The opioid crisis and urbanlibrariesItis no secret that cities across the nation have been battling the heroin and opioidaddiction crisis. During the summer of 2017, national news media outletsheavily covered the topic after the Philadelphia Inquirer featured a storyabout the Free Library of Philadelphia’s McPherson Branch in which a reporterwitnessed library staff use Narcan to keep a patron alive after a suspectedopioid overdose (Newall, 2017). While not all libraries can stock Narcan andtrain their staff to use it, there are other solutions that can be used to helpurban libraries combat the growing issue of opioid overdose.
TheCensus Bureau defines urban areas in two ways: Urbanized Areas that have 50,000or more people, and Urban Clusters that contain at least 2,500 people but lessthan 50,000 (2010 U.S. Census).
While addiction and illegal drug use affectsall communities in some way, this paper will focus on ways in which opioid use,specifically heroin and prescription opioids, has impacted public libraries inurban communities. The statisticsThe Centers for Disease Control and Prevention report that heroin use has been increasing in recent years amongmen and women, most age groups, and all income levels. Some of the greatestincreases have occurred in demographic groups with historically low rates ofheroin use: women, the privately insured and people with higher incomes. However,as heroin use hasincreased, so have heroin-related overdose deaths. Heroin-related overdosedeaths have more than quadrupled since 2010. From 2014 to 2015, heroin overdosedeath rates increased by 20.6 percent, with nearly 13,000 people dying in 2015.In 2015, males aged 25 to 44 had the highest heroin death rate.
(CDC, 2017).Thedifferences in drug use between urban and rural areas show how populationaffects patterns of drug use. For example, states such as Florida andWashington have relatively high rates of nonmedical prescription opioidoverdose and are largely urban (Keyes, Cerda, et. al.
, 2014, p. e55). Keyes,Cerda, et. al suggest that a comprehensive understanding of why, for example,rates of alcohol and drug use differ across time, across counties, and acrosscertain population subgroups should be explored and studied to betterunderstand the impact. Library response to the epidemicPubliclibrarians in urban cities such as Philadelphia and Denver are learning how torespond to overdose cases at their facilities and even becoming trained inusing Narcan. Narcan, or naloxone, is an FDA-approved medication for emergencytreatment of a known or suspected opioid overdose. Available as a nasal sprayor injectable, the drug was developed for first responders, as well as family,friends, and caregivers. (Narcan, 2017).
As many librarians can attest,libraries are often used for illicit purposes, including substance abuse. TheSan Francisco Public Library, for example, reports that some users shoot up inthe bathroom or in the stacks. Library officials are working with the San FranciscoDepartment of Public Health to increase library patrols during peak times in aneffort to combat the problem (Troknya, 2017).
Anotherurban library directly affected by opioid use is the Denver Public Library’sCentral Library. Although the library hired more security guards and installednew security cameras, drug overdoses continued. After a patron died of anoverdose in the library in February 2017, staff were trained in using naloxoneand some carry Narcan kits. (Warburton, 2017, p. 18). Butusing Narcan and increasing security are not the only methods used by urbanlibraries to deter suspected drug use. Public libraries are joining schooldistricts in an effort to provide educational resources and programming as partof their roles as information professionals in the community.
These programsprovide accurate and educational information about addiction and opioid use. In 2017, the Cleveland Public Library began a yearlong seriesthat provided patrons with information on opioid abuse, signs and symptoms ofaddiction, and how to talk to children about drug abuse. The sessions allowed communitymembers to speak with a medical expert and learn about options for treatment.
(Jacobsen& Cottrell, 2017, p. 24). Otherschool districts are providing “social emotional learning programs” to supportstudents affected by addiction within their family (Jacobsen & Cottrell,2017, p. 23).Itis not clear exactly how many libraries have made Narcan available and trainedtheir staff in its use. The Denver Public Library’s Central Library has 13 staffmembers trained to use it and library administrators believe that the cost –$75 per kit – is a small price to pay to save someone’s life (Ford, 2017, p.47). To the argument that administering Narcan falls outside the library’smission, library officials in Denver say the library is the de facto dayshelter so it is imperative that the library staff have the tools to deal withthis epidemic (Ford, 2017, p.
47). TheSan Francisco Public Library also has made it a priority to work with those whohave drug-use issues through the use of a social workerand six formerly homeless health and safety associates who provide outreach tothose in need (Ross 2017). In addition, SFPL is considering training staffmembers on how to administer naloxone through a voluntary training program. “Citypolice and emergency workers have long been trained how to administer naloxone,which has been in use for decades.
The overdose prevention project, operatingon a $245,000 annual budget, not only provides the drug, but also trainsparticipants to identify signs of overdosing and how to dispense the lifesavingmedication.” (Mark Troknya, 2017). Otherways in which libraries have attempted to combat the rise in overdoses is bymonitoring restrooms.
Philadelphia’s McPherson branch requires patrons who wantto use the restroom to show identification and enlisted the help of volunteers,who sit by the bathroom, take identification, and time people … “no overdoseshave occurred since the new rules were implemented.” (Ford, 2017, p. 47).
Restroomsin urban public areas also have responded by installing key codes on bathroomdoors and metal boxes for needles so users don’t flush them and clog pipes(Bebinger, NPR, 2017). But keeping bathrooms open, stocking naloxone, and findingstaff or volunteers to monitor bathroom usage can be a challenge for manylibraries and businesses. In response to the growing opioid epidemic, the Public LibraryAssociation and WebJunction collaborated on a virtual town hall meeting about theopioid crisis in September 2017. During the 90-minute onlineevent, representatives from libraries and community organizations described waysin which they are addressing this crisis, such as naloxone training, publicsafety initiatives and securing funding for recovery programs. Whilesome libraries have made it a priority to stock naloxone and train staff in itsuse, there are others that do not. The Public Library of Cincinnati andHamilton County has seen a rise in overdoses but does not stock Narcan becausethey are located close to a fire station. Having security patrol the buildingmore often also has helped deter negative behavior.” (Ford, 2017, p.
48). PuebloCity-County Library District is not stocking kits but instead are monitoringrelated circumstances (Severance, 2017). Some institutions have installed bluelights in restrooms, while others have placed security cameras and signageabout video surveillance right outside the bathroom doors, while others haveinstalled secure needle-disposal boxes in restrooms, and adjusting doors sothey open outward rather than inward.” (Ford, 2017, p. 48).
Interacting with patrons in crisisHowdo library staff respond when someone is using drugs or may be overdosing? Somelibraries may have a security officer, social worker or peer navigator talk tothe person. The Denver Public Library Central Library staff works closely withthe Department of Environmental Health, and other community partners such asthe Harm Reduction Action Center and the Denver Police Department, to reach outto affected individuals, as well as meeting regularly at the mayor’s office toidentify resources (Warburton, 2017, p. 18).While it’s difficult to confront patrons who are hurtingthe library experience for others, threatening other patrons or staff, orotherwise creating discomfort or chaos, there are possible solutions to try,such as partnerships with such outside groups as law enforcement, socialservices, mental health and substance abuse counselors, city attorneys and countycounsels.
(Albright, 2017, 39). Luis Herrera, a citylibrarian at San Francisco Public Library, encourages libraries to trainstaffers to identify “opiate narcosis,” or the signs that someone may beoverdosing: pin-dot pupils, hooded eyelids, sniffing, scratching, seeminglyasleep on their feet so that they know when it’s appropriate to call for help.(Albright, 2017, 40).Community responseTheMultnomah County Library in Oregon works with elected officials to discuss waysto work more effectively with community agencies such as law enforcement andthe health department (WebJunction, 2017). TheWebJunction town hall provided information about resources available throughstaff training and ways to partner with community organizations. Hadi Sedigh from the National Association of Counties, noted the importanceof a strong local infrastructure, with participation across multiple communityagencies, including libraries.
(WebJunction, 2017). “Using aholistic approach, urban public libraries are creating community awarenessthrough forums, adopting social emotional teaching strategies to fosterresilience and empathy, and connecting people to resources to help bringrelief. They are doing what libraries do. In the process, they are innovating,building partnerships, and leading with compassion.
” (Miller, 2017, p. 6). Onestudy found that 40 percent of people in San Francisco and 58 percent in NewYork City who used opioids and attended an educational program in which theyreceived a naloxone kit had used it, “which resulted in a greater ability torecognize an overdose and act appropriately after training” (Espelt,Bosque-Prous, et. al, 2017, p.
10).ConclusionIn2015, journalist Sam Quinones published “Dreamland: The True Tale of America’sOpiate Epidemic,” a book that details how sugar cane farmers in Mexico createda distribution system that brought heroin to the United States, specificallyWest Coast communities not typically associated with heroin use, and how apharmaceutical company created Oxycontin, a highly addictive pain medicationthat affects the body in a similar way as heroin in that it binds to opioidreceptors to block pain signals and create feelings of euphoria. (Quinones,2016). Since publishing his book, Quinones has been featured at communityevents, including a public library presentation in October 2017 in Ohio. Duringthat presentation, Quinones suggested that the antidote to heroin is notnaloxone, but a community that is open to finding recovery solutions.
“Theheroin and opiate epidemic is a community problem and the community is going tocome up with solutions. No one system, no one person is going to be able tomake an impact without collaborating,” he told those in attendance. (Lindstrom,2017).CheraKowalski, a librarian at the McPherson Square branch of the Free Library ofPhiladelphia who has administered naloxone to save several patrons, toldNational Public Radio that she believes the solution to the opioid epidemic is”to dramatically change the way we treat addiction. We need to continue todestigmatize mental health and addiction as well.
I think what we can do rightnow is to have more people be willing to train themselves on Narcan because itreally is a lifesaving tool.” (Scott, NPR, 2017.) Mike Newall, a columnist at the Philadelphia Inquirerwho reported on the issue in 2017, told NPR that this epidemic is an opportunityfor communities to get outreach workers where overdoses are occurring to tryand get them into treatment (Scott, NPR, 2017).
Duringthe WebJunction town hall, Hadi Sedigh from the National Association of Countiessuggested the following actions for urban public libraries:· Encourage your county commissioners, yourmayors to become a champion of this issue and to inform them, if they are notalready aware, that libraries are becoming a front line for this epidemic, andthat you need their leadership and support.· Don’t underestimate the importance oftailoring solutions. Get community input and know that what might work in arural area may not work in an urban area, and vice versa.
For instance,libraries that are 60 seconds away from first response may not need to havenaloxone on hand, versus a library that has incentive to keep a supply, becausethey’re further away from first responders. And of course, what is politicallyfeasible in one place is not feasible in another.· Don’t lose sight of the importance ofprevention and education to stay focused on the ways in which you can help tospread the message of drug prevention.
“It goes without saying that the bestway to prevent someone from overdosing is to prevent them from becomingaddicted in the first place.” (WebJunction Town Hall. 2017).Itis estimated that in the U.S., 90 people die each day from an opioid overdose (includingincidents involving prescription drugs and heroin) and that more than 1,000people go to an emergency room for treatment for misuse of prescription opioids(Jacobsen & Cottrell, 2017, p. 22-23).
And the count of overdoses happeningin public libraries across the nation – Boston, Cleveland, Chicago andPhiladelphia – continue to rise. (Sanders, 2017).Accessto trustworthy information is easily accessible for urban public librarians. The National Library of Medicine has compiled resources toassist librarians and other first responders to ensure that they understand thecomplex legal and medical issues this crisis presents: Searching the DisasterLit database for “opioid” retrieves guidelines, training material,reports, fact sheets, conference proceedings and congressional testimony. Areport by the RWJF Network for Public Health Law describes overdose GoodSamaritan laws in each state, as well as state laws about access tonaloxone.
MedlinePlus has a good overview of opioid abuse andaddiction and links to many additional resources. The University ofMinnesota’s Bio-Medical Library is designated by the National Institutes ofHealth National Library of Medicine/National Network of Libraries of Medicine toprovide free NIH and NLM resources on opioids and the opioid crisis. The U.
S.Department of Health and Human Services and the Centers for Disease Controlhave both created resource guides to help inform the public about the opioidcrisis.Mostdeaths due to illicit drugs are caused by heroin and illicit opioids, withoverdose being a leading cause of death among people who use opioids. Trainingprograms in the prevention and management of opioid overdose have proven effectivein increasing the relevant knowledge among people those who inject opioids (Espelt,Bosque-Prous, et.
al, 2017, p. 2). Oneway to stem the issues associated with heroin/opioid overdoses in libraries isto monitor restrooms. Libraries also should consider installing sharpscontainers in restrooms so that needles can be placed there rather than flusheddown the toilet, which prevents plumbing issues.
Even reinstalling bathroomdoors so they open outward rather than inward should be considered if someonedoes overdose, then blocks the door when they fall, which could prevent helpfrom reaching them in time. (Ford, 2017, 44-49).While the $75 per Narcan kit can be costly,o is the staff training to learn how to administer it. This can make itcost-prohibitive. By combining forces with other nonprofits in the community,there may be a way to reduce costs, or find an organization willing to supplyNarcan kits. Even if a library does not want to incur the costs or liabilitythat comes with Narcan, it still must train staff in what to do in the event ofan overdose, as well as revamp security procedures and monitoring efforts.
“It’s important for us to talk more aboutwhat the people in our communities are dealing with. We’re an informationprofession. Why aren’t we sharing information with each other? Being open andcompassionate is the best thing we can do.” (Cottrell, 2017.
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