Fighting on the Front Lines of the Fentanyl Crisis: A Call for Narcan Accessibility and Education

Just 2 milligrams of fentanyl, less than 0.1% the weight of a penny, is a lethal dose for most people. Photo courtesy of the United States Drug Enforcement Administration (DEA). 

Growing up in New Mexico, I witnessed the devastating impact of fentanyl overdose firsthand. In my last semester of high school in 2023, seven people in my town fell victim to this silent killer, all within the span of a few months. Only after these tragedies did awareness efforts, including posters and PowerPoint presentations about fentanyl and its antidote, Narcan, begin to appear. Narcan, also known as Naloxone, is a lifesaving medication designed to reverse opioid overdoses. However, I had never heard the word “Narcan” before my senior year. If Narcan is an available, lifesaving resource, why was it absent from my education and the education that millions of students receive across the country?

Unfortunately, a prevalent stigma around Narcan in the United States makes it challenging, if not impossible, to initiate conversations about its use in schools. A common myth is the belief that using Narcan encourages those with Substance Use Disorder (SUD) to continue taking opioids and may even incentivize others to start. However, several studies have shown there is no evidence to support the idea that Narcan provision increases substance use or intensifies the risk of overdose. In fact, research has revealed that Narcan causes opioid withdrawal symptoms, operating as a constructive abuse deterrent. 

Another misconception is that only “drug users” carry Narcan. There is a pervasive fear that carrying Narcan will lead to unwanted attention and judgment from friends, teachers, or law enforcement. As one individual anonymously shared, “I know that some people are afraid … of (other) people discovering their naloxone, and that will out them as an opioid user.” However, having access to Narcan does not equate to drug use. Instead, carrying it should be normalized as a preventive measure. 

Many people also fear the potential consequences of administering Narcan, such as the pervasive belief that law enforcement will interpret Narcan possession as evidence of drug use or association with drug users, especially for those on parole. However, every state (with the exception of Wyoming) has Good Samaritan laws that protect both the observer and the person experiencing the overdose from prosecution for minor drug possession, encouraging people to intervene and seek medical assistance without hesitation.

Another significant barrier to the widespread use of Narcan is the indifference and lack of awareness within some communities about opioid overdoses as a pressing issue. One poll found that only 43% of respondents had “a little” knowledge of Narcan, while an additional 29% had heard “nothing at all” about it. In 2021, over 80,000 of the 107,000 drug overdose deaths involved opioids, and alarmingly, bystanders were present in more than one-third of these cases. Had Narcan been accessible and employed, many of these deaths might have been prevented. To address this, it is crucial to make Narcan readily available in public places.

A critical area that needs Narcan access is public schools. Students, especially those between the ages of 14 and 18, are particularly vulnerable to opioid overdoses. Drug overdose deaths in this age group more than doubled from 2018 to 2022, with an average of 22 adolescents—equivalent to a high school classroom of students—dying from a drug overdose every week in 2022.  

Unfortunately, the District of Columbia and 24 states have no statute addressing the availability or use of Narcan in schools. In addition, as of October 2023, only 11 out of the 20 largest school districts in the United States report mandating the stocking of Narcan. It is alarming that some of the districts that do not require the medicine are taking no steps to address the issue.

This is a serious concern, as having Narcan in schools can mean the difference between life and death. For instance, a student at Central High School in Pueblo, Colorado, overdosed in a bathroom but was revived after receiving a dose of Narcan. In contrast, just 45 miles away in Colorado Springs, Mitchell High School officials did not have Narcan available when a 15-year-old student ingested a fentanyl-laced pill, resulting in the student’s death. The urgency for schools to have Narcan readily available on campus cannot be overstated. 

However, improving Narcan accessibility is only part of the solution, for many students are also unaware of how to use it. One study revealed that only 14% of undergraduate and graduate students knew how to administer Narcan. There are also significant concerns about the potential for misuse or the failure to accurately recognize an opioid overdose.

To address this, Narcan education is crucial for the younger generation. States should mandate the inclusion of Narcan training in existing health and drug safety programs, as currently, few states require opioid awareness in their curricula. It is crucial that training covers the fundamentals of what Narcan is, how and when to use it, and where to access it. If integrating Narcan training into the standard school curriculum proves challenging, at the very least, counties should establish afterschool programs to provide students with this essential training, like the successful initiative implemented in Carter County, North Carolina.

Carter County has lost nearly 60 individuals from opioid overdoses since 2014. In response, health officials started teaching children as young as six how to reverse an overdose, with one student already distributing 70 doses of Narcan. Unfortunately, Carter County and districts adopting similar measures have experienced pushback from residents, school boards, and even law enforcement regarding the mandate for Narcan training. Many adults view Narcan as a waste of resources and believe that the training is inappropriate for children.

However, some parents counter that if comprehensive drug education had been implemented years or even decades ago, their families and communities would not have suffered the tremendous toll inflicted by the opioid epidemic as harshly. Had she been taught how to recognize an overdose at her daughter’s age, Ms. Tiffany Pierce, said she might have known at 10 years old to call 911 after finding her father, an intravenous drug user, unconscious. “I would have felt more prepared. It’s great for kids to learn; I don’t think it’s ever too early.”

States should also implement Narcan training policies specifically targeting rural schools and communities. The opioid overdose rate in rural areas is 45% higher per capita than in cities. Students in these regions are at greater risk of initiating substance use at an early age, have lower levels of education, higher unemployment rates, and limited access to medical services.

To start making a difference in children’s lives, we need to educate them about Narcan. If we do not take action, it won’t just be fentanyl killing students, but also our failure to equip them with lifesaving knowledge and tools.

Yunseo Kim (CC ’27) is a staff writer at CPR studying political science and public health. She is passionate about immigration law, international relations, and addressing disparities in healthcare. Yunseo can be reached at yk3058@columbia.edu.