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Opioids and Overdose

HELLGATE ELEMENTARY SCHOOL DISTRICT ADMINISTRATION OF NALOXONE (NARCAN)

Policy and Procedure

Purpose

House Bill 323 allows a school to maintain a stock supply of an opioid antagonist to be used in the event of an actual or perceived opioid overdose emergency; limiting governmental liability; and providing an effective date. When administered during an overdose, Naloxone blocks the effects of opioids on the brain and respiratory system in order to prevent death. Naloxone has no potential for abuse and is a non-narcotic and non-addicting prescription drug.

Authority

It is the policy of the Hellgate Elementary School District that it shall provide and maintain on-site Naloxone. To treat a case of suspected opioid overdose in a school setting, the school nurse may administer Naloxone during an emergency, to any student, staff or visitor suspected of having an opioid-related drug overdose, whether or not there is a previous history of opioid abuse. The school will store Naloxone in the middle school and provide personnel who possess the training to administer Naloxone.

Definitions

            Drug Overdose: shall mean an acute medical condition, including, but not limited to, severe physical illness, coma, mania, hysteria, or death, which is the result of consumption or use of one or more controlled substances causing an adverse reaction. An individual’s condition may be deemed to be a drug overdose if a prudent, possessing an average knowledge of medicine and health, would reasonably believe that the condition is in fact a drug overdose and requires immediate medical attention.

            Naloxone: shall mean a medication that can reverse an overdose caused by an opioid drug. As a narcotic antagonist, Naloxone displaces opiates from receptor sites in the brain and reverses respiratory depression that usually s the cause of overdose deaths.

            Opioid: shall mean illegal drugs as heroin, as well as prescription medications used to treat pain as morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorphone, and buprenorphine.

Signs and Symptoms of Opioid Overdose vs. Opioid High

School nurses may administer Naloxone to a patient (student, staff member or visitor) in the event of respiratory depression, unresponsiveness or respiratory arrest, when an opioid overdose is suspected. The following are signs of an opioid overdose:

  • Blue skin tinge- usually lips and fingertips show first
  • Body is very limp
  • Face is very pale
  • Pulse is low, erratic or not present
  • Vomiting
  • Choking sounds, gurgling, snoring/gasping noise
  • Breathing is very slow, irregular or has stopped
  • Unresponsive (does not respond to name or touch)

The following are signs of an opioid high:

  • Muscles become relaxed
  • Speech is slowed/slurred
  • Appear sleepy
  • Responsive to stimuli (responds to name or touch)
  • Normal heartbeat/pulse
  • Normal skin tone/color

Procedure

Recognize
  1. Activate EMS: Medical Emergency Response. 911 must be called in all potential overdose situations.
  2. Assessment: When a patient is suspected of an opioid overdose the nurse will conduct an initial assessment of the level of consciousness and respiratory states.
    • Individuals who are not breathing: initiate CPR per BCLS guidelines
    • Individuals who are breathing: assess if there is depression of the respiratory status as evidenced by:
  • A very low or absent respiration rate
  • Interpretation of pulse oximetry measurement, if immediately available
  • Assess for decrease in level of consciousness as evidenced by:
    • Difficult to arouse (respond immediately to physical stimuli but does not communicate or follow commands, may move spontaneously) or
    • Unable to arouse (minimal or no response to noxious stimuli, does not communicate or follow commands)
  • Nurse determines needs for Naloxone administration
Respond & Reverse
  1. There are exclusion criteria for nasal trauma and epistaxis. Naloxone should not be administered if there is a known hypersensitivity to Naloxone.
  2. Via Intra-Nasal Narcan: Tilt head back and give spray (4mg) into one nostril
    • Remove Narcan spray form the box
    • Peel back the tab with the circle to open the Narcan Nasal Spray
    • Hold the Narcan spray with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
    • Gently insert the tip of the nozzle into either nostril.
  • Tilt the person’s head back and provide support under the neck with your hand. Gently insert the tip of the nozzle into one nostril until your fingers on either side of the nozzle are against the bottom of the person’s nose.
  • Press the plunger firmly to give the dose of Narcan Nasal Spray.
    • remove the Narcan Nasal Spray from the nostril after giving the dose.
  1. Place the person in recovery position (lying on their side) and stay with the person until help arrives.
  2. Narcan dose may be repeated every 2-3 minutes if patient remains unresponsive OR if their level of consciousness decreases after initial response to first dose. Alternate nostrils when administrating.
  3. Seize all illegal and/or non-prescribed opioid narcotics found on victim and process in accordance with school districts protocols.
Additional Considerations:
  • The victim may be angry or combative when he or she wakes up, therefore, it is important to stand back from victim and, if possible, have second adult present.
  • Potential adverse effects include nausea, diarrhea, abdominal cramping, irritability, restlessness, muscle or bone pain, tearing or nose running, and craving of an opioid.
  • Naloxone wears off in thirty (30) to ninety (90) minutes.
Refer
  1. Transport the individual to the nearest hospital via EMS, even if symptoms seem to get better.
    • Students who receive a dose of Naloxone must be sent to the emergency room.
  1. Follow up: if the administration was to a student, the school nurse will notify student support services and student services will provide substance abuse prevention resources to the student and family, as appropriate.
    • Contact parent/guardians per school protocol.
  1. Documentation: record encounter in student/staff health record and on incident report. The recording should list the dose, route of administration, and time of delivery. It should include the patient presentation and response to Naloxone.
    • complete Naloxone Administration Report form.