School Nurses on Front Lines for Combatting Abuse

BY JAY P. GOLDMAN/School Administrator, August 2017

A growing number of school nurses’ offices are stocking naloxone injectors.
When it comes to knowing the ins and outs of students’ lives, no one in education may be better positioned than the school nurse. So it’s no surprise that some of the better resources available to school leaders in addressing the scourge of prescription drug abuse are being produced by their professional association.

Of special note, the 16,000-member National Association of School Nurses has created a practical toolkit for stocking and using naloxone, the most widely available medication to reverse the potentially lethal effects of an opioid overdose.

“School nurses are on the front lines when it comes to knowing what kids are dealing with, their physical and mental states,” says Rebecca King, director of nursing for the Delaware Department of Social Services Division of Public Health and a school nurse for 18 years. “Parents would be surprised to know what we learn about kids.”

A former member of NASN’s board of directors, King has helped the association generate resource tools for educators from kindergarten through 12th grade to address what she calls an “epidemic” of prescription drug abuse across the country. Prescription drug-related deaths among young people (12- to 25-year-olds) have eclipsed deaths by motor vehicle in at least 29 states, according to the Trust for America’s Health. The Centers for Disease Control and Prevention reported that opioids in 2015 killed 7,163 people between the ages of 15 and 29 — more than 20 percent of total deaths — and 17 percent of 12th graders that year reported taking a prescription drug without a prescription.

In March, The New York Times quoted Roy Reese, superintendent of the Washingtonville Central Schools in Orange County, N.Y., on the likelihood of facing this issue in the schools: “I say this not reluctantly but sadly: It is only a matter of time.”

The nurses’ association, which is headquartered in Silver Spring, Md., believes the safe and effective management of naloxone (brand name Narcan), which can be administered by injection or nasal spray, be incorporated into the standard school emergency preparedness and response plans, similar to defibrillators and EpiPens for allergic reactions. At least three states allow school nurses to administer the drug, according to the National Conference of State Legislatures, and many others permit schools to stock the overdose-reversal drug. Some states authorize first responders to access naloxone, and school staff are considered to be first responders via statute in a number of these states.

While no one is formally tracking the use of the reversal drug by educators, news media reports in 2016 described an elementary school principal in Fayette County, Ohio, discovering a mother overdosed in a van in the parking lot with her kindergarten son in the vehicle. Last July in Western New York, a middle school teacher in Newfane, N.Y., was resuscitated with naloxone after overdosing on heroin. In both cases, medics administered the reversal drug.

King, who earlier worked in school nursing in Delaware’s largest school district in New Castle County, expects it won’t be long before she learns about a school staff member somewhere using naloxone to revive someone with overdose symptoms.

“I’d never want to walk into a school bathroom and not be able to help a kid slumped over,” King says. “I don’t think I could live with myself.”

Educator Resources on Drug Abuse
The National Association of School Nurses suggests these practical resources:

» “Smart Moves, Smart Choices,” a K-12 curriculum produced by NASN.

» Adapt Pharma, the maker of Narcan (brand name of naloxone), has offered free doses of nasal spray to schools and support for school-based opioid overdose education.

» NASN position statement on the central role of school nurses in using naloxone.

» National Registry of Evidence-Based Programs, a searchable database of more than 330 interventions for prevention and treatment of mental and substance use disorders, maintained by the federal Substance Abuse and Mental Health Services Administration.

» “Science Over Stigma: Saving Lives — Implementation of Naloxone Use in the School Setting” by Rebecca King in NASN School Nurse, March 2016.

» Toolkit for stocking and using naloxone in schools. The toolkit (free, but requiring users to create a log-in) provides a downloadable list of questions for a school district to consider.

» “Naloxone in School Settings,” chapter by Rebecca King in Legal Resource for School Health Services, a legal resource handbook published in 2017 by Sage.