Citing concerns about student opioid use—and fentanyl specifically—a growing number of districts have equipped schools with naloxone, a drug that temporarily reduces the harmful effects of overdoses.
The Los Angeles Unified School District became the latest to do so last month when it said it would stock the drug, and train qualified staff to use it, as part of a multiprong response to a “devastating epidemic of overdoses that are all too common in Los Angeles.”
Los Angeles police have reported a string of overdoses among high school students in the city, including one who died in a school restroom Sept. 13 after she and her friends took what they believed to be Percocet pills. Those pills appear to have been laced with fentanyl, an extremely strong synthetic opioid, police said.
“No child in Los Angeles, in any school system in our nation, should die as a result of contact from fentanyl,” LAUSD Superintendent Alberto Carvalho told Education Week in a video interview. “This is a crisis that is not unique to Los Angeles. It’s not unique to schools. It’s a national crisis that requires bold leadership.”
Other districts—from Des Moines, Iowa, to Denver— have also stocked naloxone in recent years, some empowered by changes in state laws that make it easier to do so. Here’s what educators need to know.
What is naloxone?
Naloxone is an “antagonist” drug, which means it fights against the effects of other drugs by blocking the brain receptors that respond to opioids, like heroin, oxycodone, and fentanyl, according to the National Institutes of Health.
Administered quickly— typically through a nasal mist—the drug can stop the symptoms of an overdose, like shallow breathing and a slowed heart beat, to give medical personnel a chance to intervene.
Naloxone, a generic term for the drug, is also commonly known by the brand name Narcan.
Is it dangerous for schools to use naloxone?
“This is just one more tool that can help save a life,” said Linda Mendonca, president of the National Association of School Nurses, an organization that has advocated for naloxone in schools. “If you can save even one life, that’s great.”
She compared it to rapid epinephrine injectors many schools carry to respond to serious allergic reactions.
Federal health agencies say naloxone is relatively safe to administer, even for people without medical training. Crucially, it does not harm people to receive it if they do not have opioids in their system, which means health officials are not concerned about people mistakenly administering it, Mendonca said.
Some local and regional health departments have provided naloxone for free to residents, urging them to carry it so they are more equipped to respond to an emergency. Some counties even provide naloxone for free in vending machines. And a majority of state laws provide legal immunity to lay people who administer the drug.
Who administers naloxone in schools?
State laws on naloxone vary, and legislatures have amended their laws in recent years to make it easier to dispense, prescribe, and administer the drug. By 2020, 27 states had laws that allow K-12 schools to carry it, according to the most recent analysis by the Legislative Analysis and Public Policy Association.
Of those states, six require school districts to have a naloxone policy that details how it will be used: Arizona, Maryland, Oregon, Rhode Island, Tennessee, and Washington.
Most school districts that stock the drug require training for a select group of staff who agree to be on-call to administer it if they are in the building during an emergency. LAUSD, for example, said it plans to offer training to “appropriate staff, such as nurses, wellness center providers, and trained volunteers” in cooperation with the local health department.
In some schools, school resource officers carry naloxone under their authorization from the local law enforcement agencies that employ them in cooperation with districts.
Costs of the drug vary, with brand-name Narcan costing as much as $140 for a two-dose kit. Schools have built those costs into safety budgets, worked in collaboration with local health departments, or secured grants to help cover the expense.
Why are more schools carrying naloxone?
Over the past decade, drug prevention organizations have encouraged schools to stock naloxone because they are frequently centralized in communities. Equipped with the drug, school staff could be prepared to intervene in an overdose among parents, spectators at sporting events, or even pedestrians near campus, they said.
But schools have increasingly cited concerns for students themselves as they adopt naloxone policies.
In March 2016, an Anne Arundel County, Md., school nurse used naloxone to save an overdosing high school student just 10 days after her school began carrying it, the Baltimore Sun reported.
When the Des Moines, Iowa, school board approved a naloxone policy Oct. 4, documents listed “11 times during the 2021-22 school year where district nurses would have used naloxone on students if it had been available,” the Des Moines Register reported.
While federal data show that teen drug use hit a record low in 2021, many illicit drugs themselves are significantly more potent and dangerous, increasing the risk for youth overdoses, public health officials warn. That’s in part because drug dealers mix drugs, often surreptitiously, with agents like fentanyl that make them much stronger, said an April study published in the Journal of the American Medical Association.
There were 518 overdose deaths among U.S. adolescents in 2010, that study said, a number that increased to 1,146 in 2021. Adolescent overdoses also grew more likely to lead to a fatality in that time span.
What else can schools do about fentanyl overdoses?
Schools should match their overdose-response efforts with prevention, said Mendonca, of the National Association of School Nurses.
Students need drug-prevention education that makes them aware of the increased potency of drugs in recent years and how to respond to concerns about peer use, she said.
That urging comes after the Drug Enforcement Administration warned in August about “rainbow fentanyl,” which is sold in colorful pills and powders that may be more appealing to teens.
Some districts have also offered workshops for families and community members to learn about the issue, how to identify warning signs of drug abuse, and how to intervene.
The Los Angeles school system plans to train high school juniors and seniors to teach health education to freshmen using a peer-to-peer model, the district said. The school system also plans to create a safety task force and offer training through its parent academy.