Schools stock up on opioid overdose drug
Some say resources are needed elsewhere
GLEN BURNIE, Md.– It was nearly two weeks before school opened, and Anne Arundel County’s school nurses were already getting quizzed.
The scenario: An 8-year-old boy is acting strange and sleepy. His pupils are tiny and his breathing is labored. How would they treat him?
The newly hired nurses and nurse assistants voiced mixed opinions. Then the supervisor overseeing the training session in a Maryland county walloped by the opioid epidemic made a suggestion: the overdose-reversal drug Narcan.
“What do we have to lose?" Maureen Neall asked.
Nearly 50,000 Americans died from opioid overdoses last year – more than from car accidents. Now schools across the nation are preparing for
Overdose deaths among people ages 15 to 24 jumped nearly 33 percent from 2015 to 2016.
Centers for Disease Control and Prevention
what some believe is inevitable: overdoses at schools.
High schools, middle schools and even some elementary schools are stocking nurses' offices with naloxone or Narcan, the brand name for the nasal spray version of the injectable drug. Some have been required by new state laws to keep the drug on hand.
Advocates liken the effort to having the lifesaving allergy drug EpiPen or portable defibrillators for cardiac arrest.
Only a matter of time
But critics question the need. Some say the effort would be better directed toward communities and institutions that see more overdoses.
“I have not seen a single data point that an overdose happened at a school,” said Eliza Wheeler of the Harm Reduction Coalition in Oakland, California. “The problem here is how they came up with that – investing millions of dollars into a problem with no data to know whether it is even happening."
No federal agency tracks overdoses at schools, but it’s clear teens and young adults in big cities and small towns alike are dying from heroin and, increasingly, the more powerful synthetic opioid fentanyl. Overdose deaths among people ages 15 to 24 jumped nearly 33 percent from 2015 to 2016, according to the Centers for Disease Control and Prevention. Preliminary numbers from 2017 show that total overdose deaths surged still higher but do not include deaths by age groups.
Nurses who work with students daily say it's only a matter of time before a community's ills spill over to its schools.
Karen Siska-Creel, director of school nursing at the Anne Arundel health department, pushed to get naloxone in schools because overdose deaths in the county near Baltimore were skyrocketing.
“I knew what was going on in the nation and our state,” she said. “I figured whatever is going on in our county will be in our schools.”
In 2015, Siska-Creel created the county’s overdose prevention training initiative, the first school program certified by the state of Maryland. She secured $12,500 in public funds to buy two doses of Narcan for each of the county’s 125 schools, and she trained nurses and support staff on how to administer the drug.
Ten days after the program launched in early 2016, Siska-Creel said, a teen student appeared in a school health center “acting funny.” The girl began to fade; within minutes she was not responding to questions.
The school nurse administered two doses of naloxone. The student recovered, Siska-Creel said, and was taken to a hospital for follow-up care.
Anne Arundel schools have used naloxone three more times on students, one a high school student who was nodding off in class last year.
What started with one determined nurse in one
“I knew what was going on in the nation and our state. I figured whatever is going on in our county will be in our schools.”
Karen Siska-Creel Director of school nursing at the Anne Arundel health department
county has become a statewide requirement. The Start Talking Maryland Act, passed by theMaryland General Assembly last year, requires all public schools to carry naloxone and to teach students about the dangers of heroin and other opioids.
The state appropriated $3 million to pay for naloxone, opioid education and other requirements. Now counties must report the number of times naloxone has been administered at schools. Anne Arundel is the only school district that has used the antidote since 2017, a state education official said.
New Jersey passed legislation this year that requires all high schools – public, private and charter – to stock naloxone. It authorizes school nurses to administer up to three doses of naloxone to a student, staff member or visitor without fear of prosecution.
"Our first goal was to stop these deaths," said Assemblyman Vincent Mazzeo, who sponsored the legislation. "This epidemic is hitting all forms of life here.”
But across the Hudson River, schools in New York City are taking a different approach.
With no known overdoses at school during regular school hours since 2005, city education officials say they do not see the need to stock the antidote at every school. City schools offer substance abuse education and intervention services as well as mental health programs for students and their families.
At least 10 states have passed legislation about naloxone in schools. Some states such as Maryland, New Jersey and Rhode Island require schools to stock the antidote. More often, states allow a local school board or superintendent to decide.
"It's a community decision," said Donna Mazyck, executive director of the National Association of School Nurses.
Critics say scarce resources should be steered toward groups that face greater risk of overdose.
Corey Davis, senior attorney at the National Health Law Program, cited examples such as paroled inmates with histories of drug abuse or opioid-dependent people in abstinence-based treatment programs.
Wheeler, of the Harm Reduction Coalition, said the key to reversing overdoses is giving naloxone directly to drug users. "People use drugs with other people who use drugs – or alone," she said. "They are the ones witnessing overdoses."
But she said it's difficult for an organization like hers to pay for enough naloxone to cover drug users on the street or in at-risk communities. Some organizations have resorted to bake sales to raise money.
"We often joke: 'At least we know where all the naloxone is being kept,'" Wheeler said. "It's in the schools."
'He had life in his eyes'
Others defend the idea of naloxone in schools, even if the drug is not frequently used.
Toni Torsch of Baltimore County, Maryland, has advocated for wider distribution of naloxone, compassionate laws and public investment in fighting the opioid crisis since her 24-year-oldson died from an overdose in 2010.
Daniel Carl Torsch started using OxyContin at 17. He eventually turned to cheaper heroin in what became a seven-year battle that included four stays at inpatient treatment centers.
On Dec. 3, 2010, Torsch thought her son was in a good place. He had completed a long-term rehab stint in Florida and seemed healthy and happy.
"He had life in his eyes," Torsch said. "I had my boy back."
But as she prepared to leave their home that day, she knocked on his bedroom door. There was no answer. She nudged the door open. He lay on a bed. No signs of life.
She did not know about naloxone when her son died. After she learned about the drug from a documentary, she advocated for its wider use. Now she says many others can be spared if they get the antidote in time or learn about the dangers of abuse before taking their first pill or injection.
"I found out later who he was getting his pills from – normal families. Right there in school," Torsch said.
In Anne Arundel County, Siska-Creel said she has heard many similar stories of mothers and fathers who have lost children.
She also hears from skeptics about stocking naloxone in schools.
"You know what? I am not going to wait for a child to die,” she said. “I am not willing to wait for that to happen."