In response to the growing opioid crisis among teens, Palo Alto Unified School District will be stocking school campuses with opioid antagonist naloxone hydrochloride, a medication for narcotic overdoses in emergency situations, and implementing voluntary trainings to equip staff members with skills to identify and respond to overdoses this month.

Pursuant to California Education Code 49414.3, the staff trainings will include techniques for recognizing symptoms of an overdose; standards and procedures for the storage, restocking and emergency use of Narcan; and basic emergency follow-up procedures, among other practices. According to District Health Services Coordinator Rosemarie Dowell, the county has also equipped PAUSD with 122 kits of Narcan, which will be distributed across all school campuses, as well as Greendell Preschool, Cubberley Community Center and the district office. Inside each kit will be two doses of Narcan, guidelines on how to administer it, cardiopulmonary respiration face masks and gloves. These kits will be placed in a variety of locations across the campuses, from emergency carts in health offices to automated external defibrillators mounted on walls.

According to Dowell, although the California Education Code was altered in January 2017 to allow for the administration of Narcan on school campuses, many districts—including PAUSD—decided not to move forward with opioid antagonist trainings because city emergency services could be counted upon to arrive quickly enough to intervene in the event of an overdose.

Still, rising overdose rates, particularly in the teen population, prompted action. The pandemic saw a surge in fatal adolescent drug overdoses: A report from the Centers for Disease Control and Prevention found that median monthly overdose deaths among adolescents more than doubled from July to December 2019 to July to December 2021, and 84% of the deaths involved illicitly manufactured fentanyls. According to the California Department of Public Health, the annual crude mortality rate for opioid overdoses in Santa Clara County in 2021 increased by 73% from 2019. “In the past couple (of) years, there has been a growing discussion about being more proactive,” Dowell said. “The county has had a big discussion on that, on really pushing for getting more education (and) being prepared.”

On Dec. 20, 2022, the school board updated its medication policy—Board Policy 5141.21—to reflect existing California School Board Association language regarding Narcan, which allowed district health services to move forward with implementing trainings and distributing kits. According to Safety, Security and Disaster Preparedness Manager Mike Jacobs, distribution of Narcan kits is expected to be completed by mid to late March. Trainings will begin in March and will continue as needed throughout the year. In addition to these initiatives, the district will also be holding a fentanyl awareness event on March 22 to educate students and parents on the issue and to distribute kits of Narcan to them.

These recent developments at the district level have made the severity of the opioid crisis clear. Synthetic opioids are often more potent than their natural brethren, meaning that even a tiny dose can be fatal. It’s often difficult to tell the difference between a drug and its fentanyl-laced counterpart, so if users unknowingly ingest contaminated drugs, they can easily overdose. According to the same report from the CDC, evidence of counterfeit pills was found in 25% of adolescent overdose deaths. “Fentanyl-filled pills are being sold in many forms and all look exactly like legitimate pharmaceuticals,” Jacobs wrote in an email. “The amount of fentanyl needed to overdose is equivalent to two grains of sand. In short, one pill can kill.”

Most of the time, these counterfeit pills aren’t prescribed, but instead bought on the street or on social media. Physical education teacher Amy Anderson recalled the death of her friend’s son, Carlmont High School senior Colin Walker, in 2021. According to Anderson, Walker began using cannabis to self-medicate as he struggled with mental health during the pandemic, eventually moving on to harder drugs. He died after ingesting fentanyl-laced cocaine bought off of Snapchat. “(His parents) were not condoning their son’s drug use, but the bottom line is (that) what he purchased off of Snapchat was not what he asked for,” she said.

Given the insidious nature of the counterfeit pills, students and teachers alike have advocated for greater drug education. Living Skills teacher Jeanette Tucker emphasized the importance of repeated instruction on the issue. “You just need to hear it more than once,” she said. “Obviously, your parents are going to tell you that. But if your guidance counselors are doing a show or presentation (and) your SELF class talks about it, (it sinks in).”

Some, such as junior Prianka Rao, have also pointed to education about drug medication as a way to counteract fatal overdoses. “Say you’re at a party and someone shows up under the influence of opiates and there’s an overdose,” she said. “You could be the person that could prevent someone from dying.”

Still, stigma often proves to be a roadblock to conversations about drugs. According to Tucker, the mischaracterization of drug use as a conscious choice rather than an uncontrollable addiction often results in a victim-blaming narrative, something Rao has also seen. “People at Gunn aren’t strangers to the fact that kids are doing drugs, but they’re (mostly) talking about smoking weed,” Rao said. “Things like addiction and hard drug use don’t really make sense to them. It’s kind of like, ‘Whoa, that’s scary and extreme, that’s effed up, why are you doing that?’ And it seems like ‘You’re crazy’ rather than, ‘You’re not crazy, you’re struggling.’”

Nevertheless, Dowell notes that the community has become increasingly open to conversations in the past few years. “I’ve had students that have reached out saying, ‘Hey, when are we going to have some Narcan and have some more education?’” she said. “We’ve had more parents bring up the discussions. We’ve had the support of board members like (Jesse) Ladomirak. We’re in a really nice time now where there’s a lot of support for this.”

According to Rao, this support is especially important given the gravity of the issue. “You never know when you’re going to see someone in that situation, even if they’re not your friend or they’re not you,” she said. “It’s something that everyone should know in this day and age because the fentanyl epidemic is getting so bad and out of hand. Just because it doesn’t apply to you doesn’t mean it’s not really important to know—it could save someone’s life.”