Use of Overdose Antidotes at School

Legal Brief

Two years ago, a 1st grader in Modena, Pa., brought his grandmother’s heroin to school. In 2015, two students at the same school died from heroin overdoses within a week of each other. In recent months, news accounts have reported multiple deaths of teens from opioid overdoses.

According to the National Survey on Drug Use and Health, 29 percent of high school students think it’s easy to obtain heroin, and 91,000 people over the age of 12 use heroin nationwide. According to the Network for Public Health Law, approximately 28,000 Americans die each year of a heroin overdose.

Heroin use no longer requires needles. It is just another pill that kids can buy for as little as $10.

Reversal Available

The role of elementary and secondary schools in preventing opioid overdose deaths became more prominent earlier this year when the pharmaceutical company Adapt Pharma announced it would begin providing at no charge to high schools nationwide a nasal spray that quickly reverses an overdose from heroin and prescription painkillers.

When administered in time, naloxone (whose trade name is Narcan) can prevent overdose deaths almost instantly by blocking the effect of the opioid. Previously available only by prescription, naloxone has been made freely accessible by legislators in 46 states with the goal of arming bystanders to save lives, according to the National Conference of State Legislatures.

For K-12 education leaders, the legal question is this: Does the threat of liability outweigh the value of putting naloxone in schools?

In 2014, naloxone is credited with reversing more than 26,000 overdoses, according to the Network for Public Health Law, a national initiative of the Robert Wood Johnson Foundation, but some schools are hesitant to stock the drug. Opponents argue that stocking naloxone does more to encourage opioid use than to prevent it.

Most people consider reversing an opioid overdose as an act of mercy. But administering naloxone can expose the school district and the person administering the naloxone to liability.

Naloxone can cause withdrawal symptoms such as shaking, throwing up, convulsions, high/low blood pressure, irregular heartbeat and irregular breathing. Naloxone can present a danger to individuals with heart disease, and little is known about the effect of naloxone on a pregnant woman.

To address these legal concerns, a majority of states enacted Good Samaritan laws to provide civil and criminal immunity to persons who administer naloxone. However, in Maine, Michigan, Oregon, Florida, Kansas, Oklahoma and possibly other places, a lay person is not immune from criminal or civil liability when administering the antidote drug.

Reasonable Care

Anyone administering naloxone must use reasonable care. That is the legal standard to qualify for civil or criminal immunity. Reasonable care requires training and education for anyone who might be administering this drug.

That means if a school district decides to stock naloxone, it will have to decide who can administer the drug and how to provide the training and education.

Whoever the school district designates to administer naloxone, they must be adequately prepared to recognize and react to an overdose situation.

Are there any alternatives to stocking naloxone for school use?

One alternative is to rely on police and emergency responders to arrive in time to administer the naloxone. The risk, of course, is that the first responders may not arrive in time. That is why so many school districts are opting to stock the antidote, working with police and first responders as part of a three-prong approach to prevent opioid overdoses at school.

With the heroin epidemic spiraling out of control, school administrators, staff and students are getting pulled into the first line of defense in overdose deaths. Naloxone is one of the few weapons available in this war.

Each school district should work with legal counsel to research the applicable state laws. State professional organizations ought to be a useful starting point for relevant information about naloxone use.


Michele Handzel is a school attorney with the Capital Region BOCES in Albany, N.Y. E-mail: michele.handzel@neric.org