"That's when McPherson’s door swung open, and a librarian came racing"
May 22, 2017 12:59 PM   Subscribe

"As the library overdoses mounted, the soft-spoken Moore, whom the kids call Miss Judi, took actions, small and large." Mike Newall of the Philadelphia Inquirer reports on librarians at the Philadelphia McPherson Square Library dealing with the opioid crisis on their doorstep.

Some coverage of Naxolone (aka Narcan) use at other public libraries:
- SF library workers may get training to save heroin addicts’ lives
- Denver’s Central Library sees 6 drug overdoses since Jan. 1
- Public libraries struggle with drug use, overdose in their facilities
- Libraries See Increase In Drug Overdoses

The Annoyed Librarian weighs in, questioning the wisdom of librarians become first responders.

New York Librarians also raised concerned after NY State Legislature passed legislation allowing libraries to maintain Narcan.

On the opioid crisis: previously, previously, previously, previously, and previously.

On Narcan: previously

martin q blank noted that Eric Eyre won a Pulitzer this year for his coverage of the opioid epidemic.
posted by CMcG (27 comments total) 19 users marked this as a favorite
 
Great post. Hey, where are the last places where the drug addicted can shoot up in peace that require absolutely no effort whatsoever from the government or health care organizations? Places that by definition have low-paid caring people! Ok, churches. No, libraries! Oh, wait ...
posted by Melismata at 1:09 PM on May 22, 2017 [3 favorites]


Annoyed Librarian: "if it’s something that hasn’t and never should be taught in library school, then is it something librarians should be held responsible for?" I have sincerely lost track of the number of things that library school didn't teach me that were necessary for my job.
posted by Halloween Jack at 1:10 PM on May 22, 2017 [27 favorites]


at what cost are we going to continue our drug prohibition? - if people can go somewhere and buy the right amount of opioids for themselves, aren't they going to be a lot less likely to overdose?
posted by pyramid termite at 1:15 PM on May 22, 2017 [12 favorites]


I certainly wouldn’t want it on my conscience if I tried and failed to reverse an overdose in the library.

So, apparently, Annoyed Librarian would not find it on his/her conscience if AL refused to learn how to use Narcan and a person ODed right in front of him/her, with AL unable to help? Because then they would somehow be less at fault?

That is some strange reasoning, right there. It's not like the librarians in the article are doing this because they're looking for extra work to do. People are shooting up in their bathrooms!
posted by praemunire at 1:16 PM on May 22, 2017 [4 favorites]


Annoyed Librarian can kiss my ass. There's a ton of things that I never learned in library school that have been a part of my job over the last 17 years I've been a librarian. Among them:
*Unix Administrator
*Course Advisor
*Mediator
*Manager
*Project Manager
*System Administrator
*Programmer
*Fund Raiser
*Babysitter
*Accountant
*Information Security Officer
*Copyright Lawyer

And I've only worked in academic and corporate libraries with the exception of a short year stint in the public library. I've never really had to deal with the extreme epidemic levels of homeless people in the library or overdoses. My heart goes out to these librarians and I fully support their decision to help people. I mean, the whole damn reason we became librarians is to help people. Granted, we probably thought it meant helping people find books, but they gotta be alive to be able to read the book.
posted by teleri025 at 1:25 PM on May 22, 2017 [34 favorites]


The commenters in the AL article raised a good point: how do you know which drug the person has overdosed on? What if it's not an overdose at all and some other medical issue? There are far too many liability issues here, as well as the fact that librarians aren't paramedics or other medically trained personnel. The better part of valor would be to call 911 and leave it to the people who know what to do.
posted by orrnyereg at 1:28 PM on May 22, 2017 [6 favorites]


That is some strange reasoning, right there.

I have met people who think this; I didn't get CPR training in my previous job because enough people objected. I don't get it either.

The AL doesn't like anything, so maybe take that with a shaker of salt.
posted by blnkfrnk at 1:37 PM on May 22, 2017 [4 favorites]


To all the people saying it's braver to just call 911 and be done with it, I respectfully, but forcefully disagree.

What if the person is not even overdosing and I give them naloxone? Will it hurt them?

"Naloxone has no effect on someone who has no opioids in their system. It will not help anyone who is not in an OD, but it will not hurt them either, unless it means wasting time or delaying getting access to emergency medical services."
posted by nikoniko at 1:39 PM on May 22, 2017 [23 favorites]


I think the AL actually has a good point underneath it all - obviously "I don't want to learn how to stick someone full of antidote because it's not my job" isn't a very attractive position, but (I come from a family of librarians although I am not one myself) I'm pretty familiar with the pressure on libraries to get more social-service-y even as funding gets cut. "People are shooting up in library bathrooms to the extent that librarians need to be ready to reverse an overdose" is a problem to which "train more librarians to administer naloxone" doesn't seem like the real answer.

Consider this: I am not expected to be ready to administer naloxone as part of my job, even though I work in the public sector, and this is because as a society we have created a system which has a lot of addicts who are corralled into fewer and fewer spaces, and those spaces are likely to be staffed by compassionate people. My particular part of the public sector is actually pretty highly secured. We don't have lots of people ODing in the bathrooms because this is a heavily patrolled place, and even if we did, I am pretty sure that there would not be pressure on staff to learn to administer naloxone. (Actually, I am not very into the increasing security culture here.)

The way we handle this particular social problem is "find some compassionate people who don't get a lot of pay or respect and who are used to putting out fires, make them do it for zero extra dollars on their checks". Not "everyone should be responsible for this social problem and therefore we should all get this training" or "the state should target resources adequate to the problem" but "just like dealing with homelessness, dealing with addicts is something that librarians should take care of".

If libraries are going to be library-community-center-clinics, that's actually kind of great...but let's fund and staff them appropriately and build appropriate facilities, not pretend that because librarians tend to be decent people, it's totally cool if we offload all the saving-people onto them.
posted by Frowner at 1:58 PM on May 22, 2017 [56 favorites]


"People are shooting up in library bathrooms to the extent that librarians need to be ready to reverse an overdose" is a problem to which "train more librarians to administer naloxone" doesn't seem like the real answer.

I truly don't disagree, but, at the moment, real people are dying unnecessarily.
posted by praemunire at 2:26 PM on May 22, 2017 [5 favorites]


Addiction is a disease and needs to be treated as such. As long as America is "at war" with drugs, those that do them will be marginalized and maligned.

But, I will never give up huffing books. Thanks librarians!
posted by hairless ape at 2:32 PM on May 22, 2017 [8 favorites]


This is a complicated issue with no simple answer, but I will say that as a public librarian I feel we are increasingly being gaslighted into accepting duties that are not only not part of the traditional job description (which in and of itself is fine because the job is always evolving) but that we are also not adequately trained or equipped to properly deal with. In the past six months I have witnessed a (non-fatal) stabbing of a patron, had an elderly female colleague punched in the face and knocked out, and had to call the police while a guy screamed at me about how he was going to beat the shit out of me. Voicing concerns about my personal safety at work often results in lectures about my apparent lack of dedication to public service.
posted by The Card Cheat at 3:27 PM on May 22, 2017 [71 favorites]


A librarian friend asked me why the security guards weren't administering Narcan, and I think that's a good question. While I think it's noble of these librarians to step up and meet a community need, I also do question whether or not they should. As a profession we've been conditioned to be all things to all people, and I think we take pride in it, but what about services that other agencies are supposed to provide? These kinds of story don't make me go, "Fuck yeah, heroic librarians!" More like "Fuck this society such that libraries have to do this shit."
posted by kendrak at 3:41 PM on May 22, 2017 [5 favorites]


Librarian, like public school teacher, is a coded-female job (obviously, there are male librarians, but I'm talking about how the job is seen/coded). I don't think it's a coincidence that both teachers and librarians are expected to basically save the world for peanuts. It seems like they're expected to take on all kinds of extra (mostly, again, coded female) helping/saving duties, cheerfully, and with no extra pay.

Nuts to that! I don't think librarians should be expected to be paramedics, social workers, or child care workers. If libraries need those professionals - and I think many do - there should be actual social workers on staff. Or they can train and pay librarians more.

Addiction is a disease and needs to be treated as such. Yes, this! This doesn't mean coddling or enabling addicts or allowing them to tornado through their own and other people's lives and destroy them - but if we think of addiction as a disease, like cancer, and treat it like a disease such as cancer, that is both more humane and offers a better possibility of recovery.

I'm a cancer survivor, and I sure didn't ask nice librarians to administer my chemo! (I did go to them for books to read while I was getting chemo.) With cancer, there are tests and screening protocols for those at risk or who display early symptoms, as well. Same with diabetes. We don't wait to treat diabetes until the person is blind and missing limbs; we don't wait for cancer patients to "hit bottom" and have metastatic cancer everywhere.

Decriminalizing drug possession and turning to medicine and rehab, instead of prison and the occasional 12 step program, will demand new infrastructure and cost more but will pay off in the long run, I think.

Let librarians help the public in the way they are trained - books and learning and knowledge - and don't pile more social services on their overflowing plates. Maybe libraries, if they are really community centers now, need social workers and counselors to staff them alongside librarians and paras.
posted by Rosie M. Banks at 4:28 PM on May 22, 2017 [23 favorites]


What's the liability here? If a librarian administrated Narcan and the addict dies or is disabled, can the librarian be sued? Can the library get nailed under a deep pockets provision?

The local university library has seen a syicide and a sexual assault recently; should librarians be trained as full emergency responders? Should they be issued guns? The "people are dying " argument can be used there as well.
posted by happyroach at 4:32 PM on May 22, 2017 [2 favorites]


Should they be issued guns? The "people are dying " argument can be used there as well.

In all fairness, naloxone is intended to save lives - guns, not so much.

But as regards liability, this question has come up. I'd imagine it depends on the "Good Samaritan" legislation in a given jurisdiction - IANAL, but someone who is not a medical professional administering a drug that results in injury or death vs. say, improperly-applied CPR that results in an injury or death might be two very different things in the eyes of the law.

The structural problem here is that librarians are being put in the position of being first responders and social workers because nobody else is stepping in and the War on Drugs values law enforcement salaries over addicts' lives. And said War on Drugs creates a situation in which the economics of it all means fentanyl and its analogues - against which administration of naxolone only buys a teeny tiny bit of time - will completely replace heroin and other opioids.

Morally speaking, the liability here is ultimately the people who keep drugs illegal and actively block harm reduction strategies.

These are librarians actually saving lives. Librarians are awesome. But it shouldn't have to be this way.

Attacks on the public sector by various fiscal conservatives of all stripes and nationalities shreds the very fabric of society.
posted by mandolin conspiracy at 5:24 PM on May 22, 2017 [11 favorites]


If libraries are going to be library-community-center-clinics, that's actually kind of great...but let's fund and staff them appropriately and build appropriate facilities, not pretend that because librarians tend to be decent people, it's totally cool if we offload all the saving-people onto them.

I'm in kind of a dark mood rn especially after reading this article. I have to wonder, if libraries really did become officially-acknowledged centers for social services, if funding for libraries wouldn't get cut even further or eliminated altogether.

A lot of people really hate people who are poor or have drug addictions or mental health problems etc. A lot of others just want them to go away. It's like how people will fight tooth and nail to avoid a homeless shelter or inpatient mental health facility from being opened anywhere near them. I almost wonder whether providing social services without official acknowledgement out of other institutions is the only way to make them happen, especially in communities where middle-class homeowners drive the local politics.
posted by vogon_poet at 6:36 PM on May 22, 2017 [11 favorites]


As far as hand-waving liability about administering Narcan goes, as mentioned above by nikoniko, Narcan can't hurt you. There is no downside to having more access to Narcan. The worst side effect is somebody addicted to opioids very suddenly going through withdrawal, which is preferable to death.

Likewise, my nurse-wife is very excited that more public places have defibrillator kits now. The defib kits are set up so that basically any idiot can hook them up, but the monitors in the kit decide whether the shock is actually needed.

There is apparently a lot of worry about whether Doing the Right Thing will bring legal liability, rather than this post (and thread)'s actual focus, which is that librarians and cash-strapped library systems are already having to deal with this. Please find something more relevant to worry about.
posted by ivan ivanych samovar at 7:38 PM on May 22, 2017 [8 favorites]


"Naloxone has no effect on someone who has no opioids in their system. It will not help anyone who is not in an OD, but it will not hurt them either, unless it means wasting time or delaying getting access to emergency medical services."

This is not exactly true. Naloxone causes immediate withdrawal from opioids irrespective of whether you've overdosed or not. Anyone who has had to withdraw from opioids will say the process is uncomfortable, to put it lightly. Naloxone takes you through that process through a highly accelerated rate. It's extremely painful. I read an account by one social worker who said cops in their city have taken to purposely administering it to users they know aren't overdosing just to be vindictive fucks.

I mean, sure, err on the side of caution, but let's not pretend this is all easy-peasy lemon-squeezy.
posted by schroedinger at 7:50 PM on May 22, 2017 [3 favorites]


Great post. Hey, where are the last places where the drug addicted can shoot up in peace that require absolutely no effort whatsoever from the government or health care organizations? Places that by definition have low-paid caring people! Ok, churches. No, libraries! Oh, wait ...

Ooh, I know this one! The answer is "elementary schools!"

A friend of mine works in a K-8 school near the city's largest methadone clinic. After the city closed its largest homeless shelter last year with no warning and no alternative housing provided, this elementary school had to give some of its teachers and janitorial staff a crash course in hazardous waste disposal procedures, because they have to do two circuits of the playground every day looking for used needles before the 8-year-olds head outside for recess. (One circuit a day quickly proved to be insufficient, which means there are a nontrivial number of folks shooting up on the playground during daylight hours)

But yeah, treating the opiod crisis as a moral hazard and not as a public health emergency is a great plan. Thanks, Republicans!
posted by Mayor West at 6:02 AM on May 23, 2017 [11 favorites]


Librarians: is there anything they can't do?

I heard rumors about ODs in libraries around the city but this is the first article I've seen addressing it. My gosh. So Heartbreaking
posted by james33 at 6:10 AM on May 23, 2017


Why is giving Narcan any different from giving First Aid? I'm a reference librarian at a college and as such I come into contact with many people on a daily basis. A few years ago a staff member collapsed about fifty feet from my desk. Two of us rushed to help her and gave her CPR; it took the ambulance 20 minutes to get here. We found out later she'd had a stroke and she died on her way to the hospital. After that incident we asked for and took an advanced first aid class. I plan to ask for another one that includes safe procedures for administering Narcan.

The students who use our library are of diverse ages and backgrounds. The community patrons who use our library range from infants to nonagenarians; the closest public libraries are both at least five miles away, and there is no public transportation here in rural South Carolina. As far as I know there haven't been any ODs on campus, but that could change.

I knew a lot of substance abusers when I was young in the sixties and seventies. Most of them eventually got clean, but some of died from overdoses or from diseases they got from dirty needles. All of them would have benefited from access to drugs like Narcan, as well as access to clean needles and clean drugs.
posted by mareli at 9:09 AM on May 23, 2017 [6 favorites]


Thanks CMcG for the thorough post on this fascinating and tragic subject. The Denver link is broken so I googled up what seems like a similar article. Denver Central Library.
posted by bendy at 1:03 PM on May 23, 2017 [2 favorites]


Thanks, bendy! Your update is the right link. I apologize for the error.
posted by CMcG at 1:36 PM on May 23, 2017


Mike Newell follows up.
posted by CMcG at 6:56 PM on May 23, 2017


Just throwing this out there: you pop someone with enough Narcan to wake them up, and they are going to try to beat the shit out of you. People coming out of that high are ready to fight, and that's one of the reasons we administer Narcan in teams and usually dosages just enough to get them breathing again. Let the hospital or the police handle them when they wake up; I'm not getting my butt kicked for $13.95 per hour. Most OD's now are requiring over 6mg (which anyone under paramedic level has to contact medical control for and is quite expensive) and a lot of medics are slowly waking them up and having them sign refusals because they're clogging the ERs and they won't stick around for treatment. Also, if you're not careful and they've got fentanyl patches (had a guy OD by chewing on them - I mean wtf is that) that, if handled improperly, may cause the rescuer to fall out. Some PDs are allowing cops to carry kits (they get all excited because they get a little ceremony and a life saving medal and us on the fire and EMS side just roll our eyes and go back to doing our jobs); some cops don't want the responsibility and leave it to trained medical personnel and hang around on scene in case the person decides to get violent. And what, exactly, is a cop going to do if that OD devolves into an actual code? Nothing until we get there.
I'm not saying other folks can't take on the responsibility; simply asking for folks interested to consider everything that goes along with working an OD.
posted by sara is disenchanted at 8:57 PM on May 23, 2017 [4 favorites]


Another follow up.
posted by sepviva at 6:02 PM on June 18, 2017 [2 favorites]


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