The opioid epidemic facing the United States in recent years has not spared children. Between 2010 and 2021, the death toll for adolescent overdose deaths in the United States rose from 518 to 1,146 people, according to a JAMA-published study from last year. UCLA figures showed overdose deaths increased exponentially in 2020 and the first half of 2021.
Of the 1,146 adolescent overdose deaths in 2021, 77% involved fentanyl, a synthetic opioid that is up to 100 times stronger than morphine. A San Jose Mercury News analysis found fentanyl contributed to one in five deaths of Californians aged 15 to 24 in 2021.
At least seventeen Los Angeles United School District middle and high school students, one who was 12 years old, have reportedly overdosed on campuses during this school year. Two high school students in Oregon’s Portland Public School system died from opioid overdoses last spring.
In response to these deaths and many others around the country, school districts are increasingly stocking naloxone, a drug that counteracts the effects of an opioid overdose, on campuses. When administered in time, it can restore normal breathing to someone who has overdosed on opioids within two to three minutes, according to the CDC. Naloxone is not addictive and has “no effect on someone who does not have opioids in their system,” according to the National Institutes of Health.
In January, California Gov. Gavin Newsom pledged to provide funding for naloxone for every middle and high school in the state as part of K-12 education spending for the coming year.
Major manufacturers of the drug, which was patented in 1961 by Dr. Mozes J. Lewenstein and Dr. Jack Fishman, include Pfizer, Emergent BioSolutions, Teva Pharmaceuticals, Hikma, Akorn, Adamis Pharmaceuticals, and Amphastar Pharmaceuticals.
Last year, within a few weeks of announcing a charitable distribution program with donations from Emergent BioSolutions, Direct Relief received more than 100 requests from school districts across the U.S., 582 schools/districts, making up 1,164 individual school sites, have received 2,328 doses of Narcan through the program.
Less than a month after the two Portland students died, Jamie Smith, a trained nurse and senior school health services administrator at Multnomah Education Service District, or MESD, began working to source naloxone for the eight school districts he works with and the alternative schools MESD operates. He learned about no-cost programs through his school nursing contacts.
“If we can have [naloxone] available and save someone’s life, we want to do that,” Smith said in an interview with Direct Relief. Smith said that discussions about stocking naloxone in schools began before the Covid-19 pandemic but lost traction in the face of that public health crisis. Following the student deaths, Smith said that both the community and educators expressed broad support for increasing access to the potentially lifesaving drug in schools. Policy changes were made easier, according to Smith, by basing the naloxone initiative on the epinephrine auto-injector– more commonly known as EpiPens – programs that have existed for many years in schools to counteract the effects of severe allergic reactions.
“Most community members were certainly in favor of having naloxone in schools. It was something that I advised our districts on, to make sure this is supported by your community and that this is something the school wants to take on as a responsibility,” Smith said, adding that, while administering naloxone is not technically education-focused, “all of our districts recognized the need and low bar of getting involved with it.”
Smith said that, in the past, he had concerns about unlicensed personnel, such as a secretary or support staff member, being put in a position to decide whether a student is having an allergic reaction, has low blood sugar, or has overdosed.
“I think it’s important to expand the availability in the community so we can respond, but I’m concerned with how much the schools take on without the health expertise may or may not be needed to decide if it’s an overdose situation,” Smith said, reflecting the possibility that naloxone could be used in a situation where a different intervention is needed.
In Beaverton, a neighboring town of Portland, naloxone was brought to the city’s school district before the 2022 school year after the implementation of policy changes and training sessions that began in August 2021
“The [Beaverton School] District supported the process to access, administer and store Naloxone in response to the public health crisis related to rising opioid overdoses and deaths in Oregon,” said Lori Perkins, a school nurse on special assignment.
Southwest of Portland, the small town of Sherwood has also ordered naloxone for all of its schools, including elementary schools.
“…We believe having access to Narcan at each building strengthens the ability of our staff to respond quickly to drug-related health emergencies, as well as to provide additional on-site resources for law enforcement in the event that they respond to such an incident on or near our campuses, ” according to a statement shared by Christine Andregg, executive assistant to the superintendent. Sherwood School District ordered naloxone over the summer and distributed it to schools as staff completed the required training, according to Andregg.
In late September of last year, following overdoses on its campuses, LAUSD announced it would make naloxone available in all of its K-12 schools. Like many districts, LAUSD is also increasing education efforts, through courses offered in its parent-focused program well as student peer-to-peer initiatives in high schools.
Though Los Angeles Unified School District declined to comment for this story, the district recently announced that it would allow students to carry Narcan, a nasal spray type of naloxone. The other FDA-approved form of naloxone is injectable. Most districts currently hold naloxone in nursing or other offices, to be used only in the event of a suspected overdose.
The FDA announced in a notice last November that the agency’s preliminary assessment found some naloxone products may be suitable for over-the-counter approval. In a press release issued at the tie, FDA Commissioner Robert M. Califf said that the FDA “Supports… efforts to combat the opioid overdose crisis by helping expand access to naloxone.”
In February, an advisory committee to the FDA recommended the agency approve naloxone nasal spray to be sold over the counter and without a prescription. The FDA could issue a decision as early as this month.
Since 2017, Direct Relief has distributed more than 2.3 million doses across the U.S. during the opioid crisis.