Should NC schools carry overdose reversal drug?

"The student’s laying face up and starting to turn blue at that point," Mayfield recalled. "It’s the scariest thing I’ve ever seen."

Emergency responders were on their way, but Mayfield and the nurse needed to do something. They prepared to give the student rescue breaths.

"You’re just sinking, looking at this student, trying to figure out, ‘OK, what to do next?’" Mayfield said.

The student had overdosed on opioids, a drug that comes in the form of heroin or prescription pain relievers, such as OxyContin, Percocet and Vicodin.

One of the fastest ways to help someone who is having an overdose is to give a medicine called naloxone, also known as Narcan. It comes in a nasal spray or injection and can help the person start breathing again.

Mayfield didn't have the medication. Neither did the school nurse.

At Carrboro High School, Sgt. Mayfield said he has seen two students overdose on opioids in the four years he has worked as the school's resource officer. Both students survived, including the student who stopped breathing and turned blue on the lunchroom floor three years ago.

If the same situation happened today, Mayfield would react differently. He now carries an emergency kit with naloxone nasal spray, which he keeps in his office at Carrboro High. He has had it since October 2014, when the Carrboro Police Department began carrying it.

Mayfield is one of the few school resource officers in the state who carry the drug.

Carrboro High and nearby McDougle Middle in Chapel Hill are the only two schools WRAL News could find in the state that have the drug on hand. At both schools, the resource officers are the only ones who have access to the nasal spray and are trained to use it.

Mayfield estimates he could assemble the nasal spray kit in 10 to 15 seconds and get the drug inside a student's nostrils long before emergency crews arrive.

"Knowing that I'm the only one in this school that has it, to save those extra few minutes if needed, I like that," Mayfield said. "My school principal is all for it. She's very happy that we have it. The school nurse ... she was ecstatic about it because they don't even have access to this, which is kind of surprising to me."

School nurses in North Carolina have been discussing whether they should have access to the drug and be trained to use it. The topic came up at the School Nurse Association of North Carolina's executive board meeting in Raleigh two weeks ago.

"This was one of the topics that is hot right now," said SNANC President Laura Marino.

Marino predicts that the drug could be available in all North Carolina public schools by the end of 2016. But how that could happen is unclear. Marino says she would rely on guidance from the state's school nurse consultant, Ann Nichols.

The North Carolina Department of Public Instruction has not taken a stance on the topic of naloxone in schools. Agency leaders say they also rely on Nichols, the state school nurse consultant, for guidance. But what kind of guidance she might give is unknown.

It's unclear how many students overdose on opioids in North Carolina public schools each year. The state Department of Health and Human Services collects data on student injuries and other medical emergencies and reports the findings in its Annual School Health Services Report.

A spokeswoman for DHHS said it is not uncommon for the agency to be several years behind on reports due to the magnitude of data the agency handles. She said the latest Annual School Health Services reports from 2013-14 and 2014-15 are being worked on and will be released sometime this summer.

The number one sign of an overdose is unresponsiveness, according to the North Carolina Harm Reduction Coalition, a nonprofit that has been working to increase awareness about opioid overdoses. Other signs include not breathing, turning blue, deep snoring, vomiting, gasping and gurgling.

"I'm not sure giving it to nurses at the schools is the best way. Data says the people most likely to use (naloxone) are users themselves and their peers," she said. "You'd be better off giving it to kids and peers, but the more the merrier. We'd never be against giving it to anyone."

One of the reasons NC Harm and others are open to more people having access to naloxone is that it only works if a person has opioids in their system. If the drug is mistakenly given to someone experiencing a different kind of medical emergency, it will have no effect, according to the group.

So far, North Carolina has not taken the company up on its offer. However, an Adapt Pharma spokesman said seven to 10 school districts in the state have contacted the company to ask about the drug. He declined to identify the school districts, saying releasing that information would be a violation of HIPAA, the federal law that protects the privacy and security of health information.

"Some schools have asked, 'How do I do this? How do I get it operationalized?'" said Thom Duddy, Adapt Pharma's executive director of communications.

The company has delivered about 1,800 doses of Narcan Nasal Spray to schools around the country since the drug became commercially available in February. Duddy says the company is currently working with schools in five states – Kentucky, New Hampshire, Ohio, Pennsylvania and West Virginia.

One of the questions school nurses and others have asked is how schools can get access to naloxone. Among the health experts, nurses, school officials and others WRAL News spoke with, opinions differ about how to do that.

Adapt Pharma, the drug company offering two free doses of naloxone to all U.S. high schools, says schools simply need to get a doctor to write a prescription for the drug for all students in the district. Once the company receives the prescription, it will ship the drug to the schools.

Jay Campbell, executive director of the North Carolina Board of Pharmacy, said he does not know of any state pharmacy laws that would prevent schools from getting the drug.

"I'm not aware of any impediment of having a school nurse getting a prescription," he said. "I’m not aware of any legal barrier to that."

The North Carolina General Assembly has been talking about the legality of naloxone recently but not specifically in regards to schools.

While lawmakers and others debate how easy it should be to get the drug, Linda Joseph, nurse coordinator for Chapel Hill-Carrboro City Schools, says she and other school nurses are waiting to see if they will be allowed to carry the drug.

"I had a discussion with our liaison (at DHHS), and she said that's an option coming down the road for us. (But) we haven't gone down the road any further," Joseph said. "We're sitting on the fence at the moment."

Joseph worries that the drug will be given to school nurses without the proper training and support.

One concern is that people who receive naloxone are sometimes known to "wake up in 'fight or flight' mode where they may become combative," according to NC Harm. However, that only happens in about 8 percent of patients and is especially rare if the drug is administered by someone they know and trust, according to the group.

"You would have to have something in place, a protocol, so the nurse is safe to give it," Joseph said.

But not all schools have a full-time nurse. That means principals, teachers or others may need to be trained to give the drug to students.

One thing Marino isn't as worried about is how students may react to the drug.

"I'd rather have an angry, violent student than a dead one," she said.