3424-P – Opioid-Related Overdose Reversal Procedure
An opioid overdose requires immediate medical attention. It is essential to initiate emergency medical services for medical assessment and support.
Opioid overdose reversal medication and rescue breathing are evidence-based interventions known to result in positive outcomes for individuals experiencing an opioid-related overdose. The NWESD 189 shall utilize the Opioid Overdose Reversal Policy and Training Guidelines for Schools published by the Office of the Superintendent of Public Instruction.
Opioids and Overdose
Opioids are a class of drugs derived from the opium poppy or entirely created in a lab. Opioids include morphine, codeine, oxycodone, hydrocodone, hydromorphone, heroin, meperidine, fentanyl, and methadone. There are prescription opioids and opioids that are created and obtained illicitly.
An opioid overdose happens when someone has taken too much of an opioid. Synthetic opioids such as Fentanyl are especially dangerous due to their potency and are often found in a wide variety of forms including counterfeit pills and in illicit drugs. A person under the influence of opioids may experience nausea, vomiting, or sleepiness which are not immediately life-threatening. An overdose is life-threatening when a person stops breathing or they experience inconsistent breathing, loss of consciousness, slowed or irregular heartbeat, or severe allergic reaction.
Risk factors for an opioid overdose include:
- Mixing opioids with other substances including benzodiazepines or alcohol
- Using after a break in use due to decreased tolerance
- Taking too many opioids
- Other health conditions
- Previous overdose
- Using opioids not from a pharmacy because the strength is unknown
- Using alone (increases risk of dying from an overdose)
Those who overdose rarely experience sudden breathing cessation. There is usually enough time to intervene before breathing completely stops and death occurs. Opioid overdose reversal medication and rescue breathing are evidence-based intervention outcomes for individuals experiencing an opioid overdose.
An opioid high presents differently than an opioid overdose.
| Opioid High | Opioid Overdose |
| Normal skin tone | Pale, clammy skin Blue or purple lips or fingernails for person with light complexion and white or ashy lips and fingernails for person with dark complexion |
| Breathing appears normal | Infrequent, shallow, or absent breathing Respiratory rate less than 8 breaths per minute |
| Normal heart rate | Slow or irregular heartbeat |
| Looks sleepy | Unconscious or unable to wake |
| Speech slurred or slow | Deep snoring, gurgling, or choking sounds (death rattle) |
| Responsive to stimuli | Not responsive to stimuli |
| Pinpoint pupils (with some exceptions) | Pinpoint pupils |
Opioid Overdose Response
Opioid overdose reversal medication and rescue breathing are evidence-based interventions for individuals experiencing an opioid overdose. In the case of an opioid overdose, naloxone should be administered without delay to restore breathing and improve the person’s chances of survival.
Naloxone is effective only if there are opioids involved in the overdose. Naloxone will not reverse an overdose involving alcohol, benzodiazepines, methamphetamines, or cocaine. The NWESD 189 shall follow the Washington Department of Health’s steps for administering naloxone for drug overdose. (https://www.doh.wa.gov/Portals/1/Documents/Pubs/150-126-NaloxoneInstructions.pdf)
Assessing an individual for responsiveness and breathing is critical to a successful outcome for a person experiencing an opioid overdose. A few quick ways to determine this are:
- Shout their name and shake them
- Rub knuckles hard on the breastbone in the middle of the chest or on the upper lip of the individual.
If the person responds to the stimuli, assume an overdose has not yet occurred but may continue to progress. Emergency medical services should be notified. Remain with the individual and monitor for responsiveness and continued breathing until help arrives. It is important to monitor the person and try to keep the individual awake and alert. If the person does not respond to hearing their name, being shook, or having knuckles rubbed on their breastbone or upper lip, assume they may be experiencing an opioid overdose and administer naloxone per standing order and prescription.
According to American Heart Association guidelines in response to a suspected overdose, an AED should be brought and used to rule out shockable rhythm for a victim who is not breathing/not breathing normally.
All NWESD Cooperative Programs are expected to activate emergency medical services in case of a suspected overdose.
An opioid overdose requires immediate medical attention. It is essential to have a trained medical professional assess the condition of a person experiencing an overdose. All cooperative programs are expected to activate emergency medical services in an expected case of an overdose. Naloxone is effective only if there are opioids involved in the overdose. Naloxone will not reverse an overdose involving alcohol, benzodiazepines, or cocaine.
Washington’s Good Samaritan Law provides some protections when calling 911 to save a life, even if drugs are at the scene according to RCW 69.50.315. The victim and person calling 911 cannot be prosecuted for simple possession.
Obtaining and Maintaining Opioid Overdose Medication
If a statewide standing order for intranasal or auto-injection intramuscular forms of naloxone is available, the NWESD 189 will obtain and maintain those forms of opioid overdose reversal medication exclusively.
The NWESD 189 may seek to obtain opioid overdose reversal medication through donations from manufacturers, non-profit organizations, hospitals, and local health jurisdictions. The NWESD 189 will seek at least one set of opioid reversal medication doses for each of its cooperative programs. However, if the NWESD 189 documents a good faith effort to obtain and maintain opioid overdose reversal medication through a donation source, and is unable to do so, the NWESD is exempt from the obligation to have a set of opioid reversal medication doses for each cooperative program. The NWESD 189 must maintain written documentation of its good faith effort to obtain opioid overdose reversal medication from these sources.
A program administrator at each cooperative program shall ensure that the opioid overdose reversal medication is stored safely and consistently with the manufacturer’s guidelines. Program administrators will also make sure that an adequate inventory of opioid overdose reversal medication is maintained with reasonably projected demands. Medication should be routinely assessed to ensure enough time for reacquiring the medication prior to the expiration date.
Opioid overdose reversal medication shall be clearly labeled in an unlocked, easily accessible cabinet in a supervised location. Consider storing opioid overdose reversal medication in the same location as other rescue medications. Expiration dates should be documented on an appropriate log a minimum of two times per year. Additional materials (e.g. instructions for administering opioid overdose reversal medication, barrier masks, gloves, etc.) associated with responding to an individual with a suspected opioid overdose can be stored with the medication.
Training
Cooperative Program-based health centers are responsible for training their personnel.
The NWESD 189 will ensure each cooperative program has at least one personnel member who can distribute or administer opioid overdose reversal medication. Personnel certified in first aid/CPR should be prioritized for designation and training for administration of opioid overdose reversal medication. Training for designated trained responders will occur annually prior to the beginning of each school year and throughout the school year as needed. Training may take place through a variety of platforms, including online or in person.
Training may be offered by nonprofit organizations, higher education institutions, or local public health agencies. A licensed registered professional nurse who is employed or contracted by the NWESD 189 may train the designated trained responders on the administration of the opioid overdose reversal medication consistent with OSPI’s guidelines and this policy/procedure.
Training for designated personnel will include:
- NWESD 189 policy and procedure
- What are opioids
- What is an opioid overdose
- Other types of overdoses
- Signs and symptoms of an overdose
- Actions to take when a suspected opioid overdose occurs
- Naloxone access points in the cooperative program sites
- Reporting requirements
- Skill practice
- Good Samaritan law
The NWESD 189 will maintain a log of all designated trained responders for each cooperative program. The log will include a list of all persons who are designated trained responders, a list of their trainings with the date and location of the training and the name of the trainer.
Individuals who have been directly prescribed opioid overdose reversal medication according to RCW 69.41.095 lawfully possess and administer opioid overdose reversal medication, based on their personal prescription. Individuals may also acquire over-the-counter opioid overdose reversal medications. Such “self-carrying” individuals must either show proof of training as verified by a licensed registered professional nurse employed or contracted by the NWESD 189 or participate in NWESD 189 training. These self-carrying individuals do not count toward the designated trained responders at each cooperative program.
Student Possession of Opioid Overdose Reversal Medication “Self-carry”
Administration of the NWESD 189’s opioid overdose reversal medication will be performed by designated, trained, NWESD 189 personnel when needed. However, “RCW 69.41.095 allows for “any person” (including students) to lawfully possess, store, deliver, distribute, and administer an opioid overdose reversal medication that has been properly prescribed and/or authorized. The board further recognizes that:
- incidences of opioid overdoses are increasing in communities and schools,
- naloxone is highly unlikely to cause harm if administered when not needed,
- students may carry naloxone at school in order to have access to it outside of school, and
- delay in administering naloxone for suspected overdose or delay activating emergency medical services could cause severe harm.
Therefore, neither the NWESD 189 nor its cooperative programs will pursue disciplinary action for students solely for possession or good faith administration of naloxone. Naloxone will not be confiscated from students who are found to have it in their possession at cooperative programs sites and sponsored events.
Students who exhibit concern for the risk of overdose for themselves or others shall be counseled on the availability of behavioral health supports and instructed of the NWESD 189 policy and procedure for opioid overdose response. The importance of summoning adult help and emergency services for any suspected overdose must be emphasized.
Post-incident Follow-up
The NWESD 189 will provide student and personnel support within a one to two days after a suspected overdose incident. Supports may include critical incident stress debriefing, Flight team, postvention, or other support and prevention measures. Considerations for continued prevention and wellness promotion are also recommended.
Liability
The NWESD 189’s and practitioner’s liability is limited as described in RCW 69.41.095.
First Reading: 05/23/2022
Second Reading: 06/21/2022
Revised: June 16, 2025
Date Revised: 6/16/2025