Are Schools Preparing for an Overdose?

The opioid epidemic continues to take the lives of children and teens; school leaders can play a role in preventing these deaths 

Every week, our country loses the equivalent of a high school classroom’s worth of kids to drug overdose deaths. Ninety percent of these deaths are attributable to opioids. There has never been a greater need for school boards to mount districtwide interventions that integrate the policies, tools, workflows, and education necessary to prevent and manage this crisis on their campuses, write contributors Dr. Holly Geyer and Mike Kurtenbach.

July 14, 2025

I’ll never forget the screams.

Frantic cries for help carried across a baseball field, reaching me and my 3-year-old as we enjoyed a leisurely day at a local park. Grabbing my daughter’s hand, we raced to the source. As we rounded the final corner of a bathroom, we saw the motionless legs of a pre-teen lying face down in the dirt. A hysterical entourage of juveniles encircled the body, wailing helplessly as one fumbled to dial 911. 

The surrounding pills told the story. What had started as youthful experimentation had rapidly deteriorated into a medical emergency. The drugs, evidently laced with opioids, had caused an overdose. And no one, including myself, was equipped to reverse it. Paramedics arrived within minutes. Thanks to their rapid delivery of the opioid-reversal agent naloxone, the boy survived. As a hospitalist and an addiction medicine specialist, I’ve long known the value of administering this drug. Thanks to this encounter, I now know the value of carrying it. 

Scenes like this play out daily across America as the opioid epidemic, now turned endemic, lays in wait for the next generation. Every week, our country loses the equivalent of a high school classroom’s worth of kids to drug overdoses. Overdoses are now the third leading cause of death in youth under age 18. Between July 2019 and December 2021, monthly overdose deaths in adolescents ages 10-19 doubled. Ninety percent of these deaths are attributable to opioids. And although more than two-thirds of these overdose events had a bystander present, most provided no response. 

These trends are a haunting mirror of those observed in adults. In 2023, the U.S. sustained more than 107,000 overdose deaths, with an estimated 70-75% of those related to illicitly produced opioids. The No. 1 cause of death in adults ages 18-45 is unintentional injuries, which in large part includes overdoses. At 21 cents a pill, the casualties are an easy write-off for a one-trillion-dollar drug trafficking industry operating a highly coordinated business venture taking place everywhere from back alleys to TikTok. Thanks to the drug cartels, America has been zoned, sorted, and infrastructurally supported to maximize drug sales, and their prize product is fentanyl.

Fentanyl is a synthetic opioid 100 times more potent than morphine and 50 times more potent than heroin. Widely used in health care settings to control pain, the pharmaceutical recipe has been hijacked by the illicit market for production in clandestine labs. Fast-acting and addictive, fentanyl binds to receptors in the brain, rapidly releasing the neurotransmitter dopamine that elicits a reinforcing euphoric response. Concurrently binding to brain regions controlling the desire to inspire, the drug and its more than 1,500 analogs have high potential to result in an overdose from amounts as small as seven grains of table salt. 

Opioid antagonists, such as naloxone (Narcan), can rapidly, but temporarily, reverse an opioid overdose. 

Naloxone is safe with no abuse potential and has virtually no effects on a person who is administered it for a cause unrelated to an overdose. Now available without a prescription, the drug’s average price is just $45. Indisputably, there are few pharmaceuticals on the market capable of delivering more value.

YOUTH ARE THE TARGET

So why isn’t naloxone everywhere? The drugs certainly are. Not convinced? Take a stroll through the Drug Enforcement Administration’s (DEA) One Pill Can Kill campaign website. Fentanyl is now widely available for purchase on virtually all social media platforms that youth routinely access including TikTok, Facebook, Snapchat, and Instagram. Drug solicitations and exchanges are often completed using emoji-based texts that evade parental suspicions. But fentanyl’s most dangerous attribute is its frequent covert integration into presumably reputable prescribed pharmaceutical products or herbal supplements. 

“Fentapills” are fentanyl-based products put through pill presses to resemble legitimate prescription drugs such as oxycodone, Xanax, Ritalin, and other drugs often sought out by teens to self-medicate or to help them study. More recently, fentanyl has taken the form of brightly colored, flavored pills resembling children’s candy. With five out of every 10 pills with fentanyl containing a dose lethal enough to kill the average American adult, their impending effect on children leaves little to the imagination. 

Why do cartels target children? With toxicities this severe, what’s to gain? The answer is simple: A young drug user has high potential to be a lifelong drug user, and teenager’s brains are primed to experiment, adapt, and become addicted. 

WHAT ROLES DO SCHOOLS PLAY?

Given the evolving overdose crisis and the existence of therapeutics to reverse it, it’s natural to assume that our educational systems would be prepared. But national data paints a different picture. A 2024 scan of legislation in all 50 states suggested that only 37 states had even addressed the topic of overdose management in schools by statute. In tandem, just 13 states mandate schools to have naloxone on hand, and 19 require staff to know how to use it. 

Many states limit the administration of naloxone to school nurses, and only 15 have guidelines for what to do post-overdose. The logistical side is just as bleak—only 12 states talk about inventory and storage, while a paltry eight states mandate any funding for prevention planning. 

When it comes to students, the curriculum is lacking: Just seven states require education on opioids, addiction, or prevention, with only two giving the green light for students to carry overdose-reversing agents. Around the country each year, state bills aiming to empower schools with the tools to manage this epidemic have been drafted, promoted, brought before legislative committees, and buried. 

Misunderstandings about student risks, drug prevalence, naloxone safety, and the disease of addiction continue to misrepresent science as science fiction, fueling public hesitancy to mount a response. Assumptions that parents will set the best example is an illusion. A recent JAMA study revealed that more than 1 in 10 U.S. adults admitted to sampling illicit synthetic opioids in 2024 alone.

Problems this big need big solutions. It’s time schools take back their hallways, their playgrounds, and their students. The cartels are counting on administrative inefficiencies and political obstructionism to stall school board agendas. There has never been a greater need for school boards to mount districtwide interventions that integrate the policies, tools, workflows, and education necessary to prevent and manage the opioid crisis on their campuses. These solutions are more tangible than you may think. Across the nation, interventions spanning grassroots to state-sponsored platforms have been formed to address the issue. 

GRASSROOTS OR STATE INTERVENTIONS
Take for instance the state of Oregon. In 2024, collaborative efforts between the Oregon Department of Education, the Oregon Health Authority, and the Alcohol Drug Policy Commission (ADPC) resulted in Fentanyl Toolkit 9 (https://tinyurl.com/38jj9e76) to help guide schools toward best practices. Packed with sample school policies and procedures, naloxone procurement options, addiction treatment resources, parental communication tools, and a list of helplines, this resource stands out as a model for other states and districts to adapt.

If state resources or support are lacking, consider modeling the School Training and Overdose Preparedness Intelligence Taskforce (STOP-IT) (www.azed.gov/stopit) initiative from Arizona. This grassroots partnership between the Arizona Department of Education and more than 60 volunteer members from the medical, behavioral health, government, and educational systems is the first-of- its-kind model. It’s a proven, cost-effective alternative to a state-sponsored approach. 

The STOP-IT setup is simple. The full taskforce meets monthly over a period of six months and assigns members into four working groups charged with deliverables. (See the deliverables at the bottom of this webpage.) The taskforce’s ultimate objectives are two-fold: Create a toolkit containing the information, policies, tools, and resources schools would need; and equip schools with a replenishable source of free naloxone.

These issues clearly are not solving themselves. How can school boards step up to the challenge? Here are some key steps:

• Understand current state laws on school opioid overdose preparedness.
• Look at current school policies on opioid overdose management. Do they promote uninhibited access to naloxone and widespread availability across campuses, at all events, and in all buildings? If you don’t have a policy, consider creating one.
• Identify obstacles to obtaining and integrating naloxone such as cost and administrative barriers.
• Ensure all school staff are offered training on naloxone administration and reinforce the training on a regular basis.
• Identify if students are being educated on this critical health topic and require annual education starting in grade six and above.
• Build a resource log of community programs that treat pediatric addictive disorders and mental health conditions.
• Identify potential opportunities to advocate for statewide standardization on opioid overdose prevention and management in schools.

School boards are charged with protecting their students. The evidence strongly supports that our youth are an emerging market for the illicit drug industry. With most state responses lagging behind the issue, school boards should evaluate the cost of doing nothing. At a state and national level, collective school board voices offer powerful advocacy with the potential to standardize evidence-based interventions across the educational landscape. And with existing tools prepped and ready for adaptation, action is the next logical step.

The young cries for help I heard that day are still seeking out listening ears. They’ll be echoing in the hallways today. Inaction all but guarantees the silence of those who face an exposure to illicit fentanyl and these deaths are so preventable. The school board can reverse these trends. It’s time to prepare America’s schools for overdoses.

Dr. Holly Geyer (geyer.holly@mayo.edu) is a hospital internal medicine and addiction medicine specialist with Mayo Clinic, Arizona, and oversees its Opioid Stewardship Program. She is author of the book Ending the Crisis: Mayo Clinic’s Guide to Opioid Addiction and Safe Opioid Use. Mike Kurtenbach (mike.kurtenbach@azed.gov) is the Arizona Department of Education’s director of school safety.

HOW STOP-IT WORKS
Arizona’s School Training and Overdose Preparedness Intelligence Taskforce (STOP-IT) initiative is a partnership between the Arizona Department of Education and more than 60 volunteer members from the medical, behavioral health, government, and educational systems. STOP-IT is the first-of-its-kind model. 

The committee worked through taskforces, which were assigned goals: 

• Survey and overdose monitoring subcommittee: This subcommittee was tasked with understanding the status of opioid overdose preparedness currently within schools. It developed a comprehensive statewide survey that was released to more than 2,000 Arizona schools and evaluating levels of preparedness for opioid overdoses including the availability of naloxone, school overdose policy language, staff and student training requirements, and leadership views on various topics. This information was used to build the toolkit, and offered an estimate of how much naloxone would be needed to support schools statewide. The subcommittee worked on establishing a statewide school overdose reporting system to ensure overdose metrics were tracked.
• Policy subcommittee: This subcommittee analyzed current school district policies on opioid overdose management and compared them to legislation requirements in all 50 states. It then developed evidence-based best practices for overdose prevention and management, as well as a sample policy that could be implemented across the state. It also addressed deficiencies in the state’s “Emergency Guidelines for Schools” and reviewed opportunities for legislative support to support adherence.
• Best practices for staff/student training subcommittee: This team assessed the current state of student curriculum delivery on the topics of opioids, overdose management, and addiction. It was tasked with creating a flexible training program that accommodated diverse learners, languages, and educational settings using a unique Learning Module System while eliminating the need for in-person training. The program was designed to adapt to evolving drug market trends and included social influencers to effectively communicate critical points.
• Opioid antagonist procurement subcommittee: This group was tasked with identifying a long-term supply chain solution to supply naloxone to Arizona schools at no cost. Working with the Arizona Department of Health and the Arizona Healthcare Cost Containment System, this subcommittee achieved its mission and coordinated with the Arizona National Guard to deliver the first allotment of more than 16,000 doses of naloxone directly to schools.