Should Your Schools Stock Naloxone?

The opioid crisis has infiltrated communities across the nation, leading to an urgent debate on whether schools should stock naloxone. Naloxone is a medication that can rapidly reverse an opioid overdose, potentially saving lives.

As the opioid epidemic continues to impact students and families, school administrators are faced with the difficult decision of whether to keep this life-saving drug on hand. This blog explores both sides of the argument to help school leaders make informed decisions.

What is Naloxone?

Naloxone, commonly known by the brand name Narcan, is a medication designed to quickly reverse the effects of an opioid overdose. It works by binding to opioid receptors in the brain, effectively blocking the effects of drugs like heroin and prescription painkillers. The opioid crisis has become a significant public health issue, elevating to a public health emergency in 2017, with rising numbers of overdoses affecting all segments of society, including school-aged children.

Statistics reveal the alarming impact of opioids on communities. According to the Centers for Disease Control and Prevention (CDC), opioid overdoses account for tens of thousands of deaths annually in the United States. The New England Journal of Medicine shares, “Every week in 2022, the equivalent of a high-school classroom’s worth of students — an average of 22 adolescents — died of drug overdoses in the United States, according to data from the Centers for Disease Control and Prevention (CDC).” Schools are not immune to this crisis, with reports of opioid-related incidents occurring on school grounds. This reality has prompted some school districts to consider stocking naloxone as a preventive measure.

You Might Be Required To

The increasing urgency of the opioid crisis has prompted legislative action in several states, mandating that public high schools stock naloxone. As of the end of 2023, at least eight states require public high schools to have naloxone available in the event of an overdose at school or a school-sanctioned event.

In addition to these eight states, many more require school districts that choose to stock naloxone to establish clear policies and training protocols. This means that even in states without a mandatory naloxone stocking requirement, schools that opt to carry the medication must follow specific guidelines. These guidelines ensure that the drug is stored securely, that staff members are adequately trained, and that there are protocols in place for its use.

Arguments for Stocking Naloxone in Schools

The debate over stocking naloxone in schools involves several compelling arguments in favor. Ensuring safety and preparedness, ease of training, and reducing stigma are critical aspects that highlight the necessity of having this life-saving medication readily available on school grounds.

Safety and Preparedness

One of the primary arguments for stocking naloxone in schools is the importance of being prepared for emergencies. Just as schools have fire extinguishers and defibrillators, naloxone can be a critical tool in saving lives during an overdose. In some instances, schools that have naloxone on hand have successfully intervened in overdose situations, preventing tragedy. NPR spoke with Alberto Carvalho, superintendent of the Los Angeles Unified School District and shares, “last school year, naloxone was administered 31 times in the school system. ‘That’s 31 times that we possibly saved a life,’ Carvalho, says.”

In fact, the CDC shares that “bystanders to the overdose, who could potentially intervene, were documented in 44% of deaths.” The CDC, other health organizations, and the National Association of School Nurses recommend that naloxone be readily available in places where opioid overdoses are likely to occur, including schools.

“When emergencies happen, including drug-related emergencies, proper management of these incidents at school is vital to positive outcomes…School nurses in this role should facilitate access to naloxone for quick response in the management of opioid-related overdoses in the school setting,” states the National Association of School Nurses.

Training and Implementation

Another point in favor of naloxone in schools is the relative ease of training and implementation. Administering naloxone is straightforward, often involving a nasal spray that is easy to use with minimal training. Many school districts that have implemented naloxone programs report successful outcomes with manageable training requirements.

It’s so straightforward that some districts, like Arlington Public Schools in Virginia are providing training and allowing high school students to carry Naloxone. Darrell Sampson, executive director of student services for Arlington Public Schools shares with EdWeek that the decision and community buy-in stemmed from, “collectively, we all want for students to be healthy. We all want them to live, we all want them to be mentally well, we want them to thrive and have lots of opportunities. Let’s start from that place. And then let’s talk about this particular issue that’s impacting our youth.”

Reducing Stigma

Addressing the drug crisis students are facing starts with reducing the stigma associated with overdoses and substance abuse. “We are facing a national opioid crisis and it’s affecting our young people at an alarming rate. Just as students carry prescription inhalers to treat an asthma attack, we must destigmatize substance-use disorders and treat naloxone as a lifesaving tool,” said Bobby Mukkamala, MD, chair of the AMA Substance Use and Pain Care Task Force.

In fact, most students who die from overdose don’t have a history of substance abuse disorders. Ty Schepis, Professor of Psychology at Texas State University states, “Only 1 in 10 teens and tweens who died from a drug overdose had a history of treatment for a substance use problem, and only 1 in 7 had ever experienced a prior nonfatal overdose. Adolescents who fatally overdose do not necessarily show the warning signs generally expected beforehand, such as problems with alcohol or other drugs or prior substance use treatment.”

Some students who suffer an overdose might even be taking medication they were prescribed or developed a substance-use disorder because of their prescription. The University of Michigan analyzed all prescriptions dispensed to children and young adults in the U.S. in 2019. “Of 4 million opioid prescriptions dispensed to US patients aged 0 to 21 years in 2019, 46% were high risk.”

Arguments Against Stocking Naloxone in Schools

While the benefits of stocking naloxone in schools are evident, there are significant arguments against its implementation. Safety and liability concerns, the potential diversion of focus and resources from prevention efforts, and community and parental apprehensions all contribute to the complex debate surrounding whether naloxone should be available in schools.

Safety and Liability Concerns

Despite the compelling reasons to stock naloxone, there are valid safety and liability concerns. Some fear the potential risks associated with administering naloxone incorrectly, which could lead to adverse outcomes. There is also the issue of liability; while Good Samaritan laws offer some protection, the fear of litigation remains a significant concern for many school administrators. Additionally, there are concerns about the proper storage and security of naloxone to prevent misuse or theft.

Focus and Resources

Another argument against stocking naloxone is the potential shift in focus and resources. Critics argue that the presence of naloxone in schools might divert attention from essential preventive measures and educational programs aimed at reducing substance abuse. The financial and logistical burden of stocking naloxone, including training and storage, could strain already limited school resources. It is crucial to weigh whether these resources might be better spent on comprehensive substance abuse prevention and education programs.

Community and Parental Concerns

Community and parental concerns also play a significant role in the debate. Some parents and community members might oppose the presence of naloxone in schools, fearing it could send the wrong message or stigmatize students. There is also a worry that naloxone could inadvertently encourage risky behavior by creating a false sense of security. In some districts, community opposition has been strong enough to influence policy decisions against stocking naloxone.

Balancing the Decision

The decision to stock naloxone in schools is complex, involving legal, ethical, safety, and community considerations. On one hand, naloxone can be a life-saving tool, aligning with the broader mission of schools to provide a safe environment for students and staff. On the other hand, there are legitimate concerns about liability, resource allocation, and community perception.

School administrators must weigh these factors carefully, considering their specific context and needs. Engaging with health professionals, legal experts, and community members can provide valuable insights and help navigate this challenging decision. Whether or not to stock naloxone, schools should prioritize comprehensive strategies to address the opioid crisis, including education, prevention, and emergency preparedness. As the opioid epidemic continues to evolve, ongoing dialogue and reassessment of policies will be crucial to effectively address this public health challenge.