Opioid Antagonist – Required Reporting of Administered Opioid Antagonist Medication to DSHS

Texas Health and Safety Code, Section 483.101, defines an opioid antagonist as any drug that binds to opioid receptors and blocks or otherwise inhibits the effects of opioids acting on those receptors.

In accordance with the Texas Education Code, Section 38.223, opioid antagonist medication administration that occurs on a school campus must be reported.

Education Code, Section 38.222, requires school districts serving students in grades 6 through 12 to adopt a policy regarding the maintenance, administration and disposal of opioid antagonists. An open-enrollment charter school or private school may choose to adopt a policy.

In accordance with 25 Texas Administrative Code, Section 40.87, your campus must report when a school personnel member or school volunteer administers an opioid antagonist. Reporting must be submitted no later than the 10th business day from the date of administration.

The school report must be sent to the:

  • School District
  • Charter holder if the school is an open-enrollment charter school
  • Governing body of the school if the school is a private school
  • Physician or other person who prescribed the opioid antagonist
  • Commissioner of the Department of State Health Services (DSHS)

Submission of this electronic form meets the reporting requirement for DSHS. Be sure to report complete and accurate information.

Please fill out the entire electronic form and provide detailed information. For assistance completing the reporting form, please see the Guidelines for Schools Reporting Opioid Antagonists.

All fields with an asterisk (*) must be completed.

School Information

School Information

Recipient Information

Recipient Information

Person who received the opioid antagonist
Location and Dosage Information

Location and Dosage Information

(Examples: cafeteria, classroom, school bus, hallway, sports fields, gyms, outdoor gathering areas, other (please specify), etc. You do not need to include mailing address.)
(Intranasal Route: 1 dose = 1 spray into 1 nostril) (Injectable Route: 1 dose = 1 injection)
The strength of the medication may vary by manufacturer or route, please follow dosing instructions on the label.
Type of dose administered
Other Information

Other Information

(Examples: 6th grade teacher, school librarian, basketball coach, school volunteer, etc.)
Was the school’s unassigned opioid antagonist utilized?
Education Code, Section 38.224 (b)(1)(C), requires schools to train personnel and volunteers on implementing emergency procedures, if necessary, after administering an opioid antagonist. For a training guide example on responding to an opioid overdose, please read Harm Reduction Responding to Opioid Overdose.
Notification of medication administration was submitted to the following
Please mark all that apply.
(Examples: 9-1-1 was called, emailed prescribing physician that unassigned medication was used, etc.)
After the medication was administered, the recipient
Symptom Information

Symptom Information

Opioids affect the part of the brain that controls breathing. If someone takes too much, it can slow or stop their breathing and heartbeat and cause death.
Please select the signs that the individual who received the unassigned opioid antagonist was exhibiting.
Please mark all that apply.
If no symptoms for a particular group occurred, choose "N/A."
6 + 12 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
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