Virginia schools now approved to offer opioid antidote

“Crazy” and “interesting” is how Del. John McGuire, R-Henrico, described the 2019 Virginia General Assembly session as it came to an end this weekend.

Beyond the emergence of Gov. Ralph Northam’s yearbook photo and Lt. Gov. Justin Fairfax’s accusers, the success of McGuire’s bill to allow opioid overdose treatments in schools also came as a surprise – as it passed unanimously both in the Senate and House of Delegates this session.

“I’ve asked some of the [delegates], and they said ‘I’ve been here thirty years and this is probably the craziest [session]” McGuire said.

The bill, HB2318, now sits on Northam’s desk, awaiting his signature so that it can be enacted as law.

If Northam signs the bill by March 25, which is the deadline for him to approve the legislation, then nurses and school staff who administer health services will now be allowed to possess and administer Naloxone, also known as Narcan, and other opioid overdose treatments in Virginia’s schools after receiving the required training.

“This bill is not something I’m super proud of because I wish we lived in a world where we didn’t need this,” McGuire said. “But unfortunately it’s needed, and we can save lives.”

The bill does not specify what school levels would now be able to stock Naloxone in schools. But any child, regardless of age or grade, could potentially be affected by the opioid crisis, so all schools, including elementary schools, would have the option of stocking this medication, McGuire said.

“You don’t have to be a drug addict to be affected by these drugs,” he said.

This was evident in the Virginia Department of Health’s “Opioid Addiction Indicators” 2017 dataset, as a wide range of ages were affected by opioids that year, even infants.

In 2017, Narcan was administered by EMS personnel 48.6 times to people ages 15-24 in Virginia, according to the dataset. That same year, 155 people from this age group visited the Emergency Department for an opioid overdose in Virginia.

The Virginia Department of Health (VDH) also found that 1.2 children ages 0-14 were administered Narcan in 2017, and 38.4 children from that age group visited the Emergency Department for an opioid overdose.

Despite the increased availability and administration of Narcan, the overall number of fatal opioid overdoses has steadily increased each year, and in 2013, fatal drug overdoses became the leading cause of unnatural death in the Virginia, surpassing guns and motor vehicles, according to the VDH Office of the Chief Medical Examiner’s 2018 Fatal Drug Overdose Quarterly Report.

The total number of fatal opioid overdoses in Virginia reached its peak in 2017— rising to 1,229 deaths from 516 total fatalities in 2007. Although the number in 2018 was slightly lower—at only 1,167 fatalities— that was only a predicted value, as all of the data has not been evaluated for that year yet.

This high number of fatalities, however, is not reflective of the younger population, especially people 18 and under.

In fact, the number of fatal opioid overdoses in children that are 18 or younger in Virginia is surprisingly low.

“I can honestly tell you that fatal overdoses under 18 are really rare,” said Kathrin “Rosie” Hobron, the statewide forensic epidemiologist for the Virginia Department of Health’s Office of the Chief Medical Examiner.

The number of fatal opioid overdoses in the 18 and under age group has increased since 2013, but the rise has been very tiny, she said. In 2013, there were five fatal opioid overdoses among persons 18 years of age and younger; in the past two years there were seven (2017) and then 11 in the first three quarters of 2018 (between January and September), Hobron wrote in an email.

Hobron helped develop the 2018 Fatal Drug Overdose Quarterly Report, and in it, she differentiates between numerous types of opioids, such as fentanyl, heroin, cocaine and prescription opioids. Fortunately, Narcan, or Naloxone, is able to treat overdoses caused by each of the different opioid types, she said.

“Opioids, whether heroine or fentanyl or prescription pills or whatever, actually work on the opioid receptors in the brain,” Hobron said. Narcan is an antagonist, meaning it inhibits the opioids’ ability to work on these receptors and binds to the opioid receptorsin place of the opioids themselves, which prevents someone from experiencing the high.

“[Narcan] works on everything,” she emphasized.

McGuire’s bill will allow schools in Virginia to be prepared to treat any type of opioid overdose. And although Hobron noted that the number of fatal overdoses in school-aged children is low, if his bill can save just one life it’s worth it, she said.

When asked if she could recall any opioid overdoses in Virginia’s schools, Hobron said no.

“I honestly can’t think of any [overdoses],” she said. “I can’t even tell you if I can think of one in a high school… for 18 and under [it’s] probably unheard of, at schools anyway.”

But it’s always better to be safe than sorry and prepare for these types of situations, Hobron said about the importance of this bill.

“Even if you’re not overdosing and get Narcan, it’s not like a harmful kind of thing that has counteractive kind of [effects],” she said. “It can’t harm anything at all.”