As of January 6, all New York City public schools are required to carry naloxone. This was already a requirement for the city’s high schools but has now been expanded to middle and elementary schools, which for many jurisdictions has been a point of contention.
The New York City Council legislation was more than six years in the making, and is a very good thing for the city’s public school students.
State by state, public school systems across the country are increasing on-campus access to naloxone—the opioid overdose antidote often referred to by the brand name Narcan. More naloxone in more schools is good, regardless of how it gets there, but that doesn’t mean the messaging couldn’t be improved.
For far too long, #Bronx children have been forced to tip-toe their way into their schools because needles laced with fentanyl are carelessly thrown on sidewalks and green spaces surrounding their school entrances.
— Rafael Salamanca, Jr. (@CMSalamancaJr) December 7, 2023
In September 2023, the Food and Drug Administration approved the first over-the-counter naloxone product. Removing the prescription requirement didn’t necessarily make naloxone accessible to people who are at daily risk of overdose, because each kit still costs around $45. But it has made the legal landscape much less intimidating for state departments of education to wade into.
Broader naloxone access in schools got a boost when the Biden administration called for it in October 2023. Most states allow school administrators to keep naloxone on site if they want to, but they’ve been slower to require it.
As youth overdose has increased in recent years, so has panic and misinformation about it. And as naloxone access in schools gains more support, its framing is often at the expense of people who use drugs.
“Even doses as small as 2 milligrams of fentanyl can be lethal, especially for kids,” stated Michigan Representative Dave Prestin (R) in December 2023, referencing one popular point of Drug Enforcement Administration propaganda before moving on to another: “Kids have overdosed after accidentally inhaling it.”
In calling for more naloxone in schools, Prestin cited a report widely circulated that month about five children in Virginia who’d overdosed on “fentanyl-laced gummy bears.” (All were fine; none actually required naloxone.)
In Virginia, meanwhile, one sponsor of a naloxone access bill is endorsing not just Narcan but Evzio, a naloxone product which was discontinued several years ago.
The most impactful way to expand naloxone access in schools would be to give it to students.
Virginia has already proposed multiple naloxone-related bills in 2024, including one to notify parents if an overdose takes place at a school activity even off campus. But it stopped short of authorizing students to carry naloxone, even after Arlington Public Schools allowed students to bring their own kits in 2023.
The most impactful way to expand naloxone access in schools would be to give it to students, who are likely to reach their peers much more quickly than, say, nurses or cops.
In recent months some states, like South Carolina, have removed restrictions that authorize only certain designated personnel to administer naloxone on school grounds. Often the authorized personnel are law enforcement; even if a state authorizes school nurses, most schools are too under-resourced to have those.
There’s no law that prohibits minors from carrying naloxone, but many school districts have policies that restrict access to medication on campus, even if it’s OTC. Students in jurisdictions including California and Maryland are permitted to carry naloxone on their person, but it’s not yet the norm. In Colorado, where students have successfully campaigned to be allowed to carry and administer naloxone on school grounds, legislation introduced earlier in January may make that change at the state level.
Many of these bills emphasize “limited immunity from prosecution,” phrasing which comes across like it’s implying that people who administer naloxone are likely to face civil liability. Some states’ “Good Samaritan” laws are less accommodating than others, but a public school teacher responding to a student who overdosed on campus isn’t generally who police are looking to harass.
Photograph via Easthampton, Massachusetts