HB 5244 — AN ACT CONCERNING THE PROVISION OF OPIOID ANTAGONISTS IN SCHOOLS.

No school nurse or qualified school employee shall administer such opioid antagonist under this subdivision unless such school nurse or qualified school employee annuallyhas completescompleted training in the distribution and administration of an opioid antagonist under an agreement entered into pursuant to section 21a-286.21a-286 or any such training offered by the Department of Public Health.

The parent or guardian of a student may submit a request, in writing, to the school nurse and schoolsHB5244 medical/ advisor,File ifNo. any, that an opioid antagonist shall not be administered to such student under this subdivision.

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126 school medical advisor, if any, that an opioid antagonist shall not be administered to such student under this subdivision.

Sec.

2.

(NEW) (Effective from passage) For the fiscal year ending June 30, 2023, and each fiscal year thereafter, the Department of Education shall provide grants to local and regional boards of education for the acquisition and maintenance of opioid antagonists in accordance with the provisions of section 10-212a of the general statutes, as amended by this act.

A local or regional board of education may submit an application for a grant under this section at a time and in a manner prescribed by the department.

Sec.

3.

Subsection (a) of section 10-220a of the 2022 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2022):

(a) Each local or regional board of education shall provide an in- service training program for its teachers, administrators and pupil sHB5244 / File No.

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126 personnel who hold the initial educator, provisional educator or professional educator certificate.

Such program shall provide such teachers, administrators and pupil personnel with information on (1) the nature and the relationship of alcohol and drugs, as defined in subdivision (17) of section 21a-240, to health and personality development, and procedures for discouraging their abuse, (2) health and mental health risk reduction education that includes, but need not be limited to, the prevention of risk-taking behavior by children and the relationship of such behavior to substance abuse, pregnancy, sexually transmitted diseases, including HIV-infection and AIDS, as defined in section 19a-581, violence, teen dating violence, domestic violence and child abuse, (3) school violence prevention, conflict resolution, the prevention of and response to youth suicide and the identification and prevention of and response to bullying, as defined in subsection (a) of section 10-222d, except that those boards of education that implement any evidence-based model approach that is approved by the Department of Education and is consistent with subsection (c) of section 10-145a, sections 10-222d, 10-222g and 10-222h, subsection (g) of section 10-233c and sections 1 and 3 of public act 08-160, shall not be required to provide in-service training on the identification and prevention of and response to bullying, (4) cardiopulmonary resuscitation and other emergency life saving procedures, including the administration of opioid antagonists to persons who experience an opioid-related drug overdose, (5) the requirements and obligations of a mandated reporter, (6) the detection and recognition of, and evidence-based structured literacy interventions for, students with dyslexia, as defined in section 10-3d, (7) culturally responsive pedagogy and practice, including, but not limited to, the video training module relating to implicit bias and anti-bias in the hiring process in accordance with the provisions of section10-156hh, and(8)theprinciplesandpracticesofsocial-emotional learning and restorative practices.

Each local or regional board of education may allow any paraprofessional or noncertified employee to participate, on a voluntary basis, in any in-service training program provided pursuant to this section.

Sec.

4.

(NEW) (Effective from passage) (a) The Department of Children sHB5244 / File No.

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126 and Families shall conduct an instructional program that utilizes a training model that will enable participants to provide adolescent screening, brief intervention and referral to treatment training to other individuals upon completion of the instructional program.

Such instructional program shall be offered to the employees of a local health department, district department of health formed pursuant to section 19a-241 of the general statutes, youth service bureau, municipality, paid municipal or volunteer fire department, local police department and local or regional board of education.

The department shall conduct such instructional program at no charge to participants at least four times each year.

The department may conduct each such instructional program in a different geographical region of the state during the year.

(b) (1) Each local health department shall offer training in adolescent screening, brief intervention and referral to treatment free of charge to the employees of such local health department and to members of the public.

Any employee ofalocalhealthdepartment who hasparticipated in the instructional program described in subsection (a) of this section shall be the person to provide such training in adolescent screening, brief intervention and referral to treatment under this subdivision.

(2) A district department of health, youth service bureau, municipality, paid municipal or volunteer fire department, local police department or local or regional board of education may offer training in adolescent screening, brief intervention and referral to treatment free of charge to the employees of such district department of health, youth service bureau, municipality, paid municipal or volunteer fire department, local police department or local or regional board of education and to members of the public.

Any employee who has participated in the instructional program described in subsection (a) of this section shall be the person to provide such training in adolescent screening, brief intervention and referral to treatment under this subdivision.

SectionsHB5244 1/ JulyFile 1, 2022 New section LCO No.

1543126 911 ofsHB5244 10File Raised Bill No.

5244126 Section 1 from passage 10-212a Sec.

2 from passage 10-212aNew Statementsection ofSec. Purpose:

To3 provideJuly grants1, to2022 school10-220a(a) districtsSec. for the acquisition of opioid antagonists if they include training in screening, brief intervention and referral to treatment (SBIRT) to educators as part of the school district's in-service training program, and to authorize the administration of opioid antagonists in schools in emergency situations.

[Proposed4 deletionsfrom arepassage enclosedNew insection brackets.KID Joint Favorable Subst.

ProposedsHB5244 additions/ areFile indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.] LCO No.

1543126 1012 ofsHB5244 10File No.

126 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 23 $ FY 24 $ Education, Dept.;

GF - Cost 90,000 90,000 Education, Dept.

GF - Cost See Below See Below State Comptroller - Fringe GF - Cost 36,477 36,477 Benefits1 Children & Families, Dept.

GF - Cost 160,000 160,000 Note:

GF=General Fund Municipal Impact:

Municipalities Effect FY 23 $ FY 24 $ Local and Regional School STATE See Below See Below Districts MANDATE - 2 Cost/Revenue Gain Various Municipalities STATE See Below See Below MANDATE – Cost Explanation Section 1 requires the State Department of Education (SDE) by July 1, 2022, to develop guidelines for boards of education (local and regional) to use to store and administer opioid antagonists (e.g., Narcan).

This results in an additional cost to SDE of approximately 1The fringe benefit costs for most state employees are budgeted centrally in accounts administered by the Comptroller.

The estimated active employee fringe benefit cost associated with most personnel changes is 40.53% of payroll in FY 23.

2State mandate is defined in Sec.

2-32b(2) of the Connecticut General Statutes, "state mandate" means any state initiated constitutional, statutory or executive action that requires a local government to establish, expand or modify its activities in such a way as to necessitate additional expenditures from local revenues.

sHB5244 / File No.

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126 $90,000annually beginninginFY23,associatedwithoneadditionalfull- time position, as the agency does not have the staff or expertise necessary to complete the requirements contained within the bill.

Corresponding fringe benefits of $36,477 would also be incurred annually.

Additionally, Section 1 authorizes a school nurse, or in the absence of a school nurse, a qualified school employee, to maintain opioid antagonists to administer emergency first aid to a student who is experiencing an opioid-related drug overdose.

The bill requires a school nurse or principal to select multiple qualified school employees to administer an opioid antagonist, and at least one such employee must be on school grounds during regular school hours when the school nurse is not there.

This could result in additional costs to local and regional school districts if a school must pay an employee to stay additional hours outside of their normally scheduled hours, to cover the requirements of the bill.

The cost to a district would be dependent on the number of hours a school nurse is away during normal school hours and those hours are outside the normal schedule of the qualified employees.

Section 2 requires SDE to provide grants to local and regional boards of education for the purchase and maintenance of opioid antagonists, beginning in FY 23.

This results in an additional cost to SDE as the agency does not have funding available to establish this grant program.

The cost depends on the extent of the grant program.

If grants are offered to most districts that apply and many districts do, then the cost will be significant.

If, however, grant funds are limited or few districts apply, the cost will be lower.

It is estimated that on average a single dose opioid rescue kit ranges from $22 - $60 per kit .

If a district were to purchase 100 kits, the cost would range from $2,220 to $6,000.

The cost to SDE would result in a corresponding revenue gain to municipalities to cover these expenses.

3https://bjatta.bja.ojp.gov/naloxone/what-are-typical-costs-law-enforcement- overdose-response-program sHB5244 / File No.

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126 Section 3 requires boards of education to include information on administering opioid antagonists in the in-service training provided to staff.

This could result in an additional cost to local and regional school districts associated with printing and disseminating this information;

it is anticipated that these costs would be minimal.

Section 4 requires the Department of Children and Families (DCF) to provide training on adolescent screening, brief intervention, and referral to treatment for various municipal employees, effective from passage.

DCF is required to hold this training at least four times throughout the year.

This is anticipated to result in an annual cost to DCF of $160,000.

Based on similarly structured training, it is anticipated that DCF wouldconduct two trainingsfor approximately 30individuals each,every quarter.

Itisestimatedthat thecostsassociatedwithtraining approximately 60 individuals per quarter would be $40,000.

Additionally, Section 4 requires each local health department to provide the training to its employees and to members of the public, free of charge.

This training must be provided by an employee that has attended the DCF training program.

Local health departments may incur additional costs to compensate employees for time of attendance at such training and to cover their shifts while at the training.

Any costs would vary with the number of trainings offered.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

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126 OLR Bill Analysis sHB 5244 AN ACT CONCERNING THE PROVISION OF OPIOID ANTAGONISTS IN SCHOOLS.

SUMMARY This bill requires the State Department of Education (SDE) to do the following:

1.

by July 1, 2022, and in consultation with the Department of Consumer Protection and Department of Public Health (DPH), develop guidelines for boards of education (local and regional) to use to store and administer opioid antagonists (e.g., Narcan) and 2.

starting in FY 23, annually provide grants to boards of education to acquire and maintain opioid antagonists as required by the bill.

Under the bill, a board of education may apply for a grant in a time and manner prescribed by SDE.

The bill authorizes a school nurse, or in the absence of a school nurse, a qualified school employee, to maintain opioid antagonists to administer emergency first aid to a student who is experiencing an opioid-related drug overdose and does not have a prior written authorization for administering this medication.

It requires the State Board of Education (SBE), in consultation with the DPH commissioner, to adopt regulations that specify conditions and procedures for school personnel storing and administering opioid antagonists to these students.

The bill also requires boards of education to include information on administering opioid antagonists in the in-service training they must sHB5244 / File No.

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126 provide for their teachers, administrators, and other certified pupil personnel.

Lastly, the bill requires the Department of Children and Families (DCF) to conduct a free instructional program at least four times annually that teachesparticipants how to provide adolescent screening, brief intervention, and referral to treatment training to other individuals.

Local health departments must offer training in these matterstotheiremployeesandthepublic, andseveralotherentitiesmay do so, including boards of education.

EFFECTIVE DATE:

Upon passage, except for the provision requiring boards of education to include information on opioid antagonist administration in their required in-service trainings, which takes effect July 1, 2022.

§ 1 — OPIOID ANTAGONIST ADMINISTRATION School Nurse and Qualified Employee Authorization The bill allows a school nurse, or in the absence of one, a qualified school employee, to maintain opioid antagonists to administer emergency first aid to a student who is experiencing an opioid-related drug overdose but does not have prior written authorization from a parent or guardian, or a prior order from a qualified medical professional to receive this medication.

Under thebill,a schoolnurse or principalmust select qualifiedschool employees to administer an opioid antagonist and at least one of these qualified school employees must be on school grounds during regular school hours when the school nurse is not there.

A qualified school employee may only administer an opioid antagonist when the school nurse is absent or unavailable.

A school nurse or qualified school employee administering an opioid antagonist must do so in accordance with the school board’s adopted policies and procedures.

Under the bill, a school nurse or qualified school employee may not administer an opioid antagonist unless they complete training in its distribution and administration (1) under a local agreement with a sHB5244 / File No.

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126 prescriber or pharmacist (see BACKGROUND) or (2) in a training offered by DPH.

The bill prohibits schools from administering opioid antagonists to a student under these provisions if the student’s parent or guardian has stated in writing that he or she does not consent to its use.

A parent or guardian may submit this request to the school nurse or school medical advisor, if any.

Definitions By law and under the bill, an “opioid antagonist” is naloxone hydrochloride (e.g., Narcan) or any other similarly acting and equally safe drug that the Food and Drug Administration has approved for treating a drug overdose (see CGS § 17a-714a).

Under the bill, a “qualified school employee” is a principal, teacher, licensed athletic trainer, coach, school paraprofessional, or licensed physical or occupational therapist employed by a school district.

A “qualified medical professional” is a state-licensed physician, optometrist, advanced practice registered nurse, or physician assistant.

§ 4 — DCF INSTRUCTIONAL PROGRAM The bill requires DCF to conduct an instructional program using a training model that enables participants to provide adolescent screening, brief intervention, and referral to treatment training to other individuals.

DCF must offer the program to employees of:

1.

local or district health departments, 2.

youth service bureaus, 3.

municipalities, 4.

paid municipal or volunteer fire departments, 5.

local police departments, and 6.

local or regional boards of education.

sHB5244 / File No.

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126 DCF must conduct the instructional program at least four times a year, at no charge to participants, and may conduct each session in a different region of the state during the year.

The bill (1) requires local health departments and (2) allows district health departments, youth service bureaus, municipalities, paid municipal or volunteer fire departments, local police departments, or boards of education, to offer free training in adolescent screening, brief intervention, and referral to treatment to their employees or members of the public.

The employee providing the instructional program must have participated in the program conducted by DCF.

BACKGROUND Opioid Antagonist Distribution Agreements With Certain Entities By law, prescribers or pharmacists certified to prescribe an opioid antagonist may enter into an agreement with certain entities, including government agencies, concerning the distribution and administration of opioid antagonists.

The agreement must address the agencies’ opioid antagonist storage, handling, labeling, recalls, and record keeping.

The prescriber or pharmacist must train the individuals who will distribute or administer opioid antagonists under the agreement.

Additionally, individuals who will distribute or administer opioid antagonists must receive training before doing so.

COMMITTEE ACTION Committee on Children Joint Favorable Substitute Yea 13 Nay 0 (03/10/2022) sHB5244 / File No.

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