Assessing knowledge, attitudes, and barriers to opioid overdose among college students

Abstract Background College students are a key population for opioid use, misuse, and subsequent exposure to overdose events. However, their knowledge and attitudes in response to opioid overdose warrant further study. To assess this gap, we surveyed graduate and undergraduate students about their opioid overdose knowledge, attitudes, self-reported competence, readiness to act, and concerns or barriers to intervention. Methods We conducted a cross-sectional survey of 252 undergraduate and graduate students at a large public university in the southern United States. Opioid overdose knowledge was assessed using the 45-item Opioid Overdose Knowledge Scale (OOKS), and attitudes toward overdose response—including perceived competence, readiness to act, and concerns—were measured using the Opioid Overdose Attitudes Scale (OOAS). Independent-samples t tests were used to compare knowledge and attitude scores across selected groups relevant to overdose education and naloxone training, including pre-health status and prior overdose prevention training. Open-ended responses regarding interest in naloxone training were analyzed using thematic analysis. Results Participants demonstrated moderate overall overdose knowledge (mean OOKS score: 28.2 ± 8.6), with stronger performance in naloxone-related domains and persistent gaps in recognizing overdose risk factors and signs. Students with prior overdose prevention or naloxone training consistently reported higher knowledge, perceived competence, and readiness to intervene compared with untrained peers. Despite limited prior training (9.9%), nearly two-thirds of participants expressed interest in receiving naloxone training. Thematic analysis identified “Preparedness,” “Helping Others,” and “Confidence” as motivators and “Low Perceived Risk,” “Time Constraints,” and “Stigma” as barriers. Conclusion Although students exhibit moderate overdose knowledge, targeted naloxone training is essential for enhancing their competence and readiness to address opioid overdose. Tailored campus programs that address identified barriers and leverage motivational themes may strengthen emergency response and reduce overdose fatality.