Heroin epidemic puts pressure on schools to get antidote

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PROVIDENCE, R.I. (AP) -- The heroin epidemic that has been taking the lives of teenagers for years is creeping into even younger age groups and putting pressure on the nation's schools to keep a fast-acting overdose antidote within reach of every nurse and teacher.

Although overdoses at school are rare, nurses are increasingly thinking of the drug naloxone as an essential part of their first-aid kits. Administered via syringe or a nasal spray, it works almost immediately to get an overdose patient breathing again, and it does not create a high or have major side effects.

The National Association of School Nurses wants all schools to keep the antidote on hand.

"We're facing an epidemic," said Beth Mattey, president of the group. "People are dying from drug overdoses, opioid drug overdoses. We need to be able to address the emergency."

At least five states this year adopted laws on the use of naloxone in schools, including Rhode Island, which now requires it to be available in all middle, junior high and high schools. Some states allow or encourage schools to buy it. And many schools already have the drug in stock.

Also known by the brand name Narcan, the antidote was first approved by the Food and Drug Administration in 1971. Advocates say it could save a child, parent or school employee who overdoses on heroin or prescription painkillers.

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Heroin epidemic puts pressure on schools to get antidote
In this May 13, 2015 photo, the contents of a drug overdose rescue kit is seen at a training session in Buffalo, N.Y., on how to administer naloxone, which reverses the effects of heroin and prescription painkillers. The kits are being provided to community members in Erie County who seek training in how to recognize a potential drug overdose and administer naloxone, which reverses the effects of heroin and prescription painkillers. New York and other states have been equipping lay people, as well first responders and families of addicts, with naloxone in an effort to increase the chances it will be there when needed. (AP Photo/Carolyn Thompson)
In Thursday, July 30, 2015 photo Ryan Kinsella poses outside his bicycle repair business in Penobscot, Maine. Kinsella broke his back in a rock climbing accident in 2002. The accident left him with partially paralyzed legs. He is recovering from a long battle with hepatitis C., which he contracted by sharing IV drug needles. The rise of cheap heroin has brought a rise in hepatitis C. Perhaps nowhere is the problem starker than in Downeast Maine, which has the highest hepatitis C rate in a state with quintuple the national average. (AP Photo/Robert F. Bukaty)
An anti-narcotics agent walks over seized drugs as the narcotics are prepared to be burned in Panama City, Thursday, July 23, 2015. According to authorites, they incinerated six tons of drugs, including cocaine, marijuana and heroin, all seized within the last month. (AP Photo/Arnulfo Franco)
This April 28, 2015, photo provided by the Philadelphia District Attorney's Office shows a portion of recently confiscated heroin. Authorities in Philadelphia say a drug probe led to the confiscation of 22 pounds of heroin with a street value of $3.3 million. (Philadelphia District Attorney's Office via AP)
This Wednesday, June 10, 2015 photo provided by U.S. Customs and Border Protection, packages of hard drugs are seen in the rear driver side quarter panel of a car carrying more than $377,000 worth of heroin and methamphetamine, seized at the U.S.-Mexico border port of entry in Nogales, Ariz. Authorities are reporting an alarming increase in the number of methamphetamine seizures at border ports of entry. (U.S. Customs and Border Protection via AP)
In this Jan. 27, 2015 photo, a dead poppy flower stands out after the government aerially sprayed the poppy field with a herbicide in the Sierra Madre del Sur mountains of Guerrero state, Mexico. A community leader said the aerial spraying "poisons the land, the water, and the people and animals who use the water. It's okay if the government wants to combat these crops, but they should do it manually, on the ground, rather than with aerial spraying." (AP Photo/Dario Lopez-Mills)
This April 28, 2015, photo provided by the Philadelphia District Attorney's Office shows a portion of recently confiscated heroin. Authorities in Philadelphia say a drug probe led to the confiscation of 22 pounds of heroin with a street value of $3.3 million. (Philadelphia District Attorney's Office via AP)
A firearm and 154 pounds of heroin worth at least $50 million are displayed at a Drug Enforcement Administration news conference, Tuesday, May 19, 2015 in New York. The DEA called the heroin seizure its largest ever in New York state. Officials said on Tuesday that most of the drugs were found in an SUV in the Bronx following a wiretap investigation. (AP Photo/Mark Lennihan)
This Tuesday, April 7, 2015 photo provided by the FBI shows seized guns displayed during a news conference in Santa Maria, Calif. FBI spokeswoman Laura Eimiller says that agents and local law enforcement officers raided houses Tuesday, April 7, 2015, morning and made arrests in the Santa Maria area related to a federal indictment. The indictment charges five members of a family and seven others with selling heroin, cocaine and methamphetamine. The 17-count indictment unsealed in U.S. District Court says they sold some drugs to informants working with federal agents. (AP Photo/FBI)
In this March 2, 2015 photo, Alicia Gibbons holds an empty bottle of naloxone that she used to save the life of her daughter Ashley at their home in Mays Landing, N.J. Officials across the country are agreeing that it makes sense to hand out the antidote to police, families of addicts and drug users themselves but price of naloxone, sold in the U.S. under the brand name Narcan, has doubled in the past year. (AP Photo/Mel Evans)
This photo taken Tuesday, Jan. 20, 2015, and provided by Delaware State Police, shows what they say are 15,000 packets heroin found in the car of Davon Tucker, of Paterson, N.J., during a traffic stop in Milton, Del. (AP Photo/Delaware State Police)
In this Friday, Dec. 5, 2014 photo, powder flies as an anti-narcotics agent hacks open a package of cocaine with a machete before it's burned on the outskirts of Panama City. According to police, they'll destroy on Friday just over 11 tons of cocaine, marijuana and heroin, seized within the last three months. (AP Photo/Arnulfo Franco)
An anti-narcotics agent holds a machete as he prepares to hack open packages of cocaine before they're burned on the outskirts of Panama City, Friday, Dec. 5, 2014. According to police, on Friday they'll destroy just over 11 tons of cocaine, marijuana and heroin, seized within the last three months. (AP Photo/Arnulfo Franco)
An anti-narcotics agent sprays gasoline on seized drugs to be burned on the outskirts of Panama City, Friday, Dec. 5, 2014. According to police, on Friday they'll destroy just over 11 tons of cocaine, marijuana and heroin, seized within the last three months. (AP Photo/Arnulfo Franco)
Criminal experts display glasses filled with heroin at the headquarters of the federal police in Wiesbaden, Germany, Thursday, Oct. 9, 2014. German authorities have seized 330 kilograms (728 pounds) of heroin worth an estimated 50 million euros (US$63 million) that smugglers brought to Europe hidden in a shipment of cucumbers and garlic from Iran. (AP Photo/Michael Probst)
A city employee organizes bags of seized cocaine to be destroyed at a police base in Lima, Peru, Tuesday, April 29, 2014. Police say they burned on Tuesday more than 11 tons of drugs including cocaine, marijuana, opium and heroin that was seized over the last 5 months. (AP Photo/Martin Mejia)
EMBARGOED UNTIL 3 AM APRIL 28--Syringes are packaged at Boom Health center for distribution to drug addicted users, Friday April 25, 2014 in Bronx, N.Y. New York lawmakers are putting forward a package of legislation that seeks to fight the resurgence of heroin with tougher penalties for dealers, more funding for overdose-reversal drugs and increased insurance coverage for treatment. (AP Photo/Bebeto Matthews)
PORTLAND, ME - AUGUST 3: Peppermint Park in Portland Tuesday, August 3, 2015. (Photo by Shawn Patrick Ouellette/Portland Press Herald via Getty Images)
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One Rhode Island nurse bought Narcan on her own after attending a lecture and training last fall. Kathleen Gage then took the drug into her 11th-grade health classroom to teach students how to get it at a pharmacy and use it.

"They were really enthusiastic that this could reverse an overdose, and they would have the tool to do it," said Gage, a nurse at Pilgrim High School in Warwick, who also pushed for the state law that requires schools to buy the drug for emergencies.

Rebecca King said she has observed substance abuse as a nurse in a K-8 school in Delaware. Seeing a child collapsed on the floor is the "worst nightmare" of every school nurse, she said.

"Naloxone saves lives," King said. "It can really be the first step toward recovery."

Heroin overdose deaths in the United States nearly quintupled from 2001 to 2013. More than 70 percent of overdose deaths relating to prescription drugs in 2013 involved opioid painkillers - a class of drugs that includes heroin, oxycodone, codeine, fentanyl and morphine, according to the Centers for Disease Control and Prevention.

Overdoses at school are uncommon but not unheard of.

A survey of 81 Rhode Island school nurses who participated in a naloxone training program last year found that 43 percent of high school nurses who responded reported that students in their schools were abusing opioids, according to statistics released by the state health department. Fifteen said they had to call 911 at least once in the past three years for suspected student substance use or overdose.

From July 2014 to August 2015, 29 children ages 17 and younger received the drug in Rhode Island, according to the health department. During that time, naloxone was administered once at a school, although it was later determined that the person had not overdosed.

One of the children given Narcan was just 4 years old. The details of that case were not clear, but some nurses said they worried about an overdose by a curious child with access to a relative's drugs.

Some districts have struggled with whether to add the antidote to their medical supplies.

School officials in Hartford, Vermont, last year decided not to stock Narcan because of liability concerns and worries that people who receive the drug could become combative when awakened. But they changed their minds last month, with school board members citing the drug's low cost and the region's drug-abuse problems.

Those who have experience with the drug stress that it is safe even if given to someone who has not overdosed.

People coming to are often groggy and confused and may experience withdrawal, but they do not typically become violent, said Laura Byrne, executive director of the HIV/HCV Resource Center in Lebanon, New Hampshire. She has given doses of Narcan to some school nurses who asked for it.

To allay concerns that school employees could be sued for giving a life-saving drug, the Rhode Island law says no one can be held liable for using it or be disciplined for refusing training.

Laws in Kentucky and New York explicitly allow school employees to obtain and administer naloxone and excuse them from liability for using it in an emergency. Illinois does not require schools to carry it but allows nurses to administer it.

Delaware passed a resolution this year endorsing expanded access to naloxone in schools. Since then, its 40 high schools have received donated auto-injector kits that normally cost $500 or more each.

Some lawmakers have raised questions about whether manufacturers raised the drug's price just as more cities began using it to reduce overdose deaths. But the school districts do not expect to spend much.

At $25 to $40 per dose, Rhode Island planned to spend only a few thousand dollars to put naloxone in around 115 schools. And schools won't go through the doses quickly, as EMTs or other front-line health workers might.

In Massachusetts, nurses in more than 200 school districts have been trained to use the antidote. The Boston suburb of Easton paid less than $100 to equip the middle school and high school with naloxone in the nurse's office.

Superintendent Andrew Keough said he has heard no complaints from parents and likened the decision to keeping on hand a heart defibrillator or an EpiPen, a pocket injector used to treat severe allergic reactions.

"We haven't had an emergency like this," Keough said. "But if we did, we know that seconds really count."

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