Existing law authorizes a school district, county office of education, and charter school to provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose, as provided.

This bill would require each individual public school operated by a school district, county office of education, or charter school that has made a person who has received instruction in the administration of naloxone hydrochloride or any other opioid antagonist available at the school, as provided, to maintain at least 2 doses of naloxone hydrochloride or another opioid antagonist for purposes of those authorizations. The bill would require each school district, county office of education, and charter school that has made a person who has received instruction in the administration of naloxone hydrochloride or any other opioid antagonist available at its schools, as provided, to report to the State Department of Education and the State Department of Health Care Services on or before July 31, 2024, and annually thereafter, certain information regarding opioid antagonists. By imposing additional duties on public schools, the bill would impose a state-mandated local program.

The bill would provide that it is the intent of the Legislature that school districts, county offices of education, and charter schools share information from the State Department of Public Health regarding naloxone hydrochloride or other opioid antagonists with parents or guardians of pupils.

Existing law authorizes a school district, county office of education, and charter school to provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose, as provided.

This bill would require each individual public school operated by a school district, county office of education, or charter school to maintain at least 2 doses of naloxone hydrochloride or another opioid antagonist for purposes of those authorizations. The bill would require any each school district, county office of education, or and charter school that does not exercise their authorization to distribute naloxone hydrochloride or another opioid antagonist on its campus to report to the State Department of Education and the State Department of Health Care Services on or before an unspecified date, July 31, 2024, and annually thereafter, certain information. information regarding opioid antagonists. By imposing additional duties on public schools, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law authorizes a school district, county office of education, and charter school to provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose, as provided.

This bill would require each individual public school operated by a school district, county office of education, or charter school to maintain at least 2 doses of naloxone hydrochloride or another opioid antagonist for purposes of those authorizations. The bill would require any school district, county office of education, or charter school that does not exercise their authorization to distribute naloxone hydrochloride or another opioid antagonist on its campus to report to the State Department of Education and the State Department of Health Care Services on or before an unspecified date, and annually thereafter, certain information. By imposing additional duties on public schools, the bill would impose a state-mandated local program.

The bill would provide that it is the intent of the Legislature to enact future legislation that would authorize school districts to host trainings to parents regarding naloxone hydrochloride or another opioid antagonist.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

SB 472 (Hurtado) - Pupil health: opioid overdose reversal medication

Bill Summary:

This bill requires each public school to maintain at least two doses of naloxone on its campus, and to report to the California Department of Health Care Services (DHCS) on why they are not exercising their authority to distribute naloxone and how they came to that determination.

Fiscal Impact:

By requiring K-12 schools to maintain at least two doses of naloxone hydrochloride or another opioid antagonist on their campuses, this bill could result in ongoing Proposition 98 General Fund costs of approximately $1.1 million each year. This estimate assumes a cost of $47.50 per dose but could be less to the extent that doses are not used. Opioid reversal medication typically has a shelf life of two to three years. To the extent that the Commission on State Mandates determines the bill’s requirements to be a higher level of service, there could be cost pressure on the K-12 Mandates Block Grant.

Background:

Existing law permits a school nurse or trained personnel who have volunteered to provide emergency naloxone hydrochloride or another opioid antagonist, by nasal spray or by auto-injector, to persons suffering, or reasonably believed to be suffering, from an opioid overdose.

Existing law provides a school no more than two weeks to restock their supply of naloxone hydrochloride or another opioid antagonist after use. It also requires an LEA electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid to ensure that each employee who volunteers are provided defense and indemnification for any and all civil liability. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file.

Proposed Law:

This bill requires each public school operated by a local educational agency (LEA), county office of education (COE), or charter school to maintain at least two doses of naloxone hydrochloride or another opioid antagonist on its campus.

This bill provides that if an LEA, COE, or charter schools does not distribute naloxone hydrochloride or another opioid antagonist on its campus they must report to the DHCS, as specified, detailing why they are not distributing naloxone hydrochloride or another opioid antagonist and how they made the determination to not distribute naloxone hydrochloride or another opioid antagonist.

Related Legislation:

SB 234 (Portantino, 2023) would require public school, institutions of higher education, stadiums, concert venues, and amusement parks to maintain unexpired doses of naloxone hydrochloride or any other opioid antagonist on its premises. This bill will be heard in this Committee on May 1, 2023.

SB 10 (Cortese, 2023) would require LEA and COE to include strategies for the prevention and treatment of an opioid overdose in their school safety plans and for the CDE to develop training materials on the use of emergency opioid antagonists for school personnel, and safety materials for parents, guardians, and pupils in conjunction with the California Health and Human Services Agency. This bill is pending on the Suspense File in this Committee.

AB 19 (Patterson, 2023) would require each public school operated by a LEA, COE, or charter school to maintain at least two doses of naloxone hydrochloride or another opioid antagonist for purposes of those authorizations. This bill is pending on the Suspense File in the Assembly Appropriations Committee.

Staff Comments:

The 2023 Governor’s Budget includes $3.5 million in ongoing Proposition 98 General Fund for middle schools and high schools to maintain at least two doses of naloxone hydrochloride or another medication to reverse an opioid overdose on campus for emergency aid. This proposal assumes each of the state’s 5,400 middle and high school students maintain a 12-dose kit at a cost of $570 each.

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SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: SB 472

SUBJECT: Pupil health: opioid overdose reversal medication

SUMMARY:

Requires each individual public school operated by a school district, county office of education, or charter school to maintain at least two doses of naloxone or another opioid antagonist on its campus. Requires those entities to report to the California Department of Education and the Department of Health Care Services specified information by July 31, 2024, and annually thereafter.

Existing law:

1. Authorizes licensed health care providers to issue a standing order for the distribution or the administration of naloxone to a person at risk of overdose, or family members, friends, or other persons in a position to assist a person at risk of an opioid-related overdose. Requires a person who is prescribed or possesses naloxone pursuant to a standing order to receive training, as specified. [CIV §1714.22, et seq.]
2. Permits a school nurse or trained personnel who have volunteered to provide emergency naloxone or another opioid antagonist, by nasal spray or by auto-injector, to persons suffering, or reasonably believed to be suffering, from an opioid overdose. [EDC §49414.3]
3. Permits each public and private elementary and secondary school in the state to voluntarily determine whether or not to make emergency naloxone or another opioid antagonist and trained personnel available at its school. [EDC §49414.3]
4. Permits each public and private elementary and secondary school to designate one or more volunteers to receive initial and annual refresher training, as specified, regarding the storage and emergency use of naloxone or another opioid antagonist from the school nurse or other qualified person, as specified. [EDC §49414.3]
5. Requires the Superintendent to establish minimum standards of training for the administration of naloxone or another opioid antagonist, as specified. Requires the Superintendent, every five years or sooner, to review the minimum standards. [EDC §49414.3]
6. Requires any school district, county office of education (COE), or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to distribute a notice at least once per school year to all staff that contains specified information related to volunteers to administer naloxone and specified training. [EDC §49414.3]
7. Requires a qualified supervisor of health at a school, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to obtain from an authorizing physician a prescription for each school for naloxone or another opioid antagonist, and to stock the naloxone, as specified. [EDC §49414.3]
8. Requires a school district, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to ensure that each employee who volunteers is provided defense and indemnification by the school district, COE, or charter school for any and all civil liability. Requires the information to be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file. [EDC §49414.3]

This bill:

1. Requires each individual public school operated by a school district, COE, or charter school to maintain at least two doses of naloxone or another opioid antagonist on its campus.
2. Requires each school district, COE, and charter school to report to the California Department of Education (CDE) and the Department of Health Care Services (DHCS) on or before July 31, 2024, and annually thereafter, the following:
3. The total supply of naloxone or another opioid antagonist stored on each school site;
4. The number of incidents in which naloxone or another opioid antagonist was used to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose; and,
5. The number of doses of naloxone or another opioid antagonist that expired during that school year.
6. States Legislative intent that school districts, COEs, and charter schools share information from the California Department of Public Health (CDPH) regarding naloxone or other opioid antagonists with parents and guardians of pupils.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, the current opioid epidemic is one of the biggest challenges facing California today. In 2019, CDPH reported 3,244 deaths related to opioid overdose. This bill seeks to reduce opioid overdose deaths by requiring school districts, COEs, or charter schools to maintain two doses of naloxone at all times. This bill also ensures that school districts, COEs, or charter schools who do not exercise their authorization to distribute naloxone or another opioid antagonist to report to CDE and DHCS.
2. Naloxone. According to the CDPH website, naloxone is an opioid antagonist that works almost immediately to reverse opiate overdose and has few known adverse effects, no potential for abuse, and can be rapidly administered through intramuscular injection or nasal spray. Programs to train and equip bystanders, such as friends, family, and other non-health care providers, and drug users themselves, have gained momentum as an effective way to respond to and reverse an opioid overdose. On March 29, 2023, the U.S. Food and Drug Administration (FDA) approved four milligram naloxone nasal spray for over-the-counter (OTC), nonprescription, use—the first naloxone product approved for use without a prescription. This action, according to the FDA, paves the way for the life-saving medication to reverse an opioid overdose to be sold directly to consumers in places like drug stores, convenience stores, grocery stores, and gas stations, as well as online. The timeline for availability and price of this OTC product is determined by the manufacturer. The FDA will work with all stakeholders to help facilitate the continued availability of naloxone nasal spray products during the time needed to implement the switch from prescription to OTC status, which may take months. Other formulations and dosages of naloxone will remain available by prescription only.
3. Statewide standing order for naloxone distribution. CDPH issued a statewide standing order for naloxone in June 2018. The order allows organizations and entities, including k-12 schools, colleges, and universities, to distribute naloxone to a person who is at risk of experiencing an overdose or an individual in a position to assist an at-risk person. Staff of community organizations and other entities distributing naloxone under the statewide standing order are required to receive training, and are also required to provide training to individuals who receive naloxone from them. Organizations, including colleges, may apply to use the statewide standing order and meet certain terms and conditions. A separate distribution program administered through DHCS allows organizations to apply for and obtain naloxone at no cost.
4. Naloxone Distribution Project (NDP). The NDP aims to reduce opioid overdose deaths through the provision of free naloxone. Entities can apply to DHCS to have naloxone shipped directly to their address. Eligible entities include:
5. Law enforcement such as police departments, county jails, and probation;
6. Fire, EMS, and first responders;
7. Schools and universities;
8. County public health and behavioral health departments; and,
9. Community organizations, such as harm reduction organizations or community opioid coalitions.

Since it began in October 2018, the NDP has distributed more than 2,200,000 kits of naloxone, which have been used to reverse more than 140,000 overdoses. The NDP receives State General Funds and opioid settlement funds from the Janssen and Distributors (J&D) Settlement Agreements.

1. Addressing opioids among K-12 students. CDE, in conjunction with CDPH, provides local educational agencies (LEAs) with resources and information that they can readily share with parents and students to help keep them safe. The shareable Fentanyl Awareness and Prevention toolkit page offer information about the risks of fentanyl and how to prevent teen use and overdoses. In addition to the toolkit, the CDPH’s Substance and Addiction Prevention branch also provides resources for parents, guardians, caretakers, educators, schools, and youth-serving providers.
2. Double referral. This bill passed the Senate Education Committee by a vote of 7-0 on March 22, 2023.
3. Related legislation. SB 10 (Cortese) requires LEAs and COEs to include strategies for the prevention and treatment of an opioid overdose in their school safety plans and for CDE to develop training materials on the use of emergency opioid antagonists for school personnel, and safety materials for parents, guardians, and pupils in conjunction with the California Health and Human Services Agency. SB 10 is set to be heard in this Committee on April 12, 2023.

SB 234 (Portantino and Umberg) requires schools, college campuses, stadiums, concert venues, and amusement parks to, at all times, maintain unexpired doses of naloxone hydrochloride or any other opioid antagonist. Requires these entities to ensure that at least two employees are aware of the location of the naloxone or other opioid antagonist. SB 234 is set to be heard in this Committee on April 12, 2023.

AB 19 (Patterson) requires each public school operated by a school district, COE, or charter school to maintain at least two doses of naloxone or another opioid antagonist, as specified. AB 19 is set to be heard in the Assembly Education Committee on April 12, 2023.

AB 24 (Haney) requires a person or entity that owns, manages, or is responsible for a bar, gas station, public library, or single-room occupancy hotel in a county that is experiencing an opioid overdose crisis to acquire and post an opioid antagonist kit in areas that are readily accessible only by employees, including, but not limited to, a break room, and to restock the opioid antagonist kit after each use. AB 24 is set to be heard in the Assembly Health Committee on April 11, 2023.

1. Prior legislation. SB 367 (Hurtado, Chapter 218, Statutes of 2022), requires each community college, CSU campus, and requests UC campuses with on-campus health centers to distribute opioid overdose reversal medication in accordance with the statewide standing order issued by the State Public Health Officer and to participate in the NPD.

AB 1748 (Mayes, Chapter 557, Statues of 2016) authorizes school districts to provide an emergency opioid antagonist to school nurses or trained personnel and authorizes a school nurse or trained personnel to administer an opioid antagonist to a person suffering from an opioid overdose.

1. Support. Supporters of this bill, largely law enforcement organizations, state that this bill builds upon SB 367 (Hurtado) that they supported last year, which provided for naloxone to be made available on higher education campuses throughout the state, and hope that all campuses will elect to keep this relatively inexpensive, live-saving drug on hand for any emergencies that may arise. Supporters also state that each day schools face the effects of a fentanyl and opioid crisis, and our educators and classified staff have asked that the state address this crisis.
2. Policy concern. This bill expands existing law to require schools to maintain naloxone or any other opioid antagonist onsite. However, existing law maintains that specified entities are permitted to determine whether or not to make trained personnel available to administer the naloxone. This potentially creates situations where an individual would not be administered this life-saving medication. Existing law, as well as DHCS’s NDP, requires that individuals who obtain naloxone receive training, and being that the NDP makes naloxone available for free, it is expected that many of the schools affected by this bill will receive the naloxone through the NDP.
3. Amendments. To address the policy concern, the author may wish to consider amending the bill to require that only schools that have made trained personnel available maintain at least two doses of naloxone.

SUPPORT AND OPPOSITION:

Support: Arcadia Police Officers’ Association

Burbank Police Officers’ Association

California Coalition of School Safety Professionals

California Federation of Teachers

California Youth Empowerment Network

Claremont Police Officers’ Association

Corona Police Officers’ Association

Culver City Police Officers’ Association

Deputy Sheriffs’ Association of Monterey County

Fullerton Police Officers’ Association

Los Angeles School Police Officers’ Association

Mental Health America of California

Murrieta Police Officers’ Association

National Association of Social Workers, California Chapter

Newport Beach Police Association

Palos Verdes Police Officers’ Association

Placer County Deputy Sheriffs’ Association

Pomona Police Officers’ Association

Riverside Police Officers’ Association

Riverside Sheriffs’ Association

San Francisco Community Health Center

Santa Ana Police Officers’ Association

Upland Police Officers’ Association

Oppose: None received

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SENATE COMMITTEE ON EDUCATION

Senator Josh Newman, Chair

2023 - 2024 Regular

Bill No: SB 472 Hearing Date: March 22, 2023

Subject: Pupil health: opioid overdose reversal medication.

NOTE: This bill has been referred to the Committees on Education and Health. A "do pass" motion should include referral to the Committee on Health.

SUMMARY

This bill requires each campus of a public school operated by a Local Educational Agency (LEA), County Office of Education (COE), or charter school to maintain at least two doses of naloxone on its campus, and to report to the California Department of Health Care Services (DHCS) on why they are not exercising their authority to distribute naloxone and how they came to that determination.

BACKGROUND

Existing Law:

Education Code (EDC)

1. Permits a school nurse or trained personnel who have volunteered to provide emergency naloxone hydrochloride or another opioid antagonist, by nasal spray or by auto-injector, to persons suffering, or reasonably believed to be suffering, from an opioid overdose. (EDC § 49414.3(a))
2. Requires the Superintendent of Public Instruction (SPI) to establish, and revise every five years or sooner, minimum standards of training for the administration of naloxone hydrochloride or another opioid antagonist as specified. The California Department of Education (CDE) shall maintain a clearinghouse for best practices in training nonmedical personnel to administer naloxone hydrochloride or another opioid antagonist to pupils. (EDC § 49414.3(e))
3. Requires an LEA, COE, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid to ensure that each employee who volunteers are provided defense and indemnification by the LEA, COE, or charter school for any and all civil liability. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file. (EDC 49414.3(i))
4. Provides a school no more than two weeks to restock their supply of naloxone hydrochloride or another opioid antagonist after use. (EDC § 49414.3(h))
5. If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athlete’s parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email. (EDC § 49476)
6. Requires each LEA and COE to be responsible for the overall development of all comprehensive school safety plans for its schools operating kindergarten or any of grades 1 through 12. (EDC § 32281(a))
7. Specifies that the schoolsite council or a school safety planning committee is responsible for developing the comprehensive school safety plan. (EDC § 32281(b))
8. Specifies that the comprehensive school safety plan must include an assessment of the current status of school crime committed on school campuses and at school-related functions and identification of appropriate strategies and programs to provide or maintain a high level of school safety and address the school’s procedures for complying with existing laws related to school safety, including child abuse reporting procedures; disaster procedures; an earthquake emergency procedure system; policies regarding pupils who commit specified acts that would lead to suspension or expulsion; procedures to notify teachers of dangerous pupils; a discrimination and harassment policy; the provisions of any schoolwide dress code; procedures for safe ingress and egress of pupils, parents, and school employees to and from school; a safe and orderly environment conducive to learning; and rules and procedures on school discipline. (EDC § 32282(a))
9. Requires the comprehensive school safety plan to be evaluated at least once a year. (EDC § 32282(d))

Civil Code (CIV)

1. Permits a licensed health care provider who is authorized by law to prescribe an opioid antagonist may issue standing orders for the distribution of an opioid antagonist to a person at risk of an opioid-related overdose or to a family member, friend, or other person in a position to assist a person at risk of an opioid-related overdose. (CIV § 1747.22(c))
2. A person who is prescribed or possesses an opioid antagonist pursuant to a standing order shall receive the training provided by an opioid overdose prevention and treatment training program. (CIV § 1747.22(d))
3. An opioid overdose prevention and treatment training program is any program operated by a local health jurisdiction or that is registered by a local health jurisdiction to train individuals to prevent, recognize, and respond to an opiate overdose, and that provides, at a minimum, training as specified. (CIV 1714.22(a)(2))

ANALYSIS

This bill requires each campus of a public school operated by a LEA, COE, or charter school to maintain at least two doses of naloxone on its campus, and to report to the DHCS on why they are not exercising their authority to distribute naloxone and how they came to that determination. Specifically, this bill:

1. Requires each public school operated by an LEA, COE, or charter school shall maintain at least two doses of naloxone hydrochloride or another opioid antagonist on its campus.
2. Specifies that if an LEA, COE, or charter schools does not distribute naloxone hydrochloride or another opioid antagonist on its campus they must report to the DHCS, as specified, detailing why they are not distributing naloxone hydrochloride or another opioid antagonist and how they made the determination to not distribute naloxone hydrochloride or another opioid antagonist.
3. States that it is the intent of the Legislature to enact future legislation that would authorize school districts to host trainings to parents regarding naloxone hydrochloride or another opioid antagonist.
4. Makes technical changes.

STAFF COMMENTS

1. Need for the bill: According to the author, “The current opioid epidemic is one of the biggest challenges facing California today. In 2019, the California Department of Public Health reported 3,244 deaths related to opioid overdose. SB 472 seeks to reduce opioid overdose deaths by requiring school districts, county office of education or charter schools to maintain two doses of naloxone at all times. This bill also ensures that school districts, county office of education or charter schools who do not exercise their authorization to distribute naloxone or another opioid antagonist to report to the State Department of Education and the State Department of Health Care Services.”
2. California Department of Health Care Services Statewide Standing Order for Naloxone. Naloxone can help reduce opioid overdose deaths in California, but many organizations find it difficult to obtain the required standing order to obtain naloxone from health care providers. According to the California Department of Public Health (CDPH), of the 6,843 opioid-related overdose deaths in 2021, 5,722 were related to fentanyl. CDPH issued the standing order, in 2017, to address this need and support equitable naloxone access. The standing order:
   1. Allow community organizations and other entities in California that are not currently working with a physician, to distribute naloxone to a person at risk of an opioid-related overdose or to a family member, friend, or other person in a position to assist; and
   2. Allow for the administration of naloxone by a family member, friend, or other person to a person experiencing or reasonably suspected of experiencing an opioid overdose.

Among the organizations and entities that can distribute naloxone under the order are colleges and universities. An individual at risk of experiencing an overdose or someone who can assist an individual at risk is allowed to do so. Under the statewide standing order, staff of community organizations and other entities distributing naloxone must be trained. They are also required to provide training to individuals who receive naloxone from them. Colleges and other organizations may apply to use the statewide standing order if they meet certain conditions.

A separate distribution program administered through DHCS allows universities and colleges to apply for and obtain naloxone at no cost to the institution. According to the CDPH website, since October 2018, their Naloxone Distribution Project (NDP) has distributed over 1 million units of naloxone, and recorded over 57,000 overdose reversals.

The provisions of this bill would require each public school of an LEA, COE, or charter school to maintain at least two doses of naloxone and report to DHCS if they do not use their authorization to distribute naloxone, as specified. While schools are eligible to receive naloxone through the NPD, the standing order does not require schools, or any other eligible entity, to administer or distribute naloxone. However, to the extent, the Legislature is aware of incidences regarding opioid and use of narcan on school campuses are limited. The committee may wish to consider whether the reporting requirements to DHCS could be used to better help inform the Legislature.

1. Addressing Fentanyl Among K-12 Students. According to CDPH, in 2021, there were 224 fentanyl-related overdose deaths among teens ages 15–19 years old in California. Pursuant to Chapter 557, Statutes of 2016 (AB 1748), among other things, requires the SPI to establish minimum training standards for school employees who volunteer to administer naloxone or another opioid antagonist. In addition to setting minimum training standards, the CDE must maintain on its website a clearinghouse for best practices in training nonmedical personnel to administer naloxone or another opioid antagonist to pupils. 

LEAs and COE have also adjusted to address this growing crisis. For example, the Lake County Office of Education and Washington Unified School District in West Sacramento recently implemented a local school naloxone policy consistent with an LEA’s ability to implement a naloxone policy. San Diego Unified School District created its naloxone toolkit to aid other LEAs and inform parents and guardians. In September of 2022, the Los Angeles Unified School District (LAUSD) in collaboration with the Los Angeles County Department of Public Health announced that doses of naloxone will be provided to LAUSD at no cost In response to the devastating epidemic of overdoses.

The CDE, in conjunction with the CDPH, also provides LEAs with resources and information that they can readily share with parents and students to help keep them safe. The shareable Fentanyl Awareness and Prevention toolkit page offer information about the risks of fentanyl and how to prevent teen use and overdoses. In addition to the toolkit, the CDPH’s Substance and Addiction Prevention branch also provides resources for parents, guardians, caretakers, educators, schools, and youth-serving providers.

A provision of this bill would require schools to maintain at least two doses of naloxone. This provision is similar to AB 19 (Patterson) and SB 234 (Portantino) of this Session.

Another provision of this bill states that it is the intent of the legislature to enact further policy that would allow LEAs to host training to parents regarding naloxone or another opioid antagonist. Pursuant to the standing order for naloxone, a person who is prescribed or possesses an opioid antagonist pursuant to a standing order shall receive the training provided by an opioid overdose prevention and treatment training program (CIV § 1747.22(d)). An opioid overdose prevention and treatment training program is “any program operated by a local health jurisdiction or that is registered by a local health jurisdiction to train individuals to prevent, recognize, and respond to an opiate overdose, and that provides, at a minimum, training in the causes an opiate overdose, mouth to mouth resuscitation, how to contact appropriate emergency medical services, and how to administer an opioid antagonist” (CIV § 1747.22(a)(2)). The committee may wish to consider whether it is appropriate for LEA’s to host training to parents regarding naloxone when other entities, certified by a local health jurisdiction may be better suited. .

1. Health Education Framework. The health education standards shape the direction of health education instruction for children and youths in California’s public schools: they provide LEAs with fundamental tools for developing health education curricula and improving student attainment in this area, and they help ensure that all students in kindergarten through high school receive high-quality health education instruction, providing students with the knowledge, skills, and confidence to lead healthy lives. Health education has undergone a paradigm shift over the last 15 years. Data from national and state surveys, including the California Healthy Kids Survey, indicated that although youths knew what was harmful to their health, they did not have the skills to avoid risky behaviors. To ensure students not only knew about the harms of drugs, alcohol, and tobacco but also learn how to prevent and recognize these behaviors, the State Board of Education adopted a revised health education curriculum in 2019. For example, the framework aims to achieve the following goals through different grades:
2. Kindergarten
   1. Ability to explain why medicines are used and why they can be helpful or harmful.
   2. Recognize medicines should be taken only under the supervision of a trusted adult; that some household products are harmful if ingested or inhaled; and that tobacco smoke is harmful to health and should be avoided.
3. Grade 6
   1. Explain short- and long-term effects of alcohol, tobacco, inhalant, and other drug use, including social, legal, and economic implications; the dangers of secondhand smoke; the stages of drug dependence and addiction and the effects of drugs on the adolescent brain.
   2. Identify positive alternatives to alcohol, tobacco, and other drug use; the benefits of a tobacco-free environment; and the effects of alcohol, tobacco, and other drug use on physical activity, including athletic performance.
   3. Differentiate between the use and misuse of prescription and nonprescription medicines.
      
4. Grades 9-12
   1. Describe the health benefits of abstaining from or discontinuing use of alcohol, tobacco, and other drugs; the use and abuse of prescription and nonprescription medicines and illegal substances.
   2. Explain the impact of alcohol, tobacco, and other drug use on brain chemistry, brain function, and behavior; the connection between alcohol and tobacco use and the risk of oral cancer; the impact of alcohol and other drug use on vehicle crashes, injuries, violence, and risky sexual behavior.
   3. Identify the social and legal implications of using and abusing alcohol, tobacco, and other drugs.
   4. Analyze the consequences for the mother and child of using alcohol, tobacco, and other drugs during pregnancy—including fetal alcohol spectrum disorders and other birth defects; the consequences of binge drinking and its relationship to cancer; to liver, pancreatic, and cardiovascular diseases; and to a variety of gastrointestinal problems, neurological disorders, and reproductive system disorders.
   5. Clarify myths regarding the scope of alcohol, tobacco, and other drug use among adolescents.
5. Committee Amendments. The author has agreed to take the following amendments:
   1. Revise the intent language to clarify it is the intent of the Legislature for LEAs, COEs, and charter schools to share information from the State Department of Public Health regarding naloxone hydrochloride or other opioid antagonists with parents or guardians of pupils.
   2. Delete and revise the reporting requirements to the Department of Health Care Services to provide insight on the number of incidents in which naloxone was used, the total amount of naloxone each school site has, and the number of naloxone dosages that expire from nonuse.
6. Governor’s Proposed Budget. Currently the Governor’s budget proposes $3.5 million ongoing for all middle and high school sites to maintain at least two doses of naloxone hydrochloride or another medication to reverse an opioid overdose on campus for emergency aid and an additional $79 million to the NPD.

This bill would require grades K-12 to report to DHCS while the Governor’s Budget proposes for middle and high schools to maintain at least two doses of naloxone. The author may wish to consider aligning the reporting requirement with the appropriate grade range receiving naloxone.

1. Related Legislation.

SB 234 (Portant and Umberg, 2023) would require schools kindergarten to 12 grade, institutions of higher education, stadiums, concert venues, and amusement parks, at all times, to maintain unexpired doses of naloxone hydrochloride or any other opioid antagonist on its premises, ensure that at least two employees are aware of the location of the naloxone hydrochloride or other opioid antagonist, and expands community colleges ability to administer naloxone. SB 234 also provides civil protections to a person who administers naloxone hydrochloride or another opioid antagonist on a college campus stadium, concert venue, or amusement park to a person who appears to be experiencing an opioid overdose.

SB 10 (Cortese, 2023) would require LEA and COE to include strategies for the prevention and treatment of an opioid overdose in their school safety plans and for the CDE to develop training materials on the use of emergency opioid antagonists for school personnel, and safety materials for parents, guardians, and pupils in conjunction with the California Health and Human Services Agency.

AB 19 (Patterson, 2023 ) would require each public school operated by a LEA, COE, or charter school to maintain at least two doses of naloxone hydrochloride or another opioid antagonist for purposes of those authorizations.

AB 1748 (Mayes) Chapter 557, Statues of 2016, authorizes LEAs to provide an emergency opioid antagonist to school nurses or trained personnel and authorizes a school nurse or trained personnel to administer an opioid antagonist to a person suffering from an opioid overdose.

SB 367 (Hurtado) Chapter 218, Statues of 2022, requires each institution of higher education to 1) provide educational and preventive information provided by the CDPH about opioid overdose and the use and location of opioid overdose reversal medication; 2) to require each campus health center located on a campus to apply to use the statewide standing order issued by the State Public Health Officer to distribute dosages of a federally approved opioid overdose reversal medication.

SUPPORT

National Association of Social Workers, California Chapter

OPPOSITION

None received

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