A 13-year-old student stumbles and slurs over her words as she is taken to her school’s nurse’s office. Her skin is pale and clammy, her eyes roll back and a white foam drips from her mouth.
A school nurse inserts the plastic nozzle of a nasal spray device into her nostril and pushes down on the plunger, releasing a dose of naloxone — a drug used to reverse opioid overdoses.
Soon, the girl appears responsive and alert before paramedics arrive to take her to the emergency room.
Incidents such as this one – described in school medication administration records obtained by El Paso Matters under the Texas open records law – are something most school staff hope they never have to encounter. But they have become a growing reality amid a nationwide opioid crisis fueled primarily by the rise in illicitly manufactured fentanyl. The drug is up to 50 times stronger than heroin and 100 times stronger than morphine, making even a seemingly small amount deadly.
Since 2022, 15 students from El Paso’s three largest school districts have been given naloxone for a suspected overdose on school grounds, some of whom were as young as 13, according to school medication administration records.
Schools all over Texas have been stocking up on the life-saving drug after lawmakers passed Senate Bill 629 during the 2023 legislative session, which requires all middle and high schools to carry naloxone — known by the brand name Narcan.
Narcan is a nasal spray that can reverse the effects of fentanyl overdose. (Corrie Boudreaux/El Paso Matters)
The law also requires Texas schools to develop a policy on storing, administering and disposing of the drug, and have at least one staff member trained to use it at all times.
The El Paso, Socorro and Ysleta school districts have gone beyond the state’s requirements and began stocking their elementary schools with naloxone, in addition to their secondary campuses.
“The idea is that it’s not just going to be for students. We want to have it if there’s a visitor or if there’s staff that needs it. It doesn’t matter who might have the accidental overdose,” said Norma Luna, director of health services at the El Paso Independent School District.
Since 2022, 15 students from El Paso’s three largest school districts have been given naloxone for a suspected overdose on school grounds.
Source: School medication administration records.
The Ysleta Independent School District partnered with Aliviane, a local nonprofit that offers addiction prevention and rehabilitation services, to train employees on how to use the drug. It also made naloxone administration classes a part of its yearly training for all its employees starting the 2024-25 school year.
“I’m very glad that the school districts are on board and that Narcan is not stigmatized within the schools; that they are aware that this is something very serious. At any given time, at any place an overdose can happen,” said Cynthia Monson, a peer support specialist with Emergence Health Network and mother to three boys.
Monson, 40, who has been sober from a heroin addiction for 16 years, said she worries her sons may one day become curious about taking drugs.
“I’m on the edge, you know. I was once that young and that’s when I started experimenting with substances and it’s scary, especially right now that we’re seeing a lot of fentanyl,” Monson said.
Peer Support Specialist and Community Health Worker for Emergence Health Network Cynthia Monson distrubutes naloxone, a drug used to reverse opiode overdoses. (Courteys: Emergence Health Network)
In 2023, three teens in El Paso younger than 18 died due to an opioid-related drug overdose that involved fentanyl, according to data from the El Paso County Medical Examiner’s Office obtained by El Paso Matters.
That same year, the West Texas Regional Poison Center managed 14 cases where a teen between the ages of 14 and 18 intentionally took some form of opiate and needed emergency care.
Throughout Texas, 56 children younger than 18 died from an opiate-related overdose in 2022, 53 of which involved fentanyl, according to the most recent data from the Texas Department of Health and Human Services.
Though SB 629 went into effect in January, some El Paso schools already had naloxone available for students and have had to use it.
EPISD and YISD started carrying naloxone at its middle and high schools in fall 2022, before expanding to all their campuses.
Records show the Socorro Independent School District had the drug at some of its campuses as early as 2020.
Handling overdoses in schools
Texas school policies allow trained staff to give students naloxone if they show symptoms of an opioid overdose, such as shallow breathing, becoming unconscious and fingernails or skin turning blue or purple.
“Any time an overdose is suspected, 911 is called. Now that we do have Narcan available and trained staff administers it, and then whoever’s trained can perform rescue breathing and CPR is needed while they’re waiting for EMS to arrive,” said YISD Director of Student Health Services Sylvia Belmontes.
Records show that there were at least seven instances where an El Paso student was given naloxone for a suspected opioid overdose during the 2023-24 school year, three of which happened in a middle school. Four were at an EPISD school, two were at SISD and one was at YISD.
Records show at least seven instances where an El Paso student was given naloxone for a suspected opioid overdose during the 2023-24 school year – three of which happened in a middle school.
The previous school year, there were eight of these incidents, with only one occurring in a middle school. Three were from EPISD, one was from SISD and four were from YISD.
Prior to that, there was a single instance of an SISD high school student who was given naloxone reported in February 2020.
Before schools had the drug available, students experiencing an overdose had to wait for paramedics to arrive to receive a dose of the life-saving drug.
Opiates such as heroin, oxycodone and fentanyl affect the part of the brain that regulates breathing and can lead to respiratory depression and low oxygen levels during an overdose.
Naloxone works by attaching itself to opiate receptors in the brain, reversing and blocking the effects of opioids for a short time and allowing the person to breathe normally.
Michelle Millen of Aliviane explains how Narcan can reverse the effects of fentanyl overdose to Ysleta ISD employees during a training on using Narcan, May 6, 2024. (Corrie Boudreaux/El Paso Matters)
“Our emergency services are very quick, but we know that within three to five minutes that our brain doesn’t have oxygen damage starts to occur. So at least Narcan helps us restore a person’s breathing and hopefully preserve brain function, and increase their chances,” Belmontes said.
Still, naloxone will not work if a person is overdosing on any other kind of substance or is experiencing a medical emergency.
Luna said it’s likely some of the students who were given naloxone were not experiencing an opioid overdose, but school officials don’t usually have a way of getting those details.
“If someone goes to the ER they don’t normally send us a report back unless the parent brings it because they want to,” Luna said.
Records provided by YISD show at least one instance when a student was given naloxone and had no response. The student was taken to a hospital, but the school records don’t show any details beyond that.
EPISD and SISD did not provide students’ responses to naloxone in their drug administration records.
Experts and health organizations say it’s better to air on the side of caution and give naloxone to anyone showing symptoms of an opioid overdose.
Chief Medical Officer of Outpatient Medical and Addiction Services at Emergence Health Network, Dr. Wayne Thornburg. (Courtesy: Emergence Health Network)
“They need to understand what they’re trying to look for, and at what level they determine to give Narcan. If the person that they’re trying to treat can’t communicate with them logically or cognitively, then you could administer the medication because you don’t know how far it’s going to go the other direction if you don’t administer it,” Dr. Wayne Thornburg, chief medical officer of outpatient medical and addiction services at Emergence Health Network, told El Paso Matters.
Fentanyl reaching young El Pasoans
As fentanyl-related deaths increased in El Paso, so did the number of youth overdoses.
The El Paso County Medical Examiner’s Office reported some of the first fentanyl-related deaths in 2015 and 2016. No children died of a drug overdose in El Paso County in those years.
By 2020, 45 El Pasoans died from a fentanyl-related overdose, two of whom were younger than 18. Since then, two to three El Paso children have died from fentanyl poisoning a year, while the number among adults continues to rise.
In 2021, the West Texas Regional Poison Center managed 26 cases in El Paso County where a teen between the ages of 14 and 18 intentionally took some form of opiate and needed emergency care, Director of the West Texas Regional Poison Center Salvador Baeza said. The center managed another 17 cases in 2022, 14 in 2023, and eight in 2024 through June.
Baeza said data is still limited without a way to find out exactly what drug a child took if they are hospitalized for an opiate-related overdose.
“Our hospital drug screenings aren’t designed for fentanyl,” Baeza said. “Fentanyl overdose looks just like a heroin overdose so we treat them the same. But the bigger issue is we don’t have the data or the statistics.”
How is this happening?
When criminal drug manufacturers learned fentanyl was cheaper to make and easier to transport than traditional opiates, they began finding ways to profit from their discovery.
“Initially, you would find fentanyl, as you know, in the heroin supply, but then the cartel started making counterfeit pills that looked like oxycodone, Percocet, even the Xani bars,” Baeza said. “Now we have rainbow fentanyl. So they’re not even trying to make it look like the product that they were counterfeiting.”
As these drugs make their way through the black market, they sometimes find themselves in the hands of children and teens.
Monson — who tried heroin for the first time when she was 15-years-old — said that while youths often experiment with drugs out of curiosity and peer pressure, many also begin using them as a way to deal with mental health issues.
Peer Support Specialist and Community Health Worker for Emergence Health Network Cynthia Monson. (Courteys: Emergence Health Network)
“Sometimes individuals have gone through trauma and use substances as a coping mechanism because of what they’re feeling,” Monson said. “I realized certain things had happened that led me to have depression at a very young age. I didn’t know I had depression at that time, and that is exactly what led me to turn to substances. It was always curiosity, the friends thinking I was cool, but I was also experiencing depression.”
Monson said she is open with her sons about her past, hoping that they learn from her experience.
Thornburg said there are several reasons why a young person may become interested in drugs, but there are also factors that can also help deter them.
“Communication with your family is critical,” Thornburg said. “The environment that you live in is critical, the relationship that you have with your friends and peers, coping skills and all of those things are really important for children to develop good habits and not use drugs, or at least not want to potentially take the risk of the exposure.”
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