Toolkit: Combating Fentanyl in Schools

Introduction– Accidental Fentanyl Poisonings Endanger Our Children 

Street drugs have long been pervasive in American society, but in recent years they have taken a deadly turn, transcending any prior experience in volume and lethality. From 2020 to 2021, synthetic opioid deaths—largely driven by fentanyl—surged by more than 20%, killing more than 71,000 Americans (National Institute on Drug Abuse, 2023). 

This fentanyl crisis does not solely affect those who knowingly use or abuse opioid drugs, as uninformed children and adolescents are victims now, too. Many victims of fen-tanyl are not aware that they are taking it. This deadly substance is often laced into what appear to be popular drugs, such as synthetic Xanax® and Adderall®, that young people buy from unauthorized dispensers, including friends, street dealers, and anonymous con-tacts on social media. In fact, research shows that a significant number of high school stu-dents purchase Xanax® and Adderall® from online black markets (Moyle et al, 2019). When many of these non-chronic drug users encounter the “silent killer,” they are una-ware of the poison’s presence and do not realize that only two milligrams, which could fit on the tip of a pencil, could kill them (U.S. Drug Enforcement Administration, 2022a). Because these overdose deaths occur when children and adolescents take fentanyl un-knowingly, a more appropriate term for these tragedies is accidental fentanyl poisoning. 

The fentanyl crisis, the scope of which continues to expand, is a serious, potentially exis-tential threat to our nation’s youth and to the next generation of Americans, (Overton, 2023). The number of overdose deaths in adolescents (aged 14-18 years) increased by 94% from 2019 to 2020 and by 20% from 2020 to 2021, despite a reported decline in drug use among adolescents in 2021 (Friedman et al., 2022, p.1399; National Institutes of Health, 2022). That means adolescent drug overdose deaths have increased even though reported drug use among that age group declined in 2021. Of these adolescent overdose deaths in 2021, 77% involved fentanyl (Friedman et al., 2022, p.1399). Furthermore, most deaths from fentanyl poisonings are being reported in adolescents without a record of previous opioid use and in those with no history of treatment or evidence of poor men-tal health. (Tanz et al., 2022, p.1576). According to an article published by the CDC, 

83.9% of overdose deaths among adolescents (ages 10-19) from July 2019 through De-cember 2021 involved illicitly manufactured fentanyl, yet only 35% of adolescents in the study had a documented history of opioid use (Tanz et al., 2022, p.1576). Therefore, edu-cation should be the first line of defense to prevent children and adolescents from suc-cumbing to these preventable, senseless deaths. 

Combating Fentanyl Through Educational Reform and Emergency Response 

With fentanyl-related deaths among youth on the rise, ignorance is not an option for American schools. Children and teenagers spend most of their days at school or in extra-curricular settings on campus, so it is crucial that they receive comprehensive education on the dangers of fentanyl and the use of drugs from non-official sources. This will help prevent accidental poisonings—particularly those caused by highly accessible synthetic drugs that often appear misleadingly as prescription drugs. Teenagers and young adults often buy these drugs with the belief that they are buying authentic, non-laced medica-tions, even though they are not prescribed by a doctor (U.S. Drug Enforcement Admin-istration, 2021). Often students buy drugs such as Adderall®,Xanax®, and Ritalin® for academic and stimulant purposes, so they are coined “study drugs” (Health & Wellness Services, University of Colorado Boulder, 2023; U.S. Drug Enforcement Administration, 2021). While students may buy the drugs to get an A on their next test, these fake pills, often laced with fentanyl, have other deadly consequences. Lab testing from the U.S. Drug Enforcement Administration (DEA) revealed that six out of every 10 fentanyl-laced fake prescription pills contain a potentially lethal dose (U.S. Drug Enforcement Admin-istration, 2022a). 

Social media makes the spread of fentanyl even more accessible and threatening to our youth. The DEA has confirmed that drug trafficking on platforms such as Instagram, Snapchat, Telegram, and Signal is a common means of fentanyl distribution that targets young people (U.S. Drug Enforcement Administration, 2022b). Criminal drug networks use social media to reach new clients—often unsuspecting teenagers. Teens can buy drugs on social media from the comfort of their homes or even at their schools, unaware of the poison in their online shopping cart. 

These dangers can be communicated to youth in various ways in school settings. Key to this effort are fentanyl educational campaigns in schools that break down the stigma of addiction, highlight the dangers of fentanyl, and emphasize the risk of taking pills from people other than a doctor or a pharmacist. Preparing students and educators for potential fentanyl emergencies should also be a priority. Schools should ensure that they know what steps to take in crisis situations and have the resources to do so. 

Public leaders around the country can learn from the following state-level initiatives. By adapting and refining them to suit their communities’ needs, leaders can help ensure pub-licly funded schools are combating fentanyl and saving the next generation of Americans. 

• Pass legislation, such as Tucker’s Law in Texas, to implement statewide fentanyl awareness campaigns in their respective states and ensure that school districts pro-vide students with comprehensive education on the dangers of fentanyl. 

Texas House Bill 3908 was signed by Gov. Abbott on June 17, 2023, and includes Fenta-nyl Awareness Week and fentanyl abuse prevention and drug poisoning awareness edu-cation (HB 3908, 2023). Fentanyl Awareness Week requires age-appropriate instruction delivered by schools on the dangers of fentanyl. The instruction includes guidelines on suicide prevention, fentanyl addiction prevention, awareness efforts, and expanded health education. This bill is already in effect for the 2023-2024 school year. Tucker’s Law is named after Tucker Roe who died in 2021 at only 19 years old after taking a Percocet pill purchased from a peer on social media that he didn’t know was laced with fentanyl (Simpson, 2023; Turner, 2021). A second bill signed by Gov. Abbott this past summer, HB 3144, designated October as Fentanyl Poisoning Awareness Month to honor victims like Tucker and to raise awareness about the dangers of this drug (HB 3144, 2023). 

Enact legislation, such as HB 3924 in Illinois, which requires both instruction and testing to ensure students understand certain information on the dangers of fenta-nyl, synthetic opioids, and illicit drugs. 

Illinois House Bill 3924, which is set to take effect in the 2024-2025 school year, requires every state-required health course for grades 9-12 to provide instruction, study, and dis-cussion on the dangers of fentanyl (HB 3924, 2023). The bill had bipartisan support, passing unanimously in both the Illinois House and the Senate (Illinois General Assem-bly, 2023a, Illinois General Assembly, 2023b). instruction must include a general expla-nation of fentanyl, how it is used legally and illegally, and an explanation of the differ-ences between synthetic and non-synthetic opioids and illicit drugs. The courses also must cover side effects and risk factors. Under the bill, this information can be taught via a licensed educator, school nurse, or school counselor. It is the responsibility of the State Board of Education to develop and make available instructional materials and guidelines to all elementary and secondary schools. 

Another element in Illinois’ HB 3924 is a student assessment (HB 3924, 2023). Testing students on their knowledge of fentanyl will ensure students retain knowledge on the dan-gers of fentanyl and emergency treatments, such as the opioid antagonist, naloxone. This subsection of the bill suggests that students be tested on synthetic/non-synthetic drugs, hypoxia, the effects of fentanyl on a person’s body, lethal doses, and overdose preven-tion. Without testing students on their knowledge of fentanyl, it is impossible to verify whether they have grasped the information and risks and, most importantly, know how to respond in an emergency. 

• To supplement education and prevention programs, naloxone should be made available in public places, such as schools, where poisonings often occur. 

In 2020, the National Association of School Nurses took an official stance in favor of in-corporating opioid antagonists such as naloxone in school emergency preparedness plans (National Association of School Nurses, 2020). Nurses are the main point of contact for healthcare in schools and have a keen awareness of what is needed. School nurses also provide leadership in all phases of emergency preparedness and response, so they can fa-cilitate access to naloxone for quick response in the management of opioid-related over-doses. The CDC’s State Unintentional Drug Overdose Reporting System (SUDORS) shows that in 2021, two-thirds of all drug overdose deaths had at least one potential op-portunity for intervention, including 46% with a potential bystander present (National Center for Injury Prevention and Control, 2022). Considering this evidence, the Center for a Healthy America at the America First Policy Institute recommends making nalox-one readily available in high-traffic public spaces, such as schools and colleges, public transportation stations and airports, and in larger retail spaces, such as shopping malls and grocery stores (Overton, 2023). 

Several states have acted to stock opioid antagonists in schools. Last year, Florida en-acted a law that allowed school districts to stock naloxone and administer it in case of an emergency (SB 544, 2022). In January 2023, New Jersey passed a law requiring colleges to stock naloxone and create a plan for emergency administration (A 4852, 2023). On April 14, 2023, Arkansas Governor Sarah Sanders signed a bill requiring opioid overdose rescue kits to be located on each campus of public high schools and state-supported insti-tutions of higher education (HB 1514, 2023). Finally, on June 17, 2023, Texas Governor Greg Abbott signed a bill allowing the provision of opioid antagonists at institutions of higher education under the state opioid antagonist program (SB 867, 2023). Although ed-ucation is the first line of defense, these laws are critical to ensuring that overdoses can be treated quickly and effectively during emergencies on campus. Additionally, schools should make training available for students and teachers to learn how to administer na-loxone if necessary (Peiper et al., 2019). 

• Relocate unused COVID-19 funding and Preventive Health and Health Services Block Grants for fentanyl prevention and education efforts in K-12 schools. 

Federal efforts to support schools have also been made. Rep. Doug Lamborn (R-CO-5) introduced the Protecting Kids from Fentanyl Act (H.R. 8968) in the U.S. House of Rep-resentatives during the 117th Congress (H.R. 8968, 2022). The bill died in committee, but it would have allowed elementary and secondary school emergency relief funding passed in COVID-19 relief packages to be put toward fentanyl education in K-12 schools. It was reintroduced by Congressman Lamborn in July as the Protecting Kids Against Fentanyl Act of 2023 during the 118th Congress (Congressman Doug Lamborn, 2023). This ver-sion calls for amending the Public Health Service Act to authorize the use of Preventive Health and Health Services Block Grant for fentanyl education and emergency response. Under both versions of the bill, funds could be used to purchase naloxone or other opioid antagonists, provide training to school nurses, teachers, and administrators on how to ad-minister naloxone or other opioid antagonists, and provide fentanyl awareness classes or materials to students. 

Conclusion

Fentanyl is endangering our youth because drug dealers are targeting children and teens. Nearly six in 10 people (59%) are concerned that a close friend or family member could accidentally take a fake pill containing fentanyl (RMG Research, Inc., 2023). It is vital that states act now to educate young people in schools on the dangers of fentanyl and to prevent overdoses in school or at home. States should pass legislation such as Texas House Bill 3908 or Illinois House Bill 3924 to ensure that children and teens are pro-tected and armed against deadly fentanyl (HB 3908, 2023; HB 3924, 2023). This means educating them on synthetic and non-synthetic drugs, risks, prevention, and treatment, but also stipulating mandatory assessment for all students. Teaching is part of the solu-tion, but ensuring students retain information is equally important. States should also fol-low examples set by Florida, New Jersey, Texas, and Arkansas and heed the warning of the National Association of School Nurses to ensure that schools are stocked with nalox-one or other opioid antagonists and that students and educators are trained on how to use them. Schools should provide awareness, assemble prevention efforts, and provide treat-ment if necessary. The fentanyl crisis is tightening its grip on our children, but not all hope is lost. With strong cooperation among states, educators, and parents, we can fight back and weaken its threat to our youth. 

About the Authors 

Laurie Todd-Smith, Ph.D., is the Director of the Center for Education Opportunity and the Center for the American Child at the America First Policy Institute. 

Julia Butch is a Policy Analyst for the Center for Education Opportunity and the Center for 1776 at the America First Policy Institute 

Samantha Seal is a Policy and Strategic Communications Intern at the America First Pol-icy Institute. 

To Stay Connected & Learn More text DRUGFREE to 70107