The tragic death last month of a Miami-Dade County fifth-grader after he somehow came in contact with the powerful drug, fentanyl, has many public school district officials concerned about the health and safety of students.
Count Palm Beach County School Board Chairman Chuck Shaw among them.
While careful not to outright condone stocking the life-saving, anti-overdose drug Narcan (a brand name for Naloxone) on Palm Beach County school campuses to counteract potential opioid overdose situations, Shaw says it is worth discussion when considering the school district’s responsibility to protect kids on those campuses.
I’d have to agree. The overdose deaths stemming from the county’s opioid epidemic, chronicled exhaustively over the past year by The Palm Beach Post, has yet to show any signs of abating. It’s no stretch to assume that this crisis would, at some point, spill over into our school campuses.
So, it would make sense then for school nurses — the front line of defense on health emergencies — to be prepared.
For Shaw, the question had first come to mind because the opioid overdoses reminded him of an incident he had dealt with many years ago as a local school principal.
“A girl had come to school with a couple of vials of blood for a sort of show-and-tell,” he recounted. “It turned out that her mom or sister was training to be a phlebotomist, and had drawn some of the girl’s blood. The girl asked to take the vials to school to show her friends, and the mom or sister said sure.
“That got me to thinking of all things that kids could be exposed to on a school campus,” he continued, “and how much the use of opioids is spreading; not just in our community, but everywhere it seems.”
And that got Shaw wondering whether school nurses were properly trained to handle a potential overdose situation; and then whether Narcan should be at their disposal.
The 46-year veteran of Palm Beach County schools is obviously right to be concerned.
Because this plague is getting worse. Opioids, mainly fentanyl and heroin, have killed 2,664 people in Florida in the first six months of this year — an average of 14 people per day. At this rate, fatal overdoses will outpace last year’s count by 36 percent.
In Palm Beach County alone, overdoses spiked to 311 in the first five months of this year, 20 percent more than the first five months of 2016. And Palm Beach County’s 590 opioid overdose deaths in 2016 were an all-time high for the county and nearly twice as many as in 2015, according to a Palm Beach Post analysis of records from the medical examiner.
And then there’s the tragic death of 10-year-old Alton Banks. Authorities believe that Alton, who lived in Miami’s drug-ridden Overtown neighborhood, died on June 23 after coming into contact with fentanyl — but they are still trying to pin down how.
Alton died after a visit to the pool in Overtown. He began vomiting after coming home and was found unconscious that evening. Preliminary toxicology tests show he had fentanyl in his system.
“We don’t know where he got it. We don’t believe he got it at his home,” Miami-Dade State Attorney Katherine Fernandez Rundle said last week. “It could be as simple as touching it. It could have been a towel at the pool.”
She added: “We just don’t know.”
The case has underscored how frighteningly prevalent fentanyl has become — and how potent it is. Exposure to just tiny amounts can be devastating.
Indeed, fentanyl is so powerful that some police departments have warned officers about even touching the drug. Last year, three police dogs in Broward County got sick after sniffing the drug during a federal raid, according to officials.
But where does the school district’s responsibility begin? “You’ve got the bus stop… the bus,” Shaw mused. “Then, of course, you have the campus.”
The answer, at first, may first appear simple, especially since everyone wants to protect schoolkids.
There are some, however, who worry that having Narcan on hand can also become a crutch and stop some people from taking personal responsibility. Those arguments echo those of past opponents of setting up needle exchanges and distributing condoms to stop the spread of AIDS, who argued that such moves were just encouraging drug use and sex.
Point taken. But it falls flat for Matthew Davis, a professor of pediatrics at Northwestern University’s Feinberg School of Medicine and head of general pediatrics at Ann & Robert H. Lurie Children’s Hospital of Chicago.
“Health care workers in hospitals and first responders in communities have had naloxone on hand for decades, but there is no evidence that having naloxone as an antidote has encouraged Americans to try street drugs and abuse prescription opioids,” Davis wrote in an email to NBC News last week. “Similarly, we would not expect teens to abuse opioids because naloxone is available in their schools.”
Naloxone, he wrote, must be “part of comprehensive drug use prevention programs in schools and communities, to try to reduce drug use among teens.”
“Making naloxone available in junior high and high schools is smart public health policy, given what is known about teens’ misuse of prescription opioid medicines and teens’ use of heroin in the U.S. today,” he added.
Having naloxone on hand “is just like putting a defibrillator on the gym wall for a heart attack, or having injections of epinephrine available for someone who can’t breathe because of a severe allergic reaction,” he wrote. “They are tools made available to save lives.”
Margaret Cellucci of the National Association of Schools Nurses (NASN) echoed those sentiments.
“The school nurse is often the first health professional who responds to an emergency in the school setting,” NASN said in its position statement.
“When administered quickly and effectively, naloxone has the potential to immediately restore breathing to a victim experiencing an opioid overdose,” it said.
To be sure, with 187 school district campuses, the financial cost of taking on this responsibility could be a factor as well. The demand fueled by opioid overdoses has also pushed up the price of Narcan for cities and counties around the country.
Earlier this month, Martin County Commissioner Ed Fielding discussed the possibility of limiting the number of times Martin County Fire Rescue crews would use Narcan to revive a person who has overdosed on multiple occasions. Talking about the Fire Rescue budget, he said he’d gotten the idea from Palm Beach County State Attorney’s Office representatives during their recent visit to Martin County to discuss the region’s opioid epidemic.
According to Fielding, Alan Johnson, assistant state attorney for Palm Beach County, told him “what we’ve had to come up with is, after so many, we do not administer Narcan again.”
But State Attorney’s Office spokesman Mike Edmondson said Fielding’s comments were not accurate and the agency has had no discussions about restricting the usage of Narcan.
Palm Beach County Commissioner Melissa McKinlay, who has been out front on the opioid epidemic, pushed back even harder.
“It’s the most horrific, disgusting proposal I have ever heard in my life,” she told the Post’s Julius Whigham. “It’s not our job to play God.”
Be that as it may, the issue of stocking Narcan is not likely to go away. Not for municipalities. Not for counties. And, as fall creeps ever closer, not for school districts.