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The first Naloxone vending machine in New Hampshire, April 2024.
Since 1999, drug overdoses have killed more than a million people in the United States. Opioids are responsible for 72 percent of those deaths. In 2023 alone, more than 80,000 people in the United States died due to an opioid overdose. These overall numbers are alarming for our nation, but the tragic loss of children and adolescents to opioids in particular receives far less attention than it deserves. The United States lost, on average, twenty-two adolescent lives to an overdose every day in 2022.
U.S. efforts to reduce drug usage among adolescents date back to the early 1980s, when the Drug Abuse Resistance Education (D.A.R.E.) and “Just Say No” campaigns rose to teach students about substance abuse and tell them to refuse drugs if offered. The campaigns’ premises were simple, but ultimately ineffective. Students continued to turn to drugs for a variety of reasons, including peer pressure, trauma or conflict at home, and stress from school and classmates.
The opioid epidemic in particular began to take hold in the mid-1990s, when pharmaceutical companies pushed for the over-prescribing of opioids and downplayed the risks of addiction. Since then, the fatality of drug usage has skyrocketed due to the increased use of fentanyl, a potent opioid that can easily cause an overdose even in small quantities.
It has proven difficult to tell students to stop using drugs altogether, since a complexity of factors contribute to drug usage. One approach is to try to teach students the skills they need to be safe if they do choose to use drugs, a concept known as “harm reduction.” A significant breakthrough occurred in 2023 when naloxone, an opioid antagonist that can rapidly reverse an opioid overdose, became available over-the-counter as Narcan.
But when a child is at school, where can they find Narcan? As of 2023, thirty-three states have laws that allow schools to keep naloxone on hand, but it is mainly stored in private areas managed by staff and away from students, such as the nurse’s office.
Imagine a student is overdosing on opioids in the bathroom. In the time that it takes for a friend to go to the nurse’s office, tell a staff member about the situation, and have the adult come into the bathroom to administer Narcan, the student could be dead. When responding to an overdose, Narcan must be given within five minutes to prevent brain damage and within eight minutes to prevent death. Students should call 911 and get medical professionals involved, but it is also critical that Narcan is available to students to respond immediately in an overdose situation.
Many states throughout the country require all schools to have an automated external defibrillator (AED) on campus for everyone to use, including students, because it is important that everyone can access the life-saving device in an emergency situation. Under similar principles, Narcan should be placed in openly accessible containers throughout schools, whether that is inside an AED kit or through the installation of special naloxone kit containers called NaloxBoxes.
Jennifer Knight-Levine, the co-founder and CEO of the SAFE Coalition, has collaborated with the District Attorney’s office in Norfolk County, Massachusetts, to distribute more than 100 NaloxBoxes across the county, with more than half being placed in public schools.
“We have seen an increase in overdoses on school grounds, most often related to parents or adults who are on school property,” she explains. “Utilizing the NaloxBoxes has saved lives on school grounds.”
Arlington, Virginia, has also garnered significant media attention for its leadership in increasing naloxone access to students, becoming one of the first communities to teach students how to use naloxone and allow them to carry it with them to school. Additionally, there are now Windy City Non-Locking Overdose Emergency Kit Cabinets in every middle and high school in Arlington Public Schools. Emily Siqveland, the opioid response coordinator in Arlington County, emphasizes that students have said the increased accessibility of naloxone makes them feel safer and more prepared at school. She also highlights the role that the community played in making this initiative a reality.
“One of the primary reasons we have naloxone in our schools is because parents and students advocated for it,” Siqveland says. “Parents’ and students’ voices can make so much more of a difference than they realize.”
Parent pushback is likely one of the largest barriers that schools will face in expanding access to naloxone for students. Parents may believe that because they believe their child doesn’t use opioids, there is no need for them to learn about naloxone. But even if a child does not use opioids, they may encounter those who do in their school, extracurricular activities, or community, and knowing how to administer naloxone could allow them to save the life of a person that is overdosing.
Additionally, recent years have seen an increase in fentanyl-laced prescription pills in the drug supply, with up to 60 percent of fake prescription pills containing a potentially lethal amount of fentanyl. According to Dr. Scott Weiner, McGraw Distinguished Chair in Emergency Medicine at Brigham and Women’s Hospital in Massachusetts, many young people are consuming fentanyl without even knowing it.
“What we’re seeing is a rapid change in the epidemiology of overdose,” he explains. “Now, we are seeing fentanyl in pressed pills that are fairly easy for adolescents to access. The unfortunate thing is that they look just like pharmaceutical-grade drugs so someone may assume it came from a medicine cabinet, but they’re actually not. This means that overdose can even happen to someone who doesn’t have an addiction or opioid use disorder.”
Jennifer Tracey, Chief Program Officer of RIZE Massachusetts, says that increasing accessibility to naloxone is key in addressing the stigma associated with substance use. Making naloxone more visible and normalizing conversation around it raises awareness on the topic and opens up more avenues for students who are struggling with addiction to reach out for help.
“If young people know that they can reach out to an adult in the school to talk about their own substance use or that of a family member,” Tracey says, “I think all of that plays into the role of having naloxone accessible and available.”