Efficacy of a Gamified Digital Platform for Substance Use Education and Overdose Prevention Among College Students: a Pilot and Feasibility Study

Background: For US young adults aged 18-25 in the 2018-2024 period, fentanyl was involved in 78.2% of the 44,020 unintentional or undetermined-intent overdose deaths, most often co-involving stimulants and other non-opioid substances. While fatal overdose rates in this age group have fallen to their lowest recorded level, emergency medical services-attended non-fatal overdose events have reached record highs, shifting the decisive variable toward bystander recognition and response. College students report near-universal alcohol education but minimal education on the substances actually driving overdose mortality. Methods: We conducted a single-group pre-post evaluation of the DopaGE Portal, a gamified, mastery-based digital platform covering cocaine, MDMA, benzodiazepines, and opioid overdose response, deployed at a public university (UNL) and a multi-campus volunteer network (TACO). Paired pre/post surveys (N=42) measured self-efficacy (7 items; primary), behavioral intentions, risk perception, and knowledge/attitudes on 5-point scales, plus four factual knowledge questions. Paired t-tests, exact McNemar tests, and Benjamini-Hochberg correction across eight primary tests were applied. Institutional naloxone distribution at UNL was tracked as an ecological behavioral outcome. A mandated high-school cohort (N=94) provided supplementary acceptability data. Results: Self-efficacy increased from 2.82 to 4.46 (d=2.00, 95% CI 1.46-2.55; adjusted p<.001), and behavioral intentions from 4.24 to 4.81 (d=1.43; adjusted p<.001), with effects statistically indistinguishable across sites. Three of four knowledge items improved significantly (+31 to +41 percentage points). Risk perception was at ceiling at baseline (4.38/5) and did not change. In the two months following deployment, 38 naloxone kits were distributed on campus (limited to one per person from the campus pharmacy and health center) versus 14 in the preceding two years combined; the campus health center had distributed zero kits in 2025 despite stocked availability. Evaluation ratings were uniformly positive across voluntary and mandated cohorts, with zero negative ratings. Conclusions: A digital-only, gamified intervention produced large gains in overdose-response self-efficacy and substance-specific knowledge, with concurrent campus-level naloxone acquisition consistent with behavioral translation. These findings are preliminary -- single-group, modest N, ecological behavioral outcome -- and motivate a future randomized controlled trial.