School hallways are often lined with colorful lockers, inspirational posters and hanging student work. But this summer, district leaders in Cumberland and North Yarmouth will introduce a new element: naloxone, also known as Narcan. The MSAD 51 superintendent, Jeff Porter, said he and his team first considered adding the medication, designed to rapidly counteract an opioid overdose, years ago.
“Given the continuing opioid concerns, along with a number of our own students being involved in advocating for more awareness around substance use, we decided it was too important not to do,” he wrote in response to a survey administered by The Maine Monitor.
The naloxone will be stored alongside first aid kits and portable defibrillators in each of the district’s schools. There will also be a mobile station at sporting events. A team including nurses will be trained to administer the medication via a nasal spray.
Two years after the passage of a bill that made naloxone more accessible in school buildings, administrators across the state appear to be jumping into action. Of 14 school districts surveyed by The Maine Monitor, 10 said they already had the medication in at least some school buildings and another three said they were in the process of adding it.
While the number of adolescents who overdose each year in Maine is relatively low, experts argue the introduction of naloxone in school buildings is an important step, especially since students aren’t the only ones accessing school property. Faculty, staff, parents and visitors may also benefit, particularly in rural areas in which schools often serve as community centers.
”In a lot of ways it’s like having a fire extinguisher on site or say a life preserver on a boat,” said Daniel Soucier, a research associate at the University of Maine’s Margaret Chase Smith Policy Center who collects data about the state’s opioid crisis. “In case an emergency arises, especially in the current fentanyl wave of the overdose crisis, the sooner you can respond to an overdose the better.”
“It may not necessarily be for students,” he added. “Although if a student were to overdose in the school, immediate response would be the best-case scenario.”
Asked why they chose to introduce naloxone into their school buildings, superintendents across Maine frequently echoed this point: It’s not just for students.
Raymond Phinney, the Bangor School Department’s school safety and communications director, wrote, “Schools are community institutions that serve as gathering places for students, parents and staff. We have response protocols in place to address a variety of situations. Including naloxone as part of these protocols ensures that schools are prepared to respond effectively to opioid-related emergencies.”
All Bangor school buildings, including elementary schools, currently have Narcan, and there is a safety team at each school that is trained to administer it. This fall, other staff members can opt in to training as well. Phinney noted there was no pushback from parents, staff or community members when the decision to introduce naloxone was made.
Another central Maine superintendent shared that the decision was made because, “our communities have experienced a number of overdoses and I want us to be prepared should there be an overdose, from a student or community member, in any of our buildings.”
One of the 14 districts surveyed reported having used Narcan once since its addition to a high school building last year.
Across schools, a variety of individuals are trained to administer Narcan: building administrators, school nurses, social workers, an athletic director, student resource officers and others. One district leader shared that training was made available to any school employee who wanted it. Another noted that an agreement with a local hospital allowed school nurses to train others at the school.
School leaders reported minimal pushback to adding Narcan. One district official wrote, though, that they made the choice “quietly and haven’t advertised it.” They added that, “the only pushback was from parents who did not want their children trained, which we honored.” A district representative said they wanted to avoid the “political nature” of the move so they have not instructed students in how to use it.
A southern Maine student who is in recovery at the residential treatment center Day One in South Portland, believes all high school students should be trained in applying Narcan.
In his experience, drug use is common. “You can’t turn a corner and not see someone using.”
He said he already knows how to administer Narcan. Once he returns home from Day One, he plans to begin carrying it. It feels especially important after losing a friend to an overdose.
During this legislative session, a bill passed that will require high schools to offer extracurricular instruction to students on how to use naloxone nasal spray.
In 2019, Gov. Janet Mills implemented an executive order to combat the opioid epidemic and make naloxone more widely available and accessible. To date, state-supplied naloxone has reversed a reported 3,711 overdoses, according to the Maine Drug Data Hub.
In 2021, Maine’s legislature passed a law allowing for the administration of a nasal spray version of naloxone in school buildings. Participating schools must enter a collaborative practice agreement between doctors, school health advisors, and public and private school nurses. They can access the medication through the Maine Naloxone Distribution Initiative or the drug’s manufacturer.
Earlier this year, the FDA approved Narcan for over-the-counter use, but experts argue it’s not clear how that will impact its presence in Maine schools.
“What the post over-the-counter transition looks like is still an unknown,” said Alexander Rezk, research associate at the Margaret Chase Smith Policy Center, “as that plane is kind of being built as it’s flying.”
This might eventually mean that Maine schools no longer need to have a relationship with the distributor or an organization like the Maine Naloxone Distribution Initiative; instead they would just purchase the medication independently.
Rezk emphasized that while Narcan is critical, it is only one piece of a larger puzzle. “I think that the education around it,” he said, “and around the context of the opioid epidemic overdose response is also critical.”
While youth are not the most represented group in overdoses, 74 people under age 20 died of an overdose in Maine between 2009 and 2021.
Experts and administrators across the state say adding naloxone into school buildings is important, but they also emphasize the need for preventative practices, such as education around drugs and alcohol, as well as greater access to mental healthcare and substance use disorder treatment.
Of the 14 district leaders surveyed by The Maine Monitor, 11 reported being aware of students with a substance use disorder. Alcohol, vaporizers, and marijuana were the most commonly used substances they reported. Only one district reported that students used opioids and four reported students using “other prescription pills.”
In 2021, just under 9 percent of 12- to 17-year-olds in Maine self-reported a substance use disorder over the past year. And about 7 percent of adolescents reported “needing but not receiving treatment at a specialty facility for substance use in the past year.” The figures largely match national trends.
According to the Maine Integrated Youth Health Survey, in 2021 almost one in three high schoolers reported using an electronic vapor product and about 18 percent said they used marijuana at least once in the past 30 days. Among high schoolers who reported drinking over the past month, just over one-third said they had consumed five or more drinks, and about 10 percent said they had been drunk or high at school at least once over the past year.
Experts argue early intervention is particularly important because the average age of onset for a substance use disorder is 14 years old.
That’s why earlier this year Rep. Raegan LaRochelle (D-Augusta) presented a bill to study the need for a high school that would specifically serve students in recovery. There are 45 recovery high schools across the country but none in Maine.
LaRochelle said that although there’s been an increased response to adults with substance use disorder over the past several years, the state still lacks resources for youth.
This point was echoed by one of the bill’s co-sponsors, Rep. Lydia Crafts (D-Bristol), a former social worker. “One of the major gaps in our state’s infrastructure for supporting people struggling with substance use disorder,” she said, “is access to services, and treatment for youth and adolescents.”
She added that it can be extremely difficult to find age-appropriate services just to help young people survive.
Day One is the only agency in the state that provides residential substance use services for adolescents. And it is struggling to meet everyone’s needs.
Over the past year, the organization served about 1,100 individuals across all of its services, according to Greg Bowers, the chief executive officer. Its residential facilities can serve up to eight boys and six girls at a time and typically around 75 annually. Wait lists, Bowers said, vary greatly, but generally there are five to 10 boys awaiting admission or assessment for admission.
The girls’ program, suspended as the organization worked to finance and construct a new building, is expected to reopen this month. At times, he said, there were more than 20 girls awaiting treatment, and currently there are 16 being evaluated for the reopening.
Once youth leave the residential program, the dearth of resources continues, he said. “Many of these kids do very well in our residential programs, but what the state has lacked for a long time are programs that could follow them back into the community.” When those community-based programs don’t exist, he sees kids returning to residential treatment.
Malory Shaughnessy, executive director at the Alliance for Addiction and Mental Health Services, believes this is further evidence that the state needs a high school dedicated specifically to students in recovery. Although the bill to study the need for such a high school passed the House and Senate, it stalled at the legislative Study Table and has not been funded.
While Shaughnessy was disappointed the bill was not successful, she said her fight to support students will continue. “The effort to establish a recovery high school in Maine,” she said, “or several, is not done.”
Correction: A previous version of this story spelled Raymond Phinney’s name wrong and had his incorrect title. He is school safety and communications director.