A decade after the Texas Medical Association helped pass legislation allowing schools to stock epinephrine, data indicates the medicine is still regularly in use, and physicians can take steps to bolster its availability.
Louise Bethea, MD, helped write the initial 2015 legislation and serves as chair of the Texas Allergy, Asthma, and Immunology Society’s (TAAIS’) legislative committee. An allergy, asthma and immunology specialist in The Woodlands, Dr. Bethea sees opportunities for physicians to further strengthen the program, especially given the state’s legal liability protection for prescribing physicians.
“Every county doesn’t have an allergist,” Dr. Bethea said. “For some, the distance it takes for an ambulance to reach the school may take 30 minutes or more, and it certainly can be lifesaving in that instance if there were epinephrine in the schools.”
According to a list maintained by TAAIS, a number of physicians have made themselves available to write prescriptions for schools. One physician can write prescriptions for schools within 150 miles of her practice in Flower Mound, while five others are willing to prescribe statewide.
The Texas Department of State Health Services (DSHS) reports school personnel or volunteers used epinephrine auto-injectors 263 times during the 2024-25 school year – 216 times on students, 43 times on school personnel, and four times on visitors.
Notably, 18 of the 20 Education Service Center regions that submitted data reported epinephrine administrations, demonstrating usage across the state.
DSHS is not required to maintain data on how many of the state’s 1,017 public school districts stock epinephrine. The agency only tracks when school personnel administer the medication on campus, as required by law. Still, the available data suggests the program is serving communities throughout Texas.
Additional physician participation could expand the program’s reach even further.
Physicians can support local efforts by approaching school districts or parent groups and providing education if needed, Dr. Bethea said. Food Allergy Research and Education, a charitable organization promoting food allergy education, has materials available for food allergies in the classroom and epinephrine administration.
Shade Afolabi, MD, a pediatric pulmonologist at UT Southwestern, has been asked to write district-wide prescriptions in the past. She noted the full process to get epinephrine and the rescue inhaler albuterol into schools can be “cumbersome” for districts managing tight budgets.
Schools must determine how many allergy and asthma drugs to purchase and where to strategically place them on campuses with far-flung extracurricular activities, Dr. Afolabi said. For example, schools need to consider bus trips to athletic events or educational field trips, where medications can’t be kept solely in the nurse or principal’s office.
“This is easy stuff. We don’t need a mandate,” Dr. Afolabi said. “We just need people to know about it and have the resources to do something about it. No school wants to be unable to help their students in these easily accessible ways.”
Dr. Bethea noted stocking nasal epinephrine might be particularly attractive to district officials since its effectiveness lasts 24-30 months compared to 12-15 months for injectable epinephrine. The bill allowing schools to stock epinephrine was updated in 2025 to include epinephrine nasal spray.
“First, the prescriptions need to be written, so we need physicians to volunteer to write prescriptions,” Dr. Bethea said. “Lives can be saved with their help and cooperation.”
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