Last year, a student fell unconscious after walking out of a bathroom at Central High School in Pueblo, Colorado. When Jessica Foster, the school district鈥檚 lead nurse, heard the girl鈥檚 distraught friends mention drugs, she knew she had to act fast.
Emergency responders were just four minutes away. 鈥淏ut still four minutes 鈥 if they are completely not breathing, it’s four minutes too long,鈥 Foster said.
Foster said she got a dose of naloxone, a medication that an opioid overdose, and gave it to the student. The girl revived.
Forty-five miles away in Colorado Springs, Mitchell High School officials didn鈥檛 have naloxone on hand when a in class in December 2021 after snorting a fentanyl-laced pill in a school bathroom. That student died.
Colorado Springs鈥 school district has since joined Pueblo and dozens of other districts in the state in supplying middle and high schools with the lifesaving medication, often known by one of its brand names, Narcan. Since passage of a 2019 state law, Colorado has had a program that allows schools to obtain the medicine, typically in nasal spray form, for free or at a reduced cost.
Not all schools are on board with the idea, though. Though more districts have signed on , only about a third of Colorado districts had enrolled in the state鈥檚 giveaway program at the start of this school year. And within the dozen counties with the in the state, many school districts had not signed up in the face of ongoing stigma around the need for the overdose reversal medication.
The federal Substance Abuse and Mental Health Services Administration recommends that schools, including elementary schools, as , particularly from the potent drug fentanyl. And 33 states have laws that expressly allow schools or school employees to carry, store, or administer naloxone, according to Jon Woodruff, managing attorney at the , which tracks naloxone policies across the country.
Among those, about nine states require at least some K-12 schools to store naloxone on-site, including Illinois, whose requirement goes into effect in January. Some states, such as Maine, also require that public schools in how to administer naloxone in nasal spray form.
Rhode Island requires all K-12 schools, both public and private, to stock naloxone. Joseph Wendelken, a spokesperson for the Rhode Island Department of Health, said in the past four years naloxone was administered nine times to people ages 10 to 18 in educational settings.
In early September, the medication also became available over the counter nationally, though the $45 price tag per two-dose package has some addiction specialists worried it will be for those who need it most.
But the medicine still isn鈥檛 as publicly widespread as automated external defibrillators or fire extinguishers. , president of the National Association of School Nurses, said reluctance to stock it in schools can stem from officials being afraid to provide a medical service or the ongoing cost of resupplying the naloxone and training people to use it. But the main hang-up she鈥檚 heard is that schools are afraid they鈥檒l be stigmatized as a 鈥渂ad school鈥 that has a drug problem or as a school that condones bad choices.
鈥淪chool districts are very careful regarding their image,鈥 said Yunuen Cisneros, community outreach and inclusion manager at the , which serves most of the state鈥檚 school districts. 鈥淢any of them don't want to accept this program, because to accept it is to accept a drug addiction problem.鈥
That鈥檚 the wrong way to think about it, King said. 鈥淲e really equate it to our stock albuterol for asthma attacks, our stock epinephrine for anaphylactic reactions,鈥 she said.
Colorado health officials could not say how often naloxone had been used on school grounds in the state. So far this year, at least 15 children ages 10 to 18 have died of fentanyl overdoses but not necessarily in schools. And in 2022, 34 children in that age group died, according to the state Department of Public Health and Environment. That included 13-year-old Jos茅 Hern谩ndez, who from a fentanyl overdose at home just days after starting eighth grade at Aurora Hills Middle School. His grandmother found his body over the bathroom sink in the early morning.
With the arrival of this new school year, supplies of naloxone are on hand for kids in more Colorado schools. Last year, state lawmakers appropriated $19.7 million in federal aid to the , which is accessible to school districts, jails, first responders, and community service organizations, among others.
鈥淚t鈥檚 the most we鈥檝e ever had,鈥 said Andr茅s Guerrero, manager of the state health department鈥檚 overdose prevention program.
According to data provided by Colorado鈥檚 health department, 65 school districts were enrolled in the state program to receive naloxone at low or no cost at the start of the school year. Another 16 had reached out to the state for information but hadn鈥檛 finalized orders as of mid-August. The remaining 97 school districts either didn鈥檛 stock naloxone at their schools or sourced it from elsewhere.
Guerrero said the districts decide whom to train to administer the medicine. 鈥淚n some cases, it's just the school nurses. In some cases, it's school nurses and the teachers,鈥 he said. 鈥淎nd in some cases, we have the students as well.鈥
In Durango, the 2021 galvanized students to push for the right to carry naloxone with them to school with parental permission 鈥 and to administer it if need be 鈥 without fear of punishment.
It took a school board meeting to get permission, said Hays Stritikus, who graduated this spring from Durango High School. He鈥檚 now involved in drafting legislation that would expressly allow students across the state to carry and distribute Narcan on school grounds.
鈥淭he ultimate goal is a world where Narcan is not necessary,鈥 he said. 鈥淏ut that's just not where we live.鈥
Some health experts disagree that all schools should stock naloxone. , a health economist at Western University in Canada, of naloxone in secondary schools there. While opioid poisonings have occurred on school grounds, she said, high schools tend to be really low-risk settings.
More effective strategies for combating the opioid epidemic are needle exchange sites, supervised drug consumption sites, and medication-assisted treatment that reduces cravings or mutes highs, Cipriano said. But those approaches can be expensive compared with naloxone distribution.
鈥淲hen the state makes a big, free program like this, it looks like they're doing something about the opioid epidemic,鈥 she said. 鈥淚t's cheap and it looks like you're doing something, and that's, like, political gold.鈥
Denver Public Schools, the largest school district in Colorado, started stocking naloxone in 2022, said Jade Williamson, manager of the district鈥檚 healthy schools program.
"We know some of the students are on the forefront of these things before older generations,鈥 Williamson said. 鈥淭o know where to find it, and to access it when needed through these adults who've trained, whether that's a school nurse or a school administrator, I think it brings them some sense of relief."
The state鈥檚 seven largest districts, with more than 25,000 students each, all participate in the state program. By contrast, a 蘑菇影院 Health News analysis found, only 21% of districts with up to 1,200 students have signed up for it 鈥 even though many of those small districts are in areas with drug overdose death rates higher than the state average.
Some school districts figured out a path to getting naloxone outside of the state program. That includes Pueblo School District 60, where lead nurse Foster gave naloxone to a student last year.
The Pueblo school district gets naloxone at no cost from a local nonprofit called the . Foster said she tried signing up for the state program but encountered difficulties. So she decided to stick with what was already working.
Moffat County School District RE-1 in Craig, Colorado, gets its naloxone from a , according to district nurse Myranda Lyons. She said she trains school staffers on how to administer it when she teaches them CPR.
Christopher deKay, superintendent of Ignacio School District 11Jt, said its school resource officers already carry naloxone but that the district enrolled in the state program, too, so that schools could stock the medication in the nursing office in case a resource officer isn鈥檛 around.
鈥淚t鈥檚 like everything 鈥 like training for fire safety. You don鈥檛 know what鈥檚 going to happen in your school,鈥 said deKay. 鈥淚f the unthinkable happens, we want to be able to respond in the best way possible.鈥
This story was produced with reporting assistance from .
