Pubdate: Wed, 29 Mar 2017
Source: New York Times (NY)
Copyright: 2017 The New York Times Company
Author: Elizabeth A. Harris


At every school in New Rochelle, just north of the Bronx, in
Westchester, there is a locked medicine cabinet in the nurse's office,
stocked with things like EpiPens for allergic reactions, inhalers for
asthma, Tylenol for aches and pains.

Now, those cabinets also include naloxone, an antidote for people who
are overdosing on opioids like heroin. Given as an injection or a
nasal spray, naloxone can quickly revive someone who is not breathing.
The city keeps it in every nurse's office, including in its elementary

"We have it the same way we have defibrillators and EpiPens, the way
we have oxygen in our schools," said Dr. Adrienne Weiss-Harrison, the
school district's medical director. "Rarely do we pull a defibrillator
off the wall, but it's there if we need it, and that's how we approach
this opportunity to have naloxone."

There is no comprehensive data on how often students overdose while at
school, but it happens. Renee Rider, assistant commissioner at the New
York State Education Department, said the department has heard
anecdotally of two schools where a student overdosed and was saved by
E.M.S. workers using naloxone.

But the numbers of young people dying from overdoses around the
country is striking. According to the Centers for Disease Control and
Prevention, in 2015, opioids killed 7,163 people between the ages of
15 and 29, more than 20 percent of total deaths.

And as communities across the country face this swell of death from
heroin and pills, schools see the epidemic lapping at their doorsteps
- - killing friends, neighbors, recent graduates. Educators are
increasingly deciding that they should have naloxone on hand.

In New Jersey, Assemblyman Vincent Mazzeo, a Democrat, sponsored a
bill in the fall that would require all high schools to stock
naloxone. In talking to parents and students in his district, Mr.
Mazzeo said, "It came out that kids were coming into school on
opiates, perhaps on heroin."

Without the antidote, "If a kid comes into school and he overdoses,
they don't have the proper tools. They'd have to wait for E.M.S. first
responders to come."

Now, in Massachusetts and Kentucky, Connecticut and New Mexico,
schools have the drug for emergency use. New York State has a program
that provides it free to schools, with 64 districts participating so
far. In Pennsylvania, nearly 250 public and charter schools have
received a free supply. In Rhode Island, every middle school, junior
high and high school is required to have naloxone on the premises. And
scattered around the country, there are schools and districts that
have bought the medication on their own.

"It is absolutely a sad sign of the times," said Roy Reese,
superintendent of Washingtonville Central School District in Orange
County, N.Y. "I say this not reluctantly, but sadly: it is only a
matter of time."

Naloxone has been available for more than 40 years, and for much of
that time, it was largely found in hospitals. But it has become
increasingly common outside of them as the opioid epidemic has spread,
and is now often found at the fingertips of law enforcement officers.
In recent years, laws have changed to allow schools to keep it on hand
and administer it to whoever needs it. In New York, for example,
public health law was amended in 2015 to authorize school employees to
administer naloxone.

Through the state's program, New York schools can now receive two
doses of generic intranasal naloxone in a little nylon bag; the kits
cost about $66, the State Health Department said, though schools get
them for free. The drug is also available under the brand name Narcan,
which is a nasal spray, and Evzio, which is an auto-injector like an
EpiPen. Evzio is the most expensive, with a list price of $4,100,
according to Kaleo, the company that makes it.

New York City schools are not stocking it because, officials said,
they "have not seen the need."

Many schools have chosen to stock Narcan because they can get it for
free. A partnership between Narcan's producer, Adapt Pharma, and the
Clinton Foundation, offers any high school in the country two free
doses of Narcan. Adapt Pharma covers the cost of the medication, and
the Clinton Foundation does outreach to schools and districts. In an
indication of the reach of the epidemic, President Bill Clinton said
last year that three of his friends had lost children to opioid overdoses.

An Adapt Pharma spokesman said about 1,300 units have been distributed
so far to schools in 15 states, including Pennsylvania, Massachusetts,
Kentucky, Delaware and New Hampshire. After the free supply runs out,
schools can buy more for $75 a carton, which contains two doses. The
list price for that amount is $125, Adapt said.

"I don't see this as a big land-grab for market share," said Daniel
Raymond the deputy director of policy and planning at the Harm
Reduction Coalition, which provides trainings on health issues related
to drug use. "Ultimately, schools are going to be a niche market
compared to other purchasers of naloxone."

Kathleen Neelon, the nursing coordinator for the Wallingford, Conn.,
schools, said that in recent years, there has been an alarming numbers
of overdoses among young adults in the area, so the district decided
to stock Narcan for its high schools. They keep it in an emergency
kit, which is filled with things like quick-clotting gauze and a blood
pressure cuff.

"We instituted it in December, and I hope we never have to use it" Ms.
Neelon said. The school sent out a notice about the decision, and
there were stories on the local news, she said, but she knew of no
pushback from the community. "Most people said, it's a sad statement,
but it's better to be prepared than not."

Some observers wonder if the reaction would be different if schools
were stocking an antidote to a different drug, like crack cocaine. The
crack epidemic was particularly acute among black people, while the
opioid epidemic has hit white people especially hard. Much has been
written about how race has impacted the nation's reaction to the
opioid epidemic.

"If there was an antidote to crack, the argument would be we should
just kick these people out of school, rather than trying to deal with
them in the school system," said Mr. Raymond of the Harm Reduction
Coalition. "It would be about getting tough, cracking down, kicking
them off of sports teams and expelling them."

In many school districts, educators say the severity of opioid problem
has overwhelmed any concerns they might have about the optics of naloxone.

Mark Marrone, superintendent of Mainland Regional High School in
southern New Jersey, said he knows of several Mainland graduates who
overdosed and died in their 20s, and one who overdosed and survived
after being given naloxone. If the worst happens at his school, he
said, he plans to be prepared.

"Some people worry that this says, 'Oh, there are drugs in the
schools,'" Mr. Marrone said. "No, there are drugs everywhere. We want
to teach kids the right way to respond." And maybe, he continued,
"you'll save a life."

A version of this article appears in print on April 1, 2017, on Page A18 
of the New York edition with the headline: In School Nurse's Room: 
Tylenol, Bandages and an Antidote for Heroin. |
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