Naloxone in Schools: What a National Survey Found
Publication Title: Naloxone Access in Schools: A National Survey of School Nurses in the United States
Summary
- Question
- This study examined naloxone availability, storage, and overdose prevention training in U.S. K–12 schools. Naloxone is a U.S. Food and Drug Administration (FDA)-approved medication that reverses opioid overdoses and is now available over the counter. The researchers surveyed school nurses nationwide to understand where naloxone is stored, who can administer it, and whether schools train students and staff to use it.
- Why it Matters
- Drug overdose is now the third leading cause of death among children and adolescents in the United States, driven in part by the spread of potent synthetic opioids such as fentanyl. Schools are a critical setting for overdose prevention, yet no national data existed on how consistently naloxone was available across U.S. schools. This study fills that gap and highlights where policy and training efforts are falling short.
- Methods
- In May and September 2024, the researchers conducted an anonymous, cross-sectional survey—a one-time snapshot study—of K–12 school nurse members of the National Association of School Nurses (NASN). Surveys were emailed to a random subgroup of 2,000 NASN members nationwide. A total of 462 nurses from 44 states completed the survey, for a response rate of 23%.
- Key Findings
- Most nurses (90%) reported their school stocked naloxone, and 18% reported naloxone had previously been administered on their campus. However, 37% reported restrictions on who could access or administer naloxone, and 80% of schools stored it only in the nurse's office—raising concerns about whether it could be reached quickly during a campus emergency. Only 6% of schools provided naloxone training to students, and 70% did not allow students to carry naloxone on campus.
- Implications
- While naloxone is widely stocked in U.S. schools, storage and administration restrictions may slow response times during emergencies—particularly in large schools or when nurses are unavailable. The near-absence of student training represents a missed opportunity, since many adolescent overdose deaths occur at home or in the community. Expanding training for students and non-nursing staff, and storing naloxone beyond the nurse's office, could improve emergency response.
- Next Steps
- The authors call for research to define a comprehensive naloxone accessibility index and to evaluate whether geographic and socioeconomic factors affect overdose rates and naloxone access. They also emphasize determining the appropriate age for student naloxone education, describing school policies on students carrying naloxone, and capturing perspectives from administrators, students, and families. Advocacy for dedicated state-level funding was identified as essential to sustaining availability and training efforts.
- Funding Information
- This research was supported by the National Institutes of Health's National Institute on Drug Abuse (awards 5K12DA033312-12, K23DA067328, and K23 DA048987), the Health Resources and Services Administration (NRSA award T32HP10028), and the Centers for Disease Control and Prevention (award R49CE003566). Individual investigators also received support from the Yale Drug use, Addiction and HIV prevention Research Scholar (DAHRS) program and the Children's Hospital of Philadelphia Presidential Research Scholar program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Centers for Disease Control and Prevention. Yale University also provided funding and support for this research.
Full Citation
Calihan JB, Herrera MC, Jinks-Chang S, Wilson JD, McDonald CC, Dowshen N, Bobrowski CA, Edelman EJ, Bagley SM. Naloxone Access in Schools: A National Survey of School Nurses in the United States. Substance Use: Research And Treatment 2026, 20: 29768357261478395. DOI: 10.1177/29768357261478395.
Authors
E. Jennifer Edelman, MD, MHS, AAHIVS
First AuthorProfessor of Medicine (General Medicine)
Maria Christina Herrera, MD, MSHP
Last AuthorAssistant Professor