hillary Chen, a research coordinator in the Duke University Population Health Sciences Department, said. “It’s our job to try to support people in accessing the resources they need to be safe while they make whatever choices they want in their lives.”
Through Remedy Alliance / For the People, an organization that ensures harm reduction programs have access to naloxone, the Carolina Harm Reduction Union is able to give out naloxone to students for free with step-by-step usage instructions. The union also provides fentanyl testing strips, allowing students to determine whether their drugs are safe. According to the Centers for Disease Control and Prevention, many drugs might be mixed with deadly levels of fentanyl, and you wouldn’t be able to see, taste or smell it. It is nearly impossible to tell if drugs have been laced with fentanyl unless a person uses testing strips.
Greek life organizations at UNC-CH have also started providing life-saving amenities.
Cameron Somerville, who served as the UNC Panhellenic president from 2022 to 2023, said she played a large role in distributing Narcan, a type of naloxone administered through nasal spray, to every sorority house at the university.
“I just think it’s better to always be prepared and if naloxone has no side effects, then to me there’s no harm in distributing it,” she said.
The medication should be a priority, Grumet noted. She said she has watched a person’s condition improve dramatically after receiving naloxone.
Still, harm reduction strategies themselves aren’t always enough.
A doctor’s belief in the acceptability of harm reduction is also crucial to its use in a medical setting, according to a 2010 study by University of Washington psychologists.
For example, a therapist’s consideration of harm reduction doesn’t mean they don’t see issues with their patient’s drug use. It means the therapist can see their client’s situation in “more than black and white, all-or-nothing terms,” the study said.
Grumet also believes a student-to-student approach works best for young adults. She said students have told her they’re less afraid of being “snitched” on because they’re talking to someone their age.
“I feel like sometimes when it comes from an authority figure, people feel like their choices are being judged and are less inclined to ask questions or engage with the material if it’s being forced on them,” she said.
But Grumet said she has no judgment. Chen, of the Duke collaboratory, agrees.
“We don’t think that there’s one prescribed way to tell somebody to live their life,” Chen said. “We think it’s just really important for people to have those resources to be safe.”
