Content Warning: This piece contains mention of student death.
Maura Coursey’s hugs would “squeeze me like a boa constrictor,” her mother told me on a call this April, recalling how Maura “loved everyone so intensely and completely … they felt completely held by her.” She also had an “unbelievably amazing voice,” said her father, remembering how a music producer encouraged Maura to pursue a professional career. Maura was an excellent Muay Thai boxer, a leader in the LGBTQ+ community, and a screenwriter working on a climate dystopia. She was a ferocious advocate for oppressed communities, and some friends described her as having a “righteous but productive anger.”
When she came to Princeton last fall for a Masters in Public Affairs in the School of Public and International Affairs, “she finally got to a place where she had like-minded people, people that she loved working with,” her father said. “I think she was happier than she ever expected she would be.” She was determined to continue her work with people experiencing homelessness and to work for housing justice and climate justice.
But on Jan. 26, just days before her second semester at Princeton would have begun, Maura Coursey died at her off-campus residence from an accidental overdose of synthetic opioids — a class of substances that includes fentanyl, which is driving the nationwide overdose crisis — and benzodiazepines, a sedative that can greatly increase the risk of opioid overdose.
For some, the idea of such a passionate, driven, brilliant person engaging in the use of an illicit and often harmful drug may seem incongruous. But substance use is common among young adults: in 2021, 13.8 percent of people aged 18–25 reported having used an illicit drug other than marijuana in the past year. The Daily Princetonian’s senior survey shows that 6.9 percent of seniors have tried “hard drugs.” Maura’s death reminds us that this type of substance use occurs at Princeton, like it does everywhere, and that the University must react by making life-saving care free and accessible to all students. Her life is a call to action for all of us to build a community that cares for people who use these substances and people who have substance use disorders in a non-stigmatizing way.
Harm reduction strategies are a set of highly effective tools for reducing the risks of substance use. These strategies include medications like naloxone (brand name Narcan), a nasal spray that to reverses opioid overdose; tools like fentanyl test strips, which show whether the potent synthetic opioid fentanyl is present in a drug sample; and social supports like the “never use alone” hotline for people using without another present. If substance use becomes a substance use disorder — when problematic use “lead[s] to impairments in health, social function, and control over substance use,” according to the CDC — access to evidence-based, effective treatments should be made accessible. And this isn’t just hypothetical: 16.3 percent of people aged 18 to 25 have a drug use disorder, primarily cannabis use disorder, and a smaller fraction involve other illicit substances such as opioids and cocaine. Yet harm reduction and treatment can only be used if they are made accessible and discussed openly, without judgment.
The fear of judgment is a major problem: the stigmatization of illicit drug use and substance use disorders means that use often goes unacknowledged. According to her parents, when Maura lived in Utah, her girlfriend once found syringes, evidence of injection drug use, in their home. When confronted, Maura told her girlfriend that she didn’t want to talk about it, one example of how shame around substance use can hinder people from seeking help.
Maura’s mother noted the difficulties of discussing substance use disorders, saying that “there’s this … shadow of shame … that can work against people.” The stigma surrounding drug use makes it less likely that people who use substances will engage with the harm reduction techniques that save lives. In order to fight stigma and keep people who use substances safe, Princeton must make harm reduction resources free, easily accessible, and openly advertised, creating an environment where they can be discussed without shame.
Princeton University is no stranger to harm reduction: Ethan Nadelmann, the founder of the Drug Policy Alliance, outspoken critic of the War on Drugs, and a pioneer of harm reduction, worked and taught at Princeton for seven years, from 1987 to 1994. The group of 18 scholars that he brought together (formally named the “Princeton Working Group on the Future of Drug Use and Alternatives to Drug Prohibition”) was called the “the most dynamic de facto drug-reform think tank in the United States,” and advocated for the end of the criminalization of substance use and a rethinking of the way that substance use and its legality is conceptualized. The Drug Policy Alliance has led innovation in harm reduction policy for over two decades. The University should take pride in its role in supporting Nadelmann’s groundbreaking, life-saving work by bringing it back home and implementing it on its campus.
Maura was an active advocate for harm reduction when she lived in Utah, always looking out for the people around her. Maura’s mother said “she would carry Narcan with her in case she ran across someone who needed it,” and her father added that she didn’t only carry Narcan in case of a crisis: “if she found out [someone was] using, she would give them Narcan and educate them.” Her family did not know if she ever accessed Narcan while at Princeton. Narcan, with its ability to reverse an opioid overdose, is a critical harm-reduction tool, and its accessibility is significantly associated with lower rates of overdose death. According to an email from University Media Relations Assistant Ahmad Rizvi, “the Department of Public Safety and University Health Services have naloxone readily accessible for emergencies,” but ideally, Narcan would be far more accessible — anybody who carries it can help a person who is overdosing right when they see it happen, as it is an easy-to-administer, safe nasal spray. Princeton should adopt the same spirit as Maura in its approach to Narcan: it should be free, readily available, and openly advertised.
This past March, Narcan was approved by the FDA for over-the-counter (OTC) purchase. Although this policy may take time to implement in pharmacies, Princeton should guarantee free, immediate Narcan accessibility, and, beyond that, publicize its availability and make it something that students can simply pick up at UHS, without an appointment, for themselves or others. The status quo involves a prescription and varying costs, between a $0 copay on some insurance plans to $20 on the Student Health Plan (SHP) or around $40 or more at pharmacies. But this is too much for a life-saving drug, especially one that may have to be used multiple times during an overdose: a strong body of evidence has shown that copays even as low as five dollars deter people from accessing care.
In a statement, Rizvi said that “the State [of New Jersey] is working to ensure that Narcan will be available at local pharmacies without a prescription. We will be contacting our local pharmacies to assure they are stocked with this medication” and floated the possibility that colleges might be provided with “overdose prevention kits that include Narcan” by the state of New Jersey.
Beyond just Narcan, Princeton can implement the full range of harm reduction practices to keep students safer, namely overdose prevention and safer consumption practices education (including education on which methods of consumption are more or less risky for different types of drugs), which could be integrated into current required first-year orientation events about substance use. It also would include fentanyl test strips and syringe services, which could be offered at McCosh or community hubs, and the University should make sure students know about services they already offer, like prophylactic medications such as PrEP.
Critics of harm reduction services argue that these initiatives create “moral hazard” by encouraging people to take greater risks and contribute to an increase in substance use. But nowhere in the evidence is this borne out: time and time again, harm reduction strategies like these are shown to keep people who already use drugs safer, and young people are no more likely to start using simply because harm reduction is available. In fact, engaging people in harm reduction and effective treatment for substance use disorders is the most effective strategy to decrease overdose deaths and has been accepted by communities across the US.
When it comes to unhealthy alcohol use, Princeton already recognizes that punishing students for substance use doesn’t work: its amnesty policies for underage drinking are much better than those at other schools. To follow through with this, they should make sure that the fear of disciplinary consequences never prevents students from getting medical attention for drug-related incidents, like acute drug intoxication, either. Although it’s not as well-advertised as the knowledge that McCosh won’t share information about alcohol intoxication, they won’t share information about students’ drug use with anyone, either: Counseling and Psychological Services (CPS) director Calvin Chin confirmed that “if a student is admitted to McCosh for acute intoxication, this information will not be shared with any outside parties by UHS staff,” as any student treated at UHS has “a right to confidentiality of their medical information.”
However, if a student is transported to McCosh by Public Safety, “Public Safety will inform the Deans as per their normal policies around emergency transports,” according to Chin. At that point, Princeton’s penalties for people who use illicit substances, as described in Rights, Rules, and Responsibilities (RRR), come into effect. Violations related to illicit substances, including cannabis possession and use, follow a three-strikes approach: a reprimand or probation for the first offense, a longer probation, “campus service, or revocation of on-campus residential privileges” for the second offense, and a suspension for the third offense.
If the infraction is considered among the “most serious,” which includes “possession or use of the more dangerous or highly addictive drugs,” even a first offense can result in “a lengthy separation or expulsion.” It is reasonable to assume that illicit opioids and cocaine would fall into this category, meaning that a student requiring emergency assistance due to an overdose on these substances would risk expulsion if any University authority, other than McCosh officials, became aware of their use. This dangerous policy needs to be changed. Punitive drug policies are ineffective and heighten stigma about substance use, and the fear of legal and disciplinary consequences can deter students from seeking life-saving care and make them hesitate in moments of emergency.
In addressing these challenges, Princeton, both as an university and as a community, has the opportunity to not just expand health services but also to build an inclusive spirit of caring. We have a responsibility to support and uplift one another, confront our own stigma about substance use and substance use disorders, and be ready to lend a hand. Princeton has the potential to lead by example, implementing harm reduction practices to keep students safe, fight stigma, and create an inclusive culture of compassion, where those among us who use drugs are embraced in the power of a protective community. It is these connections and the strength of our community that can make the critical difference during times of hardship and crisis. Maura’s life serves as an inspiration to us all to meet the challenge of building them.
Eleanor Clemans-Cope (she/her) is a first-year from Rockville, Md., intending to study economics. She is a musician, climate activist, associate Opinion editor for the ‘Prince,’ and friend. She can be reached on Twitter at @eleanorjcc or by email at eleanor.cc@princeton.edu.
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