In Arizona schools, stocking Narcan is the new norm
As more and more schools start carrying and learning how to administer life-saving opioid reversal medicine on campus, advocates say students themselves should be able to carry it, too.
In dozens of K-12 schools across Arizona, school nurses and administrators now carry and know how to use naloxone, a life-saving drug that reverses opioid overdoses.
Some Arizona schools have been stocking naloxone on campus for nearly five years, long before large districts in other states announced their plans to do the same.
In the Tucson Unified School District, for example, high schools have carried naloxone since 2019, and as of this school year, all of the district’s schools keep it on hand. In the Phoenix Union High School District, the board approved naloxone in 2018.
“I am seeing that more and more schools are recognizing a big need for this,” Joseph Gaw, TUSD’s director of health services, said. “So when one school is modeling it well, we spread the word a bit like hey, this is actually working. Because we're all on the same team, for the same purpose, and that is to serve the health and the welfare of all the members of our school community.”
The two large districts aren’t alone: At least 80 schools or districts, from elementary up to college, have requested naloxone from the Arizona Department of Health Services in recent years, according to data from the agency. More have likely gotten naloxone from other sources, like local health organizations or community nonprofits that work to expand access.
A state law also calls for schools to come up with policies and procedures for its employees who may administer naloxone, one of just six states that require schools to come up with policies for the medicine.
For schools that use naloxone, the medicine works similar to other emergency, life-saving medicines like albuterol for asthma attacks or EpiPens for allergic reactions. The schools say having it available gives them the ability to respond immediately in the rare event of an on-campus overdose, either by a student or anyone else in the school community.
Schools decided to add it to their emergency medicines after years of an increasing opioid crisis, recently dominated by fentanyl. They want to keep their students, staff and families as safe as possible during a growing crisis.
Naloxone, either delivered via a syringe intramuscularly or intravenously, or in the nose as an aerosol, works simply to reverse the effects of an opioid overdose, saving lives. In the years since Arizona passed a spate of laws designed to blunt the opioid epidemic, naloxone has become much more available and its usage more widespread. Anyone can legally purchase and carry naloxone, often referred to by its brand name, Narcan, without needing a prescription.
While the state’s schools have been ahead of other places in bringing naloxone to campus, advocates for naloxone’s use want to see them take it a step further. Schools should provide naloxone directly to students themselves, who are most likely to be near a peer who’s experiencing an overdose, said Christoper Thomas, a senior trainer at Sonoran Prevention Works, which works to expand access to naloxone.
“I can literally inject myself with 100 vials of naloxone and feel no effect,” Thomas said. “It's completely harmless, it can't be abused. There is no effect on anything except if a person is experiencing an overdose. So why can't kids carry it with them?”
How schools use naloxone
In TUSD schools, a yellow box typically sits outside the front office. The box holds emergency medicines like inhalers and EpiPens — and Narcan. The schools have gotten naloxone kits at no cost from either the state, county or local nonprofits.
Each school’s health office is trained on how to administer the medicine, and the school will also provide training to others who may be interested, Gaw, the TUSD health director, said. Schools don’t need to a call a parent to get permission to administer Narcan in an emergency because it is treated like other emergency medicines. They will give Narcan to a person overdosing while waiting for emergency medical services to arrive and continue care.
“When those events occur, every minute counts,” Gaw said. “So we’re expected to respond first, and then call parents after.”
This school year so far, no TUSD schools have needed to use Narcan, Gaw said. There have been instances in previous years where it was used, though.
For Orchid Lopez, Phoenix Union’s lead nurse, adding naloxone to the schools’ emergency kits made perfect sense. The longtime flight nurse and flight paramedic moved into school nursing and immediately got to work updating emergency response practices and toolkits. She found a position statement from the National Association of School Nurses, which recommended schools carry naloxone.
“I do a lot of research,” she said. “And I am more of a proactive than reactive person.”
School nurses and health assistants are all trained on naloxone, as are other campus personnel like administrators and safety officers. Administering naloxone on campus is a “rare event,” she said, but knowing it’s available and people are trained on its use should it be needed is important for campus health.
Schools still contend with a stigma about using naloxone, which can stem from people not seeing its importance or being worried about how to administer it — or they’re afraid of liability, she said. But schools have emergencies, just like everywhere else, and calling 911 often won’t be fast enough.
“Everybody thinks you're gonna call 911, they're gonna be right there. Well, no,” Lopez said. “Before the pandemic, the average response time for any EMS provider, and that really depended on whether or not they were in their response area, was seven minutes. Post-pandemic, we're at 10 (minutes). So not having the Narcan in less than five minutes will put a person into full respiratory arrest that leads into cardiac arrest.”
Why students should carry it
While schools still work to make sure their students, staff and community members aware that naloxone is legal, free and available on campus, students also may fear they’ll get in trouble if they need to use it.
In Los Angeles Unified schools, the district recently expanded its naloxone policy, which was first adopted in late 2022, to allow students to carry their own Narcan. The policy previously called for Narcan to be in a secure location on campuses.
Thomas, who has trained lots of schools’ employees on naloxone use, said schools in Arizona, with the help of community groups like Sonoran Prevention Works, have been ahead of other states on training their employees and carrying naloxone on campus.
But they often run into red tape or legal barriers that prevent them from handing out naloxone directly to students and allowing students to carry it themselves on campus, should they need to use it. Students’ prescription medications are typically managed by a school health office, though students can often carry medicines like inhalers or EpiPens on them if they keep a prescription on file with the school.
“It just doesn't do the most good sitting behind a nurse's desk,” Thomas said. “What if the nurse is busy? What if the administrators can't find it? What if they haven't been trained on how to administer naloxone?”
He pictures a scenario where some kids could be in a school bathroom using something like fentanyl when one of them overdoses. Their instinct to get help from a school official could be hindered by the idea of getting in trouble, he said.
Most overdoses are reversed by the person next to someone overdosing, who often is another person who uses drugs, Thomas said. Sonoran Prevention Works wants everyone to have naloxone to reach “naloxone saturation,” meaning a broad enough level of naloxone out in the community that it can statistically reduce overdose deaths.
“I think that students should have the option to carry (naloxone),” he said. “I'll tell you right now, my daughter carries naloxone with her at school. And they can get mad at me or she can get in trouble or whatever, and we'll have a really good conversation.”
Do you want to carry naloxone to reverse overdoses and save lives? You can buy some at any pharmacy without a prescription, provided they have it available, because the state has a “standing order” that allows anyone to get the intranasal or intramuscular versions of the medicine without a prescription.
You can also check out Sonoran Prevention Works’ map of providers that offer free naloxone to find a place near you to pick some up. Additionally, Sonoran Prevention Works has a request form where you can ask for harm reduction supplies, including naloxone kits, to be mailed to you.
Thank you for this fact based column on the safety and life saving benefits of having naloxone (narcan) widely available. One small but important revision. While the agent can be administered intravenously, that method requires applying a tourniquet and bit of skill. Nasal administration is slso possible if one has that product. Alternatives that are more commonly available and easier are using the subcutaneous (under the skin usually in the abomen) or intermuscluar (into a larger muscle like the upper arm or buttocks) routes.
I’ve used the narcan in my FAK three times over the past 7 years I’ve been carrying it. Grateful for SPW for giving me those supplies. Never going anywhere without it again.