Heroin.
Just the word itself provokes feelings of dread, sorrow and pity. Images of syringes, track marks, dirty spoons and poor, sick, strung-out people come to mind. The mental pictures conjured up by the phrase “heroin addiction” depict a life devoid of potential that no reasonable person would wish on their worst enemy.
The suffering associated with drug addiction, and in particular heroin and opioid addiction, is very real. At its worst, such addiction can lead to an overdose death. Tragically, the signs and symptoms leading to drug addiction are not always obvious and are often a subtle and hard-to-recognize deterioration in a child’s health.
Therefore, to cultivate a safe and healthy educational environment and protect each student from the threat of addiction, it is the responsibility of school leaders to ensure that adequate measures are in place for the education, prevention, identification, intervention, and treatment of substance abuse.
A Picture of the Problem Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, conducted by the United States Department of Health and Human Services, indicated that heroin abuse among first-time users ages 12 or older has increased by nearly 60 percent in the last decade. In addition, the nonmedical use of prescription drugs among youths aged 12 to 17 was the second most prevalent illicit drug use category, with marijuana being first. The most prevalent category of misused prescription drugs was pain relievers (opioids).
Other shocking statistics from that survey:
- One in 11 youths aged 12 to 17 reported it would be easy to get heroin (9.1 percent); and
- Among persons aged 12 or older in 2012-2013 who used pain relievers for nonmedical reasons in the past 12 months, 53 percent got the drug they used most recently from a friend or relative for free, and 10.6 percent bought the drug from a friend or relative. Another 21.2 percent reported that they got the drug through a prescription from one doctor. An annual average of 4.3 percent got pain relievers from a drug dealer or other stranger, and 0.1 percent bought them on the internet.
The 2014 report from the New Jersey Task Force on Heroin and Other Opiate Use by New Jersey’s Youth and Young Adults, published by the Governor’s Council on Alcoholism and Drug Abuse, stated that “the skyrocketing use of heroin and other opiates has become the number one health care crisis confronting New Jersey.” The task force report cites the connection between prescription opiates and heroin use as a major contributor to the problem.
Opioids include:
- Prescription opioids Common types are oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone;
- Fentanyl synthetic opioid pain reliever It is many times more powerful than other opioids and is approved for treating severe pain, typically advanced cancer pain. Illegally made and distributed fentanyl has been on the rise in several states.
- Illegal heroin Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.” (https://www.cdc.gov/drugoverdose/).
Although the connection between the use and misuse of prescription opioids and the use of heroin requires further study, it is undeniable that opioid drug abuse – in both prescription pain relievers and illegal heroin – presents a significant risk to health and welfare of children and young adults in the state. The task force noted that in New Jersey, heroin is relatively low in cost and high in purity. The low cost makes the drug more easily accessible. The high purity enables the drug to be inhaled rather than injected, which is a less repulsive and stigmatizing means of taking the drug.
Prescription drugs are often accessible in unlocked and unmonitored family medicine cabinets. Prescription opiates may be perceived as safer, because they are manufactured in sterile laboratories and prescribed by doctors. The difficulty associated with obtaining a supply of legally-prescribed opiates and the high cost of illegally purchased prescription opiates may be catalysts to heroin use. The increase in heroin use corresponds to an increase in the prescribing of painkiller medications. The Centers for Disease Control and Prevention reports a 300 percent increase in the sale of strong painkillers since 1999.
Recognizing and taking action to prevent, intervene and treat heroin and other opiate abuse and addiction is particularly urgent. Drug overdose deaths now surpass the number of deaths resulting from motor vehicle accidents, which had always been the leading cause of accidental death in the United States. Opioid analgesic-related overdose (pain killers) deaths now outnumber overdose deaths involving all illegal drugs combined including heroin and cocaine.
General Policy Considerations Local New Jersey boards of education have long been required by law (N.J.S.A. 18A:40A10 and N.J.S.A. 18A:40A17) to have comprehensive policies, procedures and programs in place to combat substance abuse.
Board policies and procedures (NJSBA file code 5131.6 Substance Abuse) must provide for the identification, evaluation, referral for treatment and discipline of students who are substance abusers, as well as providing assistance to parents and guardians who believe their child may have a problem. The board policies and procedures must provide for staff training on the signs and symptoms of drug and alcohol abuse. In addition, the board must provide programs for increasing the knowledge and skills of students, staff and community members for avoiding the harmful effects of alcohol, tobacco and other drug use (N.J.A.C. 6A:16-3.1).
To comply with the law, and in recognition of the connection between student health and student achievement, the NJSBA model policy 5131.6 Drugs, Alcohol, Steroids and Tobacco states that the board “must maintain that the use of drugs, alcohol, steroids, and tobacco and the unlawful possession of these substances is wrong and harmful. The board of education is committed to utilizing wellness strategies that encourage the prevention, intervention, and cessation of drug, alcohol, steroid, and tobacco abuse.” In addition to the legal responsibility for the board to have substance abuse policies, procedures and programs, the board is required to annually review the effectiveness of its policies and procedures regarding student alcohol and other drug abuse and annually disseminate the policy and procedures to all school staff, students and parents/guardians through its website or other means (N.J.A.C. 6A:16-4.2). Staff, students, parents, and other community members must be actively involved in the development and implementation of prevention program plans (N.J.A.C. 6A:16-3.1).
Law (N.J.S.A. 18A:40A-16) requires each school district to establish a parent/guardian substance abuse program offered at times and places convenient to the parents/guardians of the district on school premises or other facilities. Addressing prescription drug abuse as part of the school parent and community awareness program is one way to combat opiate abuse.
Medications left unmonitored in family medicine cabinets can inadvertently become a temptation to children experiencing peer pressure to experiment with drugs. Safetyguard My Meds, a website published by Purdue Pharma L.P., provides resources and information regarding the appropriate maintenance, storage and disposal of prescription medications. Their publication, Parents’ Guide to Understanding Prescription Drug Abuse cites the disposal of old and/or unused medications as a prudent measure for the prevention of prescription drug abuse.
Many schools are also sponsoring programs in conjunction with their local law enforcement offices for the anonymous disposal of medication through participation in the Project Medicine Drop Program. Project Medicine Drop is a statewide initiative of the New Jersey Division of Consumer Affairs for the safe disposal of unused and expired prescription medication.
Policy Considerations for Student Health Board policies and procedures on substance abuse must prioritize the health and safety of the students and provide for the evaluation, referral for treatment and discipline of students involved in incidents of abuse or possession on school property or at school functions; and of students who show significant symptoms of the use of those substances on school property or at school functions (N.J.S.A. 18A:40A11). Board policy on substance abuse must provide for a process for reporting students who are suspected of being under the influence of drugs and alcohol. Additionally students who are suspected of being under the influence of drugs or alcohol must be supervised by school staff, receive a medical examination and the district must notify the parents/guardians. The district is required to take the measures necessary to ensure that the student has appropriate medical attention and the student’s health and welfare are protected up to and including alerting emergency medical services.
The Overdose Prevention Act (P.L. 2013, c. 46), signed into law on May 2, 2013, provides immunity from liability under certain circumstances for individuals who in good faith seek medical assistance for someone experiencing a drug overdose. The law also provides protections for certain people experiencing a drug overdose who seek medical assistance or are the subject of a good faith request for medical assistance by another person. Protections include that such individuals may not be arrested, charged, prosecuted or convicted when acting according to the provisions of the law. The purpose of the law is to reduce the disincentives that obstruct seeking medical attention such as prosecution and arrest for illegal drug use and possession, and encourage people to seek the potentially lifesaving medical attention they may need (N.J.S.A. 2C:35-30 and -31).
Emergency Opiate Antidotes In May 2016 Commissioner of Education David Hespe issued a memo regarding opioid overdose, citing the civil and criminal immunity provided under the Overdose Prevention Act. The memo addressed civil and criminal immunity for non-health care professionals who in good faith believe an individual is experiencing an opioid overdose and in an emergency administer an opioid antidote (N.J.S.A. 24:6J-4).
The memo states the New Jersey Department of Education’s position that “school districts may develop and adopt policies and procedures to maintain and administer opioid antagonists (naloxone) to any student, school personnel or other person believed to be experiencing an opioid overdose during school hours or during on-site school-sponsored activities to block the opioids life-threatening effects.” A quick response during an overdose is potentially lifesaving because opioid overdose can cause breathing to slow down or stop. The immediate administration of an opioid antidote can block the effects of opioids and reverses an overdose in the time it takes emergency medical services to reach the person.
The memo emphasizes that the board is required to develop the policy and procedure before naloxone may be administered and that districts are encouraged to consult with the state Department of Human Services (DHS), their physician, legal counsel, and the school community at large prior to the development of naloxone policies and procedures.
With the policy and procedures in place, the school nurse, school doctor and volunteer, unlicensed school personnel who are trained through a Department of Human Services-endorsed program may administer naloxone in an emergency situation.
The model policy in the NJSBA Critical Policy Reference Manual, 5141.21 Administration of Medication covers the state requirements for the administration of medication including the parental consent, physician authorization, storage of medication, disposal of medication, self-administration of medication, availability of emergency medication and emergency administration of glucagon, epinephrine and asthma nebulizers. (See page 47)
The administration of medications at school is very regulated by law. Whereas the emergency administration of glucagon, epinephrine and asthma nebulizers are specifically addressed in state law and regulation (N.J.S.A. 18A:40-12.5 through -12.6, N.J.S.A. 18A:40-12.8, and N.J.A.C. 6A:16-2.1), the administration of naloxone in public schools is not specifically covered in law or regulation. In developing the policy it is advisable to consult the district’s medical staff and the board attorney, as suggested by the NJDOE as well as the district’s insurance carrier.
Drug addiction, and in particular opioid abuse and addiction are serious threats to the safety, health and well-being of children and therefore a grave issue impacting our schools and student achievement. Drug addiction has the capacity to destroy a child’s potential and future. Nothing is more terrible than lost potential and nothing is more tragic than the accidental death of a child. It is the responsibility of school leaders to ensure that state law and board policies and programs addressing substance abuse are the subject of regular board review; developed and reviewed with community participation and input; and that the district’s substance programs are implemented effectively in every school.
NJSBA policy services has model policies and sample regulations for substance abuse for students and staff (5131.3 and 4119.26/4219.23) and the emergency administration of medication (5141.23). Model policies are available on the Policy page of the NJSBA website (staging.njsba.org) or may be emailed upon request. In addition to the model policy samples, sample discretionary policy language for the emergency administration of Naloxone including a sample parent/guardian notification letter are available upon request by contacting Policy Services at [email protected].