Commentary: Naloxone Use in Schools: School Nurses on the Front Lines

Do school nurses REALLY need naloxone? The answer is YES. The data about drug overdose is alarming. The Centers for Disease Control and Prevention states, “The United States is in the midst of a prescription painkiller overdose epidemic.” Daily, 44 people will die from an overdose of prescription pain medication. The rise in deaths has mirrored the quadrupling of painkillers prescribed in the U.S.

Our youth are at risk and school nurses recognize the danger. The National Association of School Nurses (NASN) optimizes the health and learning of students by advancing the practice of school nursing. NASN keeps school nurses abreast of important issues affecting student and community health by publishing relevant position statements. In June of 2015, the NASN Board of Directors adopted a position statement supporting the emergency use of naloxone in a school setting.

Studies indicate that 1 in 4 teens have taken a prescription drug for reasons other than for what it was intended, and 18 percent of 12^th grade students report taking a prescription drug without a prescription. Recent data indicates that opioid related deaths in youth between the ages of 12-25 has either doubled, tripled or quadrupled in 35 states. More than 90 percent of adults who develop a substance use disorder began using before they were 18 years old. This data should be especially alarming to parents, school administrators and the community.

An overdose of opioids (either from prescribed opioid pain-relievers or heroin) decreases breathing and if not reversed, will cause death. While education and prevention is necessary to curb this epidemic, we must make every effort to prevent death from an overdose. School nurses are first responders in a school setting and should have as many available tools as they can to save lives. Naloxone is an opioid antagonist, and immediately reverses the life-threatening effect of an overdose.

Naloxone has been available for use in the U.S. since 1971 and directly targets opioid receptor sites reversing the cause of opioid related deaths, respiratory depression. It has no other action if opioids are not in the system. Naloxone is available for administration via two routes, intranasally and in an auto-injector to be given intramuscularly. Recognizing the life saving ability of naloxone, 40 states and the District of Columbia have provided easier access to naloxone in the community.

School nurses work to prevent potential emergencies, educating students and families on healthy behaviors and reducing risks. As first responders, school nurses are leaders in planning for and managing emergencies in the school setting. Early access to naloxone in the event of an opioid overdose can prevent loss of life and often is the first step in recovery in opioid abuse.

“This can’t happen to me,” “not my kid,” or “not in our school” are very scary words anyone, any parent or any school administrator can say. Addiction can happen to anyone, anywhere…it does not discriminate. NASN developed the naloxone statement to help school nurses save lives, just like they do with epinephrine for life threatening peanut allergies. No school nurse ever wants to have to give these medications but surely wants them on hand if an emergency arises. Our statement on the use of naloxone in schools has generated national media attention. We hope it will start conversations in homes, in schools and in communities about the dangerous addictive properties of opioid drugs, whether prescription or heroin. The body doesn’t know the difference and addiction to opioids can quickly spiral out of control. Lives are being taken too early; families are suffering from the devastation caused by the disease of addiction.

Nurses are identified as the most honest and ethical professional. School nurses are a powerful influence in school. We are who your children talk to and who they often turn to for answers. Know that we are on YOUR team. We help families prevent and deal with teen substance misuse. We are working to build healthier communities through education and advocacy but we need your help. Talk to your children and teens about appropriate use of all medication. Speak to your school nurse about what you can do to keep your child safe. Talk to your school administration about school efforts to address substance abuse. Attend educational opportunities held at your school and in your community. Demand that your school provide drug education as part of their health curriculum. Support naloxone and 911 Good Samaritan legislation in your community. Educate yourself even if you don’t ever think this will happen to you or your child. Please join forces with your school nurse to keep our kids safe, healthy and ready to learn.

Beth Mattey, MSN, RN, NCSN is President of NASN. Rebecca King, MSN, RN, NSCN, is a NASN Executive Committee Member and a board member of the grassroots organization “atTAcK addiction ” in Delaware.

Resources

CDC, 2013. High School Youth Risk Behavior Survey, 2013. Retrieved: https://nccd.cdc.gov/youthonline/App/Results.aspx?TT=&OUT=&SID=HS&QID=H56&LID=&YID=&LID2=&YID2=&COL=&ROW1=&ROW2=&HT=&LCT=&FS=&FR=&FG=&FSL=&FRL=&FGL=&PV=&TST=&C1=&C2=&QP=G&DP=&VA=CI&CS=Y&SYID=&EYID=&SC=&SO=

CDC, 2015a. Injury Prevention and Control: Prescription Drug Abuse. Retrieved: http://www.cdc.gov/drugoverdose/

CDC, 2015b. Data Overview. Retrieved: http://www.cdc.gov/drugoverdose/data/index.html

Felix, J. (2014) Teens Report Higher Use of Performance Enhancing Drugs. https://www.stage02.drugfree.org/newsroom/pats-2013-teens-report-higher-use-of-performance-enhancing-substances

Gallup, (2015) Gallup Poll: Honesty and Ethics in Professions. Retrieved: http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx

Healthday. (2011) “Addiction Starts Early in American Society, Report Finds. U.S. News and World Report Retrieved: http://health.usnews.com/health-news/family-health/childrens-health/articles/2011/06/29/addiction-starts-early-in-american-society-report-finds

The Network for Public Health Law. (2015) Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws. Retrieved from: https://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf

Trust for America’s Health, (2015) Reducing Teen Substance Misuse: What Really Works. Retrieved: http://www.healthyamericans.org/reports/youthsubstancemisuse2015

Wermeling, D. P. (2015). Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Therapeutic Advances in Drug Safety, 6(1), 20–31. http://doi.org/10.1177/2042098614564776