Addendum to the 2002 Model Policy and Guidelines for

ADDENDUM TO THE 2002 MODEL POLICY AND GUIDELINES FOR

ADMINISTERING MEDICATIONS TO PUPILS AT SCHOOL

GUIDELINES FOR RESPONDING TO AN OPIOID-RELATED OVERDOSE AT SCHOOL

Overview

According to the Michigan Department of Health and Human Services (MDHHS), states

nationwide have experienced a dramatic increase in the number of opioid-related

overdoses in recent years. In Michigan, the number of heroin-related overdose deaths

per 100,000 residents increased from 1.1 in 2007 to 6.8 in 2015. Opioids, including

heroin and prescription drugs, accounted for 473 deaths in 2007; in 2015, that number

increased to 1,275. Naloxone is an opioid antagonist that is used along with emergency

medical treatment to reverse the life-threatening effects of opiate and has a long history

of safe and effective use by organized health care systems (King, 2016). Naloxone only

has noticeable effects in people with opioids in their system [Substance Abuse and

Mental Health Services Administration (SAMHSA), 2016; National Institute on Drug

Abuse, 2016]. The National Association of School Nurses (2015) has endorsed having

naloxone available in schools. When naloxone is administered quickly and effectively, it

has the potential to immediately restore breathing to a victim experiencing an opioid-

related overdose [Centers for Disease Control and Prevention (CDC), 2015; Hardesty,

2014].

Michigan Data – Youth Risk Behavior Survey and Michigan Profile for Healthy

Youth (MiPHY)

The Michigan Youth Risk Behavior Survey (YRBS) is part of a nationwide surveying

effort led by the CDC to monitor students' health risks and behaviors [Michigan

Department of Education (MDE), 2017]. High response rates allow results of the

Michigan YRBS to be generalized to all Michigan students in grades 9-12 (MDE,

2017). In 2015, 15.8% of Michigan high school students reported ever taking drugs

without a doctor’s prescription. School districts can review the county MiPHY survey

data to help understand the prevalence of substance use risk behavior in their

community at www.michigan.gov/miphy.

Definitions

Opioid Medications: Prescription opioids are medications that are chemically like

endorphins, the opioids that our body makes naturally to relieve pain. Prescription

opioids are like the illegal drug heroin. Opioid medications can be natural (made from

plants), semi-synthetic (modified in a lab from the plant), and fully synthetic (completely

made by people). Common opioids are oxycodone (OxyContin, Percodan, Percocet),

hydrocodone (Vicodin, Lortab, Lorcet), morphine (Kadian, Avinza, MS Contin), codeine,

fentanyl (Duragesic), propoxyphene (Darvon), hydromorphone (Dilaudid), meperidine

(Demerol) and methodone (National Institute of Drug Abuse for Teens, 2017).

Michigan Act No. 385 Public Acts of 2016 provides the following definitions:

Opioid Antagonist: Naloxone hydrochloride or any other similarly acting and equally safe

drug approved by the United States Food and Drug Administration. There are three

FDA-approved formulations of naloxone:

• Injectable - A solution that can be injected intravenously, intramuscularly, or

subcutaneously

• Auto-injectable (EVIO) - Prefilled auto-injection device containing a solution to be

injected intramuscularly

• Nasal spray (NARCAN)

Opioid-related overdose: A condition, including, but not limited to, extreme physical

illness, decreased level of consciousness, respiratory depression, coma, or death that

results from the consumption or use of an opioid or another substance with which an

opioid was combined or that an individual who has received training approved by a

licensed registered nurse in the administration of an opioid antagonist would believe to

be an opioid-related overdose that requires medical assistance.

Legal Framework and Michigan Model Medication Policy and Guidelines for

Administering Medications to Pupils at School

Public Act 385 allows local school districts to stock and provide an opioid antagonist to

pupils or other individuals who are believed to have an opioid-related overdose.

MCL 380.1178 describes liability for school employees who in good faith administer an

opioid antagonist as not liable in a criminal action or for civil damages because of an act

or omission in the administration of the medication. Public Act 12 of 2014 requires schools

to have a cardiac emergency response plan that includes incorporation and integration of

the local emergency response system and emergency response agencies with the

school’s plan. Since Public Act 385 requires school personnel to call 9-1-1 if a student is

believed to be having an opioid overdose, local school districts may consider including an

opioid-related overdose in the emergency plan. The MDE Model Policy and Guidelines

for Administering Medications to Pupils at School (2002) states that each building shall

have a plan for handling medical emergencies.

Public Act 385

Adds three sections to the revised school

code to allow local school districts to

stock and provide an opioid antagonist to

a pupil or other individual on school

grounds who is believed to have an

opioid-related overdose.

Public Act 12 of 2014

The governing body of a school that

operates K-12 shall adopt and implement

a cardiac emergency response plan for

the school.

§380.1178

Sets forth legal provisions for the

immunity of school employees,

designated by the school

administrator, against an allegation of

“simple” negligence if the employee

administers the medication under certain

requirements including being in the

presence of another adult. If a school

employee is a licensed registered

professional nurse, subsection (1) applies

to that school employee regardless of

whether the medication is administered in

the presence of another adult.

http://www.michigan.gov/mdhhs/0,5885,7-

339-71550_2941_4871_79678---,00.html

Michigan pharmacists interested in

providing naloxone to Michigan families

under the standing order issued by the

state of Michigan’s chief medical

executive can register by filling out a form

on the MDHHS website. Pharmacies will

be required to keep track of the amount

of naloxone dispensed and will report

these numbers to MDHHS on a quarterly

basis.

MDE Model Medication Policy and

Guidelines for Administering Medications

to Pupils at School

The Michigan Department of Education

model policy and guidelines for

administering medications at school

(2002).

Local School Board Opioid Antagonist Information

Beginning with the 2017-2018 school year, a school board may require that, in each

school it operates, there are not fewer than two employees at the school who have been

trained in the appropriate use and administration of an opioid antagonist. A school

board that requires an employee to be trained to administer an opioid antagonist shall

ensure that the training has been approved by a licensed professional nurse.

In May 2017, Governor Snyder authorized the MDHHS to issue a standing order pre-

authorizing the distribution of naloxone by pharmacists to eligible individuals. The

standing order is not for schools/organizations. The MDE Model Guidelines for

Administering Medications to Pupils at School (2002) should be followed when a parent

requests a student self-possess Naloxone at school.

Local School Board Policy Requirements for Opioid Antagonists

A school board that requires an employee to be trained in the use and administration of

an opioid antagonist shall develop and implement a policy that ensures the following:

• Consistency with the MDE Model Guidelines for Administering Medications to

Pupils at School (2002).

• Provisions for the possession of not fewer than one package of an opioid

antagonist in each school operated by the school board to be used for

administration by a licensed professional nurse who is employed or contracted by

the school district or an employee who is trained in the administration of an

opioid antagonist and is authorized to administer an opioid antagonist under the

policy.

• Requirement that at least two employees at the school have been trained in the

appropriate use and administration of an opioid antagonist.

• Authorization for a licensed professional nurse who is employed or contracted by

the school district or a school employee who is trained in the administration of an

opioid antagonist to administer an opioid antagonist to a pupil or other individual

on school grounds who is believed to be having an opioid-related overdose.

• Requirement for school personnel to notify the parent or legal guardian of a pupil

to whom an opioid antagonist has been administered. In addition, the school

policy shall also require school personnel to, when notifying the parent or legal

guardian, encourage the parent or legal guardian to seek treatment for the pupil

from a substance use disorder program licensed under part 62 of the public

health code, 1978 PA 368, MCL 333.6230 to 333.6251.

• Requirement for school personnel to call 9-1-1 or the community’s designated

emergency medical services if a pupil is believed to have an opioid-related

overdose.

Recommended but not required:

• Annual refresher training for school personnel, including building administrators,

to be trained in the administration of an opioid antagonist. Building administrators

need to provide continuous monitoring of staff turn-over to identify the need to

train new staff to administer the opioid antagonist. This could be accomplished

with annual emergency response training for school staff.

• Utilize school nurse (if available) as the primary designee to administer the opioid

antagonist.

• Utilization of a licensed, registered professional nurse to be responsible for

providing and supervising the training which shall include an evaluation and

documentation of a participant competency assessment.

• Utilization of school health services and mental health staff for participating in the

development of the local school board opioid antagonist policy.

• Collaboration with the local Emergency Medical System (EMS) in the

development of school policy.

• Consideration of utilizing the Cardiac Emergency Response Team required by

PA 112 of 2014 as the first responders to an opioid-induced overdose.

• Provision for students and school staff to have a basic awareness of the major

signs of an opioid-related overdose and know whom to alert in case of an

emergency and where the opioid antagonists are located.

• Provision for staff to notify the building administrator any time naloxone has been

administered.

• Provision for the building administrator to notify all school staff about who has

been trained on naloxone administration and update as necessary.

• Determination of naloxone delivery system (nasal spray, auto-injection,

vial/syringe) and additional equipment needed to safely administer in school.

• Determination of where naloxone will be stored.

• Determination of designated school staff to check the expiration date of the stock

opioid antagonist at least twice per year and discard expired stock in a biohazard

sharps container or locate a needle disposal facility and replace any opioid

antagonist past its expiration date.

• Determination if naloxone will be available for field trips, before/after school

activities, and school sponsored events.

• Guidelines for documenting the administration of naloxone for a suspected opioid

overdose.

• Guidelines for reporting the event to the parent/guardians.

• Guidelines for reporting the number of opioid antagonist administrations annually

to the MDE.

• Guidelines for communicating with school staff about opioid antagonist

administrations at school including providing the "designated school personnel"

an opportunity to review the incident with a building administrator or medical

professional upon their request after an opioid antagonist has been administered

at school.

• Guidelines for providing parents assistance or information on seeking treatment

for the student who experienced an opioid-related overdose at school.

• Guidelines for building administrators about informing parents/guardians,

students and staff about the policy and administrative regulations governing the

administration of opioid antagonists.

Licensed Registered Professional Nurses

A licensed registered professional nurse who is employed or contracted by the school

district or a school employee who is trained in the administration of an opioid antagonist

may possess and administer an opioid antagonist.

Training Guidelines for the School Personnel Designated to Administer an Opioid

Antagonist

• Instruction on the provisions of state laws regarding the emergency use of opioid

antagonists at school for situations of suspected opioid-related overdose.

• Instruction on the school district’s medication policies and procedures.

• Instruction about the definitions of opioid medications, opioid-related overdose

and opioid antagonists.

• Instruction about the signs and symptoms of an opioid-related overdose, and the

anticipated effects of the opioid antagonist.

• Instruction on opioid antagonist administration including the need to provide

supportive care before and after administration.

• Development and implementation of a plan of action for an emergency response

to opioid-related overdoses that includes calling 9-1-1 or the local emergency

medical system to be dispatched if a pupil is believed to have an opioid-related

overdose and anytime an opioid antagonist is administered. The emergency plan

of action should include response guidelines for when a student possesses

naloxone that is not a stock medication in school.

• Instruction on the procedures for informing emergency contacts, completing a

school incident report, notifying parent/guardian of a student to whom an opioid

antagonist has been administered, and encouragement to the parent or legal

guardian to seek treatment for the pupil from a substance use disorder services

program licensed under part 62 of the public health code, 1978 PA 368, MCL

333.6230 to 333.6251.

• Instruction on the procedures regarding the opioid antagonist acquisition,

expiration date monitoring, maintenance, and storage requirements.

• CPR training and certification for all school personnel trained in the

administration of an opioid antagonist.

Storage of the Opioid Antagonist

• All opioid antagonists should be stored according to the manufacturer’s directions

to maintain effectiveness and in a clearly labeled, unlocked, easily accessible

cabinet in a supervised location.

• Consider storing the opioid antagonist in the same location as other rescue

medications.

• Expiration dates on the opioid antagonist should be monitored and documented

on an appropriate log at a minimum of two times per year.

• Additional materials associated with responding to suspected opioid-related drug

overdose should be stored with the opioid antagonist (e.g. copy of the suspected

opioid-related overdose emergency response plan, school incident report).

Obtaining an Opioid Antagonist

The school board can obtain a written prescription of opioid antagonist in each school

operated by the school board. Any local community prescriber can write a prescription

to a school board. School boards can seek the purchasing or donation of the opioid

antagonist through pharmaceutical companies.

Examples of opioid antagonists:

• EVZIO www.evzio.com

• NARCAN www.narcan.com

School District Reporting

At least annually, a school district shall report to the Michigan Department of Education

all instances of administration of an opioid antagonist to a pupil at school. The reporting

shall include the number of pupils who were administered an opioid antagonist at school

using the school’s stock of opioid antagonists.

References

Centers for Disease Control and Prevention (2015). Opioid overdose prevention

programs providing Naloxone to laypersons-United States, 2014. Retrieved from:

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm

Hardesty, C. (2014). Five things to know about an opioid overdose. Retrieved from:

https://obamawhitehouse.archives.gov/blog/2014/02/11/5-things-know-about-opioid-

overdoses

King, R. (2016). Science over stigma. Saving lives-Implementation of naloxone use in

the school setting. NASN School Nurse, 31(2), 97-100. doi:

10.1177/1942602X6628890

Michigan Department of Education (2017). Michigan Youth Risk Behavior. Retrieved

from: http://www.michigan.gov/mde/0,4615,7-140-74638_74639_29233_41316---

,00.html

Michigan Department of Health and Human Services (2017). Naloxone Standing Order

– For Pharmacist’s Use Only. Retrieved from:

http://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_4871_79678---,00.html

National Association of School Nurses (2015). Naloxone use in the school setting:

Role of the school nurse (position statement). Retrieved from:

https://schoolnursenet.nasn.org/blogs/nasn-profile/2017/03/13/naloxone-use-in-the-

school-setting-the-role-of-the-school-nurse

National Institute on Drug Abuse (2016). Naloxone. Retrieved from:

https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-

evzio

National Institute on Drug Abuse for Teens (2017). What is an opioid? Retrieved from:

https://teens.drugabuse.gov/blog/post/what-opioid

Substance Abuse and Mental Health Services Administration. SAMHSA Opioid

Overdose Prevention Toolkit (2016). Retrieved from:

http://store.samhsa.gov/product/SAMHSA-Opioid-Overdose-Prevention-Toolkit/SMA16-

4742