In the spring of 2014, a student fell out of his chair in a 10th-grade classroom at Buckhead’s North Atlanta High School. A teacher quickly noticed he was unconscious and hardly breathing. After someone called 911, a paramedic arrived and, suspecting an overdose, administered an opioid antidote in hopes of saving the kid’s life.

The antidote, known as naloxone, worked. In reviving the student, Atlanta Public Schools staffers suddenly found themselves on the front line of the opioid crisis. Nurses realized they could either shake it off as an isolated incident — or prepare for future overdoses to come.

Imagine a school without a plan for an active shooter in 2018. Yet there were nearly three times as many fatal opioid overdoses than gun homicides in 2016. Those deaths have left a haunting trail of news reports across the country that include students finding classmates sprawled out on school bathroom floors and paramedics responding to the overdoses of teachers.

In recent years, the rash of in-school overdoses nationwide hasn’t spared Atlanta, as the NAHS incident showed. And graduates of local public and private high schools have died from overdoses to opioids that they first tried as students. Yet many schools — including ones in Sandy Springs, Dunwoody and Brookhaven – have chosen not to stock the life-saving opioid antidote.

Sarah Callaghan, assistant professor of kinesiology and health at Georgia State University’s Perimeter College Dunwoody Campus, demonstrates the use of an Evzio brand naloxone injection device during a recent training for her students. The first photo shows the injection device. The second photo shows the Evzio device with its cover removed and ready for use. In the third image, Callaghan presses the Evzio device to her thigh, where an injection would be given in real use. (Phil Mosier)

A life-saving antidote

Naloxone, often known by the popular brand name Narcan, can revive unresponsive students before paramedics respond to a 911 call. Opioids are highly effective painkillers that bind to receptors in the brain, making users feel high. Take too much, and the drugs can force someone to become unconscious, slowing their breathing down to the point of brain damage or death. Administered as an injection or spritzed up the nose, naloxone binds to those receptors and blocks the drug from affecting the user. The antidote, as a result, has saved tens of thousands of lives over the past two decades nationwide, according to the Centers for Disease Control and Prevention.

While naloxone has been available since the early 1970s, the antidote was largely confined to clinical settings like hospitals and ambulances. Over the past four years, Georgia passed several laws to allow for laypeople to use naloxone outside of clinical settings. In Brookhaven and Dunwoody, police officers carry naloxone to revive overdose victims on 911 calls. And just last week, U.S. Surgeon General Jerome Adams issued a rare health advisory — the first from his office in 13 years — that called for every American at risk of an opioid overdose, along with their family and friends, to carry the antidote.

Now a growing number of schools, many of which have strict rules for medications kept inside their walls, are following the recommendation of the National Association of School Nurses to carry naloxone “to immediately restore breathing to a victim experiencing an opioid overdose.” A pharmaceutical company, Adapt Pharma, has offered a free carton of Narcan nasal spray to high schools and colleges — including in Georgia.

The nasal spray version of Narcan brand naloxone is demonstrated on a medical training dummy by Sarah Callaghan of Georgia State University’s Perimeter College. (Phil Mosier)

The need has grown for naloxone to be on hand for teens and young adults. Two years ago, the CDC found that 5,376 people ages 15 to 24 fatally overdosed on drugs nationwide. In 1999, only 26 Georgians of that same age group died from drugs. In 2016, those fatal overdoses rose to 106.

“It’s important to have naloxone on hand because it can save a life — even if it’s the first life in a school that’s in danger of a fatal overdose,” says Laurie Fugitt, co-founder of Georgia Overdose Prevention, a volunteer group that distributes the antidote and teaches people how to use it. “It’s the same reason you have AEDs [defibrillators] on the gym wall or teach people CPR. It enables life.”

Despite the growing embrace of naloxone, Georgia Overdose Prevention co-founder Robin Elliott — whose son Zack fatally overdosed after graduating from Buckhead’s Pace Academy — says the group has faced hurdles in getting its trainings into schools statewide. In some cases, private schools are concerned about their image. Other times, schools haven’t promoted the event, leaving only 10 people to show up to a large auditorium.

“The resistance is the same as teaching sex ed in schools — [the idea] that if we teach about condoms, they’re going to want to have sex,” Elliott said. “[That] if we teach them about naloxone, they’re going to want to use drugs.”

The response from local schools

Only seven of the 20 high schools in communities covered by Reporter Newspapers said they carried naloxone. Seven schools said they didn’t. Six others declined to provide information or didn’t respond to requests for comment.

DeKalb and Fulton’s public high schools in the area — including Chamblee, Dunwoody, Cross Keys, North Springs and Riverwood International —don’t have the antidote on hand.

“We understand the opioid crisis has reached a critical level of concern in communities across the country,” DeKalb County School District spokesperson Eileen Houston-Stewart said in a statement. “In DCSD, we have had no reported opioid overdoses in any of our schools. It is not our practice for our nurses to keep the drug naloxone on any of our school campuses.”

Similarly, Fulton County Schools spokesperson Susan Hale said that administrators “presently don’t have any data suggesting that opioid use has been an issue” in its classrooms. The school district has trained some of its staffers how to identify students potentially at risk of drug abuse, she said.

In addition, students have received some lessons on the risks of misusing and abusing prescription drugs.

Five private high schools in the area — which either purchased naloxone or received doses through grant funding — said they saw the antidote as a way to protect students. Kevin Glass, headmaster at the Atlanta International School, said he wanted “to be prepared and hope we never have to use it.”

Allison Toller, chief of external affairs at Mount Vernon Presbyterian School, said that school’s nurses haven’t stocked up on the drug yet.

“We are keenly aware there is a growing number of schools across the country and in regions of Georgia that do,” Toller said, adding that “…as we routinely monitor the well-roundedness of our emergency preparedness plan, we would not rule out the idea of carrying it in the future.”

Some of the area’s most prestigious schools — including The Westminster Schools and St. Pius X Catholic High School — declined to answer questions. At Brandon Hall — a Sandy Springs college preparatory boarding school with an annual tuition that starts at $27,000 — one official requested more information about the Reporter’s naloxone story, but no one ever answered whether the school carries the antidote.

“As you can imagine, image is everything,” one Brandon Hall administrator wrote in an email, “and not knowing the full context for which you’ll publish our answers and our brand name is causing a bit of hesitation.”

In 2016, two years after the overdose at North Atlanta High School, APS officials decided to get naloxone for each of its high schools. School nurses took part in the “Not On My Watch” first-aid opioid training course offered by the U.S. Department of Health and Human Services. The training not only shows nurses how to administer the antidote, but also other best practices in administering first-aid training to students who overdose on opioids.

Every nurse’s office at an APS high school now has two doses of naloxone nasal spray. According to Valencia Hildreth, manager of comprehensive health services, APS initially received the antidote for free, but now intends to pay for it in its budget. (APS has not responded to an open records request for the exact amount of money that would cost.) In the coming years, APS intends to have other staff members, not just nurses, trained to use naloxone. That’s something they already do in case a student with diabetes or severe allergies needs life-saving medicine.

“It’s being proactive,” Hildreth says. “We consider interventions to make our students and schools safe. We wanted to be prepared in case we need to use it.”

Coping with a Crisis: Opioid addiction in the suburbs

The combination of prescription painkillers, heroin and synthetic opioids is killing people around the nation, including within Reporter Newspapers communities. In this exclusive four-part series, we will look at how local families, nurses, prosecutors, recovering addicts and others are responding to a growing epidemic that already kills more people than cars, guns or breast cancer each year.

For the first story, about families using obituaries to tell the harsh truth of loved ones’ overdose deaths, click here. For the second story, about a Dunwoody man who runs treatment facilities for opioid users after surviving eight overdoses and facing prison time, click here. For the third story, about how a suburban mother started peddling fentanyl and became the target of federal prosecutors, click here. The results of a community survey about opioid addiction’s effects on local residents, families and relationships are available here. For a local emergency department doctor’s overview of the opioid crisis, click here. To share your thoughts and stories, email editor@reporternewspapers.net.

In our debut podcast “Reporter Extra,” we took a deeper look at the opioid crisis with Max Blau, the reporter on the series, and Dunwoody Police Sgt. Robert Parsons, who coordinates his force’s use of naloxone. 

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