With fentanyl closer to home, local schools stock Narcan out of abundance of caution

“I'd like to think that our efforts spurred some thought, because some of the school districts we gave it to didn't really have any idea what [Narcan] was. I'm hoping this spurred some of the school districts to think about what happens if we do have a fentanyl issue.”

TRI-COUNTY REGION — The Alpine Independent School District had never stocked Narcan until roughly one month ago, when the Big Bend Regional Hospital District distributed a few doses of the lifesaving overdose reversal medication to area schools. Now, the multi-campus district of fewer than 1,000 students has a total of four doses of the medication in nasal spray form — two at the middle school and two at the high school.

So far, its novelty to the staff and a lack of protocol means it remains cloistered in the nurse’s office, awaiting a formal training and policy change that will make it just another part of the administration’s arsenal by the fall.

“I have it locked up and nobody even really knows that we have it yet,” said District Nurse Gayla Owen, also the nurse for Marathon ISD, which received two doses as well. “I mentioned it to our superintendent and our principals, but we’re getting in the process of having it available for this next school year.” 

Educators simply aren’t familiar with Narcan — the brand name of the medication naloxone — explained Owen, who hopes to bring in someone with Border Patrol to conduct training for staff. And as every such change requires a codification in school policy, Owen is currently writing a policy to support Narcan administration.

“We will all be ready if needed,” said Owen, though she hopes that day never comes. To date, Alpine ISD has not had an overdose on its campuses — but Owen would rather be safe than sorry, and is grateful to have even a limited supply of the medication classified aptly as an “opioid antagonist.” 

“I’m glad that it’s available, so if it were to happen, we would be ready for it,” she said. “You just never know anymore.”

Spurred by a worsening statewide opioid crisis and accompanying proliferation of illicit fentanyl — a synthetic opioid roughly 50 times more potent than heroin and 100 times stronger than morphine, per the U.S. Drug Enforcement Administration — board members of the Big Bend Regional Hospital District, which encompasses Presidio and Brewster counties, took it upon themselves to procure a supply of Narcan to ensure local schools were stocked in case of emergency.

In March, the district filled out a request form via morenarcanplease.com, an initiative to distribute state-funded naloxone by the UT Health San Antonio School of Nursing. They received a few doses, which they were then able to distribute to area schools in Alpine, Marathon, Terlingua, Marfa and Presidio. “There wasn’t a lot,” said Director J.D. Newsom, “But it was some.” (Owen said she hopes to procure more of the nasal sprays in the future.) The hospital district also distributed 32 doses to Sul Ross State University.

Newsom said the initiative had turned out to be an opportunity for education, and hoped it prompted school districts to think proactively about overdose prevention. For some administrators, it was a completely foreign topic.

“I’d like to think that our efforts spurred some thought, because some of the school districts we gave it to didn’t really have any idea what it was,” said Newsom. “I’m hoping this spurred some of the school districts to think about what happens if we do have a fentanyl issue.”

Nationwide, overdose deaths have increased among teens and adolescents since the start of the pandemic. Median monthly overdose deaths among people ages 10 to 19 increased 109% from July–December 2019 to the same time period in 2021, per the CDC; 90% of those deaths involved opioids and 84% involved illicitly manufactured fentanyls. Deaths involving illicitly manufactured fentanyls in that age group increased by 182%. 

In Texas alone, more than 5,000 people died of drug overdoses between October 2021 and October 2022, per CDC data. From 2019 to 2021, overdose deaths involving fentanyl in the state rose 399%, from 333 deaths to 1,662. 

Many of those who die from fentanyl overdoses do not know they are consuming the drug — it is more often the case that a person will unknowingly consume an illicit substance or counterfeit pill laced with fentanyl. Law enforcement seizures of fentanyl-laced pills increased dramatically from 2018 to 2021; the DEA’s “One Pill Can Kill” initiative stresses the increase in fatal doses of fentanyl in fentanyl-laced pills, according to a lab analysis. 

In Texas, Governor Greg Abbott in April launched a $10 million information campaign called “One Pill Kills,” geared towards raising awareness among Texans about the dangers of fentanyl, and announced a plan to distribute 20,000 doses of Narcan to county sheriff’s offices across the state.

When it comes to combating the crisis, Texas lawmakers have set their sights on schools in particular. There are currently eight bills making their way through the state Legislature aimed at facilitating the distribution and use of Narcan by school staff and educators. 

It remains unclear how immediate a danger fentanyl currently poses in the tri-county region, but news of fentanyl seized at the border crossing into Presidio County has caused some alarm. In November of last year, U.S. Customers and Border Protection seized 32 pounds of methamphetamine and two pounds of fentanyl from a driver on the Presidio International Bridge — the first time fentanyl was seized by local authorities. In January, authorities seized 15.43 pounds of fentanyl along with a shipment of meth. 

Overall, the amount of fentanyl seizures at ports of entry along the U.S.-Mexico border have roughly doubled over the last two fiscal years. Of course, that’s only one method of entry — in February, a California man was arrested at the Sierra Blanca CBP checkpoint when a search revealed he was carrying 1.005 kilograms of fentanyl.

It’s enough to prompt a heightened vigilance among law enforcement and healthcare workers. 

“Of course it’s in our communities,” said Newsom. “It’s coming across the border.”

Brewster County Sheriff Ronny Dodson said his officers are equipped with Narcan but have never had to use it. Their only encounter with fentanyl so far was approximately six months ago, when an abandoned backpack stashed with bags of the drug was found outside Marathon.

“Whoever was bringing it got scared, dumped it and took off,” said Dodson.

Joel Nuñez, who serves both as Presidio County Sheriff’s Office chief deputy and the chief of Presidio ISD’s Department of Public Safety, has anticipated the drug’s appearance in the county for some time — he first hosted a presentation on the dangers of fentanyl at the high school for concerned parents in October. 

When reached for comment on Narcan distribution in Presidio ISD, he clarified that the school had been stocked with the medication prior to the hospital district’s donation, thanks to Emergence Health Network out of El Paso.

“All school nursing staff, medics, and police officers are well stocked with Narcan in case of emergency,” said Nuñez.

Sul Ross State University Health Services Coordinator Danielle Bell said that while the University Police had been carrying Narcan for two years, the university was in the process of expanding its stockpile of the medication and training for staff. With the hospital district’s recent donation of 32 nasal spray doses, the university will be training administrators to recognize signs of an overdose and to administer the medication.

“The people who will be the most likely to be on scene first in an emergency situation will carry at least one dose,” said Bell. “Those include designated people in Residential Living, Health Services, and University Police.” 

Training for staffers is expected to wrap up this summer.

As with Alpine ISD, Bell clarified that there had never been an overdose on Sul Ross campus — but she was grateful to have life saving medication on hand just in case.

I would never want to have an overdose incident on campus, but I am sure glad that we are prepared with the medication and knowledge to help prevent a death,” she said.

Editor’s note: Updated 5/11/23 to note that the hospital district distributed Narcan to Terlingua CSD.