Some Indiana schools put Narcan on shelves years ago. Training and stigma comes next.

In the late winter of 2019, Cameron Powell took a pill and went to school. A few hours later, the high school junior went to the school nurse, complaining of nausea and fatigue.

Amy Powell figured her son was just under the weather when she got the call. And, the school nurse never considered that his symptoms might be the signs of opiate use and that he could be at risk of overdosing.

Cameron's grandmother picked him up from school and he decided to stay with her for the night.

The next morning, Powell heard from her mom. Cameron wasn’t breathing. There was blood on his bed. Powell fell to the ground, screaming.

Paramedics worked on Cameron for a long time before transporting him to Peyton Manning Children’s Hospital, where he was pronounced dead.

Eight weeks after that February day in 2019, Powell learned what had killed her son with such speed. Cameron consumed what he thought was Xanax, but the pills were laced with three types of fentanyl, a synthetic opioid, she said.

The fentanyl crisis

Powell knew Cameron dabbled with marijuana recreationally but she did not realize he was self-medicating.

His Washington Township school did not recognize his symptoms nor did the nurse's office at the time carry naloxone, which works to halt the effects of opioids, she said.

And Cameron is not alone.

The fentanyl crisis across the country is bleeding into communities, leading school districts to address how to combat the narcotic that’s far stronger than heroin and morphine.

But Indiana does not mandate that schools keep a supply of naloxone, also known by the brand name Narcan. Instead a 2017 law details how schools should stock it and requires that if they do have it, they report to the state when it’s used.

Some advocates think that law should be strengthened, especially as some counties, like Marion and Hamilton, see more young people impacted by substance use.

This last year, there were fewer than six overdoses of 15 to 18-year-olds in Hamilton County, but a few resulted in death, local health department officials said.

In Marion County, fatal drug overdoses overall were up by 3% in 2022 from the previous year. There were 11 deaths of 13 to 19-year-olds due to drug overdoses in 2022, according to the Marion County Coroner’s Office.

In the eyes of Powell, every school, whether public or private, should carry naloxone and match that with training on why it’s in schools to begin with: from mental health to rising substance use.

Powell said she does not blame those who missed the signs of her son's drug use like she did; she only hopes naloxone will soon be in every school, coupled with education to save a life.

“They weren't out to harm anybody,” Powell said. “They weren't out to do anything wrong. They just weren't prepared.”

One district’s effort

Every kit that school nurses bring to an emergency situation in the Westfield Washington school district contains inhalers for respiratory distress, epinephrine for allergic reactions and a smattering of other aids for students or faculty in medical need.

Also tucked into the kit is naloxone which school nurses and advocates say is no different from those other life-saving treatments.

Since 2021, Westfield Washington has stocked naloxone and trained staff to use it in case it should ever be needed in the district’s intermediate, middle school or high school. Naloxone is not yet in the district's elementary schools.

The nasal spray usually has immediate results and few adverse effects, even if the person suspected of overdosing on an opioid has not actually taken any drugs.

In the time since Westfield Washington started stocking naloxone, school officials have not administered or reported using a dose to the state. However, they are still prepared should the need arise, Teresa Layton, nurse coordinator for Westfield Washington, said.

Every year prior to school’s start, school nurses retrain on emergency procedures, Layton said.

That training makes the need for naloxone slightly less taboo, she said.

“I think having people trained knowing it's super easy, it's accessible, anybody can use it, it's a way to help your family members as needed and that it's just education,” Layton said. “Educating people has definitely brought people around to do that.”

Bleeding into communities

Naloxone does not exist just to help students but could also be deployed to save faculty, staff, or parents.

More than 580 overdoses were reported in the Hamilton County from the start of 2023 to Dec. 4, resulting in 31 deaths after 108 doses of naloxone were administered, the County Health Department reports. Those numbers exclude the city of Fishers, which has its own health department.

And those are just reported numbers, Jim Ginder, health education specialist for the Hamilton County Health Department, said. The county, a few miles north of Indianapolis, is on par to see a similar number of overdoses and deaths as it did in 2022 with more than 60 overdoses from synthetic opioids, like fentanyl, alone.

Ginder, who has offered naloxone training in Hamilton County since 2018, said his presentations show how the drug epidemic touches many lives today.

“It's really sad after a lot of people go through the presentation, they’re like my friend does this or I've heard my friend's parent had to give them Narcan or they have a relative that almost died because of an overdose,” Ginder said.

A lifeline

Overdose Lifeline, the nonprofit responsible for supplying a majority of the state with naloxone, sends out more than 24,000 kits a month across the state, including to Indiana's schools.

But the kits are only one part of the organization's work, Justin Phillips, the founder of Overdose Lifeline, said. Her group has a particular focus on increasing awareness of the need for Indiana schools to keep naloxone on hand.

"It is a training that is specifically for school health personnel and school resource officers to understand the potential for overdose on a school campus, be it a student or a member of the public visiting the school, which is also likely and why they should have naloxone on hands," Phillips said.

The National Association of School Nurses and its Indiana chapter promote continued training for naloxone, saying it should be part of all emergency preparedness.

"Opioid related overdoses are nationally at all time high and schools nurses are able to support students by having this life-saving drug readily available," Tori LaMotte, the president-elect for the organization, told the IndyStar in an emailed statement.

Powell, who serves as a peer grief volunteer for Overdose Lifeline, said Cameron's story is shared through a video by ODL to educate schools across the state, and that's what she wanted.

"She came to me and wanted to do something to advocate for naloxone in schools because it is not mandated," Phillips said. "It's not required. It's allowed, but it's not required."

Breaking a stigma

In December of 2022, Hamilton Southeastern Schools administered a dose of Narcan to a student suspected of overdosing. It was the district's first time using the medication.

HSE joined 12 districts who reported using Narcan last school year and another seven who have done so this year, according to the state's Department of Education.

Noblesville Community Schools and Carmel Clay Schools, like Westfield, have naloxone on campuses; neither has used it, according to both school districts.

In Indianapolis Public Schools, Overdose Lifeline has supplied Narcan kits to every school. They all have participated in OL's training.

As of October of this year, the nonprofit has trained 107 school districts, covering 51 of 92 counties in the state.

Phillips said they will keep doing so with hopes that sometime soon Indiana's lawmakers will take up the subject by requiring that all school systems store the medication.

"The schools have always been reluctant to even have naloxone because of the stigma," Phillips said.

That stigma inspired Powell to share her story about her Cameron so no other child is lost like him, she said.

On Powell's wrist there's a tattoo of Cameron's signature. Cameron's two brothers and his father also carry his name on their bodies in memory of Cameron.

That tattoo and doses of naloxone go everywhere they go.

What schools administered naloxone this school year?

What schools administered naloxone in the last 5 years?

Rachel Fradette is a suburban education reporter at IndyStar. Contact her at rfradette@gannett.com or follow her on Twitter at @Rachel_Fradette.

This article originally appeared on Indianapolis Star: Some Indiana schools have Narcan to help decrease fatal overdoses