As the opioid-addiction crisis continues unabated, Massachusetts schools have begun to respond to community need by adding another medication to their arsenal: Narcan.
While most parents like to think of the school nurse as the person who applies Band-Aids with cartoon characters to skinned knees from the playground, their role is far more complex. “The school nurse is often the first health professional who responds to an emergency in the school setting,” says a statement by the National Association of School Nurses. In a community struggling with opioid addiction, that may mean the school nurse is the first professional to recognize an overdose.
“Narcan is available now,” says Allan Cameron, Superintendent of the Wrentham Public Schools since 2014. “The school nurses participated in training sessions with regional districts on when and how to administer Narcan.”
Because schools are at the heart of the community and dealing with a vulnerable population, several states in addition to Massachusetts have moved toward a position of providing Narcan to the schools.
During an opioid overdose, parts of the brain that control breathing are overwhelmed, causing dangerously low levels of oxygen and eventually death. There is time to intervene, but not much.
Cameron says, “The nurses will administer it to anyone experiencing an opiate overdose during the school day. Administration of Narcan will be accompanied by a 911 call.”
Narcan, or naloxone, acts by binding to the opioid receptors in the brain, usually acting within two to three minutes. The individual will still require emergency medical care afterward, but when dealing with oxygen deprivation, the time it takes for an ambulance to arrive can drastically change the outcome.
Narcan can be delivered either as a nasal spray or via intramuscular injection. Wrentham Public Schools will be using the nasal spray.
Dr. Elizabeth Zielinski, Superintendent of King Philip Regional School District, says, “We have not yet approved the use of Narcan, but the school committee is reviewing the policy.”
That’s not to say there is currently no policy at all, but that all angles of the policy must be considered, from the logistics of keeping it, to the issues of training individuals to administer it, to the question of funding it. For example, students who require an EpiPen or an inhaler are typically prescribed it and provided with their own. Narcan would not be prescribed to individuals, and therefore the liability shifts.
“If there’s a situation in the school day, emergency personnel are called. It’s a good idea, but the administering needs to be done by a professional. During the day we have access to the School Resource Officer and the school nurses,” says Zielinski, “but during evening events when something could happen, there’s no one to administer it.”
School-age children are unlikely to overdose on opioids, and even the 15-24 age range only accounted for 114 opioid-related deaths in Massachusetts from a total of 1465 such deaths in 2016. Statistically, the parents are more likely to abuse opioids than the children.
“We have a lot of great facilities to rent out and that are used, seven days a week,” says Zielinski. “A lot of the community comes in and uses our facility.” Any KP policy would have to account for non-students who might face issues on the premises when no nurse is available to administer the Narcan outside of school hours.
Still, if medications are being abused, a child could accidentally ingest or experiment with someone else’s medication. That risk is admittedly low.
“I know of several other school districts in the state that have Narcan available,” says Cameron. “I do not know of any that have administered Narcan.”
For more information about Narcan/naloxone, visit www.narcan.com. The NASN policy is available online at www.nasn.org/portals/0/positions/2015psnaloxone.pdf, and statistics for the state of Massachusetts can be found at www.mass.gov/chapter55/.
Issue Date:
May, 2017
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