'It's a no-brainer': Rising adolescent overdoses prompt calls for schools to stock naloxone

School nurse Katie Straub felt the weight of each second go by as she waited for paramedics to arrive. A student had overdosed on opioids, and the school didn't have naloxone, a drug that counteracts the effects of an opioid overdose.

"It was horrendous," said Straub, a nurse for Tucson Unified School District, the largest school district in Tucson, Arizona. "Nothing feels worse than standing by watching, not really able to do anything."

Paramedics were able to save the student's life with a dose of naloxone. Motivated by the incident and rising adolescent overdoses nationwide, the school district decided in 2019 to stock naloxone. Later, when another student overdosed, Straub said health staff members were able to "quickly and easily" administer Narcan — a name brand of naloxone typically in the form of a nasal spray.

"The kid came around immediately," she said. "It was night and day. It was such a huge relief and maybe saved a life."

Experts have noticed a surge in adolescent opioid overdoses, and school health staffs nationwide are searching for ways to treat students who have overdosed. Overdoses by students in two Connecticut schools this year renewed calls by researchers and advocates for schools to have naloxone and offer training on how to recognize and respond to overdoses.

“It’s about emergency preparedness,” said Linda Mendonca, president of the National Association of School Nurses. “This is just another one of our tools in the toolbox for keeping kids safe.”

In Hartford, Connecticut, a 13-year-old student at the Sports and Medical Science Academy died in January from fentanyl overdose. A month later, less than 10 miles away at Bloomfield High School, a 16-year-old survived an apparent fentanyl overdose and was released from the hospital the same day. The Blooomfield student received naloxone, NBC News reported

“I don't know for sure if the child who died in Hartford Public Schools would have been saved by naloxone,” said Dr. J. Craig Allen, vice president of addiction services for Hartford HealthCare’s Behavioral Health Network. “But there's that possibility that it would have made that difference.”

Fighting the 'primary driver' of increasing opioid deaths

Experts say traces of fentanyl have been found in marijuana, cocaine, illicit pills and other drugs, fueling record levels of fatal overdoses nationwide, including among young people.

Synthetic opioids like fentanyl are “the primary driver” of increasing opioid deaths, according to the U.S. Drug Enforcement Administration.

Teen deaths from fentanyl nationwide have tripled in two years, according to a 2022 report by the nonprofit Families Against Fentanyl. The analysis, based on data from the Centers for Disease Control and Prevention, found 374 deaths from fentanyl among teens ages 13 to 19 in the year ending May 2019. That number grew to 1,365 deaths in the year ending May 2021.

MORE DATA:Adolescents and young adults lost more than 1.25M years of life to drug overdose deaths in 4 years

Fentanyl is faster-acting, more potent, and more addictive than other opioids, said Caleb Banta-Green, principal research scientist at the Addictions, Drug & Alcohol Institute at the University of Washington School of Medicine. While opioid overdoses once took many minutes to hours to cause death, someone overdosing on fentanyl can die within minutes or seconds, he said.

The synthetic opioid is also easier and cheaper to produce and distribute than other drugs, which has led to an “unprecedented influx” of it, he added.

By contrast, Banta-Green, who in December published a report that noted the rise of fentanyl-related deaths among people under 30 years old in Washington state, called the cost of naloxone "obscene and offensive." It can be about $75 for one kit, an issue that needs to be addressed "by the manufacturer or the government stepping in to address cost," he added.

“We need to make access to effective treatment medications and treatment easier than getting the drugs that are killing people,” he said.

How many schools have naloxone?

Nora Volkow, director of the National Institute on Drug Abuse, also acknowledged “alarming” increases in mortality rates among teens using opioids.

She advocated for naloxone in an interview with USA TODAY. 

“It's a very safe drug and it saves lives,” Volkow said. “Why should we not want it to be more accessible? It's a no-brainer.”

Seven states — Washington, Oregon, Arizona, Tennessee, Maryland, Rhode Island and Connecticut — require some schools to have naloxone policies with Connecticut only requiring such policies for higher education, according to an August 2020 report by the nonprofit advocacy group, the Legislative Analysis and Public Policy Association.

But there is no national data on how many schools have naloxone or training programs that teach staff members how to recognize the signs of overdose, Volkow said. More data is needed to fully understand how prevalent adolescent opioid overdoses are, she said.

In 2016, the National Association of School Nurses put out a position statement encouraging naloxone in schools. The association also has an online naloxone toolkit for school nurses.

NASN President Linda Mendonca suggested school nurses wanting their schools to start stocking naloxone use the position statement as support.

“School nurses should be advocating for the safety of students, whether it be in your school or at the state legislature,” she said. “We all have a role to play here. We need school nurses to advocate and to help protect their school communities.”

The nonprofit Overdose Lifeline, Inc. in Indianapolis has been distributing naloxone statewide since May 2020, but very few local schools have requested naloxone kits, said executive director Justin Phillips. Phillips said school officials may worry about how parents and community members may perceive them if they choose to stock naloxone.

“There's a belief that this can't happen to you, that this can't happen in your school. But it can,” she said.

Instead, Phillips said schools should treat naloxone as an emergency measure much like they treat having fire extinguishers, defibrillators and CPR training.

Naloxone training efforts

Overdose Lifeline recently launched an online training course focusing on substance use and opioids. The organization is working to tailor the program specifically to school nurses, Phillips said. It also offers youth drug prevention programs to help students learn about the risks of fentanyl. The programs offer fentanyl test strips to help identify if there are traces of the opioid in a substance.

Banta-Green said Seattle and other cities in Washington are installing naloxone vending machines. King County, the most populous county in the state, also offers a mail-order naloxone program for people to order naloxone anonymously. Banta-Green said his team has done training with school nurses in the past and is working to add school-specific content to their website’s resource list.

In Hartford, where the 13-year-old student died of apparent fentanyl overdose in January, school officials launched a series of online discussions with parents, officials and community organizations, Superintendent Leslie Torres Rodriguez said in a statement to USA TODAY. Hartford Public Schools distributed naloxone to all schools and trained school nurses, administrators and security officers on how to administer it.

Allen from Hartford HealthCare testified in front of Connecticut's state legislature Tuesday in favor of a bill aiming to off school districts grants to stock opioid antagonists like naloxone.

After naloxone is used, Allen said the school’s role isn’t over. They should also follow up with the student’s family to share treatment options and resources, he said. Prevention is also important and should center around helping young people learn how to manage their mental health and emotional and physical pain, he added.

“First and foremost, we need naloxone in schools and in the community,” Allen said. “...But naloxone is not treatment. We need to look at the underlying causes and invest in our intervention programs and address a crisis in children's mental health that's only gotten worse with COVID.”

Contact News Now Reporter Christine Fernando at cfernando@usatoday.com or follow her on Twitter at @christinetfern.