KingSpry Naloxone Use In Schools

To Stock or Not to Stock? Naloxone Is the Question For Pennsylvania Schools

Dr. Kathleen Conn

Posted on April 29th, 2016
by Dr. Kathleen Conn

Illegal drug users are likely in your school. Some are students; some may also be staff members. Users don’t usually display identifying marks or bear signs of illicit behavior. In fact, the student users may be your honor students, and your staff users may be your outstanding staff member or teacher of the month. The drugs may be in backpacks or deep in private desk drawers.

Schools cannot help all users, but they can prevent overdose deaths among users of one widely available, cheap, and dangerous opioid – heroin.

Dangers of Heroin

Opioids are a class of drugs that relieve pain by occupying the brain receptors for pain stimuli. Opioids are the opposite of stimulants like amphetamines and cocaine that raise blood pressure, heart rate, and breathing rate. Opioids depress breathing and blood flow to the extremities, and overdoses may cause convulsions or loss of consciousness, coma, and death. Opioid drugs require a doctor’s prescription if obtained from a pharmacy, but they are also available as “street drugs.” Perhaps one of the most dangerous of the opioids, and the most available opioid on the street now, is heroin.

Heroin is a white or brownish powder, but it can be diluted with other drugs or sugar, starch, quinine, or other substances before it is taken by injection, snorting, or smoking. Heroin has no legitimate medical use in the U.S., and is highly addictive, especially among those who initiate use as younger adolescents. On the street it may be known as a variety of names: Big H, Black tar, smack, dope, horse, skag, junk, H, Brown sugar, China white, and others. Street heroin has varying chemical composition, contains different degrees of purity, varying dosage amounts, and unspecified adulterants.

Heroin has become the drug of choice for adolescents and young adults largely because of its cost. Cheaper than other opioids or stimulants like cocaine, a “stamp bag” of heroin containing several small paper packets of heroin is cheaper in some states than a pack of cigarettes. The going price of a bag in Pennsylvania is reported to be six to eight dollars, not too much more than most packs of cigarettes. Heroin production and distribution has skyrocketed all around the world, but most heroin reaches the U.S. from Columbia, S.A. and Mexico.

The list of famous celebrities who have died from heroin overdose includes Cory Monteith, River Phoenix, John Belushi, Janis Joplin, Sid Vicious, Jim Morrison and dozens more – but there are many more “un-famous” victims of the drug. Up to 22% of regular heroin users will have a near miss every year. Part of the reason for this is that regular users have to ingest more and more of the addictive substance in order to get the same high. The other more compelling reason is that street heroin is often laced with fentanyl. Cheaper than heroin and 50-80% more powerful than heroin, fentanyl prolongs the high, but also, synergistically with the heroin, depresses the urge to breathe along with the euphoria. A drug named naloxone can help reverse this process.

Naloxone Saves Lives

Naloxone, administered by injection or nasal spray called Narcan, is receiving an increased amount of attention in Pennsylvania public schools today, largely because the number of adolescents dependent on or abusing heroin is growing. Naloxone reverses the binding of heroin to brain receptors and helps comatose heroin users begin breathing again. The effect of naloxone is temporary, lasting only 20-90 minutes, so further assistance from 911 is necessary in treating an overdose.

An amendment to Act 139 signed into law by Governor Tom Corbett in 2014 added a “Drug Overdose Response Immunity” provision that confers limited immunity on persons who, in good faith, report drug overdoses. Act 139 also confers immunity from criminal prosecution, civil liability, and liability for adverse outcomes of naloxone administration on any person who, in good faith, administers naloxone to a person experiencing or believed to be experiencing an opioid overdose. Undergoing the in-person or internet-available training in administering naloxone and prompt seeking of additional medical help constitutes a rebuttable presumption of good faith.

Naloxone has shown no negative side effects if administered in the case of coma for what turns out to be other than suspected drug overdose. In October 2015, Governor Tom Wolf stood at her side as Pennsylvania Physician General Rachel Levine signed a statewide standing order for Naloxone, essentially a prescription that anyone can use to buy naxolone at any pharmacy that stocks it. If a pharmacy lists “Standing order in place,” any person may now purchase naloxone in either nasal spray or injectable form without a doctor’s prescription. Governor Wolf equipped all State and Capital Police with naloxone. Fifteen Lehigh County and Bethlehem Police Departments have recently supplied their officers with kits containing rubber gloves and two doses of Narcan.

On September 18, 2015 the Pennsylvania Secretaries of Education, Health, and Drug and Alcohol Programs sent a joint letter to superintendents in the Commonwealth to encourage them to consider stocking and training personnel to administer naloxone in cases of heroin overdose.

The Pennsylvania Department of Health announced that the Department will supply to public high schools free two-dose cartons of Adapt Pharma™ Narcan to schools that have in place a Board-adopted policy on naloxone administration. Schools must apply through the Narcan Grant Application Packet, posted on April 15, 2016 at http://www.health.pa.gov.  The cost of these Narcan dosage kits have been skyrocketing as more and more law enforcement and first responders order them; this grant may save school districts up to $75 per kit. The typical shelf life of the naloxone doses is approximately 18 months to two years, but they can be used after expiration if a larger dose is administered.

Bottom Line

Naloxone has already saved the lives of countless individuals across the country and in Pennsylvania counties that have equipped their police officers and first responders with the heroin antidote. Stocking and possible administration of naloxone in schools require that School Boards have sound naloxone policies in place. School Boards that desire to take advantage of the free Narcan kits would do well to begin discussing the adoption of Narcan administration policies with their solicitors.

KingSpry is hosting a free workshop on this topic on May 10. Click here for details.

 

School Law Bullets are a publication of KingSpry’s Education Law Practice Group. It is meant to be informational and does not constitute legal advice. John E. Freund, III, is our editor.