• September 2018

  • Andrew Babiak

  • High Schools Required to Maintain an Adequate Supply of Opioid Antidotes 

     

    Overview

    The non-medical use of opioids by adults in the United States has reached epidemic proportions,1 leading to tens of thousands of overdoses and to over 42,000 deaths in 2016.2 The opioid crisis affecting adults in the United States impacts individuals in all types of jobs3 and has also impacted young adults including high school students.4 In fact, there are reports of high school students across the country having suffered drug overdoses.5

     

    On August 24, 2018, in response to the ongoing opioid crisis, Governor Phil Murphy signed Assembly Bill No. 542 into law.6  Beginning December 1, 2018,7 this new law requires all boards of education to develop a policy, in accordance with guidance from the New Jersey Department of Education (NDJOE), for the emergency administration of an opioid antidote to a student, staff member, or other individual who is experiencing an opioid overdose.8 

     

    Policy Contents and NJDOE Guidelines

    The new law requires NJDOE, in consultation with the Department of Human Services (DHS) and other medical experts, to prepare guidelines for the development of the policy for the emergency administration of opioid antidotes.9 The guidelines must include a requirement that each school nurse and each district employee designated to administer an opioid antidote in the absence of the school nurse, as discussed below, receive training on the protocols for the administration of an opioid antidote in the event an individual experiences an overdose.10 The guidelines must specify the overdose prevention information contained in section 5a. of the Overdose Prevention Act11 and must identify the appropriate entity or entities responsible for training the district employees who are designated to administer opioid antidotes.12 

     

    Every board must implement the NJDOE’s guidelines in developing and approving the opioid antidote policy.13 The policy must require each school with any grades of nine through twelve to:  (1) obtain a standing order for opioid antidotes under section 4 of the Overdose Prevention Act codified at N.J.S.A. 24:6J-4 as amended;14 (2) maintain a supply of opioid antidotes in a secure, unlocked and easily accessible location; (3) permit the school nurse or designated employee, who has undergone training, to administer the antidote to any person whom the nurse or employee, in good faith believes, is experiencing an opioid overdose;15 and (4) require the transportation of a victim of an overdose to a hospital emergency room by emergency services personnel after the administration of an opioid antidote, even if the individual’s symptoms appear to have subsided.16 The policy may also allow for the use and/or accessibility of opioid antidotes during school-sponsored functions off school grounds.17 For any other school that does not operate any grades nine-through-twelve, the law is permissive and the policy may allow the school to undertake the conditions in items (1) through (4) above.18

               

    The Types and Quantities of Opioid Antidotes Schools Should Maintain

    The new law does not state the precise types and/or quantities of opioid antidotes schools must maintain.  Rather, the law requires that the board, in consultation with NJDOE and the DHS, decide the quantities and type(s) of opioid antidote(s) to be kept on hand.19 The law does not restrict boards to one treatment option; it recognizes that there is more than one type of antidote available and that there may be other FDA-approved treatments in the future. 

     

    Maintenance of and Responsibility for Administering Opioid Antidotes By School Nurses and Board-Designated Employees

    The new law provides that school nurses have the primary responsibility for the emergency administration of opioid antidotes in accordance with the board-approved policy.20 The board must also designate additional employees who will volunteer to administer an opioid antidote if the nurse is not physically present at the scene of an overdose.21 The designated employees will only be authorized to administer an opioid antidote after receiving specified training based on the guidance issued by NJDOE, in consultation with DHS.22 

     

    Any opioid antidote must be stored in a secure, unlocked and easily accessible location. It must be accessible during regular school hours and during school-sponsored functions that take place in the school or on school grounds adjacent to the school.23 School officials will need to seek guidance on the appropriate storage of opioid antidotes to the extent a board decides, in its discretion, to make them available for school-sponsored functions that take place off school grounds. 

     

    Protection from Liability for the Good Faith Administration of Opioid Antidotes

    School officials should be aware that the new law protects school nurses and any school employee from liability for acting in “good faith” when administering an opioid antidote to a person believed to be experiencing an opioid overdose.24 The Overdose Protection Act, as amended, protects school nurses, and school employees from criminal liability, civil liability, and disciplinary action for the administration of an opioid antidote.25 This means school nurses and district-designated volunteer employees who administer an opioid antidote, in good faith, in a particular situation cannot be criminally prosecuted, sued civilly, or face tenure charges or other disciplinary action for his/her actions. The Overdose Protection Act, as amended, also protects school districts from liability for permitting the administration of an opioid antidote.26 

      

    Costs of Opioid Antidotes; Two Free Cartons of Narcan Available from ADAPT Pharma

    The Legislature’s Office of Legislative Services (OLS) undertook a fiscal analysis of the costs of complying with the new law and concluded that it would “lead to an indeterminate expenditure increase among school districts.”27 OLS’s analysis indicated that the costs of different opioid antidotes varies considerably from $20 for the least expensive injectable to $4,500 for a two-pack of an auto-injectable.28 It noted, however, that one pharmaceutical company was offering two cartons of the opioid antidote to high schools free of charge.  Therefore, high schools that obtain the free supply would only incur costs once it used its supply or once the antidote reached its expiration date.29

     

    ADAPT Pharma, Inc., the manufacturer of Narcan nasal spray, will make two cartons (i.e., four 4 mg doses) of this antidote available free of charge to high school districts.  It made this announcement on March 19, 2018.30  School officials are encouraged to apply for the free supply on the following website: https://www.narcan.com/partnerships.

     

    Conclusion

    School administrators must ensure that their boards develop and approve a policy for the emergency administration of opioid antidotes in accordance with guidelines from NJDOE.  School employees should be recruited as volunteers for the administration of opioid antidotes in the absence of the school nurse, and all such employees must receive training on administration of the antidote and the signs of an opioid overdose.  School administrators must then determine, in consultation with NJDOE and DHS, the types and quantities of the opioid antidote(s) to maintain in school(s).  School administrators, in consultation with school nurses, should decide on the secure and accessible location for the storage of each opioid antidote. Questions regarding the new law and its implementation should be directed to the board attorney.

     

     

     

    1. See 2015 National Drug Threat Assessment Summary, U.S. Drug Enforcement Agency (November 2015). 
    2. See Centers for Disease Control and Prevention, Overview of the Drug Overdose Epidemic.
    3. See, e.g., “Worker Likely Dies of Overdose at New Jersey School Construction Site,” NBC 10 News, January 5, 2017; Tom Davis, “Carnival Worker Dies Of Heroin OD In Paterson Park,” The Patch, July 5, 2018; and Jeff Bonty, “Prominent Doctor, BBCHS Grad Dies of Suspected Overdose,” The Daily Journal, December 21, 2017.
    4. See Joseph J. Palamar, Jenni A. Shearston, Eric W. Dawson, Pedro Mateu-Gelabert, and Danielle C. Ompad, “Nonmedical Opioid Use and Heroin Use in a Nationally Representative Sample of US High School Seniors,” Drug Alcohol Dependency, Jan 1, 2016 (12.4% of a representative sample of approximately 67,000 high school seniors reported using a nonmedical opioid at least once in their lives).
    5. See Pressley Baird and Sarah Nagem, “Six Deaths Over Three Years. Drugs Are Taking a Toll on This Raleigh High School,” The News & Observer, April 03, 2018; Tim Callery, “Keene High School Student Suffers Fatal Overdose,” The News & Observer, August 19, 2018; and Zeke Hartner, “Possible Overdoses Send Several DC High School Students to Hospital,” WTOP Radio, April 13, 2018.
    1. Pub. Law 2018, ch. 106.
    2. Pub. Law 2018, ch. 106, §9 (“This act shall take effect on the first day of the fourth month next following the date of enactment, except the Department of Education may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.”).
    3. Pub. Law 2018, ch. 106, §2.
    4. See Pub. Law 2018, ch. 106, §3.
    5. See id.
    6. N.J.S.A. 24:6J-5(a). Pursuant to section 5a. of the Overdose Prevention Act school nurses and board-designated employees to receive at a minimum, the following information: “information on opioid overdose prevention and recognition; instructions on how to perform rescue breathing and resuscitation; information on opioid antidote dosage and instructions on opioid antidote administration; information describing the importance of calling 911 emergency telephone service for assistance with an opioid overdose; and instructions for appropriate care of an overdose victim after administration of the opioid antidote.” Id.
    7. See Pub. Law 2018, ch. 106, §3.
    8. Id.
    9. N.J.S.A. 24:6J-4 addresses, among other things, the circumstances and authority under which physicians and other health care providers to prescribe and administer opioid antidotes. It was amended to include schools, school districts, and school nurses as authorized recipients of opioid antidotes. See Pub. Law 2018, ch. 106, §§7 and 8.
    10. Pub. Law 2018, ch. 106, §2(a).
    11. Pub. Law 2018, ch. 106, §2(d).
    12. See Pub. Law 2018, ch. 106, §2(b).
    13. See Pub. Law 2018, ch. 106, §2(d).
    14. Pub. Law 2018, ch. 106, §2(b).
    15. Pub. Law 2018, ch. 106, §2(c).
    16. Pub. Law 2018, ch. 106, §2(c).
    17. Id.
    18. Pub. Law 2018, ch. 106, §2(b).
    19. Pub. Law 2018, ch. 106, §4.
    20. Pub. Law 2018, ch. 106, §8 (codified at N.J.S.A. 24:6J-4(f) (as amended)).
    21. Id.
    22. Office of Legislative Services, Legislative Fiscal Estimate, Assembly Bill No. 542 (March 9, 2018).
    23. See id.
    24. See id.
    25. “ADAPT Pharma Expands Program Offering Free NARCAN (naloxone HCl) Nasal Spray to Eligible Schools and Universities,” Press Release (March 19, 2018).