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Karen Siska-Creel beat her when she decided that all schools in her district should have life-saving medication to treat heroin overdoses, but she would not wait for someone to come in. one dies.
USA TODAY & # 39; HUI
Schools in Anne Arundel County, Maryland, and throughout the country are stocking up on naloxone, an overdose drug, presented here in the form of Narcan Nasal Spray, to combat the epidemic outbreak. # 39; opioids. Schools train nurses and other staff to respond to overdoses of heroin and fentanyl.(Photo: for USA TODAY & # 39; HUI)
GLEN BURNIE, Md. – Almost two weeks ago before the school opened, school nurses from Anne Arundel County were already surveyed.
The scenario: An 8 year old boy acts in a strange and sleepy way. His pupils are tiny and his breathing is laborious.
How will they treat it?
Newly hired nurses and nursing assistants expressed mixed opinions. The supervisor overseeing the training session in a Maryland County, ravaged by the epidemic of opioids, made one suggestion: the anti-overdose drug Narcan.
"What should we lose?" Asked Maureen Neall..
Last year, nearly 50,000 Americans died of opioid overdoses, more than car accidents. Today, the country's schools are preparing for what some consider inevitable: overdoses in schools.
High schools, colleges and even some primary schools supply nurses with naloxone or Narcan, the brand name of the nasal spray version of the injectable drug. Some new laws force some to keep the drug in hand. Others benefit from the offer by a private drug company of two free kits for any high school that requests it.
Human rights advocates compare efforts to using the anti-allergic drug EpiPen or portable defibrillators used for cardiac arrest.
"Everything that happens in our county will be in our schools"
But critics question the need. Some say that the effort would be better directed to communities and institutions that see more overdoses.
"I have not seen a single data point stating that an overdose has occurred in a school," said Eliza Wheeler, an overdose response strategist at the Harm Reduction Coalition in New York. Oakland, California. "The problem here is how they invented this – investing millions of dollars in a problem without data to know if it even happens?"
No federal agency oversees overdoses in schools, but it's clear that teens and young adults in both big cities and small towns are consuming and dying with heroin and, increasingly, synthetic opioids. more powerful. Fentanyl.
According to the Centers for Disease Control and Prevention, overdose deaths among people aged 15 to 24 increased by almost 33% between 2015 and 2016. Preliminary figures for 2017 show that the total number of overdose deaths increases higher, but do not include deaths by age group.
Nurses who work with Students say every day that it is only a matter of time before the evils of a community affect their schools.
Karen Siska-Creel, Director of Nursing at Anne Arundel's Department of Health, pushed to get naloxone in schools because overdose deaths in the county near Baltimore were skyrocketing.
"I knew what was happening in the country and in our state," she said. "I thought everything in our county will be in our schools."
In 2015, Siska-Creel implemented the county's overdose prevention training initiative, the first state-certified school program in Maryland. She received $ 12,500 in public funding to purchase two doses of Narcan for each of the 125 schools in the county, and trained school nurses and drug support staff.
Ten days after the launch of the program in early 2016, said Siska-Creel, a teenage student has appeared in a high school health center"Act funny." The unidentified girl started to fade; in a few minutes she was not answering questions.
The school nurse administered two doses of naloxone. Siska-Creel stated that the student had recovered and had been transported to the hospital for follow-up care.
Anne Arundel's schools used naloxone three more times among students, including a high school student who nodded in class last year.
What started with a determined nurse in a county has become a requirement of the state. The Introductory Act of Maryland, adopted by the The Maryland General Assembly of last year requires all public schools to have naloxone and to teach students the dangers of heroin and other opioids.
More: To save lives, the general surgeon says he's getting the opioid antidote naloxone. Here's what to do
More: General Surgeon's Opinion: You can stop an overdose death by wearing this simple kit
New Jersey passed a law this year that requires all high schools – public, private and private – to stock naloxone. It allows school nurses to administer up to three doses of naloxone to a student, staff member or visitor without fear of prosecution.
"Our first goal was to put an end to these deaths," said MP Vincent Mazzeo, sponsor of the legislation.. "This epidemic is hitting all forms of life here – we already have defibrillators – we think it's a proactive approach."
But across the Hudson River, New York City schools take a different approach.
In the absence of known overdose in the school during normal school hours since 2005, municipal education officials claim that they do not see the need to stock the "school". antidote in every school. The schools in the city provide addiction and mental health education and intervention services to students and their families.
A special education teacher was found dead in a bathroom at the Bronx School last November. with a syringe and a small bag containing drug residues.
Medical examiners concluded that Matthew Azimi had overdosed fentanyl. A man has been accused of selling the lethal drug to Azimi and another was accused of selling heroin and fentanyl near the school. Azimi would have died after school hours.
Elsewhere in New York State, suburbs and rural districts retain drugs.
L & # 39; state has committed more than $ 300 million to programs to combat the opioid epidemic. More than 100 school districts have enrolled in overdose prevention programs and trained more than 11,000 non-medical school staff to recognize overdose and administer naloxone.
Overdoses of students have been rare in New York, but there are at least two known cases.
Students received naloxone in high schools in Suffolk County and Ulster County in 2017, according to public health officials. They had no information on how these two students had managed to get the antidote.
Rhode Island, considered one of the most aggressive states facing the epidemic of opioids, demands all colleges, public colleges and high schools have naloxone. No school in Rhode Island has used the antidote on a student overdose, said a spokesman for the health department.
At least 10 states have passed naloxone laws in schools. Some states such as Maryland, New Jersey and Rhode Island require schools to stock the antidote. More often, states allow a school board or local superintendent to make a decision.
"It's a community decision," said Donna Mazyck, executive director of the National Association of School Nurses.
L & # 39; Association adopted three years ago the position that schools and school nurses should make available to naloxone to respond to overdoses.
Adapt Pharma, the company that markets Narcan, awarded the association a $ 25,000 grant in 2016. Nurses has spent the money to create a brand agnostic training kit for opioid emergencies that schools can download on its website.
The association has also offered training or supplies for CPR, epinephrine injectors and albuterol inhalers.
"The health departments have tackled this problem all over the country," said Mazyck. "Schools happen to be one more place in the community."
"Schools are the cornerstone of every community"
While many states are investing taxpayer dollars to buy naloxone, Adapt Pharma has donated two Narcan starter kits to high schools free of charge.
The US-based Irish company in Philadelphia launched the program through the Clinton Foundation in April 2016, spokesman Thom Duddy said. He has since donated or sold 3,436 kits to 1,167 schools across the country.
The states that received the most free kits are Massachusetts, New Hampshire, New Jersey, Pennsylvania and Georgia.
A Narcan kit that contains two doses. The drug expires after two years. Most states have standing orders that allow pharmacies to sell Narcan and other naloxone products without a prescription. Narcan is selling for $ 130 to $ 150, according to the GoodRx prescription drug website.
Adapt Pharma charges a group purchase price of $ 75 per kit to entities such as emergency medical teams, government agencies, community organizations and schools not covered by the program's distribution program .
The company does not check if its kits are used, said Duddy, in part to avoid the possibility of violating federal patient privacy laws. So, he does not know if a given kit has already saved a student.
Company officials view the kits as part of a broader educational offering, a topic of discussion that can help reduce the stigma of addiction and educate students on the slippery slope from pain medications such as Vicodin and Percocet.
Adapt also sees free kits as another potential guarantee for the entire community. The kits may be available in case of overdose in an adult during a high school football game, a school game or a school polling station.
"We strongly believe that schools are the cornerstone of every community in the United States," said Mike Kelly, president of Adapt Pharma's US operations.
Critical: Higher priority groups should first get naloxone
Critics say that scarce resources should be directed to groups that are at greater risk of overdose.
Corey Davis, lead counsel at the National Health Law Program, cited examples such as parolees with a history of substance abuse or opioid addicts in abstinence-based treatment programs.
"I can not imagine that Adapt says it's the best use of resources," Davis said.
Wheeler, of the Harm Reduction Coalition, said the key to reversing overdoses is to give naloxone directly to drug users.
"People use drugs with other people who use drugs – or alone," said Wheeler. "They are the ones who witness overdoses."
Other priority groups include parents of dependent persons or public places such as restaurants, libraries or public toilets.
Wheeler said it's difficult for an organization like his to pay enough naloxone to cover drug addicts on the street or in at-risk communities. Some risk-reduction organizations have used bake sales to raise funds.
"We often joke:" At least we know where all the naloxone is, "said Wheeler." It's in the schools. "
"He had life in his eyes"
Others advocate the idea of naloxone in schools, even though the drug is not frequently used.
Toni Torsch, Baltimore County, Maryland, has advocated for a wider distribution of naloxone, compassionate laws and public investments in the fight against the opioid crisis since his teenage 24 yearshis son died of an overdose in 2010.
Daniel Carl Torsch started using OxyContin at age 17. He eventually turned to cheaper heroin in what became a seven-year battle that included four stays in inpatient treatment centers.
On December 3, 2010, Torsch thought his son was well placed. He had recently completed a long-term rehab training in Florida and seemed healthy and happy.
"He had life in his eyes," said Torsch. "I had my boy back."
But while she was preparing to leave their home that day, she knocked on her bedroom door. There was no answer.
She nudged the open door. He was lying on a bed No sign of life.
She did not know about naloxone when her son died. After learning about the existence of the drug from a documentary, she pleaded for its wider use. Now, she says that many others can be spared if they get the antidote in time, or learn the dangers of abuse before taking their first pill or their injection.
"I later discovered who he was receiving his pills – from normal families.Just in school," Torsch said.
In Anne Arundel County, Siska-Creel said she heard many similar stories of mothers and fathers who lost children.
She also heard skeptics about storing naloxone in schools.
"People came to me and said," You will never use it. It's a waste of money. It will affect our property values, "she said.
"You know what? I'm not going to wait for a child to die, I'm not ready to wait for that to happen."
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