National review of state laws on opioid antagonists in Kindergarten-12th grade schools across the United States

BACKGROUND: Opioid overdoses have surged among United States (US) youth, who face high risk of morbidity and mortality. Opioid antagonists (OAs), like naloxone, are life-saving medications that can reverse overdoses. For youth, schools can be key venues for harm reduction. As states enact laws governing OAs in schools, it is important to understand how states permit schools to manage and respond to emergencies with this medication. This study's objective was to examine statutes on OAs in Kindergarten-12th grade schools to identify and compare key legislative components across states. METHODS: This national review analyzed US state laws on OAs in K-12 schools enacted by December 31, 2024. A search of statutes was conducted using Nexis Uni. Team members iteratively reviewed each statute to identify components and extract relevant language. Discrepancies were resolved through discussion. Findings were summarized and reviewed with experts in school health, addiction, and harm reduction for validity. RESULTS: Thirty-eight states have laws on OAs in K-12 schools. Nine states (24%) mandate a supply of OAs to be available in schools, while eight states (21%) require policies to be adopted for school systems to have OAs. State laws vary in terms of components. State laws commonly define OA (n = 24, 63%) and specify school types and/or levels (n = 35, 92%). Most states detail individual(s) who may administer OAs in school settings (n = 34, 89%) and training on OAs (n = 25, 66%). More than half of states detail acquisition (n = 22, 58%) and inventory logistics (n = 21, 55%). Few state laws include incident response post-administration (n = 9, 24%), reporting of administration (n = 8, 21%), and parental involvement (n = 5, 13%). Lastly, most states include immunity (n = 32, 84%) protecting school systems and/or individuals who provide or administer OAs. CONCLUSION: This study found most states have laws on OAs in K-12 schools with variation in specific language. Such variability in state legislation contributes to varied implementation in school, which may affect accessibility to OAs and response to overdose emergencies in schools. If implemented effectively, such legislation has potential to promote harm reduction and reduce opioid overdoses among youth.