In School Nurse’s Room: Tylenol, Bandages and an Antidote to Heroin


A naloxone kit at Washingtonville High School in Orange County, N.Y. 

At every school in New Rochelle, just north of the Bronx, in Westchester, there is a locked medicine cabinet in the nurse’s office, stocked with things like EpiPens for allergic reactions, inhalers for asthma, Tylenol for aches and pains.

Now, those cabinets also include naloxone, an antidote for people who are overdosing on opioids like heroin. Given as an injection or a nasal spray, naloxone can quickly revive someone who is not breathing. The city keeps it in every nurse’s office, including in its elementary schools.

“We have it the same way we have defibrillators and EpiPens, the way we have oxygen in our schools,” said Dr. Adrienne Weiss-Harrison, the school district’s medical director. “Rarely do we pull a defibrillator off the wall, but it’s there if we need it, and that’s how we approach this opportunity to have naloxone.”

There is no comprehensive data on how often students overdose while at school, but it happens. Renee Rider, assistant commissioner at the New York State Education Department, said the department has heard anecdotally of two schools where a student overdosed and was saved by E.M.S. workers using naloxone

But the numbers of young people dying from overdoses around the country is striking. According to the Centers for Disease Control and Prevention, in 2015, opioids killed 7,163 people between the ages of 15 and 29, more than 20 percent of total deaths.

And as communities across the country face this swell of death from heroin and pills, schools see the epidemic lapping at their doorsteps — killing friends, neighbors, recent graduates. Educators are increasingly deciding that they should have naloxone on hand.

New Jersey Assemblyman Vincent Mazzeo, a Democrat, in the fall sponsored a bill in the state legislature that would require all high schools to stock naloxone. In talking to parents and students in his district, Mr. Mazzeo said, “It came out that kids were coming into school on opiates, perhaps on heroin.”

Without the antidote, “If a kid comes into school and he overdoses, they don’t have the proper tools. They’d have to wait for E.M.S. first responders to come.”

Now, in Massachusetts and Kentucky, Connecticut and New Mexico, schools have the drug for emergency use. New York State has a program that provides it free to schools, with 64 districts participating so far. In Pennsylvania, nearly 250 public and charter schools have received a free supply. In Rhode Island, every middle school, junior high and high school is required to have naloxone on the premises. And scattered around the country, there are schools and districts that have bought the medication on their own.

“It is absolutely a sad sign of the times,” said Roy Reese, superintendent of Washingtonville Central School District in Orange County, N.Y. “I say this not reluctantly, but sadly: it is only a matter of time.”

Naloxone has been available for more than 40 years, and for much of that time, it was largely found in hospitals. But it has become increasingly common outside of them as the opioid epidemic has spread, and is now often found at the fingertips of law enforcement officers. In recent years, laws have changed to allow schools to keep it on hand and administer it to whoever needs it. In New York, for example, public health law was amended in 2015 to authorize school employees to administer naloxone.

Brian Connolly, principal of Washingtonville High School. The school keeps naloxone in the nurse’s office and with Mr. Connolly’s secretary. 

Through the state’s program, New York schools can now receive two doses of generic intranasal naloxone in a little nylon bag; the kits cost about $66, the State Health Department said, though schools get them for free. The drug is also available under the brand name Narcan, which is a nasal spray, and Evzio, which is an auto-injector like an EpiPen. Evzio is the most expensive, with a list price of $4,100, according to Kaléo, the company that makes it.

New York City schools are not stocking it because, officials said, they “have not seen the need.”

Many schools have chosen to stock Narcan because they can get it for free. A partnership between Narcan’s producer, Adapt Pharma, and the Clinton Foundation, offers any high school in the country two free doses of Narcan. Adapt Pharma covers the cost of the medication, and the Clinton Foundation does outreach to schools and districts. In an indication of the reach of the epidemic, President Clinton said last year that three of his friends had lost children to opioid overdoses.

An Adapt Pharma spokesman said about 1,300 units have been distributed so far to schools in 15 states, including Pennsylvania, Massachusetts, Kentucky, Delaware and New Hampshire. After the free supply runs out, schools can buy more for $75 a carton, which contains two doses. The list price for that amount is $125, Adapt said.

“I don’t see this as a big land-grab for market share,” said Daniel Raymond the deputy director of policy and planning at the Harm Reduction Coalition, which provides trainings on health issues related to drug use. “Ultimately, schools are going to be a niche market compared to other purchasers of naloxone.”

Kathleen Neelon, the nursing coordinator for the Wallingford, Conn., schools, said that in recent years, there has been an alarming numbers of overdoses among young adults in the area, so the district decided to stock Narcan for its high schools. They keep it in an emergency kit, which is filled with things like quick-clotting gauze and a blood pressure cuff.

“We instituted it in December, and I hope we never have to use it” Ms. Neelon said. The school sent out a notice to parents about the decision, and there were stories on the local news, she said, but she knew of no pushback from the community. “Most people said, it’s a sad statement, but it’s better to be prepared than not.”

Some observers wonder if the reaction would be different if schools were stocking an antidote to a different drug, like crack cocaine. The crack epidemic was particularly acute among black people, while the opioid epidemic has hit white people especially hard. Much has been written about how race has impacted the nation’s reaction to the opioid epidemic.

“If there was an antidote to crack, the argument would be we should just kick these people out of school, rather than trying to deal with them in the school system,” said Mr. Raymond of the Harm Reduction Coalition. “It would be about getting tough, cracking down, kicking them off of sports teams and expelling them.”

In many school districts, educators say the severity of opioid problem has overwhelmed any concerns they might have about the optics of naloxone.

Mark Marrone, superintendent of Mainland Regional High School in southern New Jersey, said he knows of several Mainland graduates who overdosed and died in their 20s, and one who overdosed and survived after being given naloxone. If the worst happens at his school, he said, he plans to be prepared.

“Some people worry that this says, ‘Oh, there are drugs in the schools,’” Mr. Marrone said. “No, there are drugs everywhere. We want to teach kids the right way to respond.” And maybe, he continued, “you’ll save a life.”

Source:www.nytimes.com

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