As the Opioid crisis continues, questions arise on the use of naloxone/Narcan by school and college staff. This document provides information on the product, regulations, guidelines, potential liability concerns, and the many resources available.
What is naloxone hydrochloride/Narcan and what is it used for?
Naloxone hydrochloride is an “opioid antagonist”, life-saving medication that reverses an opioid overdose while having little to no effect on an individual if opioids are not present in their system. Naloxone is administered when an individual is showing signs of opioid overdose. The medication can be given by intranasal spray, or by intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection.
NARCAN® Nasal Spray is a brand name version of naloxone hydrochloride. It is a prescription medicine used for the treatment of an opioid emergency such as an overdose or a possible opioid overdose, indicated by signs of breathing problems and severe sleepiness or not being able to respond. NARCAN® Nasal Spray is to be given right away and does not take the place of emergency medical care.
Laws and Regulations
California Education Code §49414.3 allows (but does not require) K-12 school districts, county offices of education, and charter schools to provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered to administer, and school nurses or trained personnel may use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
The law provides that in making the determination as to whether to stock this medication, a school must evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to naloxone hydrochloride or another opioid antagonist and trained personnel. http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=EDC§ionNum=49414.3.
§49414.3 also provides criminal and civil immunity to trained persons who administers naloxone hydrochloride or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose. However, there is no immunity in a case of gross negligence or willful and wanton misconduct of the person who administers naloxone hydrochloride or another opioid antagonist.
Additionally, California Civil Code § 1714.22 eliminates civil and criminal liability for:
licensed health care providers that prescribe naloxone and issue standing orders for the distribution of naloxone, and
individuals that administer naloxone to someone suspected of experiencing an overdose after receiving it along with required training. California Civil Code Section 1714.22 (Statutes of 2013, Chapter 707, Sec. 1) (PDF)
California law does not, however, eliminate civil liability for a school district for negligence in choosing to stock (or not stock) naloxone hydrochloride or train volunteers.
Are Schools and Colleges required to have Narcan?
The use of Narcan is voluntary for K12s and CCDs.
Does the Good Samaritan Law apply?
The immunity provisions described above apply to the use of naloxone hydrochloride.
There are no reported cases outside the hospital context where there was a claim for a failure to provide naloxone to someone experiencing an opioid overdose. According to this article, at least 10 states require or allow schools to stock naloxone.
Who should have access and authority to use Narcan?
School nurses or trained personnel who have volunteered may use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
Districts that decide to stock naloxone hydrochloride should follow the manufacturer’s instructions regarding storage and shelf life. In general, naloxone is a stable medication, with a shelf life between 18 months and two years. Naloxone should be stored between 59- and 86-degrees Fahrenheit and should be kept away from direct sunlight. In most law enforcement settings, naloxone can be stored in the cab of the vehicle, according to the National Training and Technical Assistance Center, Law Enforcement Naloxone Tool Kit.
What training is required?
Education Code § 49414.3 outlines training requirements for K-12 schools who chose to administer naloxone/Narcan. Training is required initially and an annual refresher for those administering naloxone. Topics include:
Techniques for recognizing symptoms of an opioid overdose.
Standards and procedures for the storage, restocking, and emergency use of naloxone hydrochloride or another opioid antagonist.
Basic emergency follow-up procedures, including, but not limited to, a requirement for the school or charter
school administrator or, if the administrator is not available, another school staff member to call the emergency 911 telephone number and to contact the pupil’s parent or guardian. Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation.
Written materials covering the information required under this subdivision.
Community College districts are not subject to § 49414.3. Therefore, the following should be followed:
Staff of community organizations and other entities distributing naloxone under the Naloxone Distribution Project (NDP) are required to receive opioid overdose prevention and treatment training and are required to train individuals who receive naloxone from them. Minimum training requirements, and an example training resource, are included on the NDP application, which can be found on this link.
For additional training resources, please visit the website www.getnaloxonenow.org or the Harm Reduction Coalition’s Overdose Prevention and Naloxone Manual
What is a Standing Order and when can it be used?
A standing order authorizes:
Non-prescribing entities to distribute naloxone to individuals at risk of opioid overdose, their family members and friends, or other persons in a position to assist during an opioid-related overdose, who have completed an opioid overdose prevention and treatment training program.
The administration of naloxone received from the entity using this standing order to assist a person experiencing or reasonably suspected of experiencing an opioid overdose, by a family member, friend, or other person who has received opioid overdose prevention and treatment training from an opioid overdose prevention and treatment training program.
The Standing order is your prescription to administer and disseminate naloxone so make sure you keep a copy for your records.
"Non-prescribing entities" means organizations that do not employ or contract with a medical provider that has a license to prescribe and can issue a standing order and provide oversight for the distribution and administration of naloxone.
How do I apply for a Standing Order?
You will need to complete the standing order application online by visiting the CDPH statewide standing order for naloxone webpage for the application instructions. You will need to save a copy and send it in with your Naloxone Distribution Project (NDP) application through the Department of Health Care Services (DHCS) to receive free naloxone (Narcan) kits.
What training is required under the Standing Order?
An opioid “overdose prevention and treatment training program” is required under the standing order and is any program operated by a local health jurisdiction or that is registered by a local health jurisdiction to train individuals to prevent, recognize, and respond to an opiate overdose, and that provides, at a minimum, training in all the following:
The causes of an opiate overdose.
Mouth to mouth resuscitation.
How to contact appropriate emergency medical services.
How to administer an opioid antagonist.
Additionally, the training program should include how to recognize an opioid overdose. An example of an "overdose prevention and treatment training program" that is registered with or operated by a state or local health jurisdiction includes, but is not limited to: Administering Naloxone - CDPH training video. See Keenan SafeSchools Training Solutions below.
Keenan SafeSchools Training Solutions
The Los Angeles County Department of Public Health’s Division of Substance Abuse Prevention and Control Program (DPH-SAPC) has reviewed the Keenan SafeSchools (KSS) Opioid Overdose Response Awareness course. We received a certification letter from DPH-SAPC that verifies that the KSS Opioid Overdose Response Awareness course meets the minimum educational requirements outlined by the California Civil Code § 1714.22 and that our program is now registered with DPH-SAPC. Therefore, K12 schools and CCDs statewide only need to take the KSS/KSC Opioid Overdose Response Awareness course to meet the requirements when applying for the Standing Order and providing and administering emergency naloxone hydrochloride or another opioid antagonist under Ed. Code Requirements.
CDPH Rainbow Fentanyl Alert 9/21/22
Sample Policy - Lake County Department of Education
CDPH Standing Order FAQ’s here 6/18/18
Statewide Standing Order Application Process
Naloxone Distribution Project (NDP) Application Process
California DHCS Naloxone Distribution Project FAQs
California Department of Public Health (CDPH) Safe and Active Communities Branch (SAC) Naloxone Website
This website has several valuable resources for those that are or thinking about using naloxone hydrochloride/Narcan.
The California Department of Health Care Services – Naloxone Distribution Project (NDP) offers assistance in obtaining naloxone hydrochloride/Narcan. Click on the link to access the application. Naloxone Distribution Project.