Forty percent of school and district leaders nationwide said their schools stock the opioid-reversing drug naloxone to counter dangerous drug overdoses, according to a survey this fall by the EdWeek Research Center of more than 1,050 educators and school leaders. That number is likely to climb as adolescent drug overdoses continue to surge nationwide. From 2010 to 2021, overdoses among teens more than doubled, increasing from 518 to 1,146, according to data reported in the medical journal JAMA.
The same can’t be said, though, of programs designed to prevent students from getting addicted in the first place. An abundance of school-based drug-prevention and education programs exist; over 200 commercial programs were available as of 2014, according to the National Institutes of Health. But experts suggest that thinly stretched and uneven resources make it harder for districts to adopt and stick with those programs than to stock up on naloxone, better known by its original trade name of Narcan.
Drug prevention expert Karen Pershing has noticed the shift in the landscape. “I’ve been in this position for 12 years. Our focus has always been primary prevention; now we’re doing harm reduction,” said Pershing, executive director of the Knoxville-based Metro Drug Coalition, a nonprofit whose community partners include schools. “It [prevention-oriented education] has always been a hard sell … You don’t necessarily see the impact of primary prevention. People want a quick fix.”
In comparison, naloxone is relatively easy to access and utilize—even non-medical personnel can be trained on administering the nasal spray. Comprehensive school-based drug prevention programs require significant resources in time and human capital.
“There’s a large body of literature around school-based prevention and programs shown to work,” said Amy Goldstein, the chief of prevention research at the National Institute on Drug Abuse. “The challenge is in the implementation. There are a lot of demands on a school’s time.”
Statistics show uneven application of drug prevention education
Data on school-based drug prevention education programs is somewhat sparse. But available statistics indicate that they’re not reaching students uniformly.
The CDC periodically conducts the School Health Policies and Practices Study; its most recent iteration, from 2016, showed that 63.9 percent of elementary schools, 79.7 percent of middle schools, and 86 percent of high schools were required to teach alcohol- or other drug-use prevention education. But it provided no detail on the type or frequency of education implemented.
In a 2017 survey of students ages 12 to 17, more than 1 in 4 respondents said they had not seen or heard drug- or alcohol-prevention messages at school, according to the Center for Behavioral Health Statistics and Quality. An overview of drug- and alcohol-prevention programs found that schools in the West had far fewer prevention programs than those in other regions. And, schools with a higher proportion of white and affluent students received significantly more prevention programs than in schools where Black, Hispanic, or economically disadvantaged students made up a majority of the student body.
Even the best school-based drug-prevention programs are under-utilized
Even nationally recognized school-based drug prevention programs proven by independent researchers to minimize students’ risk behaviors are not being employed to their fullest extent, experts say. Consider the Michigan Model for Health program.
Developed in 1985, it is frequently referred to as the “gold standard” among programs of its kind. It addresses every major health risk behavior identified by CDC, including alcohol and other drug use. Multiple studies by independent researchers have reported positive impacts of the program, including one study in which students who were taught the curriculum in elementary school for two consecutive years self-reported improvements in drug refusal skills, less intent and actual use of alcohol and tobacco, and feeling reduced levels of aggression.
“It is age-appropriate and sequential. Concepts are reinforced throughout grades as students grow and age and experience new real-world situations,” said Jessi Shaffer, school health education consultant for the Michigan Department of Health and Human Services.
But currently, only about 86 percent of Michigan public schools use the program, according to Karen Yoder, MDHHS’s adolescent and school health unit manager. That’s in spite of efforts by Yoder and colleagues that include regularly updating the program—recently, it was completely digitized—and looking for ways to provide free or low-cost training to schools.
“Some schools come in and out of it, some have been great implementers. Some don’t even know yet about the quality of the curriculum,” Yoder said. “It’s all over the board.”
In 2017, Michigan also became one of the first states in the nation to enact a law allowing schools to stock Naloxone.
One district’s experience with Naloxone and prevention education
Denver Public Schools has stocked naloxone in each of its schools (including elementary schools) since the fall of 2022. This December, an overdose incident involving five teenage students, one of whom was subsequently hospitalized, occurred around 9 a.m. on a school day in the parking lot of John F. Kennedy High School. According to a Denver Public Schools spokesperson, one of the students was treated on-site by paramedics and then transferred to a local hospital. Student privacy concerns prevented the release of any additional information.
Beginning with the 2023-2024 academic year, Denver Public Schools is set to introduce new requirements from kindergarten to high school for comprehensive health education, according to Juliana Evans, a curriculum and instruction specialist for the district. These plans have been in development since the summer of 2022. Details of the curriculum have yet to be developed, but it will be medically accurate, developmentally appropriate, and culturally sensitive, according to Evans.
The DPS Substance Use Prevention Program already provides districtwide access to prevention and early intervention programs to head off and reduce substance use, according to Amanda Wentz, who oversees them. But Wentz said that only about 30 percent of the district’s schools use the drug education and the related services her team offers. Wentz confirmed that John F. Kennedy High School does offer substance prevention education, but could not offer any offer any specific information about it.
Whether schools take up the programs, Wentz said, “depends heavily on the priorities of [individual] schools’ administration and financial resources.”
