March 24, 2022 — Raagini Jawa, MD, was high schooler in a small New England town when she experienced firsthand the shock and grief of a deadly drug overdose. Jawa lost a close friend — a classmate who had been to her house for countless dinners and sleepovers.
That was 15 years ago. Since then, the problem has become even deadlier and more widespread, she says.
“You would think drug use would not be prevalent in these small communities, but it is. And it’s almost invisible,” says Jawa, who is now an infectious disease and addiction medicine specialist at Boston Medical Center. “The rate of unintentional overdoses has skyrocketed. Fatal overdoses aren’t just adults — more and more we’re seeing teenagers dying.”
Schools are acting in response to the increase in overdoses among teens. In Oregon City, OR, a city of 37,000 south of Portland, the local school board this month approved school officials to use naloxone, a lifesaving medicine, also known by its brand name Narcan, that can reverse an opioid overdose. The move was prompted by the fatal overdoses of two Portland teenagers.
High schools in Tucson, AZ, began stocking naloxone in 2019 after a student overdosed on opioids — and was revived by emergency responders — while in school.
A 13-year-old in Hartford, CT, died in January after overdosing at his school on fentanyl, a synthetic opioid that is 50 times stronger than heroin and 100 times stronger than morphine. The school did not have a naloxone supply, and the tragedy renewed national conversations about Narcan in schools that in recent years has taken a backseat to the COVID-19 pandemic.
As of August 2020, a total of 20 states had passed laws allowing naloxone in schools, according to the Legislative Analysis and Public Policy Association. Although it is often left up to school boards, states including Maryland, New Jersey, and Rhode Island require that schools keep it on hand.
“It’s a wonderful thing to get more Narcan out in the community,” says Ryan Marino, MD, an addiction specialist at Case Western Reserve University. “There has been an increase in overdoses, and fentanyl is the primary driver.”
Though most people agree with the presence of Narcan at schools — which can be given nasally or injected — he says some believe having a safety net will encourage students to use drugs.
But Marino likens the measure to having defibrillators nearby for cardiac emergencies and fire extinguishers.
“You want these things to be there just in case, and you hope you’ll never have to use them,” he says.
According to the CDC, the number of drug overdose deaths has quadrupled since 1999, and increased by 5% from 2018 to 2019. More than 70% of the 70,600 overdose deaths in the United States in 2019 involved an opioid. People ages 15 to 24 had the largest increase in drug overdose death rates from 2019 to 2020, at 49%.
Marino says that while some people intentionally take fentanyl for the potency, it is often added to pills and heroin without the user’s knowledge.
Members of the National Association of School Nurses, which has long been a proponent of Narcan in schools, hope that more school boards take action and secure a supply of naloxone, says association president Linda Mendonca.
The association has created a toolkit that provides information on how to advocate for the use of Narcan and the proper way to administer it.
“Schools need to be prepared, whether it’s a student, staff member, or visitor,” Mendonca says. “I think and hope it will catch on elsewhere. We’ve been buried under this COVID-19 pandemic, and things get pushed aside, but there are other things going on. Schools are a great place to educate about this and provide resources.”
But there is much more to be done, says Jawa.
Though having a drug overdose antidote on school property is crucial, she says there must be more access across communities in public areas.
“It’s so important that students get knowledge and tools about how to keep themselves and their loved ones safe,” Jawa says. “This is a great first step. I think hopefully, this will help get naloxone to other low-barrier access points, like grocery stores or movie theaters.”