The Flagler County School Board on Tuesday gave its administration direction to develop a policy that will make naloxone available for use in every school. But the final decision to locate the agent in schools is still ahead.
Naloxone, commonly known as Narcan, one of the brands that market the agent, is a neutralizing agent that almost immediately reverses the effects of an overdose by restoring normal breathing patterns. It works when an overdose has not crossed a certain threshold. It is either injected or sprayed nasally. Narcan is sprayed. It is routinely used in Flagler County by law enforcement and firefighter-paramedics, who now respond to hundreds of overdose calls a year. The school district has been talking about adding naloxone doses in schools for half a year, and some were pushing for more talk on Tuesday before a final decision.
“The one thing I don’t want us to do is drag this out,” Board member Colleen Conklin said. “It’s great to have the experts at the table. But I would hope that that would be sooner rather than later, like on an immediate agenda down the road, so we’re not wasting any time. God forbid something were to happen, right?” Conklin is seeking a phased roll-out paired with education to parents and personnel that clearly explains why the district would be stocking Narcan. “We would like to see this very soon in the future so we can move forward and get it in the right hands.”
“The faster we can move forward on this and make this accessible to our staff, the better,” Board Chair Cheryl Massaro said. The administration will write a policy and bring that back to the board within weeks, along with protocols. The agent will be placed at all school properties, including sports fields and the technical school.
The overdoses are caused primarily by fentanyl, a drug that multiplies the effects of heroin by several orders of magnitude, with morphine, methamphetamines, and certain prescribed narcotics also ranking high on the list of overdose causes.
While confiscation of drugs, usually pot–which does not cause overdoses, let alone death–happens from time to time on campus, there has not been a single case of a drug overdose at a public school in recent memory, either among students or among faculty and staff. While there is little reason to think that that record will change, school and public health officials want to be prepared just in case, especially since it costs nothing to have Narcan on hand, training for its application is simple, and storing it uncomplicated. It is no different than making defibrillators readily available, knowing that they will likely never be used.
On the other hand, fentanyl’s properties are such that even trace amounts that inadvertently or unintentionally end up on a surface that transfers to a human being’s reach can have bad reactions.
A new state law clears the way for schools to acquire and stock naloxone as long as it’s stored in secure locations. School employees who administer the agent are immune from liability–as long as they use the agent as trained. School nurses are expected to be the primary care givers, although there is interest among some board members to have the agent in every classroom for easier access–or at least every floor or wing of a school, “something where you’re cutting down on that time to get the nurse, get the Narcan, bring it to the classroom,” in the words of School Board member Colleen Conklin.
“I would be in favor of more than just the school nurse having access, whether that is in the classrooms or on each floor in multiple doses,” Conklin said. She said some of the schools are “massive,” making it difficult for a nurse to get to some rooms. The foundation is recommending having doses in lockboxes in bathrooms and locker rooms, since that would ensure availability in all parts of a school. Other board members had procedural questions, attempting to become more familiar with the mechanics of an overdose and how personnel is to react.
The district hasn’t gone into those procedural details yet. It was waiting on the board’s direction. It’s not necessary that only nurses administer the agent. They would almost certainly be included, but board members are interested in having personnel more broadly trained to do likewise. It’s not a complicated thing: Narcan has become so common that households are encouraged to have doses on hand, and family members or friends administer the doses on those who experience overdoses–without formal training beyond directions on a box. It’s a nasal spray.
“I already have some. It’s in my home,” Massaro said. “Everybody should have it and you should carry it, women should have them in their purse.”
Normally a 10-milliliter dose of naloxone costs around $60. The district would not have to worry about cost. Michael Feldbauer, who heads the Flagler County Drug Court Foundation, told board that the foundation has a supply of free Narcan that will be made available to the district until September 2024, with the likelihood that the grant making the donation possible will be extended through 2025. The foundation can make a limitless supply available.
The doses have expiration dates, but also have 36-month shelf-lives (up from 24 with older versions), according to the company that produces Narcan. The Food and Drug Administration approved the longer shelf life.
While it is critical for the agent to be administered within minutes of an overdose, individuals typically get a dose after someone near them has called 911 and authorities have had time to make the drive to the location.
The board’s direction was just what Feldbauer and the foundation have been pushing for. “We are have a great desire to save lives. And that’s what we’re here for,” Feldbauer said. “We need to reduce the stigmatism of people thinking that we’re saving lives of people that don’t need saving.”