It’s understandable that the tragic death last month of a Miami-Dade County fifth-grader who somehow came in contact with the powerful drug fentanyl has raised concerns among some Florida public school district officials about the health and safety of students.
A child is dead. Not an adult struggling with addiction. An innocent child.
We can count Chuck Shaw among those concerned.
The Palm Beach County School Board chairman was careful, last week, not to outrightly condone stocking the life-saving, anti-overdose drug Narcan (a brand name for naloxone) on public school campuses to counteract potential opioid overdose situations. But he was equally clear that doing so was worth discussion when considering the school district’s responsibility to protect kids on those campuses.
I agree. The overdose deaths stemming from the county’s opioid epidemic, chronicled exhaustively over the past year by The Palm Beach Post, have yet to show any signs of abating. It’s no stretch to assume that this crisis would, at some point, spill onto our school campuses.
It would make sense then for school nurses — the front line of defense on health emergencies — to be prepared.
Schools could be exposed
For Shaw, the opioid overdoses remind him of an incident he dealt with many years ago as a local school principal.
“A girl had come to school with a couple of vials of blood for a sort of show-and-tell,” he recounted. “It turned out that her mom or sister was training to be a phlebotomist, and had drawn some of the girl’s blood. The girl asked to take the vials to school to show her friends, and they said sure.
“That got me to thinking of all things that kids could be exposed to on a school campus,” he continued, “and how much the use of opioids is spreading — not just in our community, but everywhere it seems.”
And that got Shaw wondering whether school nurses were properly trained to handle a potential overdose situation. And then whether Narcan should be at their disposal.
The 46-year veteran of Palm Beach County schools is right to be concerned.
This plague is getting worse. Opioids, mainly fentanyl and heroin, have killed 2,664 people in Florida in the first six months of this year — an average of 14 people per day. At this rate, fatal overdoses will outpace last year’s count by 36 percent.
In Palm Beach County alone, fatal overdoses spiked to 311 in the first five months of this year, 20 percent more than the first five months of 2016. And Palm Beach County’s 590 opioid overdose deaths in 2016 were an all-time high for the county and nearly twice as many as in 2015, according to a Palm Beach Post analysis of records from the medical examiner.
Add to that terrible mix 10-year-old Alton Banks. Authorities believe that Alton, who lived in Miami’s drug-ridden Overtown neighborhood, died on June 23 after coming into contact with fentanyl — but they are still trying to pin down how.
Alton died after a visit to the pool in Overtown. He began vomiting after coming home and was found unconscious that evening. Preliminary toxicology tests show he had fentanyl in his system.
“We don’t know where he got it. We don’t believe he got it at his home,” Miami-Dade State Attorney Katherine Fernandez Rundle said last week. “It could be as simple as touching it. It could have been a towel at the pool.”
She added: “We just don’t know.”
The case has underscored how frighteningly prevalent fentanyl has become — and how potent it is. Exposure to just tiny amounts can be devastating.
Stocking Narcan worth the risk?
But where does a school district’s responsibility begin? “You’ve got the bus stop … the bus,” Shaw mused. “Then, of course, you have the campus.”
The answer, at first, may appear simple, especially since everyone wants to protect schoolkids.
There are some, however, who worry that having Narcan on hand can also become a crutch for drug-users and stop some people from taking personal responsibility. Those arguments echo past opponents of setting up needle exchanges and distributing condoms to stop the spread of AIDS, who argued that such moves were just encouraging drug use and sex.
The point falls flat, however, for Matthew Davis, a professor of pediatrics at Northwestern University’s Feinberg School of Medicine and head of general pediatrics at Ann & Robert H. Lurie Children’s Hospital of Chicago.
“Health care workers in hospitals and first responders in communities have had naloxone on hand for decades, but there is no evidence that having naloxone as an antidote has encouraged Americans to try street drugs and abuse prescription opioids,” Davis wrote in an email to NBC News last week. “Similarly, we would not expect teens to abuse opioids because naloxone is available in their schools.”
Naloxone, he wrote, must be “part of comprehensive drug use prevention programs in schools and communities, to try to reduce drug use among teens.”
“Making naloxone available in junior high and high schools is smart public health policy, given what is known about teens’ misuse of prescription opioid medicines and teens’ use of heroin in the U.S. today,” he added.
Having naloxone on hand “is just like putting a defibrillator on the gym wall for a heart attack, or having injections of epinephrine available for someone who can’t breathe because of a severe allergic reaction,” he wrote. “They are tools made available to save lives.”
A responsibility to protect the kids
To be sure, with 187 school district campuses, the financial cost of taking on this responsibility could be a factor as well. The price of Narcan for cities and counties around the country has risen commensurate with demand fueled by overdoses.
Earlier this month, Martin County Commissioner Ed Fielding discussed the possibility of limiting the number of times Martin County Fire Rescue crews would use Narcan to revive a person who has overdosed on multiple occasions. Talking about the Fire Rescue budget, he said he’d gotten the idea from Palm Beach County State Attorney’s Office representatives during their recent visit to Martin County to discuss the region’s opioid epidemic.
But State Attorney’s Office spokesman Mike Edmondson said Fielding’s comments were not accurate, and that the agency has had no discussions about restricting the usage of Narcan.
Palm Beach County Commissioner Melissa McKinlay, who has been out front on the opioid epidemic, pushed back even harder.
“It’s the most horrific, disgusting proposal I have ever heard in my life,” she told the Post’s Julius Whigham. “It’s not our job to play God.”
It is our job, however, to protect our children. And the question of whether to stock Narcan, and train professionals like police and school nurses in how to use it is not likely to go away anytime soon.
Not for municipalities. Not for counties. And, as fall creeps ever closer, not for school districts.
“That got me to thinking of all things that kids could be exposed to on a school campus, and how much the use of opioids is spreading; not just in our community, but everywhere it seems.” — Chuck Shaw, Palm Beach County School Board Chairman