Baltimore-area school systems are stocking their health suites with naloxone, the heroin overdose drug, and training nurses to administer it.
Use of naloxone has become commonplace for paramedics, police officers and family members of addicts as the number of opioid-related deaths has increased dramatically in Maryland and across the country.
Now schools say they must be prepared as well.
"We can't hide our head in the sand," said Mary Nasuta, nurse coordinator for Harford County schools, which will stock naloxone in middle and high schools after a training program for nurses this month. "We have to realize if this is a problem in the community, it can be a problem in our schools, and we have to be ready for it."
Anne Arundel County schools began stocking naloxone — also known by the brand name Narcan — in school health rooms last spring. Baltimore County and Carroll County started programs this school year.
Officials in Howard County and Baltimore City say they are working on plans to put naloxone in schools.
Ten days after the launch of Anne Arundel's program in March, a school nurse used the drug to save a high school student who was overdosing, said Karen Siska-Creel, the county's director of school health.
"A lot of people said, 'Oh, you'll never give it in schools. You'll never need it.' I said, 'I don't want to wait for a child to die,'" Siska-Creel said.
Naloxone can quickly reverse the respiratory distress of a person who has overdosed on heroin or another opioid drug. The latest version of the drug is a nasal spray that's relatively easy for anyone to administer, even those with no medical training. Kits contain two doses and cost $100 each.
It cost $12,500 to stock each of Anne Arundel's 125 schools, Siska-Creel said. She said she found money in her budget for naloxone after she was able to obtain Epi-Pens, which treat allergic reactions, for free from the manufacturer.
Siska-Creel's staff created a training program and obtained training certification from the state. Naloxone training is now part of orientation for new school nurses, she said. Training includes how school nurses can distinguish opioid overdose from other medical emergencies a child might have, such as an allergic reaction.
Siska-Creel plans to expand training to other school employees as well.
"Heroin is an epidemic. It's everywhere. I just didn't see it getting better," she said. "We needed to put ourselves in a position where we were able to take care of our students."
In 2015, a record 1,089 people in Maryland died of opioid-related overdoses — including from heroin, fentanyl and prescription opioids. They accounted for 86 percent of all of the state's drug- and alcohol-related overdose deaths.
Opioid-related deaths in Maryland have more than doubled since 2010, according to state data. Deaths from heroin specifically have tripled during that period.
Overdose deaths due to heroin have increased among all age groups, including those younger than 25.
In Maryland, health officials have identified naloxone as a way to save people from dying of overdoses.
Since 2014, nearly 35,000 people who are not medical professionals have been trained on how to use naloxone. The group includes friends and relatives of addicts and employees of treatment programs. Once trained, individuals can buy naloxone without a prescription in Maryland.
State officials say those 35,000 people have administered the drug 1,181 times.
Police officers in many jurisdictions carry naloxone because they sometimes arrive at overdose calls before paramedics. When the Annapolis Police Department instituted a naloxone program in 2014, an officer used the drug to save a man from an overdose within 10 minutes of completing the training.
The National Association of School Nurses recommends school nurses be trained in administering naloxone because of the chance someone might overdose in a school.
"There is a problem in this nation and that problem transcends all communities," said Donna J. Mazyck, executive director of the National Association of School Nurses. "The potential for an emergency and the need to respond is there."
If someone overdoses in a school, the school's nurse is likely to be the first health professional on the scene, Mazyck said.
The association offers online educational materials on naloxone, paid for by a grant from Adapt Pharma, which manufactures the nasal-spray form of the drug. The company announced this year it would offer free naloxone kits to all U.S. high schools.
Mazyck said it's ultimately up to school systems to decide whether to use naloxone or not. "It's one of those decisions that is driven by the school itself, not a company," she said.
The Baltimore-area school systems that stock naloxone have bought the drug either through school or health department budgets.
In Harford County, the system had relied on law enforcement officers assigned to schools to carry naloxone in the event of an overdose. But Nasuta, Harford's school nurse coordinator, said the heroin epidemic, coupled with the fact that victims are getting younger, made it important to have school nurses involved.
She doesn't have reports of students using heroin in schools, but she said it could be happening.
"It's always a possibility, and we need to prepare for emergencies," she said.
Since the beginning of this school year, all Baltimore County public high schools and alternative schools — 28 schools altogether — have had naloxone on hand. School nurses were trained to use the drug over the summer, said Deborah Somerville, coordinator of health services for the school system.
"We see it as an emergency medicine," Somerville said.
Baltimore County schools received naloxone kits from the county Health Department as part of its overall naloxone drug and training expenditure of about $60,000 this year.
Somerville said the county chose to put the drug in high schools and alternative schools — which offer extra support to students facing particular challenges — because teens are more likely than younger students to use heroin or opioids.
"Children of high school age are at risk of using opioids. They come to high school, so we need to be prepared," she said.
Baltimore County's program is focused on naloxone availability during the school day — Somerville noted police officers and paramedics, who also carry naloxone, are often present during sporting events and other after-school activities. School nurses sometimes are on duty during other after-school events.
Carroll County decided to put naloxone in middle and high schools this school year. Officials there say they have not had an overdose in a school in the past, and haven't yet used naloxone since nurses put it in their emergency bags this year.
"We want to try to get naloxone out any place that we can," said Ed Singer, Carroll's health officer.
Carroll officials are considering whether to train athletic trainers to administer naloxone.
In Howard County, plans are in the works to train nurses in naloxone use after the winter holidays, according to schools spokesman John White. For now, school resource police officers stationed in Howard's middle schools and high schools carry the drug.
Baltimore City schools do not have naloxone on hand and school police officers do not carry the drug, said Edie House, a city schools spokeswoman.
City health officials are developing a naloxone proposal to present to school officials, but there's no timeline for when a program might be put in place, said Sean Naron, a city Health Department spokesman.
Baltimore Sun Media Group reporter Emily Chappell contributed to this article.