At the Frontline: How Libraries Are Fighting the Opioid Epidemic

Many public libraries across the U.S. have experienced overdoses, but chances are the second half of that story, the part where a life is saved, is not as common. However, with the right tools and training, it could be soon. In August, President Trump promised to declare the it a national emergency, yet in October he lessened the crisis to a public health emergency and laid out the framework for a new plan set to use "sound metrics... guided by evidence and guided by results." The President's commission tasked with fighting this epidemic has reportedly finalized a 53-page recommendation document to guide the implementation of this plan. But as we wait for official details, the intense, negative effects of this crisis continue to devastate many.

Drug overdose is now the leading cause of death among Americans under 50 and early data for 2016 reports drug-related deaths rose by an estimated 19 percent – the largest annual U.S. increase ever to occur. According to the Center for Disease Control and Prevention, more than six out of every 10 overdoses involve an opioid, and an estimated 91 deaths occur every day from opioid O.D.s. Illegally used opioids include heroin, prescription pain meds and carfentanil, an elephant tranquilizer 10,000 times stronger than morphine.

No one is claiming opioid use is more prevalent in a library when compared to other areas within a city, but the truth remains they too are struggling with opioid-related issues, including discarded, contaminated needles; drug use inside the library; and even onsite overdoses and fatalities. But instead of doing the bare minimum and simply calling 911 when an O.D. occurs, some have become first responders to the situation. The McPherson Square branch of the Free Library of Philadelphia, situated in the middle of what has been nicknamed “Needle Park,” experiences almost daily overdoses. Chera Kowalski, a librarian at the library, was recently spotlighted in local and national news organizations as one of the first librarians to start administering Narcan. “We call 911 when things happen to make sure trained professionals are on their way,” she told The Washington Post. “But in this neighborhood, there’s a lot going on with drug use, drug overdoses. Sometimes there’s a wait time. So we found that sometimes this is the best way to keep someone else alive.”

Thankfully, there’s no negative impact if Narcan is administered to someone who is not overdosing and the drug itself is not addictive, so there’s no threat of anyone abusing it. However, there is some concern that stocking the drug means more drug users are likely to come to the library. Yet, the consensus is pretty much unified in that the alternative – not stocking it – won’t keep them away but stocking it will save lives. “I've always thought of libraries [as] a responsive space that responds to community needs,” Kowalski told NPR. “And in the situation that we're in, one of the needs [is] we have to help people who may be engaging in behaviors not many are comfortable with. And when someone's overdosing, that's a need. And utilizing Narcan, it gives them a second chance.”

Libraries are also taking action to prevent overdoses from occurring in the first place. Some libraries, like Philadelphia’s McPherson branch, sees the bathroom as one of the largest problem areas. So, they began requiring patrons to show identification before gaining entry. They found a local nonprofit to partner with who supplies volunteers to sit by the bathroom doors to check the identification and keep track of how long people are in there. Since these new rules were implemented, no overdoses have occurred inside their bathrooms.

Some libraries simply have added the bathrooms to their security staffs’ normal patrol. Or, they now lock single-user bathrooms so patrons have to ask for a key at the front desk. If the key isn’t returned after a period of time, the library staff will then check the bathroom. Other libraries are adding security cameras outside of bathrooms with the hope it will deter drug use. One important thing to note is that although most libraries should be ADA compliant, bathroom doors need to open outward in case someone overdoses against the door. This is critical so first responders will not be blocked from entry.

While no one suspects this epidemic to end anytime soon, many see hope now that more is being done to stop it. This past summer, the U.S. Federal Drug Administration, for the first time in history, has taken steps to remove a currently marketed opioid pain medication from being sold due to the high risk of abuse and lower potential benefits. “We are facing an opioid epidemic – a public health crisis, and we must take all necessary steps to reduce the scope of opioid misuse and abuse,” said FDA Commissioner Scott Gottlieb in a press release. “We will continue to take regulatory steps when we see situations where an opioid product’s risks outweigh the benefits.”

Some states, like New York and Maryland, have passed legislation meant to fight the crisis, including making Narcan more easily available, requiring physicians to prescribe the lowest effective dose of opioids, and allowing prosecutors to seek longer prison sentences for drug dealers knowingly selling fentanyl – an extremely potent and highly addictive opioid. But whether or not these efforts produce the desired results, librarians, like Kowalski, will be armed with medicine to help anyone who walks into their branch.

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