Md. Schools to be Supplied with Narcan Kits

July 04—When summer break ends, Frederick County campuses will be stocked with a new type of school supply: naloxone, the overdose reversal medication.

A new state law, which went into effect on Saturday, requires all public schools and institutes of higher education to begin stocking the drug—more commonly known by its prescription name, Narcan—and training staff on how to administer it.

Locally, that includes all 69 Frederick County Public Schools—including elementary and charter schools such as Monocacy Valley Montessori—and the county's three accredited higher education campuses: Hood College, Frederick Community College and Mount St. Mary's University.

"It's certainly a reflection of the epidemic that's happening across the state of Maryland," said Liz Barrett, the vice president of the Frederick County Board of Education. "The cost of stocking naloxone is unfortunately an unfunded mandate right now, but it is a reality, and I'm glad we're doing something to keep our kids alive."

The Heroin and Opioid Education and Community Action Act of 2017, or the Start Talking Maryland Act, sets several requirements for schools in response to the continuing rise in opioid-related overdose deaths across the state.

In addition to storing naloxone at schools, local boards of education are responsible for developing specific policies on its use, expanding courses on opioid addiction and, if relevant, hiring community action officials to provide outreach and addiction education to the local community.

Colleges and universities must also stock naloxone on campus, train designated personnel on administering the medication, and provide in-person drug awareness training to students. Schools that award medical degrees must also offer specific instruction on substance use disorders, effective treatment and pain management, though no Frederick County colleges qualify for the requirement.

According to the language of the bill, the governor must appropriate at least $3 million in fiscal 2019 to the Maryland State Department of Education (MSDE), allowing the organization to supply local school boards with grants to help offset the cost of implementing the new law. But for now, the cost of purchasing naloxone and implementing other changes falls largely on Frederick County, Barrett said.

The school system spent roughly $4,800 to stock naloxone on all campuses for the coming year, according to Jenifer Waters, the health services specialist for FCPS. The system purchased 74 Narcan kits—which come with two doses of the medication —and saved money through a one-time offer by manufacturer Adapt Pharma to provide one free kit per high school.

"But we only get that one time, so the budget will change in the future," Waters said. She anticipated that the school system would spend around $6,000 when it comes time to replace the medication, which has a shelf life of one and a half to two years.

The Board of Education is also working quickly to implement official policies by the start of the 2017-18 school year, Barrett said. The board's Policy Committee—which consists of Barrett, Joy Schaefer and April Miller—met last week to draft a policy asserting the school system's commitment to implementing the new law.

The committee will meet again on July 12 to determine if the draft should stand alone or be incorporated into FCPS' current policy on drug and alcohol use. The new bill also requires that schools develop a policy on parental or guardian notification in cases of student overdose, but Barrett said the school system would likely follow existing notification procedures.

"We're still working through things, but really, the goal is to implement the law as smoothly and efficiently as possible," Barrett said.

The Board of Education also hasn't set a definitive policy on disciplinary measures for students who overdose on school property. The new bill includes a clause that exempts school nurses and other personnel from personal liability while responding to an emergency, and the state's Good Samaritan law protects anyone who seeks medical attention during an overdose. But students who overdose on campus could be subject to disciplinary measures by FCPS, according to Barrett.

"I think the first and foremost goal of the school system is to make sure students are safe and they're OK and they get treatment," she said. "But if students are using drugs on school property, certainly there are disciplinary actions."

Neither Waters nor Michael Doerrer, the spokesman for FCPS, were aware of an opioid-related overdose ever occurring on a public school campus in Frederick County.

And while board members are working to craft new policies, Barrett said she didn't anticipate any changes to school staffing or drug education programs. That's largely due to Frederick County already meeting many of the requirements of the new law, said Brian Griffith, the secondary health curriculum specialist for the school system.

According to the language of the bill, local boards of education or health departments are required to hire at least one community action official to provide public outreach and drug education. But the Frederick County Health Department already provides outreach and drug prevention programming with the help of community partners such as the Frederick County Sheriff's Office, Griffith said.

The department also provides Frederick County teachers with information on naloxone and the Good Samaritan law. School nurses and health technicians are hired through the health department and already trained in Narcan use, according to Waters.

FCPS also meets the educational requirements set by the new bill, which requires schools to create standalone courses that specifically address heroin and opioid abuse. The instruction should be delivered in three separate groupings: third through fifth grades, sixth through eighth grades and ninth through 12th grades.

According to Griffith, FCPS adjusted its drug education programming within the past two years to include more recent opioid-related concerns, including the deadliness of fentanyl. Schools also use the Health Department's "Take Back My Life" campaign to teach a unit on the opioid epidemic and ways for students to address it, he added.

At the high school level, Maryland requires that students complete a half credit of health education—or roughly 45 days—before graduation. Most students take that health class, which includes instruction on heroin and other opioids, in their freshman year, Griffith said.

Tenth grade biology classes include a small unit on substance abuse, which was recently changed to focus on heroin and nicotine, and 11th grade American Studies 2 classes address alcohol and marijuana use. Twelfth grade English classes include a research project on substance abuse, according to Griffith, and the school system is currently considering how to use a $4,000 grant from the MSDE for opioid-related programming.

"As long as we have a section somewhere in our curriculum that addresses heroin, that's going to meet it," he said, referring to requirements set out in the bill. "We can meet those standards no problem."

While stocking naloxone is new for public schools, all three Frederick County colleges have kept the medication on campus for at least the past year.

Hood College began stocking Narcan in early 2016 in response to news reports on the rise of fatal overdoses in the community, said Teresa Cevallos, the school's director of health services. Both public safety officers and health center staff members received naloxone training through the Frederick County Health Department, and the college independently purchased two Narcan kits through Adapt Pharma.

Mount St. Mary's University also purchased Narcan and trained health and safety staff members on how to use it about a year ago, said spokesman Jack Chielli. Neither school has needed to administer the medication since purchasing the kits, but Cevallos and Chielli said they remain aware of the risks that opioids present to the community.

"I'm not naive enough to think that no one has ever done it or will never do it, but as far as I'm aware, no students are using right now," Cevallos said. "So far, we've been able to keep the students safe and well."

Both Hood and Mount St. Mary's also have the option to receive eight free doses of Narcan through the Maryland Independent College and University Association (MICUA). The organization partnered with Adapt Pharma to provide its 13 member institutions—including Hood and Mount St. Mary's—with the medication, said Tina Bjarekull, the president of MICUA.

While Chielli couldn't confirm whether Mount St. Mary's would accept the free doses, Cevallos anticipated that Hood would, and hoped that MICUA would be able to provide replacement Narcan kits for the college once its current supply expires.

Bjarekull didn't know if Adapt would replace the medication after it expired or if schools used all eight doses.

"It is an emergency drug, and one would hope that schools wouldn't run out of eight doses on campus in a 18- to 24-month period," she said.

For Frederick County campuses, a more pressing concern is providing in-person drug awareness training for students. Hood is currently developing an opioid-specific training that it plans to offer during freshman orientation, Cevallos said. Mount St. Mary's provides drug and alcohol training through Alphapoint.me, an online program that also addresses mental health and Title IX concerns, but also directly addresses opioid abuse during orientation, Chielli wrote in an email.

The concern is even greater for Frederick Community College, where a majority of students have been directly or indirectly affected by the opioid epidemic, said Jeanni Winston-Muir, the director of the Center for Student Engagement and Co-Curricular Programs.

"When you look at our demographics, it's been significant," she said. "We are that feeder school for some of the areas that are really hard-hit right now, like Brunswick or Thurmont."

FCC independently purchased Narcan and trained 64 staff members to administer the medication last October through the Frederick County Health Department, added Jerry Haynes, the school's Dean of Students. As a community college, he said it's more difficult for the school to provide in-person training for students. Currently, Haynes and Winston-Muir are developing an opioid-specific tutorial—with a focus on Good Samaritan laws and local access to Narcan—to present during FCC's formal convocation on the Friday before fall classes start.

The school also added a specific reference to opioids in the title for its guidelines on drug and alcohol use. The modified Alcohol, Tobacco, Opioid and Other Drug Awareness Policy took effect on Saturday and now references the Maryland Start Talking Act, in addition to outlining the appropriate response to an opioid overdose.

"FCC has always been ahead of the curve in that regard, so we really had to make very few policy changes," Haynes said. "It's hard not to read about addiction or the epidemic in our community, so our response has been appropriate for a community college."

The Frederick News-Post, Md.