Naloxone Administration in School Settings Toolkit
Opioid Overview
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Rising opioid overdose deaths are a public health crisis. According to the Centers for Disease Control and Prevention (CDC), from May 2020 – April 2021, deaths due to accidental overdose surpassed 100,000 for the first time on record. The 2021 data reports half of these deaths are opioid related with a total of 50,942 fatal opioid overdoses. Narcan was administered in only 20% of these fatal opioid overdoses. CDC: SUDORS Dashboard- Fatal Overdose Data
Opioids in Minnesota
The Minnesota Department Health (MDH) provides comprehensive information, resources, data in Opioid Overdose Prevention webpages. Schools should use this website for additional information and to stay up to date as evidence and data evolve.
MDH Opioid Data web pages contain much data including data on statewide trends in overdose deaths and nonfatal overdoses by county as two examples. Opioid-involved overdose deaths among Minnesotans increased 44% from 2020 to 2021. However, there are 4 times as many non-fatal opioid overdoses as opioid related deaths. The percentage of Minnesota 8th and 9th graders who reported inappropriate use of pain medications (e.g., OxyContin, Percocet, Vicodin) in the past 12 months has continued to increase. Inappropriate use among 11th graders remained steady from 2019 to 2022. Drug Overdose Dashboard
Minnesota State Statutes
These statutes are listed here are for reference only, this is not an exhaustive list related to medication administration, nursing practice or other school health topics that could impact a school policy or procedure. The Minnesota Guidelines for Medication Administration in Schools webpages and the Minnesota School Board Association Model Policy 516.5 Overdose Medication both also cover many federal and state statutes. Schools should consult with their legal counsel to specifically address local decisions related to how statutes impact policy, procedures, and which school personnel will be trained to administer naloxone.
157.37 LEGEND DRUGS: WHO MAY PRESCRIBE, POSSESS. Subd. 12 Administration of opiate antagonists for drug overdose was amended this past legislative session from (6) a licensed school nurse or certified public health nurse employed by, or under contract with a school board under section 121A.21. The new language reads (6) nurses and school personnel in public, charter and private schools.
Subd. 12. Administration of opiate antagonists for drug overdose.
(a) A licensed physician, a licensed advanced practice registered nurse authorized to prescribe drugs pursuant to section 148.235, or a licensed physician assistant may authorize the following individuals to administer opiate antagonists, as defined in section 604A.04, subdivision 1:
(6) a nurse or any other personnel employed by, or under contract with, a charter, public, or private school;
(b) For the purposes of this subdivision, opiate antagonists may be administered by one of these individuals only if:
(1) the licensed physician, licensed physician assistant, or licensed advanced practice registered nurse has issued a standing order to, or entered into a protocol with, the individual; and
(2) the individual has training in the recognition of signs of opiate overdose and the use of opiate antagonists as part of the emergency response to opiate overdose.
(c) Nothing in this section prohibits the possession and administration of naloxone pursuant to section 604A.04.
(d) Notwithstanding section 148.235, subdivisions 8 and 9, a licensed practical nurse is authorized to possess and administer according to this subdivision an opiate antagonist in a school setting.
604A.04 GOOD SAMARITAN OVERDOSE PREVENTION. This statute addresses a person who is NOT a health care professional related to the possession and administration of an opiate antagonist and health care professionals release from liability.
604A.04 Subd. 2. Authority to possess and administer opiate antagonists; release from liability.
(a) A person who is not a health care professional may possess or administer an opiate antagonist that is prescribed, dispensed, or distributed by a licensed health care professional pursuant to subdivision 3.
(b) A person who is not a health care professional who acts in good faith in administering an opiate antagonist to another person whom the person believes in good faith to be suffering a drug overdose is immune from criminal prosecution for the act and is not liable for any civil damages for acts or omissions resulting from the act.
604A.04 Subd. 3. Health care professionals, release from liability.
A licensed health care professional who is permitted by law to prescribe an opiate antagonist, if acting in good faith, may directly or by standing order prescribe, dispense, distribute, or administer an opiate antagonist to a person without being subject to civil liability or criminal prosecution for the act. This immunity applies even when the opiate antagonist is eventually administered in either or both of the following instances: (1) by someone other than the person to whom it is prescribed; or (2) to someone other than the person to whom it is prescribed.
Definitions
Drug-related overdose means an acute condition, including mania, hysteria, extreme physical illness, respiratory depression, or coma, resulting from the consumption or use of a controlled substance, or another substance with which a controlled substance was combined, and that a layperson would reasonably believe to be a drug overdose that requires immediate medical assistance.
Naloxone is a medication that works to rapidly reverse an opioid overdose when administered properly and at the right time. It can very quickly restore normal breathing for a person whose breathing has slowed down or stopped because of an overdose of fentanyl, prescription opioids, counterfeit laced prescription pills, or heroin.
Narcan is one of the brand names for naloxone medication.
Opioid refers broadly to all compounds related to opium; the drug derived from the opium poppy. Opioids can be natural products (e.g., morphine, codeine), semi-synthetic products (e.g., heroin, oxycodone, hydrocodone), or completely synthetic (e.g., fentanyl, methadone).
Opiate antagonist means naloxone hydrochloride (“naloxone”) or any similarly acting drug approved by the federal Food and Drug Administration (FDA) for the treatment of a drug overdose.
Opioid overdose is the accidental overdose or intentional self-poisoning by opioids. It is the most common cause of drug-related mortality in the Unites States. Synthetic opioids (primarily illicit fentanyl) appear to be the primary driver of the increase in opioid overdose deaths.
Policy is a guide for decision making within an organization that is a rule for action. Policies are typically developed and adopted by the local school board after being systematically reviewed by a team.
Prescription is an authorization for a specified medication from a medical provider licensed to prescribe in Minnesota to a pharmacy or organization legal authorized to dispense the medication. In Minnesota, a prescription is required to obtain naloxone.
Procedure is a sequence of steps that should be followed to implement policies. It represents the series of steps in which trained staff members will follow in a certain order when a believed or suspected opioid overdose. This procedure may vary slightly by site.
Protocol-Condition Specific is the written direction/orders signed by a Medical Provider that provides directions on which type of medication is to be used, when to use the medication, and to whom the medication can be administered. This is required for all nurses and school personnel to administer naloxone in the school setting. (Note: many people use the term “Standing Order” to mean the same as Protocol-Condition Specific, but technically there is a difference.) See the Guidance for Naloxone Condition Specific Protocol for additional information.