The Case for Making Overdose Reversal Medication Accessible to Students

Since 1999, drug overdoses have killed more than a million people in the United States. Opioids are responsible for 72 percent of those deaths. In 2023 alone, more than 80,000 people in the United States died due to an opioid overdose. These overall numbers are alarming for our nation, but the tragic loss of children and adolescents to opioids in particular receives far less attention than it deserves. The United States lost, on average, twenty-two adolescent lives to an overdose every day in 2022.

U.S. efforts to reduce drug usage among adolescents date back to the early 1980s, when the Drug Abuse Resistance Education (D.A.R.E.) and “Just Say No” campaigns rose to teach students about substance abuse and tell them to refuse drugs if offered. The campaigns’ premises were simple, but ultimately ineffective. Students continued to turn to drugs for a variety of reasons, including peer pressure, trauma or conflict at home, and stress from school and classmates. 

The opioid epidemic in particular began to take hold in the mid-1990s, when pharmaceutical companies pushed for the over-prescribing of opioids and downplayed the risks of addiction. Since then, the fatality of drug usage has skyrocketed due to the increased use of fentanyl, a potent opioid that can easily cause an overdose even in small quantities. 

It has proven difficult to tell students to stop using drugs altogether, since a complexity of factors contribute to drug usage. One approach is to try to teach students the skills they need to be safe if they do choose to use drugs, a concept known as “harm reduction.” A significant breakthrough occurred in 2023 when naloxone, an opioid antagonist that can rapidly reverse an opioid overdose, became available over-the-counter as Narcan.

But when a child is at school, where can they find Narcan? As of 2023, thirty-three states have laws that allow schools to keep naloxone on hand, but it is mainly stored in private areas managed by staff and away from students, such as the nurse’s office.

Imagine a student is overdosing on opioids in the bathroom. In the time that it takes for a friend to go to the nurse’s office, tell a staff member about the situation, and have the adult come into the bathroom to administer Narcan, the student could be dead. When responding to an overdose, Narcan must be given within five minutes to prevent brain damage and within eight minutes to prevent death. Students should call 911 and get medical professionals involved, but it is also critical that Narcan is available to students to respond immediately in an overdose situation.

Many states throughout the country require all schools to have an automated external defibrillator (AED) on campus for everyone to use, including students, because it is important that everyone can access the life-saving device in an emergency situation. Under similar principles, Narcan should be placed in openly accessible containers throughout schools, whether that is inside an AED kit or through the installation of special naloxone kit containers called NaloxBoxes.

Jennifer Knight-Levine, the co-founder and CEO of the SAFE Coalition, has collaborated with the District Attorney’s office in Norfolk County, Massachusetts, to distribute more than 100 NaloxBoxes across the county, with more than half being placed in public schools. 

“We have seen an increase in overdoses on school grounds, most often related to parents or adults who are on school property,” she explains. “Utilizing the NaloxBoxes has saved lives on school grounds.”

Arlington, Virginia, has also garnered significant media attention for its leadership in increasing naloxone access to students, becoming one of the first communities to teach students how to use naloxone and allow them to carry it with them to school. Additionally, there are now Windy City Non-Locking Overdose Emergency Kit Cabinets in every middle and high school in Arlington Public Schools. Emily Siqveland, the opioid response coordinator in Arlington County, emphasizes that students have said the increased accessibility of naloxone makes them feel safer and more prepared at school. She also highlights the role that the community played in making this initiative a reality. 

“One of the primary reasons we have naloxone in our schools is because parents and students advocated for it,” Siqveland says. “Parents’ and students’ voices can make so much more of a difference than they realize.”

Parent pushback is likely one of the largest barriers that schools will face in expanding access to naloxone for students. Parents may believe that because they believe their child doesn’t use opioids, there is no need for them to learn about naloxone. But even if a child does not use opioids, they may encounter those who do in their school, extracurricular activities, or community, and knowing how to administer naloxone could allow them to save the life of a person that is overdosing. 

Additionally, recent years have seen an increase in fentanyl-laced prescription pills in the drug supply, with up to 60 percent of fake prescription pills containing a potentially lethal amount of fentanyl. According to Dr. Scott Weiner, McGraw Distinguished Chair in Emergency Medicine at Brigham and Women’s Hospital in Massachusetts, many young people are consuming fentanyl without even knowing it. 

“What we’re seeing is a rapid change in the epidemiology of overdose,” he explains. “Now, we are seeing fentanyl in pressed pills that are fairly easy for adolescents to access. The unfortunate thing is that they look just like pharmaceutical-grade drugs so someone may assume it came from a medicine cabinet, but they’re actually not. This means that overdose can even happen to someone who doesn’t have an addiction or opioid use disorder.”

Jennifer Tracey, Chief Program Officer of RIZE Massachusetts, says that increasing accessibility to naloxone is key in addressing the stigma associated with substance use. Making naloxone more visible and normalizing conversation around it raises awareness on the topic and opens up more avenues for students who are struggling with addiction to reach out for help. 

“If young people know that they can reach out to an adult in the school to talk about their own substance use or that of a family member,” Tracey says, “I think all of that plays into the role of having naloxone accessible and available.”

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In the heartland of Louisiana, between Baton Rouge and New Orleans, a 150-mile corridor along the Mississippi River tells a tale of environmental degradation, social injustice, and economic struggle. This region, home to more than 150 behemoth chemical facilities and oil refineries, is also home to numerous communities, predominantly low-income and marginalized. Nearly 50 percent of the residents are African American, their roots intertwined with the land for centuries, dating back to the days of slavery when they were forced to cut and process sugarcane on vast plantations that dominated Louisiana’s River Parishes.

The Environmental Protection Agency (EPA) reports a staggering 95 percent higher risk of cancer due to air pollution for residents in this area compared with the rest of the United States. This tragedy has earned the corridor the morbid moniker “Cancer Alley,” a term underscored in 2021 by United Nations human rights experts as a stark example of environmental racism.

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President-elect Donald Trump has repeatedly promised to impose trade tariffs ranging from 25 percent to 100 percent unless Mexico “secures” its border with the United States. The concept of using Mexico as an arm of the U.S. immigration enforcement is not new. 

During his first administration, Trump pressured Mexico to increase the number of detentions and deportations of migrants from Mexico, accelerating a trend that had already begun under the Obama Administration. Mexico became a de facto detention center, where migrants from Latin America and other parts of the world seeking protection in the U.S. were forced to wait while their cases—and futures—were decided.

Over the course of the Trump and Obama Administrations, I traveled across Mexico and witnessed firsthand the transformation these pressures were causing in the Mexican immigration system. I observed increasing numbers of checkpoints and raids in highways, bus stations, and workplaces throughout Mexico. 

As a result of these efforts, migrants from Central and South America were moving increasingly to and through isolated areas in Mexico to avoid detection and detention. This mirrors what has been thoroughly documented along the U.S. border, where migrants attempt to cross through more remote (and therefore deadly) areas to avoid the U.S. Border Patrol.

I also witnessed a burgeoning migration industry throughout Mexico, an industry that had once existed mainly along the U.S. border. Towns that were previously far away from migrant routes have become key transit points, shaping local economies and turning migrants into commodities rather than recognizing their humanity.

In border areas, on both sides, I observed how the criminalization and persecution of migrants by Mexican authorities at all levels forced them to wander the streets, beg for food, and gather around bus stations, shelters, or any place that felt marginally safer than being out in the open. And I saw increasing numbers of migrants stranded without the means to move forward in various parts of Mexico that were previously not frequented by migrants. 

As a result, migrants became more and more visible to locals. And, just like we have seen in the United States, this visibility has led Mexican locals to complain that migrants use services meant for Mexicans or bring undesirable diseases into the country. By the time I left the field, migrants were frequently conveying to me and other investigators that they experienced discrimination in Mexico in jobs and the receipt of essential services like health care and education. 

Mexico is being pushed into treating migrants from other countries, including Venezuela, Guatemala, Honduras, and El Salvador, in the same way that the U.S. has treated undocumented Mexicans for decades. And in its eagerness to serve U.S. interests, Mexico has transformed its relationship with migrants, allowing the same abuses of migrants that occur on the U.S. side of the border. 

To date, Mexico has shown willingness to cooperate with Trump’s immigration plans. This cooperation is key: Mexico’s immigration policies can help him realize his much-touted dream of a completely closed U.S. border, while avoiding the challenges he can expect within the United States.

But will Mexico continue to cooperate with Trump? Maybe. The Mexican government has seen a change in head of state since Trump’s last term. Its newly elected president, Claudia Sheinbaum, will face internal resistance to stepped-up immigration enforcement from civil and religious organizations that have expanded their support of migrants over the last few years. And Trump’s overreach will likely be met with pushback here in the United States.

Trump’s economic clout is powerful, and anti-immigrant sentiment has a foothold in Mexico. Only time will tell whether that is enough to hold the countries’ border-based partnership together. In the meantime, I expect to see more of the same: migrants suffering at the hands of two states in a system that does not deter migrants, but only punishes them.

This column was produced for Progressive Perspectives, a project of The Progressive magazine, and distributed by Tribune News Service.

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