“Leaving the decision step to me”: School Naloxone Policies Developed and Implemented by District and School Nurses

BACKGROUND: Some state legislatures have passed laws that allow or require that districts and schools maintain naloxone on campus. In response to the ongoing opioid and overdose epidemic, school and district nurses are increasingly involved in the development of policies related to naloxone administration. This study examined how some Texas districts and schools developed and implemented policies related to access to and availability of naloxone. METHODS: We surveyed personnel who requested a standing order for naloxone from the Texas Opioid Training Initiative (N = 388 active contacts, 25.0% response rate) and conducted semi-structured interviews with a subset of survey respondents (N = 16). Most respondents were district or school nurses. RESULTS: Respondents used multiple resources to develop their policies, including other schools' policies, extant medication policies, professional associations, and legislative language. Most respondents (87% district-level; 100% school-level) reported that naloxone was available. Common locations for naloxone storage were a nurse's office (72% respondents) and a closet or cabinet in a common area (41%). CONCLUSION: Supporting district and school nurses in developing policies on access to and availability of naloxone can build confidence in school staff's preparedness to respond to overdose.