Schools ranking
Schools have the opportunity to address opioid overdose risk at the earliest moment in lifespan development. School strategies include[MR1] providing opioid education to both students and families, ensuring naloxone access in spaces with the highest risk of overdose, and equipping parents with the resources to address opioid use and overdose prevention with their families.
The four indicators that make up the Schools Ranking are:
- Percentage of youth reporting they did not receive drug or alcohol education in school in the past year
- Percentage of schools reporting they taught the difference between proper use and abuse of OTC and prescription medications
- Percentage of schools reporting they provide parents and families with health information about drug and alcohol prevention
- Percentage of youth reporting they have talked with a parent about the danger of tobacco, alcohol, or drugs
- Two of the five indicators used in the Overall Schools Ranking were taken from the CDC’s School Health Profiles data. Nine states are excluded from this ranking because they either did not participate in the School Health Profiles survey or did not collect representative state data.
The 10 states with the highest need for strategic investment in school opioid overdose prevention are: Arizona, Hawaii, South Carolina, Mississippi, Tennessee, Kansas, North Carolina, California, Louisiana, and Michigan. These states had the lowest rates of school-based education on opioid and overdose prevention for youth and families.
| Rank | State |
|---|---|
| 1 | New Jersey |
| 2 | Utah |
| 3 | Connecticut |
| 4 | Massachusetts |
| 5 | Montana |
| 6 | Arkansas |
| 7 | Maryland |
| 8 | New Hampshire |
| 9 | Kentucky |
| 10 | West Virginia |
| 11 | Oregon |
| 12 | Rhode Island |
| 13 | Minnesota |
| 14 | Nebraska |
| 15 | Illinois |
| 16 | Maine |
| 17 | Wisconsin |
| 18 | Indiana |
| 19 | Missouri |
| 20 | Virginia |
| 21 | Idaho |
| 22 | New Mexico |
| 23 | Vermont |
| 24 | District of Columbia |
| 25 | North Dakota |
| 26 | Ohio |
| 27 | Nevada |
| 28 | Delaware |
| 29 | Washington |
| 30 | Texas |
| 31 | Pennsylvania |
| 32 | Iowa |
| 33 | Michigan |
| 34 | Louisiana |
| 35 | California |
| 36 | North Carolina |
| 37 | Kansas |
| 38 | Tennessee |
| 39 | Mississippi |
| 40 | South Carolina |
| 41 | Hawaii |
| 42 | Arizona |
| * | Alabama |
| * | Alaska |
| * | Colorado |
| * | Florida |
| * | Georgia |
| * | New York |
| * | Oklahoma |
| * | South Dakota |
| * | Wyoming |
Percentage of youth reporting they did not receive drug or alcohol education in school in the past year
Nationally, 38% of students reported they did not receive any drug or alcohol education in school in the past year. In Arizona and Oklahoma, the two bottom-ranked states, over half of students did not receive drug or alcohol education.
Percentage of schools reporting they taught the difference between proper use and abuse of OTC and prescription medications
About 80% of all schools that participated in the CDC’s School Health Profiles reported that they taught the difference between proper use and abuse of over the counter (OTC) and prescription medications. However, in Arizona (ranked last) only 35% of schools taught students about prescription medications.
Percentage of schools reporting they provide parents and families with health information about drug and alcohol prevention
Overall, fewer than half of schools surveyed by School Health Profiles reported that they provided parents and families with information on drug and alcohol prevention. Schools in Arkansas, New Jersey, and Texas were most likely to provide parents with drug prevention information. In Kansas, Pennsylvania, and Hawaii, the three lowest-ranked states, only about one-third of schools provided parents with health information on drug prevention.
Opioid overdose prevention education should go beyond the school walls. Schools should provide parents and families with resources to better understand the risk of overdose, even among youth using substances for the first time. From 2019 to 2021, over 90% of overdose deaths among youth ages 10 to 19 involved opioids, but only 35% of them had a history of opioid use. About 25% of youth overdose deaths had evidence of counterfeit pills, where youth may not have known that the drug they were taking contained fentanyl or other substances.1 Schools should partner with state and local health departments to supply local updated information on the changing landscape and risk associated with youth substance use in their community.
1. Tanz, L.J., Dinwiddie, A.T., Mattson, C.L., O’Donnell, J., Davis N.L. (2022). Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021. MMWR Morbidity and Mortality Weekly Report, 71:1576–1582. DOI: http://dx.doi.org/10.15585/mmwr.mm7150a2.
Percentage of youth reporting they have talked with a parent about the danger of tobacco, alcohol, or drugs
Only about half of youth in the U.S. report that they have talked with a parent about the danger of tobacco, alcohol, or drugs. Even in Arkansas (ranked 47th), where 70% of schools report they provide parents with information on drug and alcohol prevention, only 45% of youth say their parents have talked to them about it.
Family engagement is a key protective factor against youth substance use.2 Not only do parents and families need to receive resources on opioid use and overdose prevention from the school, but they need to feel comfortable and supported in using them.
Schools should partner with both local health departments and PTAs to gather information on what parents want or need to start conversations about preventing opioid use, especially in communities that have experienced an overdose. Through these partnerships, health departments and families can co-design informational resources and workshops that would be most effective and useful to them within the context of their state or community.
2. Readiness and Emergency Management for Schools Technical Assistance Center. Fentanyl and opioids: Preventing overdoses and related emergencies at K-12 and higher education campuses. Retrieved June 2025 from https://rems.ed.gov/docs/OpioidsFactSheet_508c.pdf