Naloxone Use in the School Setting:
The Role of the School Nurse
It is the position of the National Association of School Nurses (NASN) that the safe and effective management of opioid pain reliever (OPR)-related overdose in schools be incorporated into the school emergency preparedness and response plan. The registered professional school nurse (hereinafter referred to as school nurse) provides leadership in all phases of emergency preparedness and response. When emergencies happen, including drug-related emergencies, managing incidents at school is vital to positive outcomes. The school nurse is an essential part of the school team responsible for developing emergency response procedures. School nurses in this role should facilitate access to naloxone for the management of OPR-related overdose in the school setting.
Deaths from prescription painkillers (opioid or narcotic pain relievers) have reached epidemic levels in the past decade according to the Centers for Disease Control and Prevention (CDC) (2014a). A crucial mitigating factor involves the nonmedical use of prescription painkillers—using drugs without a prescription or using drugs to obtain the "high" they produce. In 2010, the CDC stated about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year (CDC, 2014a). The 2013 Partnership Attitude Tracking Study (PATS) stated almost one in four teens (23 percent) reported abusing or misusing a prescription drug at least once in his or her lifetime, and one in six (16 percent) reported doing so within the past year (Feliz, 2014). According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health in 2013, there were 2.2 million adolescents ages 12 to 17 who were current illicit drug users (SAMHSA, 2014). Given the magnitude of the problem, in 2014 the CDC added OPR overdose prevention to its list of top five public health challenges (CDC, 2014b).
Schools should be responsible for anticipating and preparing to respond to a variety of emergencies (Doyle, 2013). The school nurse is often the first health professional who responds to an emergency in the school setting. The school nurse possesses the education and knowledge to identify emergent situations, manage the emergency until relieved by emergency medical services (EMS) personnel, communicate the assessment and interventions to EMS personnel, and follow up with the healthcare provider. Harm reduction approaches to OPR overdose include expanding access to naloxone, an opioid overdose antidote, which can prevent overdose deaths by reversing life-threatening respiratory depression. When administered quickly and effectively, naloxone has the potential to immediately restore breathing to a victim experiencing an opioid overdose (Hardesty, 2014).
Naloxone saves lives and can be the first step towards OPR abuse recovery. It provides an opportunity for families to have a second chance with their loved ones by getting them into an appropriate treatment regimen (Lagoy, 2014). Ensuring ready access to naloxone is one of the SAMSHA’s five strategic approaches to prevent overdose deaths (SAMHSA, 2013).
OPR overdose kills thousands of Americans every year. Many of these deaths are preventable through the timely provision of an inexpensive, safe, and effective drug and the summoning of emergency responders (Davis, Webb & Burris, 2013). School nurses must be familiar and sensitized to the legal issues, which vary from state to state in terms of the prescription and availability of naloxone. They should review local and state policy on how to access naloxone and implement its use as part of their school emergency response protocol.
It is also important to prevent students from ever misusing opiates. School nurses are crucial primary prevention agents in school communities. Through utilization of prevention materials, school nurses can provide valuable awareness and education on the dangers of prescription drug misuse to K-12 students and their families. In addition, school nurses can help families recognize signs and symptoms of substance abuse, guide them to locate resources, and assist them in making referrals for treatment of OPR addiction.
Centers for Disease Control and Prevention. (2014a). Vital signs: Prescription painkiller overdoses in the US. Retrieved from http://www.cdc.gov/vitalsigns/opioid-prescribing/
Centers for Disease Control and Prevention. (2014b). CDC’s top ten: 5 health achievements in 2013 and 5 health threats in 2014. Atlanta, GA: CDC. Retrieved from http://blogs.cdc.gov/cdcworksforyou24-7/2013/12/cdc%E2%80%99s-top-ten-5-health-achievements-in-2013-and-5-health-threats-in-2014/
Davis, C., Webb, D., & Burris, S. (2013). Changing law from barrier to facilitator of opioid overdose prevention. Symposium conducted at the Public Health Law Conference: Practical Approaches to Critical Challenges, Spring 2013. Journal of Law and Medical Ethics, 41(1), 33-36. doi: 10.1111/jlme.12035
Doyle, J. (2013). Emergency management, crisis response, and the school nurse’s role. In J. Selekman (Ed.) School nursing: A comprehensive text (2nd ed.), pp.1216-1244. Philadelphia, PA: F.A. Davis Company.
Feliz, R. (2014). National study: Teens report higher use of performance enhancing substances. Partnership for Drug Free Kids. Retrieved from http://www.drugfree.org/newsroom/pats-2013-teens-report-higher-use-of-performance-enhancing-substances
Hardesty, C. (2014). Five things to know about opioid overdose. Office of Drug Control Policy. Retrieved from http://whitehouse.gov/blog/2014/02/10/5-things-know-about-opioid-overdoses
Lagoy, A. (2014). Heroin and naloxone. American Journal of Nursing, 114(10), 12.doi: 10.1097/01.NAJ.0000454829.51619.02
Substance Abuse and Mental Health Services. (2013). Opioid overdose prevention toolkit (HHS Publication No. [SMA] 13-1472). Rockville, MD: Author. Retrieved from http://store.samhsa.gov/shin/content/SMA13-4742/Overdose_Toolkit_2014_Jan.pdf
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2014, September 4). The NSDUH report: Substance use and mental health estimates from the 2013 National Survey on Drug Use and Health: Overview of findings. Rockville, MD: Author. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUH-SR200-RecoveryMonth-2014/NSDUH-SR200-RecoveryMonth-2014.htm
Acknowledgement of Authors:
Rebecca King, MSN, RN, NCSN
Mary Louise Embrey, BS
Adopted: June 2015
Suggested citation: National Association of School Nurses. (2015). Naloxone use in the school setting: The role of the school nurse (Position Statement). Silver Spring, MD: Author.
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.