Opioid-related overdoses remain an epidemic in the United States, and of particular concern is the impact the epidemic continues to have on children and adolescents. In response, California legislators have introduced legislation, Assembly Bill 19, to require public middle and high schools to maintain overdose reversal medications on campus.
If passed, Assembly Bill 19 would require public schools to maintain two doses of naloxone hydrochloride or another opioid antagonist (Naloxone) on schools’ campuses at all times. While this law would not apply to private schools, it presents a good opportunity for private schools to consider maintaining doses on their campus and the obligations associated with doing so.
Currently, Education Code section 49414.3 permits private elementary and secondary schools to make Naloxone available for administration, subject to certain requirements. The law states that schools should consider whether initiating emergency medical services in response to an overdose is a reasonable alternative to maintaining Naloxone on campus and implies that schools in difficult-to-reach or remote locations should make Naloxone available. Emergency response time is a significant consideration as the timely administration of Naloxone can be the difference between life and death.
Below are some additional requirements and considerations for schools to be aware of with regard to making Naloxone available on campus.
Standing Orders
In 2017, the California Department of Public Health (CDPH) issued a statewide standing order to help reduce mortality associated with opioid overdoses. The standing order permits certain entities, including private schools, to obtain and distribute Naloxone without working with a physician. (Civ. Code § 1714.22) Qualified entities, broadly defined as those in a position to administer Naloxone to those in need, must apply to use the standing order and obtain Naloxone. The application can be found here. Once an entity submits an application, CDPH will immediately generate a standing order. Once the entity has a standing order issued, it may obtain dosages of Naloxone for emergency administration.
Certain entities, including private schools, may also apply for free doses of the medication through the California Department of Health Care Services’ Naloxone Distribution Project. The application for the free doses can be found here.
Trained Personnel & Immunity
If a private school elects to make Naloxone available, a school nurse may administer the medication to students. If the school does not have a nurse or the nurse is unavailable, a volunteer may administer the Naloxone after meeting certain criteria. (Ed. Code §49414.3 subd. (h)(1).)
The Education Code prohibits a school from bestowing a benefit to a person that volunteers for this responsibility. (Ed. Code §49414.3 subd. (c).) It also prohibits any retaliation against an individual if they rescind an offer to volunteer for this responsibility. (Ed. Code §49414.3 subd. (d)(1).) The volunteer may also rescind their offer to administer the medication at any time, even after receiving training. (Ed. Code §49414.3 subd. (d)(1).)
Individuals who administer Naloxone, in good faith and without compensation, to an individual who appears to be experiencing an overdose, are immune from civil action, and criminal prosecution, and cannot be subject to professional review. (Ed. Code §49414.3 subd. (j).)
Training Requirements (Ed. Code §49414.3 subd. (e)(2).)
Individuals that volunteer to administer an opioid antagonist must first undergo training. Training must be completed initially and then annually and must include:
The school must also maintain written materials covering each of the above-specified items. The training must also be consistent with the most recent guidelines for medication administration issued by the Department of Education.
Additional Considerations
Schools that elect to maintain Naloxone on campus must follow the legal requirements set forth in the Education Code. Schools should also consider implementing a policy that educates its staff on how to manage emergency overdose situations that may occur on campus and who will be involved in the administration and follow-up. Even if schools elect to not make Naloxone available on campus, they should review their policies to ensure that a timely response can be taken to address an overdose on campus.
Assembly Bill 19 will not require California private schools to maintain Naloxone on campus. However, it highlights the importance of making sure that schools have the resources available to protect their students.