3424 - Opioid Related Overdose Reversal

The Richland School District’s Board of Directors (the “Board”) recognizes that the opioid epidemic is a public health crisis and access to opioid-related overdose reversal medication can be lifesaving. To assist a person at risk of experiencing an opioid-related overdose, the district will seek to obtain and maintain at least one set of opioid overdose reversal medication doses at each of its schools. 

The district has authority to obtain and maintain opioid overdose reversal medication either through a standing order, prescribed and dispensed according to RCW 69.41.095(5), or through one or more donation sources. The district will seek at least one set of opioid reversal medication doses for each of its schools. However, if the district documents a good faith effort to obtain and maintain opioid overdose reversal medication through a donation source, and is unable to do so, the district is exempt from the obligation to have a set of opioid reversal medication doses for each school. Documentation of good faith effort must be kept on file. 

The following personnel may distribute or administer the school-owned opioid overdose reversal medication to respond to symptoms of an opioid-related overdose: 

• A school nurse; 
• School personnel who become designated trained responders; or 
• A health care professional or trained staff person located at a health care clinic on public school property or under contract with the school district. 

Training for school personnel to become designated trained responders and distribute or administer opioid overdose reversal medication must meet the requirements for training described in the statute and any rules or guidelines for such training adopted by the Office of Superintendent Public Instruction (OSPI). The district shall identify at least one member of each school’s personnel to become a designated trained responder who can distribute and administer opioid overdose reversal medication. 

Opioid overdose reversal medication may be used on school property, including the school building, playground, and school bus, as well as during field trips or sanctioned excursions away from school property. A school nurse or a designated trained responder may carry an appropriate supply of school-owned opioid overdose reversal medication on in-state field trips and sanctioned in-state excursions. 

If any type of overdose is suspected, including an opioid related overdose, staff will call 9-1-1 and alert a first responder. The school nurse, designated trained responder, or trained staff person located will follow the Washington Department of Health steps for administering naloxone for a suspected opioid related overdose. 

An opioid overdose requires immediate medical attention. It is essential to initiate emergency medical services for medical assessment and support. 

Opioid overdose reversal medication and rescue breathing are evidence-based interventions known to result in positive outcomes for individuals experiencing an opioid related overdose. The district shall utilize the Opioid Related Overdose Policy Guidelines & Training in the School Setting published by the Office of the Superintendent of Public Instruction (OSPI). 

Opioids and Overdose 

Opioids are a class of drugs derived from opium poppy or entirely created in a lab. Opioids include morphine, codeine, oxycodone, hydrocodone, hydromorphone, heroin, meperidine, fentanyl, and methadone. There are prescription opioids and opioids that are created and obtained illicitly. 

An opioid overdose happens when someone has taken too much of an opioid. Synthetic opioids such as Fentanyl are especially dangerous due to its potency and are often found in a wide variety of forms including counterfeit pills and in illicit drugs. A person under the influence of opioids may experience non-life-threatening effects such as nausea, vomiting, or sleepiness. A person may also experience life threatening effects that may lead to death, including infrequent or absent breathing, slowed or irregular heartbeat, no response to stimuli, and severe allergic reaction. 

Risk factors for an opioid overdose include: 

• Mixing opioids with other substances including benzodiazepines, stimulants, or alcohol 
• Using after a break in use due to decreased tolerance 
• Taking too many opioids 
• Other health conditions 
• Previous overdose 
• Taking medications that were not prescribed for them 
• Using opioids not from a pharmacy because the strength is unknown 
• Using alone (increases risk from dying from an overdose) 

The effects of opioid exposure include: 

Opioid Overdose Response 

Opioid overdose reversal medication and rescue breathing are evidence-based interventions for individuals experiencing an opioid overdose. In the case of an opioid overdose, naloxone should be administered without delay to restore breathing and improve the person’s chances of survival. 

Naloxone is effective only if there are opioids involved in the overdose. Naloxone will not reverse an overdose involving alcohol, benzodiazepines, or cocaine. 

The district shall follow the Washington Department of Health’s steps for administering naloxone for drug overdose. (https://www.doh.wa.gov/Portals/1/Documents/Pubs/150-126-NaloxoneInstructions.pdf) 

An opioid overdose may occur intentionally or in many cases unintentionally. Assessing an individual for responsiveness and breathing is critical to a successful outcome of a person experiencing an opioid overdose. A few quick ways to determine this are: 

• Shout their name and shake them 
• Rub knuckles hard on the breastbone in the middle of the chest or on the upper lip of the individual. 

If the person responds to the stimuli, assume an overdose has not yet occurred. However, emergency medical services should be notified. Remain with the individual and continue to assess for responsiveness and breathing until help arrives. It is important to monitor the person and try to keep the individual awake and alert. If the person does not respond to hearing their name, being shook, or having knuckles rubbed on their breastbone or upper lip, assume they may be experiencing an opioid overdose and administer naloxone per standing order and prescription. 

According to the American Heart Association guidelines in response to suspected overdose, an AED should be brought and used to rule out a shockable rhythm for a victim who is not breathing/breathing irregularly. 

An opioid overdose requires immediate medical attention. It is essential to have a trained medical professional assess the condition of a person experiencing an overdose. All schools are expected to activate emergency medical services in an expected case of an overdose. 

Washington’s Good Samaritan Law provides some protections when calling 911 to save a life, even if drugs are at the scene according to RCW 69.50.315. The victim and person calling 911 cannot be prosecuted for simple possession. 

Obtaining and Maintaining Opioid Overdose Medication 

If a statewide standing order for intranasal or auto-injection intramuscular forms of naloxone is available, the district will obtain and maintain those forms of opioid overdose reversal medication exclusively. 

The district may seek to obtain opioid overdose reversal medication through donations from manufacturers, non-profit organizations, hospitals, and local health jurisdictions. The district may also purchase opioid overdose reversal medication directly from companies or distributors at discounted pricing. If the district is unable to obtain naloxone through a donation source and pursues an exemption from the requirement to stock naloxone per RCW 28A.210.390 the district must maintain written documentation of its good faith effort to obtain opioid overdose reversal medication from these sources. 

A school administrator at each school shall ensure that the opioid overdose reversal medication is stored safely and consistently with the manufacture’s guidelines. School administrators will also make sure that an adequate inventory of opioid overdose reversal medication is maintained with reasonably projected demands. Medication should be routinely assessed to ensure enough time for reacquiring the medication prior to the expiration date. 

Opioid overdose reversal medication shall be clearly labeled in an unlocked, easily accessible cabinet in a supervised location. Consider storing opioid overdose reversal medication in the same location as other rescue medications. Districts may store additional doses in unsupervised locations such as Automated External Defibrillator (AED) cabinets for faster access on large campuses or after hours. Naloxone stocked in unsupervised locations should be checked at least weekly. Districts are encouraged to stock additional doses in first aid and sports kits. Expiration dates should be documented on an appropriate log a minimum of two times per year. Additional materials (e.g. barrier masks, gloves, etc.) associated with responding to an individual with a suspected opioid overdose can be stored with the medication. 

Training 

School-based health centers are responsible for training their personnel. 

The district will ensure each school has at least one personnel member who can distribute or administer opioid overdose reversal medication. Districts should consider having adequate designated and trained personnel for availability at school and school-sponsored activities. Any staff member may be designated and trained upon approval by Principal and/or school nurse. Personnel certified in first aid/CPR should be prioritized for designation and training for administration of opioid overdose reversal medication. If opioid overdose reversal medication is stocked in first aid and athletic kits as encouraged by RCW 28A.210.390, staff members in possession of these kits at off-site events should be designated and trained to administer the medication. 

Training for designated trained responders will occur annually prior to the beginning of each school year and throughout the school year as needed. Training may take place through a variety of platforms, including online or in a more conventional classroom setting. Training may occur in small groups or conducted one-on-one and may be offered by nonprofit organizations, higher education institutions, or local public health agencies. A licensed registered professional nurse who is employed or contracted by the district may train the designated trained responders on the administration of the opioid overdose reversal medication consistent with OSPI’s guidelines and this policy/procedure. 

Training for designated personnel will include: 

• District policy and procedure 
• What are opioids 
• What is an opioid overdose 
• Other types of overdoses 
• Signs and symptoms of an overdose 
• Actions to take when a suspected opioid overdose occurs 
• Naloxone access points in the school 
• Reporting requirements 
• Skill practice 
• Good Samaritan law 

The district will maintain a log of all designated trained responders for each school. The log will include a list of all persons who are designated trained responders, a list of their trainings with the date and location of the training and the name of the trainer. 

Administration of the district’s opioid overdose reversal medication will be performed by designated, trained, district personnel when needed. However, “RCW 69.41.095 allows for “any person” (including students) to lawfully possess, store, deliver, distribute, and administer an opioid overdose reversal medication that has been properly prescribed and/or authorized. The board further recognizes that: 

• Incidences of opioid overdoses are increasing in communities and schools; 
• Naloxone is highly unlikely to cause harm if administered when not needed; 
• Students may carry naloxone at school to have access to it outside of school; and 
• Delay in administering naloxone for suspected overdose or delay activating emergency medical services could cause severe harm. 

Therefore, neither the district nor its schools will pursue disciplinary action for students solely for possession or good faith administration of naloxone. Naloxone will not be confiscated from students who are found to have it in their possession at school and school-sponsored events. 

Students who exhibit concern for the risk of overdose for themselves or others shall be counseled on the availability of behavioral health supports and instructed of the district policy and procedure for opioid overdose response. The importance of summoning adult help and emergency services for any suspected overdose must be emphasized. 

Post-Incident Follow-Up 

Districts should plan to provide student and personnel support within one to two days after a suspected overdose incident. Supports may include critical incident stress debriefing, Flight team, postvention, or other support and prevention measures. Consideration of continued prevention and wellness promotion are also recommended. 

Liability 

The district and practitioner’s liability are limited as described in RCW 69.41.095.