Rep. David Bennett, D-Warwick, introduced legislation Jan. 28 that would require nurses in public middle and high schools to be trained in the use of naloxone, marketed and sold as Narcan. The substance, which is already used by state police, can temporarily relieve potentially fatal respiratory depression caused by overdoses from drugs like heroin and certain painkillers until the patient can be transferred to hospital care.
School nurses in Rhode Island are already permitted to administer certain kinds of emergency aid, such as epinephrine, in life-or-death situations. By adding naloxone as an available resource for school nurses, the proposal aims to combat the state’s growing drug epidemic as it threatens to reach the educational system.
Bennett crafted the bill in response to medical research that identified a growing trend in opioid usage among teenagers statewide. “Since April, emergency rooms have used Narcan 10 times on people under 18, and emergency services have had to use it 41 times on people under 18,” he said. “It’s just a matter of time before it reaches the schools.”
The Rhode Island Association of School Committees initially expressed concerns over funding the initiative, said Rep. Joseph McNamara, D-Warwick and Cranston, and chairman of the House Health, Education and Welfare Committee. But at a price of around $35 per school, the costs of introducing naloxone to public schools would be far outweighed by the potential benefits, Bennett said. “I myself hope that it sits in the nurse’s office and expires year after year, but that one time you need it, you want to have it. I want to get this into schools as soon as I can.”
In response to its rising rate of drug use, Rhode Island has attempted to increase access to Narcan, stocking pharmacies and equipping law enforcement officers with the drug. But the state has yet to provide schools with similar resources, said Traci Green, assistant professor of emergency medicine and epidemiology.
“As we were doing our training, we did realize that school nurses did not have access to naloxone on site, and the solution of ‘just go to Walgreen’s and get it’ didn’t make sense for a health professional who can administer other medications” such as epinephrine, she said.
Broader effects on society arise from dealing with drug abuse in the educational theater, Green said. “Schools are a reflection of the community,” she said, adding that Rhode Island has the highest illicit drug use per capita in the country, with rates that are “unfathomable.”
Naloxone is regarded by the medical community as a safe and reliable substance. Jef Bratberg, a clinical professor at the College of Pharmacy at the University of Rhode Island, said it is among the most utilized emergency agents by medical responders. “Naloxone is an antidote, meaning that if you don’t have opioids in you and you receive an injection, nothing happens,” he said. “From that perspective, it’s perfectly safe. Either it works, or it doesn’t cause a problem.”
Bratberg also spoke to the ease of the drug’s usage. “I could teach you how to use it in ten minutes,” he said, adding that the bill’s requirement that school nurses and school personnel will be trained in the procedure will reinforce its overall safety.
The bill has gone through an amendment process, with some concerns about implementation raised by school nurses themselves. “There was a fear that school nurse teachers would be given this extraordinary extra duty” without sufficient background knowledge and training, McNamara said. One of the proposed amendments would require school pediatricians to produce a “standing medical order” that clearly lays out the procedure for the usage of Narcan, as well as training the nurses themselves. Naloxon “would be treated like every other medication that is already authorized,” he said.
Neither Bennett nor McNamara offered a timeline for the bill’s vote, but after the concerns of outside groups were assuaged, the bill received no significant opposition from members of the legislature during debate, McNamara said.
