Officials at the University of Rochester are discussing a problem that rarely reaches the agendas of campus medical centers or presidents: How do you identify and treat students who are addicted to heroin?
Last month’s death of freshman Juliette Richard, which her father attributed to a heroin overdose, led President Joel Seligman to issue  a “special plea” to students to “please get help” despite campus and national surveys that show less than 1 percent of students use the drug. The college is starting to consider substance-free housing on campus, though administrators have just started to focus on the issue.
“Frankly, there was not a lot of discussion about hard drug use before last month because our surveying data suggested it’s at very low level and we didn’t have any kind of event that drew our attention to it,” said Ralph A. Manchester, director of the Rochester’s department of health service. “The problem is, there’s not been a great deal of research done on what kinds of programs work for college students who use drugs like heroin.”
Like most campuses, Rochester has been focused mostly on abuse of alcohol, marijuana and prescription drugs. Now, colleges located in cities with new, well-documented heroin scourges are starting to realize they have a lot of catching up to do. In the Rochester region, heroin overdoses increased fivefold in three years.
After Vermont Governor Peter Shumlin devoted his entire annual address to the “full-blow heroin crisis” in the state, the University of Vermont’s campus health center is staring down a “paradigm shift,” said Jon Porter, director for the Center for Health and Wellbeing.
The health center will screen all patients for hard drug use for the first time this fall, using a piece of a $10 million state grant that aims to try to combat alcohol and drug use among 18- to 25-year-olds in the state.If the patient uses drugs, doctors and nurses intervene with a short talk on the risky behavior and then refer the student for treatment.
“It’s the most meaningful thing we can do. It’s not just throat swabs anymore,” Porter said. “Who’s having a problem we catch early enough to make a difference and get an intervention done?”
Porter said the screening system is critical to identify hard drug users because “the students who use opiates and heroin are immune to traditional outreach efforts that what we might use for alcohol and marijuana.”
The health center has worked with about 25 students who use heroin on campus, he added, with number of campus users likely rising as the state as a whole has seen a 770 percent rise in treatment for opiate addictions since 2000.
The number of students referred to the university’s addiction recovery group has increased five times to 60 in the last few years. About 100 colleges nationwide have established these recovery communities.
The university is trying to take on the issue despite the fact that “colleges don’t like to talk about that publicly because the pushback will be, ‘What’s the problem in Vermont?' ” Porter said. “That’s a tremendously sad state of affairs.”
National surveys also show that colleges have a relatively small number of heroin users. Only 0.1 percent of college students used heroin in the past 30 days in 2012, compared to 20.5 percent who smoked marijuana according to University of Michigan’s annual survey on drug use. Lloyd D. Johnston, a researcher at Michigan’s Institute for Social Research, said the “sporadic epidemics” of heroin use get media attention and thus become overblown.
But national surveys aren’t always a helpful gauge for the heroin problems that face individual campuses because “the numbers are too small,” said Robert Reff, chair of alcohol and other drugs division NASPA: Student Affairs Administrators in Higher Education, and the substance abuse prevention coordinator at Oregon State University.
At Yale University, Michael Rigsby, the campus medical director, emailed  the student body this month that “several recent incidents have raised our concern that use of drugs such as LSD, cocaine, and heroin is on the rise among college students, fueled in part by a mistaken belief that occasional use is really not that dangerous.”
College students who become addicted to prescribed drugs like oxycodone sometimes turn to heroin, a cheaper alternative with a similarly intense high. Colleges struggle to respond to that pattern because most are stretched to their limits responding to alcohol and marijuana issues, Reff said.
Plus, few administrators prioritize the problem. “We don’t think of college students as IV drug users. A lot of people have images of what IV drug users look like, and it’s not college students,” Reff said. “When I talk with administrators that heroin is in my community they look shocked at me and think college students don’t use it. But with addiction, it covers race, gender, socioeconomic status.”
Heroin users on campus usually become addicted before they get to campus and go home to replenish their supply, said William Carlo, who works on substance abuse issues at University of Massachusetts at Boston, Massachusetts Institute of Technology and Boston College. Colleges in the Northeast with commuter populations are more likely to have higher populations of heroin users, he said.
Though marijuana and alcohol are “on the radar every weekend” of college administrators, they are less aware of heroin users who “aren’t out at the parties and don’t get caught very often,” Carlo said.
“There’s no good reporting. It’s not possible to know the extent of the problem because they don’t come to the surface,” he said. “You can’t treat what you don’t see."