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Opinion: Why naloxone belongs in the classroom

Drug overdoses are at record levels, and as recent news reports indicate, children are succumbing to fentanyl-related exposures in the classroom


At least 10 states have passed legislation about naloxone in schools, some requiring it be stocked, but others leaving it up to the local school boards and administrators to decide.

AP Photo/Matt Rourke

Annual drug overdose deaths are at a record high in the United States, as deaths from fentanyl and other opioids climb to previously unseen levels.

According to the US Centers for Disease Control and Prevention’s National Center for Health Statistics, an estimated 105,752 people died of drug overdoses in the 12-month period ending October 2021. The Drug Enforcement Administration has issued a Public Safety Alert warning Americans of the “alarming increase in the lethality and availability of fake prescription pills containing fentanyl and methamphetamine.”

A recent study from UCLA found that the rate of overdose deaths among U.S. teenagers nearly doubled in 2020, then increased again in the first half of 2021, when compared with the decade before the pandemic. The increase in deaths was almost completely due to counterfeit pills tainted with fentanyl.

Addicts, celebrities, professional athletes, college kids, schoolchildren, rich and poor – no group has been immune from this scourge.

The Rocky Mountain High Intensity Drug Trafficking Area recently sponsored a 2-day class on overdose death investigations presented by retired Irving (Texas) Police Department Narcotics Detective Steve Junker, who is an instructor for Professional Law Enforcement Training.

The class was gritty, gut-wrenching and tremendously informative. Steve discussed several senseless deaths in young people that could have been avoided with the prompt administration of naloxone had it been available.

I grew up in the area where Steve did his years of undercover work, and after hearing his presentation, it exposed a dark side to these neighborhoods that I was unaware of. I reached out to Steve after the meeting, and we discussed the damage that fentanyl-laced drugs and counterfeit pills are doing to our communities, as well as the misguided decriminalization and defelonization of fentanyl possession that some states, including Oregon and Colorado, have adopted. He also mentioned serious concerns about children in school taking drugs containing potentially lethal doses of fentanyl and not having rapid access to naloxone. It is Steve’s opinion, which I share, that naloxone should be available in every classroom with teachers instructed in its use, just as police officers, EMTs and paramedics are trained.

What’s happening in our classrooms

In January, a 13-year-old in Connecticut died in his classroom from a fentanyl overdose, and a 12-year-old New Jersey boy was found unresponsive on a school bus and later died due to fentanyl intoxication.

In February, five middle school students in Las Vegas were rushed from their school to the hospital, allegedly after taking drugs containing fentanyl – sadly one 15-year-old died.

A little over 2 weeks later, a report of a death in a high school was released, this time in my hometown of Colorado Springs, allegedly due to snorting counterfeit crushed Percocet pills containing fentanyl. Although school officials called 911 as soon as the child was found unresponsive, life-saving naloxone was not reported to have been administered by the school staff. Now, the school district plans to stock naloxone at all middle and high schools after two additional overdose deaths occurred this year.

Other school districts in Colorado are either planning to stock naloxone or are considering it. It is the position of the National Association of School Nurses (NASN) that “the safe and effective management of opioid-related overdoses in schools must be incorporated into the school emergency preparedness and response plans,” but only

Thirty-nine percent of public schools employ a full-time nurse, and there can be significant barriers for some school nurses willing to use naloxone. At least 10 states have passed legislation about naloxone in schools, some requiring it be stocked, but others leaving it up to the local school boards and administrators to decide. The Ohio Department of Health’s “TakeChargeOhio” has published a brilliant policy brief titled “Naloxone in Schools” that could be used as a roadmap for other states to emulate, and the NASN’s “Naloxone in Schools Toolkit” has some excellent resources for those interested in starting a program.

What are SROs doing?

There are school districts served by school resource officers (SRO) who carry and are trained to use naloxone, such as the Metro Nashville Public Schools, high schools in Irving, Texas and schools in southern Colorado, including those in Colorado Springs, Pueblo and unincorporated El Paso and Teller Counties.

The National Association of School Resource Officers (NASRO) is unsure how common it is for SROs to carry naloxone, and they do not have a naloxone position statement on their website. NASRO’s Basic 40-hour SRO Course does have a section titled “Effects of Youth Trends and Drugs on the School Culture and Environment” – perhaps there would be an opportunity to do additional training on the use of naloxone in schools. Neither the National Education Association nor the American Federation of Teachers have advocated for naloxone in schools outside of the school nurse’s office.

Access to naloxone

All law enforcement officers should know the value and simplicity of administering naloxone in cases of suspected opioid overdoses. What are the potential downsides?

Naloxone was first approved by the FDA in 1971, and it is a very safe medication and no allergies have ever been documented. You are not likely to hurt anyone when administered correctly, and a life could be saved. Most states have “Naloxone Access laws,” which protect individuals who administer the opioid-reversal drug.

In November 2021, the White House released a “State Model Law” to help make access to naloxone consistent across the country, but it will require a concerted state-by-state effort to get the laws in place. President Biden’s proposed 2023 budget addresses the opioid and drug overdose epidemic by mentioning “a full range of services and supports are needed for individuals who use or are at risk of using substances that cause overdose, and their families.” No specifics are given as to how this will be achieved, and there is no mention of increasing access to naloxone.

Why is this a police issue?

Like it or not, we are often the first responders on the scene when someone goes down from an opioid overdose, whether it be on the street, in the jail, or in a school. We are trained to make quick decisions when we encounter a person who is unresponsive and not breathing, and we can “bring them back to life” with CPR, AEDs, Heimlich maneuvers, first aid and now, naloxone.

Prompt administration of naloxone nasal spray, also known as Narcan, can mean the difference between life and death for a person who has overdosed, and the precious few minutes that a person’s brain is deprived of oxygen means irreversible brain damage. To paraphrase – when seconds count, EMS is often minutes away. There is no doubt that with similar training and support our teachers, bus drivers and school staff can learn to do the same things, if provided with the training, supplies and support from their schools and those of us who have “been there, done that.”

NEXT: Evolving strategies to win the war on opioids (eBook)

John M. Williams, Sr., MD, MPH, is a physician with a Master’s of Public Health degree, board-certified in both occupational medicine and ophthalmology. He is also a retired Navy medical officer, combat veteran and former Marine Corps Medical Battalion Commander. For the past 12 years, he has been a reserve deputy sheriff in southern Colorado and has also served as an academy instructor.