Deciding Under the Influence

When I left home for college, I went about as far from rural Arizona as possible without actually leaving the country. At 18 years old, I packed my life into a single suitcase and boarded a one-way flight to Boston. My mom was terrified. I’d be alone in a strange new place, and I know she wondered, would I make any friends? Would I struggle in class? My mom can be pretty overprotective, so I’m sure she considered most challenges I might face.

But I doubt she ever imagined me slumped on the floor, bleeding, drunk and slurring to my friends, “Please don’t call campus medical services!”

It’s an open secret that American students drink in college. But for most undergraduates, any night of drinking could end with their arrest, their expulsion or both. So when underage students drink too much and get seriously hurt, they’re faced with a terrible choice: call for help and risk their future or say nothing and risk their safety.

This shouldn’t be a difficult decision. And with amnesty policies that shield students from university sanctions in cases of emergency, we can reassure students that our society values their lives more than their résumés.

Amid the COVID-19 pandemic, we’ve already been forced to assess and innovate the way we structure higher education. In a matter of days last spring, higher education institutions canceled classes, sent students home and donated dorm rooms to help quarantine local patients. Through these changes, we’ve abandoned countless college traditions to protect students from the coronavirus. Why can’t we do the same for underage drinking?

Because this isn’t a small problem. Based on the 2018 National Survey of Drug Use and Health, 44 percent of all Americans consume alcohol before they turn 18, while nearly two-thirds drink alcohol before they turn 21. And that shouldn’t be surprising; wild college parties are a cornerstone of American movies and music. American presidents from George W. Bush to Barack Obama have openly discussed their days of drinking in high school and college. And a recent study of parenting styles even found that most parents who oppose underage drinking still view it as somewhat “unavoidable.”

For some reason, college is a time when American culture allows -- and sometimes even celebrates -- underage drinking. But our colleges aren’t necessarily safe. A National Institutes of Health study found that more than 1,800 college students died in one year from alcohol-related causes, and a staggering 696,000 alcohol-related assaults and over 97,000 sexual assaults among college students occurred.

And those are just the tragedies we know about.

When faced with an emergency, students might not ask for help because they’re afraid, ashamed or they simply don’t know who to call. But as an underage drinker, dialing 911 often means admitting a crime and submitting your fate to the whims of police officers or college administrators. And some states -- including Ohio, Tennessee and Arizona -- are even prepared to punish underage drinkers who call emergency services for their at-risk friends. So even when students are at their most vulnerable, they can’t necessarily count on the support of their classmates.

The United States is essentially the only highly developed nation that puts college students in this impossible position. Many Western European countries allow the purchase of wine and beer as early as 16 years old, while nations like the United Kingdom and Canada set the drinking age at 18. And though the data aren’t conclusive, many speculate this earlier, parent-supervised entry to drinking helps form healthier habits. Either way, a drunk 19-year old student in France doesn’t have to consider criminal charges when they need an ambulance.

Fortunately, bringing this sense of security to American universities is easier than one might expect. Forty-three states already have “Good Samaritan” laws that apply to alcohol and drug consumption, ensuring those who call 911 won’t face criminal charges. And advocacy groups like Students for Sensible Drug Policy are working to expand these laws in states like Arizona and Tennessee.

But for students to feel completely safe calling emergency services, such protections must also exist at the college level. In 2002, Cornell University instituted a medical amnesty policy that exempted both callers and patients from university sanctions in the case of an emergency. In the first year of the policy, twice as many Cornell students sought medical care following an alcohol-related emergency. And while some critics portray medical amnesty as a “get-out-of-jail-free card” that encourages students to drink even more, several studies find these policies have almost no effect on how much students drink.

In recent years, dozens of higher education institutions have established amnesty policies. But according to my estimates, based on a survey by Students for Sensible Drug Policy, roughly one-third of all colleges in the United States still have no form of medical amnesty -- which leaves about six million college students unprotected. Even colleges and universities with amnesty policies tend to offer narrow, somewhat arbitrary protections for students. Based on this survey, medical amnesty often excludes the purchase of alcohol, drug use and other drinking-related crimes. So many students still risk countless forms of punishment, even if their college offers amnesty for underage drinking.

Ultimately, I’m not a medical doctor or a public health expert, and I certainly can’t say medical amnesty is a perfect solution to this challenge. But I know how the pressures of college can make a dangerous choice seem like the only choice. I had some rough nights in college, and I’m incredibly thankful I graduated with only a couple bumps and bruises. Because it could have been so much worse.

College students drink, and the entire country is in on the secret. Let’s stop pretending we don’t know better. Because medical amnesty isn’t about prestige, propriety or tradition. With broad amnesty policies that protect everyone from freshmen to Good Samaritans, colleges can save lives.