By Taylor Knopf

Now a national emergency, opioids have seeped into all areas of American life, including grade school.

A survey published in the Journal of Addictive Diseases found that school nurses in North and South Carolina sometimes encounter students with opioid prescriptions. The nurses also say they’d like more opioid education for themselves and students.

The voluntary 22-question survey asked school nurses in elementary, middle and high schools about their experiences with opioids and what would be helpful for their students.

In 2016, there were 1,318 registered school nurses in North Carolina and 1,168 in South Carolina. A total of 665 nurses took the survey, about 27 percent of the two-state total.

The questions ranged from how comfortable nurses felt talking to kids about prescription painkillers to what kind of drug education would be most helpful for students.

“Few studies have looked at opioids in schools even as more children are coming to school with prescription opioids that the school is responsible for administering,” Delesha Carpenter, the study’s senior author said in a press release.  Carpenter is an assistant professor at the University of North Carolina-Chapel Hill Eshelman School of Pharmacy.

“The responsibility for storing, monitoring and administering students’ medications falls on school nurses,” she added. “They are asking for more resources to help them deal with these powerful drugs.”

‘Particularly concerning’

About 40 percent of nurses who took the survey said they had seen a student with an opioid prescription in the last year.

Only 4.6 percent reported seeing opioid prescriptions on a monthly basis. A small number – only 1.5 percent – said they see them on a weekly or daily basis.

However, 70 percent, especially nurses from rural areas, said they believed their students would benefit from opioid education.

While 97 percent of school nurses said they have access to secure opioid storage at school, fewer than 4 percent reported having naloxone, an opioid reversal drug, available at school.

“This is particularly concerning considering the agreement between Adapt Pharma and state Departments for Education, to provide intranasal naloxone to high schools free of charge,” the study authors wrote.

“The National Association of School Nurses has endorsed school nurse access to naloxone for the emergency treatment of opioid overdose,” they continued. “Although complicated by variations in state law, this highlights the need for local implementation plans to increase uptake of Narcan within schools.”

Opioid deaths on the rise

Prescription drug overdose deaths in the U.S. have quadrupled since 1999, according to the Centers for Disease Control and Prevention. More than 183,000 people died in the U.S. from opioid overdoses between 1999 and 2015.

North Carolina has paralleled the nation, with overdose deaths climbing from 150 deaths in 1999 to 1,110 in 2015. A total of 11,072 North Carolinians died from opioid overdose during that time.
About 67 percent of nurses said they have had some sort of opioid education, but only 26 percent of them had been trained to use naloxone.

Study authors wrote that they have seen opioids used for conditions such as headaches or tooth extractions when non-narcotic pain relievers would suffice.

“School nurses are in a position to contact prescribers, students, and families to discuss alternative pain relief, such as non-steroidal, anti-inflammatory drugs (NSAIDs), which could curb the number of young people who become addicted to opioid medications,” they wrote.

“Training school nurses to effectively communicate with different providers may be key, as rural school nurses more frequently encountered prescriptions from ED and urgent care providers than urban nurses.”

Common story

Lately, news stories have been filled with people who either died from a drug overdose or are struggling through long-term addiction recovery. It’s not uncommon to hear that addiction started with a prescription painkiller in high school.

For example, Drew Gintis was a Raleigh high school senior who injured his shoulder during a wrestling match. He became dependent on an opioid that a doctor prescribed for him. Later he turned to heroin. After multiple attempts at rehab, Gintis died of an overdose at age 21.

Gintis’ parents have been very vocal about their loss and advocated for passage of the STOP Act at the state legislature earlier this year.

Ashley Fabrizio has a similar story, but with a different ending.

A young woman stands at a podium, speaking.
Ashley Fabrizio speaks at an event with Attorney General Josh Stein and Nashville Police Chief Thomas Bashore this fall. Fabrizio fell from the top of a pyramid and injured herself as a 16-year-old cheerleader and became addicted to opioids given to her to treat her injuries. Photo credit: Taylor Knopf

Fabrizio was a high school cheerleader in Nash County when she fell during practice one day and hurt her ankle.

She left the hospital on crutches with a 20-day supply of Vicodin. Four days later, she went to an orthopedic surgeon.

“I told him the meds were not working, and he said that’s not strong enough. So he prescribed 60 Percocet,” Fabrizio, now 28, said at a September press conference with Attorney General Josh Stein. “I was 16 and weighed 100 pounds. That’s a lot of medicine for a little girl.”

After going through the medication in three weeks, she went back to the doctor and asked for another opioid prescription.

“There were no questions,” she said. “So I was prescribed 50 more Vicodin with a refill for 50 more. So that’s where it all started… I was high as a kite in school.”

She described needing to have the pills with her at all times. She was irritable and not herself without them. Fabrizio was experiencing withdrawal symptoms but didn’t know it at the time.

After years of recovering and falling back to her “old familiar friend,” Fabrizio said she is in long-term recovery.

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...

One reply on “School Nurses Need Help to Combat Opioids”

  1. How will taking their prescribed medications away, limiting what their physician has carefully considered and prescribed, or cutting supplies so their prescribed medications cannot be filled correctly serving children with pain issues?

    Shall we go back to assuming infants and children feel no pain because of their age? We know they do. Yet, rather than address what truly is driving addiction to all substances (alcohol, tobacco, illicit drugs, heroin, and the like) we continue to address one small percentage of the problem.

    School nurses should be provided education in properly handling, storing, administering, and documenting ANY medications to children in their care.

    I do have one question. Where were this 16 yr old’s parents? Who gets 60 Percocet for a sprained ankle? And a refill for 100 more when they weren’t taken as prescribed?? And no one asked any questions? Of a child? Where are the checks and balances, and again, the parents whose responsibility this child was? Punish the guilty, educate those who need educating, treat the addicted, and allow both children and adults with pain access to medication.

    Our lawmakers should make sure nothing comes between patients, their physicians, and the care those patients require.

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