The military is required to stock Narcan to prevent drug overdoses — why aren’t our schools? 

Beginning January 2025, the Pentagon will be required by the 2024 National Defense Authorization Act to make the opioid overdose antidote Narcan available to all members of the armed forces. With the rise of fatal opioid overdoses in our nation’s schools, it is imperative that K-12 schools do the same and protect our school children like we do our soldiers.  

The decision for the Department of Defense to make the opioid overdose reversal agent available on all military installations and in each operational environment does not come as a surprise. From 2017-2021, the department reported more than 15,000 overdoses among active-duty service members, of which 332 were fatal. From 2017 to 2021 among active-duty, the number of drug overdose deaths linked to fentanyl, a synthetic opioid, more than doubled. 

The rapidly rising number of fatal overdoses is not unique to the military. Our schools face the same challenge — and should embrace this same approach. 

Drug overdose deaths among those ages 14-18 more than doubled from 2018 to 2022. A recent report in the New England Journal of Medicine found that an average of 22 adolescents — equivalent to a high-school classroom of students — died from a drug overdose every week in 2022. With the four-month total number of fatal overdoses among adolescents exceeding the four-year total among military, the need for Narcan to be available in schools is clear. 

Narcan, generically known as naloxone, is a nasal spray medicine that reverses an opioid overdose in minutes. Last year, it received approval by the Food and Drug Administration to be sold over the counter. Despite recommendations by the U.S. Department of Health and Human Services and American Medical Association to have Narcan available and integrated into emergency protocol at schools as early as the elementary level, schools have been slow to stock the medication. 

Data published by the Legislative Analysis and Public Policy Association reports that nine states have laws that require naloxone to be carried in public high schools. Illinois and Rhode Island require that both public and private K-12 schools have Narcan available. An additional 33 states have laws permitting Narcan availability on school grounds and its administration by a trained employee. The District of Columbia and 24 states have no statute addressing the availability or use of Narcan in schools. 

Narcan has saved lives in schools. At Park View High School in Virginia, nine students suffered from a fentanyl-related overdose within a span of three weeks in October 2023. The school district, allowed but not required to keep Narcan, according to Virginia law, had it in stock, and staff administered it on campus. Four students were saved on school grounds with Narcan and no fatal overdoses were reported. 

However, such positive outcomes are not universal.  

A month later and a few states over, in Connecticut, the opposite was seen. At the Sports and Medical Sciences Academy in Hartford, a student overdosed and was left unresponsive in his school gym. The school district, also allowed but not required to keep Narcan, according to Connecticut law, did not carry Narcan. The 13-year-old student was pronounced dead that day. The school district is now stocked with Narcan following this incident but is faced with a lawsuit by the student’s family for negligence and failure to have Narcan available. 

A fatal or non-fatal overdose on campus should not be the deciding factor on whether a school stocks Narcan. With teen overdose death rates more than doubling in recent years and teens spending most of their daytime hours at school, Narcan should be made readily available at all elementary and secondary schools across the U.S.  

Last week, New York City Schools — the nation’s largest school district — became a national leader and voted to require that all elementary, middle, and high schools carry Narcan. The second largest school district, the Los Angeles Unified School District, did the same last year and equipped their K-12 schools with Narcan after a 15-year-old student died from an opioid overdose on school grounds.  

It is time that attorneys general of the 41 remaining states devote a portion of National Opioid Settlement funds to require and distribute Narcan in schools. We cannot afford to keep losing a full classroom of students every week. 

Kevan Shah, MSM, is the founder and executive director of End Overdose Together, which aims to train and equip individuals to prevent opioid overdose. He is currently an MSc candidate at Stanford University School of Medicine and a Knight-Hennessy Scholar.  

Dr. Daniel Ciccarone, MD, MPH, is the Justine Miner Professor of Addiction Medicine in the department of Family and Community Medicine at UCSF. He is also a voluntary medical director at Remedy Alliance.