Opioid addiction and overdoses have increased sharply across the country over the past two decades in what many organizations describe as a national crisis. Recent opioid overdoses among students have placed a spotlight on the role of schools in administering opioid antagonists on their campuses.

Opioids are a class of drugs that reduce pain. Some, including oxycodone (e.g., OxyContin), hydrocodone (e.g., Vicodin), morphine and methadone are prescription medications that are often abused. There are also illegal opioids such as heroin, which has traditionally been the main cause of opioid overdoses, and fentanyl, which has sharply boosted the risk of overdoses as it becomes increasingly available.

Fentanyl is a deadly synthetic opioid that is 50 times more potent than heroin and just two milligrams of fentanyl (equivalent to 10-15 grains of salt) can be lethal, according to the U.S. Drug Enforcement Administration. The DEA also warns that criminal drug networks are manufacturing fake pills containing fentanyl that are made to look like OxyContin, Xanax, Adderall and other pharmaceuticals. The combination of fentanyl’s potency and its deceptive manufacturing has resulted in heightened risk.

Students may buy pills without knowing they contain fentanyl and may overdose on as little as one pill. According to the California Department of Public Health, opioid-related overdose deaths in California’s youth ages 10–19 years increased from 2018 (54 total) to 2020 (274 total), marking a 407 percent increase over two years, largely driven by fentanyl. The most common way to revive someone suffering from an opioid overdose is to administer naloxone hydrochloride (often referred to by the brand name Narcan), a medication that reverses or reduces the effects of opioids. Naloxone can be injected or given intravenously, but the easiest way to administer it is as a nasal spray.

With opioid overdoses increasingly affecting students, schools may experience a student who has overdosed on campus, said California Department of Education official Abel Guillen in a Nov. 15 webinar hosted by the department. “Opioids are the fastest growing cause of death in our state, and just last week in Riverside a student stopped breathing in the main office while school staff administered CPR. While preparing the defibrillator, her pulse returned. When emergency rescue crews arrived, they administered Narcan on suspicion of a drug overdose. Shortly after, the good news was she regained full consciousness. Thankfully, staff was prepared and trained and knew what to do.”

At the start of the 2023 legislative season, lawmakers in both parties introduced legislation that could require California schools to store naloxone and train administrators on its use. Further, Gov. Gavin Newsom’s proposed 2023–24 state budget released on Jan. 10 includes $3.5 million to purchase naloxone for every middle and high school in the state, citing the fentanyl crisis as “a growing concern for parents and school district officials.” Regardless of the outcome of the proposed legislation, many districts and counties are already moving forward with making sure some or all their campuses have naloxone or other opioid antagonists on hand.

Currently, Education Code 49414.3 authorizes, but does not require, districts to make emergency naloxone hydrochloride or another opioid antagonist available to school nurses or trained personnel who have volunteered to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose. In December 2016, CSBA added language to Board Policy and Administrative Regulation 5141.21- Administering Medication and Monitoring Health Conditions, in its sample policy manual to address this authorization.

BP 5141.21 includes sample language directing the district to stock opioid antagonists and administer them to anyone suffering from an opioid overdose. AR 5141.21 contains a section titled “Emergency Medication for Opioid Overdose” that sets out how districts can administer medication, including naloxone, for opioid overdoses. Districts and county offices of education can adopt the direct language in the CSBA sample policy regulation or modify it to fit their needs. The CSBA policy team will update its sample policy manual as needed to address any new legislation that passes.

Districts can also find information on how to use naloxone to prevent opioid overdoses on the California Department of Public Health’s Overdose Prevention Initiative webpage (bit.ly/ 3QYq79M). The CDPH also has training videos on how to use naloxone, while the Department of Health Care Services has information on the state’s free naloxone distribution program for schools and local educational agencies.