Abstract
Objectives
To describe naloxone availability, accessibility, barriers and facilitators to naloxone availability in United States-based schools.
Methods
In May and September 2024, we conducted an optional, cross-sectional national survey of K-12 school nurse members of the National Association of School Nurses. The anonymous emailed survey assessed: (a) nurse demographics, (b) school and community characteristics, (c) school naloxone availability and accessibility, (d) related barriers and facilitators, and (e) available naloxone trainings.
Results
Respondents included n=462 school nurses (response rate 23%) from 44 states. The majority reported their school(s) stocked naloxone (90%); many (18%) reported prior naloxone administration on campus. A third (37%) reported restrictions on who can access/administer naloxone. Few schools (6%) provided student naloxone training. Nurses reported experience with prior school (11% respondents) and/or community overdose (44%).
Conclusions
In this exploratory national survey, most school nurses reported that their K-12 school(s) stocked naloxone. However, many schools limit who can access and administer naloxone, and few provide training to students. There is an urgent need to improve naloxone availability and accessibility to optimize access to this potentially life-saving treatment.
Keywords: overdose prevention, naloxone, school nurses, health policy, United States schools
Introduction
The United States (U.S.) opioid overdose epidemic has impacted youth: drug overdose is now the third leading cause of death among children and adolescents. 1 The ubiquitous presence of highly potent synthetic opioids (like fentanyl or nitizenes) and other emerging novel substances in the drug supply have increased the risk of overdose both among individuals who intermittently use substances and those with regular use.2-4 Many adolescents who died of an overdose had no documented opioid use history, suggesting a need to offer universal overdose prevention education to adolescents. 2 This includes teaching about strategies to reduce overdose risk and respond to an overdose with the opioid antagonist naloxone, an FDA-approved opioid overdose reversal medication that is now available over-the-counter. As the drug supply continues to evolve, adolescents will continue to need education on overdose risk reduction and response, including checking for responsiveness, calling 911, and administering naloxone.
In 2023, the U.S. Secretary of Education and Director of the Office of National Drug Control Policy called for every K-12 school in the country to have naloxone available and to prepare students and staff to use it. 5 Although the letter stated, “it is critical that youth and school personnel can access naloxone on school grounds during and after school,” there is no funding to support this goal. Legislation proposed in 2023 to incentivize schools to maintain naloxone has not been passed, and federal funding for strategies to reduce substance-related harms is tenuous.5-9 At present, 37 states allow K-12 schools and/or employees to store, possess, and/or administer opioid antagonists. However, only six states – Arizona, Maine, Maryland, Oregon, Tennessee, and Washington - require public K-12 schools to stock opioid antagonists. 10
Despite this state legislation, there is currently limited information regarding naloxone availability (i.e., whether naloxone is stocked on campus) and accessibility (i.e., where it is stored, and who can administer it, how quickly it can be used) in U.S. schools. The absence of reliable availability and accessibility data prevents an assessment of how consistently and feasibly current legislation is applied. Therefore, evaluation and monitoring of both implementation and effectiveness of existing naloxone availability in schools is needed to understand the importance of proposed legislation.
Nurses working in K-12 schools are important members of school emergency preparedness teams. 11 They help develop disease prevention strategies, 12 inform communities about public health concerns, 13 and provide valuable information on availability of naloxone in schools. 14 They have unique expertise to assess the need for and implement campus naloxone programs as recommended in the National Association of School Nurses (NASN) Naloxone Education for School Nurses Toolkit, and they may often be responsible for maintaining and/or administering naloxone.15,16 Furthermore, many states employ a State School Nurse Consultant within the Department of Education and/or the Department of Health to coordinate data collection, develop state-level school health guidance, provide consultation and technical assistance to schools, and collaborate with state-level entities on school health-related decisions.17,18 As clinicians, public health experts, school personnel, advocates, and consultants, school nurses have a valuable perspective on promoting student health. School nurses have previously provided valuable state-specific information about naloxone access in schools; however, to our knowledge, no studies have examined naloxone access on a national level. 14
Therefore, we distributed a novel survey to K-12 school nurses to explore (a) naloxone availability and accessibility in U.S. schools, (b) barriers and facilitators to available naloxone, and (c) school provision of overdose prevention training to staff and students. These descriptive findings have potential to inform future research, advocacy, and policy efforts to enhance naloxone access and education to improve youth-focused overdose prevention strategies.
Methods
Survey Development
We developed a novel 80-item School Nurse Naloxone Survey informed by literature review, a prior survey of Pennsylvania school nurses, and the study team’s addiction medicine, school nursing, implementation science, and health services research expertise (Supplement 1).14,19 The survey was piloted with 10 school nurses, and we received comprehensive feedback from cognitive interviews with three school nurses from two different states. 20 The survey assessed (a) nurse demographics, (b) school and community characteristics, including nurses’ knowledge of prior overdoses in the school or community, (c) naloxone availability and accessibility in the nurses’ school(s) (d) barriers (e.g., lack of funding or training) and facilitators (e.g., state law, available funding) to naloxone availability, (e) school provision of naloxone training to staff, and (f) school rules around students’ naloxone access and training.
Study Participants & Procedures
The cross-sectional, anonymous, optional survey was emailed to a random subgroup of 2000 of 180,000 members of NASN, a nonprofit specialty nursing organization representing 33% of all nurses in U.S. K-12 schools, who had opted to receive research recruitment opportunities. 21 NASN research procedures determined the cohort size. 21 Study data were collected and managed using REDCap electronic data capture tools hosted at Children’s Hospital of Philadelphia. 22 Two initial emails were sent two weeks apart in May 2024; a final reminder email was sent September 2024. School nurses currently working in a US public or private school were eligible to participate and received a $10 electronic gift card for survey completion. Incentives were provided through the first author’s institutional funds. The study was considered exempt by the Children’s Hospital of Philadelphia Institutional Review Board (ID 24-022050) as a de-identified survey (45 CFR 46.104(d) 2(i)), and the need for written consent was therefore waived (Supplement 2). The study adhered to Checklist for Reporting of Survey Studies (CROSS) recommendations (Supplement 3). 23
School Nurse Characteristics
The survey queried nurse age, gender, race and ethnicity, nursing degree, role in the school, number of years as a school nurse, and prior nursing roles. Nurses also reported on prior receipt of overdose response and naloxone training and personal knowledge of someone who experienced a prior overdose.
School Characteristics
We collected data to describe the school in which nurses primarily practiced, including school type (i.e., public, private, parochial), grades served, typical nurse-to-student ratio, and the presence of a school-based health center. We asked about prior naloxone administration on the school campus and knowledge of prior fatal or nonfatal opioid overdose(s) by a student, staff member, friend of a student, family member of a student, or unrelated community member on school campus or in the community. The survey also assessed the availability of existing or planned school-provided naloxone training for school nurses and other personnel such as coaches and teachers. Nurses were asked whether students could carry naloxone in school and whether their school offered or planned to offer naloxone training for students.
Naloxone Availability & Accessibility
A single question assessed school availability of naloxone: “Do you stock naloxone in the school(s) you work in?” with answer choices “yes” and “no”. To describe naloxone accessibility, the survey assessed: naloxone formulation, number of doses available, storage location, availability for non-students and during before/after school events (i.e., staff, visitors, etc.), restrictions on personnel allowed to access and administer naloxone, and whether nurses perceived naloxone was readily accessible to promptly respond to an overdose anywhere on campus.
Barriers and Facilitators
Nurses who reported a lack of naloxone at school were asked about eight potential barriers on a 5-point Likert scale (0=“not at all a barrier”, 3=“neutral”, 5=“the most significant barrier”). Those who reported their school stocked naloxone were asked about funding source and eight potential facilitators on a 5-point Likert scale (0=“not at all a facilitator”, 3=“neutral”, 5=“the most significant facilitator”). The 5-point Likert scale was consolidated to a 3-point scale for analyses. For the facilitators and barriers questions, response options included “None of the above” and “Other” with an opportunity for free text response.
Statistical Analyses
We used descriptive statistics to characterize the analytic sample, including nurse demographics, school characteristics, and details regarding naloxone accessibility and training. We used bivariate analyses (chi square test, t-test) to evaluate associations between naloxone availability and school characteristics. Analyses were completed using R version 4.4.1.
Results
School Nurse Characteristics
Analyses included 462 nurses (response rate 23%) who completed the survey. Nurses were predominantly 40-59 years old (59%), white (90%), non-Hispanic/Latino (89%), cisgender females (88%) who worked as registered nurses (94%); 42% had over ten years of school nursing experience. Most nurses (95%) had received prior overdose response and naloxone education in a variety of settings that was required by their current district (56%) or voluntary (38%). Almost half of nurses knew someone personally who had a fatal or nonfatal overdose (47%).
School Characteristics
Nurses predominantly worked in public schools (93%) serving a combination of elementary and middle/high school students (51%) with an average nurse-to-student ratio of 1:842. One in ten knew of a student overdose on school campus, 18% reported prior naloxone administration on their campus, and almost half (44%) were aware of a fatal or nonfatal overdose in the school community (Table 1). The majority of nurses (70%) reported that students cannot carry naloxone on their campus. Of those representing schools that allowed students to carry naloxone (11%), many required permission from a provider (41%) and/or school (41%).
Table 1.
School Characteristics and Overdose Experience by School Availability of Naloxone (N=462)
| | | Total (N=462) | Schools without naloxone (N=44) | Schools with naloxone (N=418) | p |
|---|---|---|---|---|---|
| School Type | Public | 428 (93%) | 39 (89%) | 389 (93%) | 0.254 |
| School serving students with disabilities/special needs | 14 (3%) | 1 (2%) | 13 (3%) | | |
| Private/non-religious | 4 (1%) | 1 (2%) | 3 (1%) | | |
| Religious | 12 (3%) | 2 (5%) | 10 (2%) | | |
| Boarding School | 1 (0%) | 0 | 1 (0.2%) | | |
| Other | 3 (1%) | 1 (2%) | 2 (0.5%) | | |
| Spend most time with grade | Elementary School (preschool - 5th grade) | 120 (26%) | 16 (36%) | 104 (24%) | <0.001 |
| Middle School (6th - 8th grade) | 32 (7%) | 0 (0%) | 32 (7%) | | |
| High School (9th-12th grade) | 70 (15%) | 1 (2%) | 69 (16%) | | |
| Elementary & Middle School | 64 (14%) | 10 (23%) | 54 (13%) | | |
| Middle & High School | 21 (5%) | 0 (0%) | 21 (5%) | | |
| Elementary, Middle, & High School | 153 (33%) | 17 (39%) | 136 (32%) | | |
| School-Based Health Center? | Yes | 30 (6%) | 1 (2%) | 29 (7%) | 0.342 |
| Number of school buildings nurse works in | 1 | 238 (52%) | 25 (57%) | 213 (51%) | |
| 2 | 73 (16%) | 3 (7%) | 70 (17%) | | |
| 3 | 44 (10%) | 3 (7%) | 41 (10%) | | |
| 4 | 29 (6%) | 1 (2%) | 28 (7%) | | |
| 5 | 18 (4%) | 1 (2%) | 17 (4%) | | |
| >5 | 59 (13%) | 11 (25%) | 48 (12%) | | |
| Typical nurse-to-student ratio is 1 nurse to _ students* | Mean (SD) | 842 (818) | 851 (1166) | 842 (774) | 0.960 |
| Have you ever had to administer naloxone on your school campus or at a school sponsored activity before? | Yes | 30 (6%) | 1 (2%) | 29 (7%) | 0.342 |
| Someone had administered naloxone on my school campus before. | Yes | 82 (18%) | 4 (9%) | 78 (19%) | 0.146 |
| Are you aware of anyone ever experiencing a fatal or nonfatal opioid overdose on your school’s campus? | Yes | 50 | 2 (5%) | 48 (12%) | 0.206 |
| Student | 46 (10%) | 2 (5%) | 44 (11%) | | |
| Staff | 0 | 0 | 0 | | |
| Friend of a student | 2 (0%) | 0 | 2 (0.5%) | | |
| Family member of a student | 2 (0%) | 0 | 2 (0.5%) | | |
| Community member not related to student | 4 (1%) | 0 | 4 (1%) | | |
| Are you aware of anyone ever experiencing a nonfatal or fatal opioid overdose in your school’s community? | Yes | 204 (44%) | 14 (32%) | 190 (46%) | 0.116 |
| Student | 100 (22%) | 6 (14%) | 94 (23%) | | |
| Staff | 8 (2%) | 1 (2%) | 7 (2%) | | |
| Friend of a student | 34 (7%) | 1 (2%) | 33 (8%) | | |
| Family member of a student | 88 (19%) | 5 (11%) | 83 (20%) | | |
| Community member not related to student | 112 (24%) | 7 (16%) | 105 (25%) | | |
| Unaware of overdose | 258 (56%) | 30 (68%) | 228 (55%) | |
Bold formatting indicates p‑values that are statistically significant.
*A t-test was used to evaluate an association between the nurse-to-student ratio and naloxone availability. All other associations were evaluated using chi-squared or Fisher’s exact tests.
Schools provided or were planning to provide naloxone training opportunities for nurses (63% in the last year, 58% planned in the next year), administrators (49%, 52%), and teachers (39%, 47%). Few schools provided (6%) or planned to provide (10%) naloxone training opportunities for students (Supplemental Table 1).
Naloxone Availability & Accessibility
Most nurses (90%) reported their school stocked naloxone. Elementary schools were less likely than middle/high schools to stock naloxone; other school characteristics were not associated with school naloxone availability (Table 1).
Schools typically stocked 1-2 doses (49%) of intranasal naloxone (98%) in the nurses’ office (80%) and/or a secure and unlocked unit (43%). Nurses reported that naloxone could be administered to non-students (89%) and before or after school (72%). Although almost all the school nurses (96%) reported naloxone was readily available to respond to an overdose emergency anywhere on campus, 37% reported restrictions on who was allowed to access and administer naloxone (Table 2). In 12% of schools, only nurses were trained to access and administer naloxone; less than half of surveyed nurses reported their school allowed teachers (46%), school security (43%), and sports coaches (38%) to administer naloxone (Supplemental Table 1). School naloxone doses were typically funded by the state or county Department of Public Health (35%) or school budget (14%).
Table 2.
School Naloxone Accessibility in Schools With Available Naloxone (N=418)
| Variable | Response categories | N (%) |
|---|---|---|
| Do all schools in your district stock naloxone? | Yes | 364 (87%) |
| No | 32 (8%) | |
| I don’t know | 22 (5%) | |
| Naloxone Formulation | IM | 1 (0%) |
| Intranasal | 409 (98%) | |
| Both | 8 (2%) | |
| How many doses of naloxone are currently in your school building? | 1-2 doses | 206 (49%) |
| 3-4 doses | 96 (23%) | |
| 5-6 doses | 42 (10%) | |
| 7-10 doses | 24 (6%) | |
| >10 doses | 50 (12%) | |
| Is it possible to promptly administer school-supplied rescue naloxone anywhere on campus? | Yes | 402 (96%) |
| Is naloxone accessible for administration to non-students (i.e., staff, visitors, etc.)? | Yes | 373 (89%) |
| No | 33 (8%) | |
| I don’t know | 12 (3%) | |
| Is the naloxone available for before/after school events and school sponsored events? | Yes | 299 (72%) |
| No | 107 (26%) | |
| I don’t know | 12 (3%) | |
| Are there restrictions on who is allowed to access and administer school naloxone in your school? | Yes | 153 (37%) |
| No | 198 (47%) | |
| I don’t know | 67 (16%) | |
| Where is the naloxone stored? | Nurse Office | 336 (80%) |
| Front Office | 76 (18%) | |
| Athletic Trainer Office | 39 (9%) | |
| Classrooms | 7 (2%) | |
| In a secure, unlocked unit | 178 (43%) | |
| Bathrooms | 0 | |
| Other | 63 (15%) | |
| I don’t know | 1 (0%) |
Barriers & Facilitators to Naloxone Availability
Nurses from schools that stocked naloxone (n=418) described available staff training (65%), administration (66%) and employee (59%) perceived need, and state laws requiring naloxone (44%) as facilitators of naloxone availability (Figure 1). Reported additional facilitators included concerns about community youth overdoses (“community overdoses include students in neighboring school districts”), external sources of naloxone (“state grant program”, “a community partner”), and presence of school champions (e.g., nurses, school resource officers). Nurses from schools without available naloxone (n=44) described the lack of funding (41%), state laws (32%), and support from administrators (45%), parents (38%), and employees (34%) as barriers. Notably, few reported that employee (14%) or administration (9%) misconceptions that naloxone would encourage student substance use were a barrier (Figure 1). Reported additional barriers included a perception that naloxone was unnecessary (“Our school population consists only of students with significant special education needs, therefore initiation of drug use is essentially non-existent”) and need for multi-faceted supports (“Funding, advocacy, education, training”).
Figure 1.
Facilitators (n=418) to stocked naloxone reported by school nurse respondents working at schools with naloxone and barriers (n=44) to stocked naloxone reported by school nurse respondents working at schools without naloxone
Discussion
To our knowledge, this is the first national study of naloxone availability, accessibility, and related training for staff and students in schools. Our cross-sectional descriptive study of U.S. school nurses revealed high naloxone availability with 90% of nurses reporting their school stocks the medication. Strikingly, almost 1 in 5 nurses reported prior naloxone administration on their school’s campus, which is higher than that reported in prior studies of high school personnel and was frequently cited by nurses as a facilitator of naloxone availability. 24 However, few schools stored naloxone in spaces outside the nurse’s office and over a third restricted who was allowed to access and administer naloxone, raising questions about rapid naloxone accessibility in the event of an emergency. Furthermore, schools are missing valuable opportunities to prepare students and non-nursing staff to respond to overdoses that occur outside of schools.
Limitations on naloxone accessibility in the form of storage and administration restrictions are problematic given 11% of nurses reported prior opioid overdose on campus and 18% reported naloxone was previously administered on campus. For example, in large schools, storing naloxone outside of the nurses’ offices may facilitate use in an emergency that occurs across campus or during before- or after-school activities. Available school-based training for non-medical personnel, which was not available at many schools, could also improve timely responses to overdose emergencies when a school nurse is unavailable or delayed in responding. Training non-medical personnel is crucial for overdose prevention given that a third (34%) of U.S. public schools do not have a full-time nurse, 6% have no nurse coverage, and studies suggest up to a third of anaphylaxis events at schools were not treated by a school nurse.25,26 Furthermore, staff training was a commonly-reported facilitator among nurses reporting available naloxone, and lack thereof was a barrier among nurses without available naloxone. Other studies have found that overdose response didactic and hands-on experiential learning for non-medical school personnel improves knowledge and confidence in recognizing and responding to an overdose.24,27
Education of Students
Concerningly, few nurses indicated their school allowed students to carry their own naloxone, and only 1 in 10 nurses reported their school trained or planned to train students about naloxone despite 22% of nurses reporting prior overdose of a student off campus in the community. This represents a missed opportunity to integrate universal overdose prevention and naloxone education for youth into existing emergency response and health curricula, which could be a potentially efficacious public health strategy to prevent overdose deaths. 28 Youth may encounter overdose off campus as most adolescent and adult overdose deaths occur at home; 759,000 youth lost a parent to overdose between 1999 and 2020.2,29 Naloxone education that builds overdose response knowledge, confidence, and skills is necessary to prepare youth to respond to overdoses in their schools, homes, and communities. 27 Education could also improve youth access to naloxone, which is associated with decreased youth opioid use, by improving awareness of naloxone access laws, addressing misconceptions about naloxone dispensing to minors, and potentially distributing naloxone. 30 Although naloxone access and administration is a crucial component of overdose response, education should also include other evidence-based strategies to minimize substance-related harm and prevent over-intoxication or overdose given youth are exposed to a rapidly evolving and increasingly dangerous drug supply.2-4
Previously evaluated naloxone curricula for youth utilize didactics, case scenarios, and role-play that can be easily implemented in multiple settings. 27 Technological strategies, such as virtual reality trainings, may be efficacious and particularly appealing to youth. 31 Notably, the American Heart Association and American Society of Anesthesiologists recommend integrating naloxone education into CPR and automated external defibrillator (AED) training for schoolchildren, which is required training in 43 states and the District of Columbia and recommended by the World Health Organization for all children.32-34 The addition of naloxone training to pre-existing curricula may help address staffing, time, and funding barriers. Involvement of adolescent stakeholders will be critical to the successful design and implementation of new curricula in the domain of overdose prevention and response.
Public Health Implications
Over half of nurses from schools with available naloxone reported that available funding (51%) and administration (66%) and employee (59%) perceived need for available naloxone were important facilitators. These findings provide important context and targets for potential public health interventions and legislation to improve naloxone availability and training in school settings. The need for funding is concerning given recent changes in federal funding for addiction treatment and prevention strategies. In 2023, three pieces of federal legislation were introduced to use grant funding to incentivize naloxone availability in schools: the School Access to Naloxone Act of 2023 (S.2946, H.R.3065) and the proposed Stop Overdose in Schools Act (H.R.5652) would provide schools grants to maintain naloxone, while the Helping Educators Respond to Overdoses (HERO) Act (H.R.6251) would fund the development and implementation of overdose prevention curricula for students and community members in addition to the purchase of opioid overdose reversal agents.6-9 However, none of these laws have been passed, and the recent withdrawal of funds supporting addiction treatment and prevention of substance-related consequences suggests federal funding for school naloxone may remain difficult to attain. 35 State-level funding may be more feasibly attained, particularly as states independently determine how to use opioid settlement funds.
In this political and funding climate, understanding the need for naloxone and overdose prevention education is particularly important to improve naloxone availability, accessibility, and education in schools. Nurses in this study reported the frequent need for naloxone administration on school campuses. Public health communication about rising adolescent overdose deaths could improve school administration, employee, and parent perceptions around the need for naloxone in schools. Furthermore, the systematic collection and sharing of information about naloxone availability, school overdoses, and naloxone administration would provide crucial opportunities to define a naloxone accessibility index and facilitate multivariate analyses. Such analyses should evaluate potential geographic, socioeconomic, racial and ethnic inequities that have been described in rates of overdose death and bystander response to cardiac arrest.36,37 Findings could be used to inform relevant education and public health personnel, tailor accessibility to ensure naloxone is immediately available in an emergency, and advocate for necessary funding.
Limitations
Our study has some limitations. First, nonresponse bias limits generalizability and likely contributed to the overrepresentation of nurses from schools with available naloxone who were knowledgeable about overdose response. Surveys are also subject to sampling bias, and we lack details on NASN’s random sampling procedure. However, the response rate is comparable to studies using similar recruitment methods, demographics of included nurses are similar to other studies of NASN members,25,38 and the predominance of nurses reporting available school naloxone provided an opportunity to more thoroughly describe accessibility and facilitators in schools with naloxone. Second, this descriptive study was meant to generate hypotheses for future work, and we therefore did not develop a priori hypotheses about naloxone availability and accessibility to test in comparative analyses. Furthermore, we lacked sufficient information about schools and their experiences with overdose to operationalize a comprehensive index of naloxone accessibility, which merits future study. Third, the survey only assessed barriers in schools without naloxone access. Given the small proportion of schools without naloxone, we were limited in understanding barriers. Forth, a validated survey tool was unavailable given the nascent literature on this topic. However, we used pilot testing and cognitive interviews with school nurses to refine our survey prior to distribution. Fifth, we did not ask nurses working in multiple schools or grades to specify differences in naloxone accessibility, education, and student access by grade. While naloxone access is likely appropriate in all schools in case of an emergency involving staff or students, future studies and policies should consider the ideal age for naloxone education. There is also a need to describe school policies around students carrying naloxone. Sixth, the survey did not capture other relevant perspectives, such as those of school administrators, students, and students’ family members. However, school nurses have a unique perspective on logistical facilitators and barriers to naloxone access, important roles in implementing emergency response and disease prevention strategies, and potential opportunities to advocate for and create policies related to student health.11,12,17
Conclusions & Future Directions
Our descriptive results contribute to the currently nascent literature on how nurses and schools approach naloxone availability and accessibility and have important implications for the development of school-based interventions. This is particularly important as youth overdose deaths remain elevated and states consider legislation allowing schools to maintain naloxone and/or equip students.39,40 The widespread presence of naloxone reported by school nurses in their schools indicates promise for normalizing overdose preparedness. Additional research to define naloxone accessibility, funding to support availability and training efforts, standardization of policies guiding how students can carry naloxone, and advocacy for youth education is required to ensure naloxone is available in all schools, accessible when emergencies occur, and effectively utilized by youth educated about overdose prevention. Such strategies are crucial to prevent further adolescent overdose deaths.
Supplemental Material
Supplemental material for Naloxone Access in Schools: A National Survey of School Nurses in the United States by Jessica B. Calihan, Maria Christina Herrera, Samara Jinks-Chang, J. Deanna Wilson, Catherine C. McDonald, Nadia Dowshen, Chlo-Anne Bobrowski, E. Jennifer Edelman and Sarah M. Bagley in Substance Use: Research and Treatment.
Supplemental material for Naloxone Access in Schools: A National Survey of School Nurses in the United States by Jessica B. Calihan, Maria Christina Herrera, Samara Jinks-Chang, J. Deanna Wilson, Catherine C. McDonald, Nadia Dowshen, Chlo-Anne Bobrowski, E. Jennifer Edelman and Sarah M. Bagley in Substance Use: Research and Treatment.
Supplemental material for Naloxone Access in Schools: A National Survey of School Nurses in the United States by Jessica B. Calihan, Maria Christina Herrera, Samara Jinks-Chang, J. Deanna Wilson, Catherine C. McDonald, Nadia Dowshen, Chlo-Anne Bobrowski, E. Jennifer Edelman and Sarah M. Bagley in Substance Use: Research and Treatment.
Acknowledgements
Dr. Herrera was supported as a Yale Drug use, Addiction and HIV prevention Research Scholar (DAHRS), and Dr. Edelman is supported as a Yale DAHRS faculty member (NIDA, 5K12DA033312-12). Dr. Herrera is supported by a NIDA career development award (K23DA067328). Dr. Calihan is supported by HRSA NRSA (T32HP10028). Dr. Jinks-Chang is supported as a Children’s Hospital of Philadelphia Presidential Research Scholar. Dr. Wilson is supported by NIDA career development award (K23 DA048987). Dr. McDonald is funded by the Center for Disease Control and Prevention under Award R49CE003566. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Center for Disease Control and Prevention. The authors are grateful to the National Association of School Nurses for providing access to their membership research mailing list, the school nurses who participated in cognitive interviews to pilot tested the survey tool, and the research participants.
Author Contributions: JBC and MCH contributed equally to this work and were equally supervised by EJE and SMB. JBC, MCH, SJC, JDW, CCM, CAB, EJE, and SMB contributed to conceptualization and methodology; CAB contributed to conceptualization. ND provided funding acquisition. MCH and JBC wrote the original draft, and all authors reviewed, edited, and approved the final manuscript.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material: Supplemental material for this article is available online.
ORCID iD
Maria Christina Herrera https://orcid.org/0000-0001-9261-0540
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Supplementary Materials
Supplemental material for Naloxone Access in Schools: A National Survey of School Nurses in the United States by Jessica B. Calihan, Maria Christina Herrera, Samara Jinks-Chang, J. Deanna Wilson, Catherine C. McDonald, Nadia Dowshen, Chlo-Anne Bobrowski, E. Jennifer Edelman and Sarah M. Bagley in Substance Use: Research and Treatment.
Supplemental material for Naloxone Access in Schools: A National Survey of School Nurses in the United States by Jessica B. Calihan, Maria Christina Herrera, Samara Jinks-Chang, J. Deanna Wilson, Catherine C. McDonald, Nadia Dowshen, Chlo-Anne Bobrowski, E. Jennifer Edelman and Sarah M. Bagley in Substance Use: Research and Treatment.
Supplemental material for Naloxone Access in Schools: A National Survey of School Nurses in the United States by Jessica B. Calihan, Maria Christina Herrera, Samara Jinks-Chang, J. Deanna Wilson, Catherine C. McDonald, Nadia Dowshen, Chlo-Anne Bobrowski, E. Jennifer Edelman and Sarah M. Bagley in Substance Use: Research and Treatment.