LOS GATOS, California – Los Gatos High School principal Kevin Buchanan felt helpless on the third day of the 2021 school year.
It wasn’t the typical chaos of the first week back. Instead, Buchanan sat on the floor and rocked a student’s body—watching their faces turn white, their bodies clammy, and their breathing become increasingly shallow.
The student had an opioid-induced overdose.
“There was nothing I could do but try to keep them awake until the ambulance arrived,” said Buchanan.
Although this Los Gatos High School student survived the crisis, many students do not.
In 2021 alone, 36 teens died of opioid-related overdoses in the Bay Area, and 224 teens statewide have fatally overdosed in the past two years, according to the California Department of Public Health.
Today, Los Gatos High School has naloxone hydrochloride in its health center.
Naloxone, also known as Narcan, is a nasal spray that can block opioid absorption and restore breathing in the event of an overdose.
“We had to do something,” Buchanan said. “We had to prepare our staff for these situations.”
While it’s not the only method of harm reduction, substance abuse experts say naloxone is a useful tool because minimally trained bystanders can administer it.
According to the Centers for Disease Control, the number of naloxone prescriptions dispensed nationally doubled between 2017 and 2018. California has programs that provide free naloxone to schools.
However, schools decide to use naloxone based on perceived school drug use, and schools also need administrators advocating for naloxone in their health centers.
There are no top-down government guidelines requiring schools to carry naloxone on campus; they have the option to do so voluntarily.
Some Bay Area school districts, such as Novato Unified, began supplying naloxone to their health centers as early as 2017.
Palo Alto Unified and Campbell Union added it in 2018. In 2020, eleven Bay Area school districts had naloxone on campus.
This fall, the San Francisco Unified School District will investigate whether to create a district protocol for opioid overdose.
Along with cities and towns, some counties recommend schools provide naloxone, although it is not required. In September, the Santa Clara County Board of Supervisors earmarked $135,000 to provide naloxone kits to the county’s 65 high schools.
Not more common, just more deadly
The teenage dose crisis is a recent phenomenon.
For decades, teens, as a demographic, have been relatively isolated from increased opioid overdose deaths, as teen drug use is often characterized by experimentation rather than addiction.
While teen overdose deaths have always existed, the spike in overdoses began just two years ago.
In 2020, overdose deaths have doubled for teens in America. In 2021, the rate will increase by another 20 percent.
Yet illicit drug use among teens has remained essentially the same throughout this period.
“Drug abuse is not becoming more common,” said Joseph Friedman, a Ph.D. researcher at the David Geffen School of Medicine at UCLA. “It’s only getting more dangerous.”
While teens report experimenting with prescription drugs such as benzodiazepines (Xanax) and stimulants (Adderall), today there is a greater risk of using counterfeit pills that look similar to prescription drugs.
There is also a high risk that the pill contains fentanyl, a powerful synthetic opioid.
According to the Centers for Disease Control, Fentanyl is about 50 to 100 times more potent than morphine and induces drug overdoses.
By 2021, 77 percent of teen overdoses in America were from fentanyl.
“We see that a lot of the overdoses are kids who are just experimenting,” Friedman said. “That changes the approach and urgency around harm reduction.” Despite this crisis, the California Department of Education was unwilling to do more than recommend schools stock naloxone on campus.
There are no legal mandates requiring his attendance at high schools.
The absence of naloxone reflects the autonomy given to school districts.
“Schools are perhaps the most local part of our society,” said Ori Tzvieli, Contra Costa County’s director of public health.
Before schools can add naloxone to their health centers, the local school board must approve the new regulation, a process that can be time consuming and cumbersome.
“By going school by school, we have to reach out and educate the school districts themselves. You have to find someone to champion this cause,” said Gretchen Burns Bergman, executive director and co-founder of A New PATH, a harm reduction advocacy group in San Diego. “It’s a laborious process.”
The perceived risk may not correspond to reality
In the Los Gatos-Saratoga Unified School District, for example, it took teachers a year to get a naloxone protocol through the bureaucratic process and get approval from the school board.
This per-school approach also allows schools to decide whether to carry naloxone based on their own perceived risk.
“We have two schools in our district,” Buchanan said. “I don’t think we experienced the same sense of urgency because the experience happened at our school.”
This can be a problem when the larger school community lacks local statistics and data and underestimates community risk.
“People bury these stories,” Buchanan said. “It’s hard to get people to accept that this is a crisis.”
National Association of School Nurses president Linda Mendonca said lack of awareness is the main reason schools don’t keep naloxone on campus.
“People think that this does not happen in the Netherlands [their] community, or they don’t want to.” The National Association of School Nurses publicly supports providing naloxone to high schools.
Proponents say more explicit policies, including naloxone mandates from state and local governing boards, would help reduce teen overdoses.
Those mandates do exist in higher education.
In August, Governor Gavin Newsom signed legislation requiring California community colleges and state universities to make naloxone available on their campuses.
In 2019, Rhode Island Governor Gina Raimondo signed into law a law making naloxone mandatory in state public and private schools.
The lack of naloxone in high schools is not due to a lack of funding.
The California Department of Health Care Services runs the Naloxone Distribution Project which provides free naloxone to schools and organizations serving high-risk groups, including teens.
In May, Governor Newsom added $10 million in funds to the Naloxone Distribution Project as part of his budget review.
The program now receives $15 million in state funds.
Schools in the Bay Area use this program to deliver naloxone to their health centers.
For example, Los Gatos High School received naloxone kits through this program, and schools in Contra Costa County want to do the same.
An additional problem surrounding naloxone is perceived liability.
Some schools worry that families can hold them accountable if things go wrong.
“There’s a bureaucratic protection that I found in high schools,” Burns Bergman said. “It’s not just about stigma, it’s about self-defense from accountability.”
However, UCLA’s Friedman stresses that naloxone is safe.
More importantly, as of 2017, every state and the District of Columbia have laws protecting individuals from liability for administering naloxone.
“Accidentally using naloxone in someone who isn’t overdosing isn’t going to be dangerous to their health,” Friedman said. “It should be considered an obligation not to have naloxone around.”