At Johnnie Cochran Middle School in Los Angeles this spring, three students suffered from a suspected overdose on the same day. School personnel quickly sprayed a substance up the noses of the children, and they revived. They were taken to the hospital as a precaution, but all three recovered.
The life-saving substance? Naloxone – a nasal spray also sold under the brand name Narcan — that works to reverse the effects of opioids.
Most often it works to combat fentanyl, a drug that is up to 50 times more potent than heroin. The fentanyl crisis around the country has created special challenges for schools and is having tragic consequences for young people.
"Never would I have imagined that students would today have contact with a substance where even just a small bit of a pill could kill you," says Alberto Carvalho, superintendent of the Los Angeles Unified School District.
LAUSD, the second largest district in the country, is an early adopter of using naloxone in schools. The 2022-23 school year was the first year they stocked it in all schools. The move came in response to a 15 year-old student dying from an overdose in a school bathroom nearly a year ago.
Last school year, naloxone was administered 31 times in the school system. "That's 31 times that we possibly saved a life," Carvalho says.
Which may sound like a big number, but in the Prince George's County, Md., schools outside Washington, D.C., officials there used it even more.
"I'm going to say 45," says Richard Moody, the director of alcohol, tobacco and drug prevention intervention for the district. That's more than once a week.
Prince George's County officials are trying to get naloxone everywhere they can. This year is the first time it's officially in all of its schools, and, like LAUSD, the district is now allowing students to carry the spray themselves.
The medicine itself is a small nose spray that experts say is easy to dispense. It's a fast-acting counteragent to an opioid overdose. In some places – including public libraries in large cities like Chicago and Philadelphia, it's available for free.
A national movement to get naloxone in schools is gaining momentum. An NPR analysis found that, last school year, only 5 of the 20 largest school districts in the country stocked naloxone in all of their schools. This year, 11 of 20 do. Three more told NPR that getting the medicine in every school is a priority.
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A dangerous game
That's because fentanyl is killing kids at an alarming rate. In 2021, the drug was involved in the large majority of all teen overdose deaths – 84% – according to the Centers for Disease Control and Prevention. Fentanyl-related overdose deaths among adolescents nearly tripled from 2019 to 2021, with nearly a quarter of those deaths involving counterfeit pills.
"But we know that all of the circumstances and things we look at are underestimates," says Julie O'Connell, an epidemiologist and lead author on the CDC's most recent report on counterfeit pills.
She says that, for a particular incident to be counted in their data, there has to be physical evidence at the scene, or a witness has to come forward.
In short, there are lots of cases falling through the cracks: "We know that it's a bit higher," than what CDC reports, O'Connell says. "We just don't know how much."
How to train a community
The CDC firmly encourages naloxone as a solution for a suspected overdose, and provides fact sheets and training materials on its website. Training to dispense the drug is a large part of the challenge schools face in adopting it.
"It's not as simple as just saying, 'Hey, we're going to have Naloxone in our school tomorrow,' " says Kate King, a school nurse in Columbus, Ohio, and the president of the National Association of School Nurses. She looks at the drug as a tool – but a tool that requires procedures and protocols.
Some districts agree. Michael Ollendorff, a spokesperson for the Orange County public schools in central Florida, said his immediate response to the question of whether or not the district stocks naloxone was "no." But later, he explained that at least one person on school grounds does have it – the school resource officer. SROs in Florida are law enforcement officers who partner with the school. The schools themselves, including the nurses, don't keep naloxone on hand, Ollendorff said.
In Prince George's County, Moody agrees that training is important, but thinks that the knowledge should be spread as far and wide as possible. He has spent the past few years trying to get that training out to as many community members as possible – visiting 80 schools.
To him and many educators, there's no time to waste.
