Prescribing Nasal Naloxone in Pediatrics: A Clinical Perspective on Reducing Overdose Deaths

Adolescents continue to be at increased risk for fatal opioid overdoses, driven by the widespread presence of illicitly manufactured fentanyl. Naloxone, a lifesaving opioid antagonist and an effective overdose reversal agent, remains underutilized in pediatric and adolescent populations. This clinical perspective addresses gaps in naloxone accessibility, common barriers that prevent clinicians from prescribing it, and solutions to overcome these barriers by presenting and discussing a case study of a 16-year-old girl suspended for carrying nasal naloxone to school. Our objectives are to (1) outline clinical recommendations for identifying at-risk adolescents who should be prescribed naloxone, emphasizing its utility for adolescents using opioids or other substances and those with social connections to individuals engaging in substance use; (2) review common school policies that place naloxone in nurses’ stations and the impracticality of retrieving it in emergencies; and (3) provide evidence debunking the myth that naloxone access encourages substance use and propose advocacy strategies for clinicians to navigate restrictive school policies and community stigma. This clinical perspective also touches on the ethical considerations surrounding adolescent confidentiality laws, which may limit naloxone prescribing in cases where parental consent is unattainable. Several actionable solutions are discussed, including prescribing naloxone universally with comprehensive education on its benefits and safety profile. By equipping clinicians with evidence-based strategies and advocacy tools, this article aims to enhance the accessibility of naloxone for adolescents, reducing the tragic toll of opioid overdoses.