States are increasingly turning to schools as they work to stave off the devastating opioid epidemic, which is claiming a growing number of lives and ravaging the lifespans of middle-aged white people. Yet local laws prevent some districts from stocking a life-saving antidote, and critics worry it won’t discourage drug use.
A 2015 law in Rhode Island took the most aggressive approach by requiring all public middle, junior and high schools be equipped with naloxone, which reverses the effects of an overdose when someone passes out.
The lifesaving drug can be administered through an auto-injector called EVZIO or a nasal spray called Narcan. “The vision behind this move, to have naloxone in schools throughout the state, was part of work we are doing throughout Rhode Island to normalize naloxone and to really have people understand that addiction is a disease, that it impacts communities throughout the state and that anyone could have a substance abuse problem,” said Joseph Wendelken, spokesman for the state’s health department.
The drug has been used by police and emergency medical technicians for decades, but newer, easy-to-use devices have hit the market as the country is facing an opioid epidemic. Deaths from opioids reached more than 33,000 people in the U.S. in 2014, according to the most recently available data compiled by the Centers for Disease Control and Prevention.
New Jersey is considering a similar approach to Rhode Island, and other states have reduced barriers for allowing schools to administer the antidote without fear of getting sued. These states have said that if school staff are allowed to administer EpiPens to a student in anaphylactic shock, or inhalers to students with asthma, then staff should be allowed to rescue a student who is overdosing.
A bill introduced in Tennessee would require schools to come up with protocols for when students overdose. An Ohio law that took effect in March makes it easier for schools to get naloxone by waiving a licensing requirement, and a law passed last year in Michigan allows schools to carry it. New York Gov. Andrew Cuomo announced in 2015 that the state would spend nearly $300,000 to put naloxone in schools and to train staff on how to use it.
School nurses in Delaware are allowed to carry it and they distributed it after they received donations from Kaléo, the drug company that makes the auto-injector.
The National Association of School Nurses holds an official position that naloxone administration should be part of a school’s emergency and response plan. The group is supported by a grant from Adapt, the company that makes Narcan. Adapt also has partnered with the Clinton Foundation to offer 40,000 doses of the drug at no cost to high schools across the country, and has developed a similar initiative for colleges.
But some states, or individual districts, still face hurdles because they don’t have laws in place that would protect school staff from liability.
Opponents to making naloxone more available, meanwhile, say they are concerned that people who abuse drugs will continue their behavior if they know an antidote is available. In Maine, for instance, Republican Gov. Paul LePage has vetoed measures that would make naloxone more available, saying it would give drug abusers a false sense of security.
The drugs can cause severe withdrawal that leads people who use drugs to take them again shortly after being resuscitated, and people can sometimes become violent when they reawaken.
But defenders of expanding naloxone policies point out that drug overdoses may happen by accident involving someone who is taking a prescription opioid to treat pain, or by a school visitor. Children may also be experimenting in their parents’ medicine cabinet, or may be in a situation outside of school where they have to respond to an overdose.
“We launched these programs to not only provide schools this much-needed, community-ready naloxone, but also offer school administrators and nurses an opportunity to educate their students on the inherent risk in misusing an opiate,” said Thom Duddy, spokesman for Adapt, in an email. Duddy noted that the program also comes with a toolkit to educate school nurses and others about how to identify and respond to an opioid overdose.
Mark Herzog, vice president of corporate affairs for Kaléo, said the company hasn’t been actively involved in the legislative efforts to increase the use of naloxone in schools, but that it was pleased to see new laws increasing access. Kaléo has donated nearly 250,000 auto-injectors to a variety of organizations, including schools.
The list price for Narcan is $125. EVZIO is more expensive, with a list price of $4,100. Both come in packs of two. An increased demand has the potential to drive up prices, which could complicate the response to the opioid crisis in other settings. Baltimore, for example, is running low on naloxone.
“We are definitely keeping an eye on it,” Wendelken said about the potential of price hikes, “but the priority is making sure the medication is there that could save someone’s life.”
