Librarians in Michigan and across the country are coming into direct contact with the opioid epidemic as an increasing number of overdoses occur in libraries.
“I personally experienced an opioid overdose in my branch and the patron died,” said Jeanessa Smith, a regional manager at Grand Rapids Public Library. “I didn’t have any options.”
Opioid overdoses have increased dramatically in America over the last two decades from around 8,000 in 1999 to 47,600 in 2017, according to the Centers for Disease Control and Prevention.
A pair of bills moving through the Michigan Legislature would allow librarians to store and administer opioid overdose antidotes with legal immunity, an option many are eager to have. Proponents point to similar protections offered in 2017 to public schools and school staff.
Michigan residents can already obtain naloxone, the opioid antidote often packaged as Narcan, without a prescription. The state also protects good Samaritans who administer naloxone to someone they believe is suffering an opioid overdose. But public librarians were excluded from these protections because they’re government employees.
Libraries can attract opioid users; librarians can help them
For Smith, the Legislature can’t act fast enough.
“I’m hoping that it passes quickly,” Smith said. “They’re taking too long. They’re dragging their feet and they need to get it done. We need options.”
Librarians say they need options because they can’t avoid the problem. Public libraries are open to anyone — and that makes them attractive to some drug users. There are 397 public library systems with 651 locations in Michigan, according to the Library of Michigan.
“When you work with the public, you work with whatever issues they have,” Smith said. “We take that mantle of responsibility pretty seriously, at least that’s what we’re taught in library school.”
Some needle exchange programs advise opioid users to inject drugs in a public space for their own safety, Smith said. An overdose can be reversed by naloxone, but only if someone is there to find you to administer it.
There have been four or five overdoses and one death in Grand Rapids Public Libraries over the past two years, said Marla Ehlers, the assistant director for the libraries.
“Our libraries are part of our communities,” Ehlers said. So, she said, libraries work to meet the needs of their communities, even overdoses.
Some Grand Rapids residents aren’t as aware of the problem libraries face.
But it makes sense, said Aman Khan, a student at nearby Kendall College of Art and Design.
“It’s open to anyone,” he said.
Libraries are a resource for people with nowhere else to go, like the city’s homeless population. If stocking naloxone can help those who need it, libraries should do it, Khan said.
“I think it’s a bold statement, but there’s not really a lot of downsides,” he said. “I think it’s going to help people.”
Lou Johnson, a library patron who has taken prescription opioids, has some reservations about libraries treating overdoses. Johnson had an opioid prescription for back pain, but started “taking them like candy” before asking for a non-opioid painkiller and something to help with withdrawal symptoms.
“If you look at the side of saving a life, it’s a good thing,” Johnson said.
But Johnson has concerns the policy could make libraries more attractive to people who use drugs — and that might have a negative effect on kids and families. Johnson thinks kids shouldn’t see the potentially traumatizing effects of opioid use and, therefore, libraries should bar people who use opioids at the library multiple times.
“It hurts to turn people away because it’s a public library, but if you use the public library for that reason then it’s no longer considered an option,” Johnson said.
Epidemic comes to Michigan
Michigan’s libraries aren’t the first to grapple with the reality of the opioid epidemic.
Libraries on the east coast, which felt the effects of the opioid crisis earlier, started administering naloxone a year or two ago, said Gail Madziar, executive director of Michigan Library Association, which supports the two bills.
New York and Maryland passed laws in 2017 allowing libraries to store and administer the antidote..
The CDC identifies three waves in the epidemic’s 20-year history.
The epidemic began 1999 with abuse of prescription opioids. A second waved occurred with a 2010 spike in heroin use followed by a third in 2013 driven by abuse of fentanyl, a synthetic opioid often mixed with others.
From 1999 to 2017 opioid overdoses killed almost 400,000 people. They kill 130 Americans each day, the CDC reports.
Michigan is experiencing its own increase, according to Michigan’s Department of Health and Human Services. In 2015, 1,320 people died opioid-related deaths. In 2017, the number rose 47 percent to 1,941.
Despite a drop in opioid prescriptions across the state, law enforcement are seeing more fentanyl, the CDC says.
This means that the library bills are meant to fix one small part of a much larger problem.
The life-saving benefits are easy to see across the country. American Libraries Magazine reported in 2017 that Denver Public Library had administered seven doses of Narcan in under four months. The Philadelphia Inquirer reported in 2017 one librarian had stopped four overdoses using Narcan.
A safe antidote
“Naloxone itself is very safe to use,” said Megan Rocha-Adams, the opioid program manager at The Grand Rapids Red Project, an organization that provides naloxone and training needed to administer it. The group’s website reports that hundreds of lives in West Michigan have been saved by naloxone.
Naloxone doesn’t harm people, even if they haven’t taken an opioid.
“Their bodies will process it like water,” Rocha-Adams said.
The group is ready to train librarians at Grand Rapids Public Libraries and other area libraries if the bills become law.
Help for willing librarians
If the bills pass, they will provide much needed clarity for librarians caught in the middle of the epidemic.
Without immunity, attorneys advise libraries not to stock or use the antidote, though a number do, Smith said. But with immunity, she expects libraries and librarians to jump on board.
Smaller libraries, away from urban centers and emergency response personnel, might be particularly eager to have the life-saving option close at hand.
As for her colleagues, she expects 70 percent to take the optional training and be willing to administer the drug. Narcan, which will likely be used, is a nasal spray, which makes administering it more palatable, Smith said. Another common option is an automatic injection called Evzio.
Smith is clear: Librarians deal with the opioid epidemic regardless of whether they want to. They’d like to have some better options.
“No one that I have spoken with thinks this is a bad idea,” she said.