On August 10, while fielding a reporter's question, President Trump first declared the opioid crisis a "national emergency." The announcement came less than one year after two 13-year-old boys from Park City School District in Utah passed away from overdoses in the span of 48 hours. And it came just months after five recent graduates of Norwin School District, near Pittsburgh, Pennsylvania, were lost to opioid-related deaths.
The president made that statement official on October 26, when he declared the crisis a public health emergency. As the nation waits for the necessary resources to follow, districts aren't taking their chances.
Slow-Moving Disaster
"I always thought of myself as a rather 'with it' administrator as far as being in tune with kids," says Ember Conley, superintendent of Park City School District. Although the crisis was on her radar to some extent, she was unaware of how easy it is for students to access opioids like prescription painkillers and synthetics.
Last fall, two best friends attending Treasure Mountain Junior High died from taking U-47700 or "pink." The dangerous synthetic was purchased legally online from China. (The drug has since been classified as a Schedule I drug by the federal Drug Enforcement Administration [DEA]).
The boys' deaths, which happened less than two days apart, left the community reeling. In the immediate aftermath, district officials gave students and staff the space to grieve. They brought in substitutes to give teachers periodic breaks, opted for barbecues and bike rides instead of professional development, and provided counseling and other services.
District officials then turned their attention to ensuring this never happened again in their system. "We've been on fast forward ever since," says Conley.
The availability and overprescription of opioids has seemingly accelerated the epidemic. Drug overdoses are now the leading cause of death among Americans under 50, according to a preliminary report from the New York Times. In 2016, 62,000 people died from overdoses—a 19 percent increase from the year before.
Since 1999, the number of teens dying from drug overdoses has more than doubled, according to the Centers for Disease Control and Prevention.
Despite the alarming data, Nina Fekaris, president of the National Association of School Nurses (NASN), says there's a misconception in some more affluent communities that "this will never happen here." But in Oregon's Beaverton School District, where she has served as a nurse for 27 years, she has seen students get hooked not on drugs they got off the streets but on those prescribed by a trusted doctor. Yet the damaging effects of addiction, she's noticed, are just the same.
This "crosses all boundaries—race, gender, socioeconomic status, rural, urban, suburban," adds William Kerr, superintendent of Norwin School District. "It is a national crisis affecting every corner of every state. There's no family, school, or community immune from the opioid and heroin epidemic."
Some counties and states are suing pharmaceutical companies to get help shouldering the burden. Lawsuits are popping up nationwide accusing the companies of intentionally concealing the addictive nature of opioids.
According to a study from the National Institute on Drug Abuse, more than one in three Americans were prescribed opioids in 2015. "Access alone provides a massive risk, especially to our students who don't understand the consequences," says Conley. "Kids are impulsive. That one time could make a difference."
If administrators "think it's not in their schools, they're foolish," warns Conley. In Fekaris's own suburban high school, two student athletes became addicted to opioids following sports injuries.
We're All First Responders
"It can happen anywhere," Fekaris says. "Schools need to be prepared." As a first step, she recommends principals sit down with their school nurses to ask, "Have you seen this problem in our school? How can we best handle an emergency? What about the long run?"
Just "begin that dialogue," she advises. Then, take "five minutes in a staff meeting" to let nurses train faculty members about the symptoms of a potential overdose. For example, they need to recognize if a student is suddenly drowsy and difficult to rouse or has pinpoint pupils. Slurred speech and uncoordinated movement are also signs of a medical emergency, and staff should flag down the nurse for a deeper assessment.
NASN recommends that school and state policies include specifics on "how to access naloxone and implement it as part of the school emergency response protocol." Also known by the brand name Narcan, the life-saving antidote can reverse the effects of an opioid overdose. In Beaverton School District, for example, schools don't stock naloxone, but local EMTs carry it on ambulances.
Some states, including Ohio, are passing legislation to lift restrictions so that nurses, school resource officers, and other trained personnel can administer naloxone in schools. Other states are mandating that schools stock it alongside life-saving medical devices like EpiPens. In 2015, Rhode Island started requiring all middle and high schools to carry naloxone. Maryland enacted a similar law on July 1 that includes elementary schools.
"If students are in danger, it's our job to save a life," relates Conley. And if an antidote exists and state laws permit schools to carry it, she adds, schools should do so.
An Ounce of Prevention
But having naloxone within arm's reach, says Fekaris, is just the "tip of the iceberg. The other key is educating our children about prevention."
Superintendent Kerr agrees that prevention is crucial, especially starting at an early age at both home and school. Opioids have ravaged the suburban Norwin community in Westmoreland County, just 15 miles outside of Pittsburgh. In 2016, 174 people in the county died of a drug overdose, a 38 percent increase from the year before. According to the coroner's office, 94 of those deaths were heroin-related. This past spring, five recent graduates of Norwin School District lost their lives to overdoses.
"We had two brothers from one family die within a week of one another," says Kerr. "As an educational leader, my mission and passion have been intensified more than ever before. We're tackling awareness and prevention from all angles."
Norwin Middle School was one of the first to pilot Operation Prevention, a free K–12 curriculum developed by the DEA and Discovery Education. The district chose middle school, the superintendent says, because that's when students may first be exposed to opioids after experiencing sports injuries or having their wisdom teeth removed.
The research-based curriculum focuses on the "science of addiction," teaching students how drugs affect the brain and body. The district plans to implement the curriculum as part of an interdisciplinary approach, bringing in science teachers to expand on certain concepts and using a character education program to teach attributes like responsibility, courage, and respect.
Aligned to national health and science standards, Operation Prevention's digital lessons include stories, videos, and commentary by addicts and their family members. "We want students to have an in-depth understanding of how drugs can be destructive to a family, a community, or a school," says Kerr.
Interventions like these may be working: The 2016 "Monitoring the Future" survey, from the National Institute on Drug Abuse, found that the nonmedical use of opioid pain relievers among 12th graders has dropped to 4.8 percent, down significantly from its peak of 9.5 percent in 2004.
A Holistic Approach
"One thing we know from DARE is the whole 'just say no' [message] doesn't work for kids," says Conley. Park City's curriculum also educates about the effects of drug use on the brain. When the district showed Dying in Vein, a film about a young adult who overdoses on heroin, students were astounded. They "didn't know this is how it could affect you," recalls Conley.
To tackle this complex epidemic, the district has added "trauma-informed and resiliency-focused" measures, such as teaching mindfulness, promoting connections through peer groups, and using a positive psychology framework to "build on the strengths of our kids rather than trying to diminish that depression and anxiety," Conley notes.
Instead of "self-medicating to feel better," students are learning skills to help them "move forward." It's a message of hope, explains the superintendent. When students cultivate grit, perseverance, and resilience, they understand that "hurt doesn't last forever"—that they can forge ahead through life's challenges instead of avoiding them.
"It's mental well-being that we're focused on, not just drugs," says Conley.
A Community Response
"Law enforcement people get it; they can't arrest their way out of this problem," says Kerr. "We need to engage the total community."
Norwin School District has brought in guest speakers—addicts in recovery, representatives from the drug and alcohol commission, and agents from the FBI and DEA—to lead staff training and engage in community events.
Harford County Public Schools, just outside of Baltimore, Maryland, is addressing opioid prevention through a coordinated effort with the Office of Drug Control, sheriff's department, and local health department. These agencies have provided opioid response training for nurses and health teachers, funded naloxone kits, and facilitated one-day lessons for middle and high school students on how "the opioid crisis affects our community," says Mary Nasuta, the district's nurse coordinator.
School resource officers also lead activities within the high schools about opioid prevention, and student clubs participate in a grassroots initiative to raise awareness among peers.
"The most important thing is to involve your community partners—to not go it alone," says Nasuta. "Look at your community resources, government resources, and local legislative bodies that can help provide information, funding, and education—not just in schools but for the whole community."
"Be in Their Business"
In Ohio, which by some estimates leads the nation in drug overdose deaths, the path to prevention starts with a conversation. To encourage adults to talk with kids about being drug free, Governor John Kasich launched the statewide initiative Start Talking! in 2014. Director Sarah Moore says the program was built on research from the Partnership for Drug-Free Kids that "children are up to 50 percent less likely to start using drugs if their parents or trusted adults simply talk to them about drug use."
The program offers free tools to kick-start these conversations in schools and communities. For example, educators can sign up for Teachable Moments, a biweekly newsletter that shares the latest information on the opioid crisis as well as classroom tips and action steps.
Promoting prevention "doesn't have to be complicated," Moore assures. "There are a million simple things that districts can do to engage this issue. Educating parents and staff is a great way to start."
Schools can use Ohio's Parents360 Rx Action Toolkit, an 11-minute video and discussion guide, with parents or for professional learning. Operation Prevention also offers a parent toolkit with warning signs and conversation starters. In Pennsylvania, Norwin School District, which expanded Operation Prevention to its elementary and high schools this fall, established an opioid advisory committee to bring parents to the table.
Harford County Public Schools in Maryland hosts community forums and a "Night of Conversation" with parents, says Joe Harbert, supervisor of elementary and middle physical education and health. And parent meetings for fall, winter, and spring sports include a discussion of how pain drugs (following a sports injury) can lead to addiction.
After the tragedy in Park City, district administrators urged parents to start a dialogue at home. They sent notices asking parents to "please go through your kid's stuff," says Conley. They recommended checking backpacks and unmarked containers (like eye droppers and felt markers) for drugs and reviewing social media use.
Even if you trust your child, the superintendent pleaded, "you need to be in their business."
Not One More
When it comes to addressing the opioid epidemic, "we can't do enough," admits Kerr. But that doesn't mean the superintendent will stop trying.
"For those of us affected by the opioid and heroin epidemic, our only choice is to help other families so [that] it doesn't happen to them," says Kerr. "I don't want anyone to experience what the Norwin community experienced."
Educating our way out of the epidemic, administrators agree, is a start. "People don't just wake up and decide they want to do heroin," says Harbert. "There's a pathway that [leads to] that addiction. Having people understand that and identify ways to create detours is important."
"As educators," Conley asks, "what can we do differently each and every day to make sure that we don't lose one more kid?"
OPIOID EPIDEMIC RESOURCES
National Institute on Drug Abuse
Lesson plans, games and videos for teens, and other classroom and parent materials
Operation Prevention
Free K–12 opioid prevention curriculum, developed by the DEA and Discovery Education, with digital lessons on the science of addiction
Smart Moves, Smart Choices
K–12 schoolwide awareness program from NASN that includes free fact sheets, posters, parent tips, and videos for assemblies
Start Talking!
Ohio initiative to facilitate conversations between adults and kids about drug use with tools like an educator newsletter and Parents360 Rx video and discussion guide
