Hudson grapples with overdose antidote policy in schools

HUDSON–A group of Hudson City School District (HCSD) officials met on March 2 to discuss supplying schools with Narcan, an emergency antidote to opioid overdoses. The state Department of Health is trying to persuade all schools to have Narcan available, and several schools in the area already have a Narcan policy in place, according to June Boucher, the registered nurse for the HCSD Intermediate School.

Narcan (naloxone HCl) blocks opioids from affecting the body for half an hour. It does not replace emergency medical treatment but it can keep an overdose victim’s body functioning until emergency responders arrive. People familiar with the drug say that anyone who one administers it must also call for emergency medical help.

Narcan kits consist of pre-measured doses of naloxone and equipment for administering it. There are two methods used to administer naloxone: injection or nasal spray. For schools, nasal spray is recommended, Ms. Boucher said by phone after the meeting, because it is easier for non-medical people to give nasal sprays than to administer injections correctly.

In New York state, she added, Narcan is available to people who undergo training. Often medical doctors or nurse practitioners attend training sessions to write prescriptions for those who successfully complete the training.

Narcan is not supposed to have adverse effects, even if it is mistakenly given to a person not overdosing on opiates, according to people at the meeting. “It is safe to treat it differently than other medications. Most meds are double locked. Narcan kits can be available to everyone,” said Michael Needham, an independent risk management consultant who has advised the Hudson district on various matters. He spoke at the March 2 meeting.

“At the training class I took, we were spraying it on each other,” said Robert LaCasse, Associate Principal of Hudson High School.

On the other hand, the relative ease of obtaining Narcan makes it more difficult to monitor. Some kits have been recalled because they would not spray. If a private individual offers to provide a Narcan kit, “We have no way to tell if it’s been left in a car” and exposed to extremes of heat and cold, Ms. Boucher said at the meeting.

The health department recommends adding Narcan kits to the cabinets schools already have for storing automatic defibrillators (ADs), and the Hudson School District plans to follow that recommendation. Every school building in the district has two ADs, each in its own special cabinet. Officials now propose that each AD cabinet also have a Narcan nasal spray kit and that each building keep a third Narcan kit as a spare in the nurse’s office. “I like the idea of keeping a back-up supply,” said school board member Linda Hopkins.

“If we use a Narcan kit Friday night, we want it replenished Monday morning,” said Superintendent Maria L. Suttmeier.

But Ms. Boucher cautioned that the kits reach their expiration date after two years, so it is pointless to stock too many. Still, she said, “Custodians are suppose to check the AD units every night, and nurses check the AD units once a month from top to bottom,” so they could add checking the Narcan kit to the AD-checking routine.

The March 2 meeting was part of establishing an official district policy to address opioid abuse. An important element of this policy will be who and under what circumstances the district authorizes the administering of Narcan. Meeting participants identified questions the policy must answer.

• Would the authority to administer Narcan be restricted to RNs and MDs only? Would it include LPNs? District staff trained to handle Narcan? Any district staff? Anyone who has passed Narcan training? Anyone?

• Will that authority differ by time and location (school grounds during school time, school activities on school grounds after school hours, school activities off school grounds, outside organizations using school grounds)?

The current policy is written for “in-school time,” said Dr. Suttmeier. “But what about events after hours attended by people who are not students or staff?” asked Dr. Suttmeier.

Ms. Hopkins indicated that if somebody appeared to be suffering from an overdose, it would be terrible if nobody helped the person because all who were able to help feared they were not authorized to do so.

• How can the policy maximize the chance of rescuing an overdosed person while minimizing the chance of a lawsuit? Ms. Boucher said nurses should not have to spend their time testifying in court.

Mr. Needham recommended a program with a medical director to “write the script” and a program director for tasks such as filling out paperwork and ordering Narcan kits.

The issues discussed at the March 2 meeting will go into the district’s opioid abuse policy under development. The whole HCSD Board of Education will have the opportunity to discuss establishing the policy at the board meeting Monday, March 13 at 7 p.m., at the Hudson High School Library.

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