Library Needs and Responses to the Opioid Crisis: a Town Hall Summary

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Courtesy of Marco Verch, CC BY 2.0

The opioid overdose and addiction crisis is crashing through American cities and towns. Opioids, including prescription drugs and heroin, now kill 91 people each day and the number of opioid associated deaths have more than quadrupled since 1999, according to recent CDC data.1 To explore library needs and responses to this growing crisis, WebJunction, in collaboration with the Public Library Association (PLA), hosted a virtual town hall on September 12. This provided an opportunity for library staff, community health practitioners and other city and county partners to come together, ask questions and share experiences. 

The town hall agenda covered three facets: Interacting with patrons in crisis, direct intervention, and working with community agents and partners. The event was moderated by WebJunction’s Betha Gutsche, who provided a brief overview of libraries and the current crisis, and then asked the panelists and attendees (via chat) to share how their library or community is being impacted by the opioid abuse epidemic.

The panelists, in program order, included:

  • Rachel Fewell, Central Library Administrator, Denver Public Library (CO)
  • Kim Fender, Director, Public Library of Cincinnati and Hamilton County (OH)
  • Dana Murguía, Senior Program Manager, Public Health, Healthy Communities, Humboldt County Department of Health and Human Services (CA)
  • Vanessa Christman, Assistant Director, Santa Barbara Public Library, previously County Librarian/Director of Library Services, Humboldt County (CA)
  • Shawn Cunningham, Director of Communications and Strategic Initiatives, Multnomah County Library (OR)
  • Hadi Sedigh, Associate Legislative Director for Justice & Public Safety, National Association of Counties, and liaison to the National City-County Task Force on the Opioid Epidemic

Local impact: Your responses

The town hall began with the panelists providing a quick glimpse into the impact of the opioid epidemic in their communities, and what approaches they were taking. Examples included training their staff to administer naloxone, a medication used to block the effects of opioid use; working with local partners on public safety; and seeking funding to sustain programs.

Town Hall registrants were asked, "Which of the following is your library/organization currently providing, related to the opioid crisis (check all that apply)." Nearly 50% of respondents said they have not developed responses or are not sure if their library has responded in some way to the crisis. Some libraries have perhaps not felt the direct impact in their community, or others haven't figured out how to formulate a viable response to what they are experiencing.

Crisis response at the library

The next segment took a deeper dive into three facets of the crisis: Direct interaction with patrons in crisis who are coming into the library or onto library grounds, direct intervention solutions, including staff training on the use of naloxone; and working with community agents and partners that are addressing the opioid crisis.

Interacting with patrons in crisis

Rachel Fewell, Central Library Administrator at Denver Public Library (DPL) described how their staff works closely with the Department of Environmental Health (DEH), including the installation of sharps containers throughout the library system. Additional partners include the Harm Reduction Action Center and the Denver Police Department, which has been piloting a co-responder program. Co-responders are social workers who assist when police are called to incidents throughout the city as a way to connect those in need with additional help, diverting some people from jail and getting them into beneficial programs. The library is also a part of a growing group of agencies that meets every other week at the mayor’s office to talk about what’s happening and to identify needed resources.

DPL has created a team of community resource specialists, including two (soon to be four) social workers committed to connecting people to needed services. The team also includes five peer navigators, people who are in recovery or who have experienced homelessness or other life challenges who can meet with library patrons to talk about issues, “They are better able to connect with people throughout the library, in fact, one of our navigators last week got two people into treatment.”

The community resource specialists also provide training for staff on topics including trauma-informed systems of care, and how to approach people who need compassionate care. Another class they offer, "Finding Resiliency," helps to address the fact that staff themselves are experiencing a kind of second-hand trauma. “We want to make sure we're providing a safe environment for people to do that and a way to kind of bounce back and be able to come back to work and feel okay,” Rachel said. They’re also starting a class called "Homelessness 101" that will talk about those challenges along with mental health first aid. DPL also requires most of their frontline staff to go through a sharps training for proper handling of needles and injection devices. To date, 62 staff members have been trained to deploy Narcan, a brand-name version of the medication naloxone. Training is optional for branch staff, though nearly a third of their 26 locations have staff ready to deliver the antidote. Security staff are required to have Narcan training, and the social workers work closely with security, so if someone is found in a bathroom injecting, the social worker responds to the situation along with security. They can both have the intervention conversation, and the customer is then banned from the library until they can set up a meeting with the security manager. “But it's all done with the social workers there providing resources, making phone calls to make sure we're connecting people to resources and not just throwing them out of the library.”

Kim Fender from PLC&H addressed concerns raised by town hall attendees in chat about public perceptions about the library not being a safe or family-friendly place. With press coverage about libraries and homelessness or drug use, especially in downtown locations, it can be a challenge to help people remember that libraries remain a vibrant and safe place for everyone. She referenced the recent Cincinnati Enquirer piece “Seven Days of Heroin: This Is What an Epidemic Looks Like" and noted that, while the community often assumes that overdoses only happen in downtown urban areas, “this is something that's happening in the suburbs and the smaller cities and villages all around our region.”

Despite the name, the Public Library of Cincinnati and Hamilton does not function as a part of either the city or county infrastructures. The library’s main location and 40 branches serve 49 different political jurisdictions, which makes it challenging to manage communications and decisions related to public safety and facilities. Their library has decided not to train staff to administer naloxone, but instead relies on first responders who are less than two blocks away from the main library. Kim noted that a special detailed police officer is assigned to the main library afternoons and evenings. The library also employs security staff 24/7. “They are really the ones more likely to be called if someone sees a patron in the restroom or somewhere else in the building who is not responsive.”

Direct intervention

Dana Murguía, a senior program manager at the Humboldt County Department of Health and Human Services, began partnering with the Humboldt County Library after the bookmobile driver inquired about training for library staff on administering the opioid antidote, naloxone. She started her presentation by encouraging everyone to reach out to local health departments for technical assistance and free training on how to administer naloxone, also known by the brands Narcan and Evzio.

Concerns around public perception also surfaced in Humboldt County, and Dana noted that sometimes the opioid epidemic is dealt with from an “us vs them” perspective, which isn’t founded or based on reality. “We know the opioid epidemic impacts us all…though sometimes there is the perception that injection drug users are a different population that none of us really belong to. And it's important to remember that many people who do inject heroin started out with prescription medications administered by their doctors.”

She noted an important factor about the safety of naloxone. “You can give naloxone to someone and it's not going to have any kind of negative impact whatsoever. There's no abuse potential, either. Essentially, what it does is reverses an opioid overdose so that someone can start breathing again, and emergency medical services can be called in. However, it doesn't work if someone has overdosed on a drug other than an opioid.”

In Humboldt county, public health staff began administering naloxone in 2003, when the overdose death rate was 18 times higher than the national average. After one year, the county’s opioid overdose deaths decreased by 42%. Dana’s agency provides outreach to rural areas, as well as technical assistance training to public institutions, including law enforcement, local university police and tribal police.

Emphasizing issues around perception and stigmatization, Dana pointed out that “it's very surprising how easy it is to become vulnerable to overdose.” The assumption is that only people injecting drugs and living on the street overdose. “At one of our recent coalition meetings, with medical providers in the room, emergency medical services shared the information they gathered, tracking all of the calls related to overdoses for the past quarter," Dana said, "and all of those calls came from residents. None of them were from individuals who were without housing. And the oldest person that had been administered naloxone was 87 years old.”

Dana also touched on the issues related to liability. “Laws vary from state to state, but in California, several laws protect doctors and licensed professionals and medical providers from any kind of civil or criminal liability. And California’s Good Samaritan Law protects people who call 911 at the scene of an overdose from being prosecuted for possession of a useable amount of a controlled substance.”

Vanessa Christman followed up with additional information about Humboldt County Library’s approach to direct intervention. They have naloxone available, in a secured container at the reference desk and on the bookmobile, which visits surrounding rural and tribal communities that are very much impacted by the crisis.

Sustaining these types of programs in a library with such limited resources, especially financial resources, is difficult. Vanessa, who previously worked at Humboldt County Library but is now the Assistant Director at the Santa Barbara Public Library (CA), shared that it can be hard to find the staff time to do day-to-day tasks and continue to be educated on these types of issues. While her library's response strategy was initiated by frontline staff members, she pointed out that it’s especially important to create a coalition with a variety of staff members, that includes both those who are public facing, and those who work behind the scene, to acknowledge this is a system-wide, community issue. The knowledge should be shared widely and not live within a department or team, to ensure that it's properly supported and communicated. This systematic approach supports ongoing training needs and sustainability, in case of staff turnover.

Addressing the concerns raised regarding community perceptions and the reputation of the library, Vanessa observed that, outside of library staff, there hadn't been public messaging that their library is a microcosm of what's going on in the community. Libraries are experiencing the opioid crisis along with everybody else. “It's going to be something that is acknowledged by a lot of different groups in your community, so essentially denying it's a problem, denying that the library staff have been trained, denying anything that's going on, is not in your best interest. Because if you don't own the information, if you aren't the ones communicating the message out to the community, then you are losing your ability to shape the message and letting other people shape it for you.”

Instead, shape the message to reflect all the powerful things the library is doing to help with this issue, and that the library is an active, vibrant community partner, worthy of funding. “Staff were even able to leverage public safety funding to get increased security guard presence, and this would not have been possible, unless the library spoke openly with community members to acknowledge this problem and talk about what we're doing to solve it.”

Working with community agents and partners

Shawn Cunningham, Director of Communications and Strategic Initiatives at Multnomah County Library (OR), shared that “we are fortunate to have the leadership of a key elected official who helped initiate a number of vital conversations with mayors, law enforcement agencies and municipal partners, our health department, the agency that provides mental health services, and to start talking about ways we can work together more effectively.”

Shawn recommends looking at local facilities departments as a key partner. Their facilities department started installing sharps containers in the bathrooms, and looks for ways that landscaping and outdoor spaces can be reconfigured to deter behavior. “We are trying things like having vendors adjust schedules so we come and make a sweep of a particular location in the morning to make sure there aren’t needles in the landscaping or that it's addressed before the patrons visit that location.”

Shawn highlighted the need to support staff as they deal with the intensity of the crisis. Making resources available through their employee assistance program, and providing training opportunities for staff has become important. “We’ve partnered with a non-profit called the Trauma Intervention Program. We make sure that staff have access to people who are trained and available to deal with people in various kinds of post traumatic situations.”

And finally, Shawn emphasized “keeping a focus on resilience and how our staff and team can demonstrate that libraries can be responsive and tackle this crisis in new ways and hopefully come out the other end for the better and provide better service to our communities.”

Hadi Sedigh from the National Association of Counties began by echoing the suggestion from a participant in chat to read the book Dreamland: The True Tale of America's Opiate Epidemic, by Sam Quinones. The author refers to the opioid epidemic as the “quietest epidemic.” “An example that he used was the mother of an overdose victim telling him that when you lose a kid to leukemia, everyone in the community surrounds you and sends their well wishes and brings you food. When you lose a kid to a heroin overdose, people don't know if they should come around and when they do, they don't know what to say.”

Hadi works at the national level with city and county leaders and has heard concerns about the strain the epidemic is having on county functions. From hospitals to jails to community agencies, there is a struggle to keep up with caseloads related to the opioid epidemic. “And in the most grim and unfortunate scenarios in some of the counties throughout the country, we've seen coroners struggling to keep up with caseloads and we've seen morgues that are literally running out of space to store bodies.” He shared this sobering reminder of the importance of prevention and of a strong local infrastructure, with participation across multiple community agencies, including libraries.

Hadi shared a bit of background on the report, A Prescription for Action: Local Leadership in Ending the Opioid Crisis, which was a joint project of the National Association of Counties and the National League of Cities. The taskforce “traveled around the country and tried to observe the impact of the epidemic, how it was impacting local governments and how local governments can respond to it.”

A few highlights Hadi surfaced from the report:

  • Encourage your county commissioners, your mayors to become a champion of this issue and to inform them, if they are not already aware, that libraries are becoming a front line for this epidemic, and that you need their leadership and support.
  • Don’t underestimate the importance of tailoring solutions. Get community input and know that what might work in a rural 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 have naloxone on hand, versus a library that has incentive to keep a supply, because they’re further away from first responders. And of course, what is politically feasible in one place is not feasible in another.
  • Don’t lose sight of the importance of prevention and education to stay focused on the ways in which you can help to spread the message of drug prevention. “It goes without saying that the best way to prevent someone from overdosing is to prevent them from becoming addicted in the first place.”

Hadi ended his comments with a powerful statement about the roles we can all play in our communities. “And finally, something that might not seem optimistic but it ultimately is...This is an epidemic that has developed over time. And it's going to take years to get out of it. There is not going to be a single solution that's going to turn the tide. Not a switch to flip to make it go away. It's important to keep that in mind to highlight the importance of doing your individual part even if it feels miniscule or even if it feels you are not turning the tide overall. And to focus on prevention and education and not lose sight of that big picture of the importance of stopping that revolving door of individuals becoming addicted.”

The town hall concluded with the panelists and participants being invited to share a word or phrase to reflect what they see as most important in relation to libaries responding to this crisis. The panelists comments included "resilience," "understanding the problem," and "partnerships across the community." The participant comments and ideas were also captured in the transcript from the event and in this word cloud:


As the session closed, participants were reminded that the town hall was a first step by WebJunction and PLA to bring the library community together to explore this important topic. Libraries play a key role in their communities and this crisis represents another opportunity to provide information, support and compassion when it's needed most.

A recording of the town hall is available for review, as well as a growing compilation of resources related to the crisis. Tweets from the town hall are at #libsopioidtownhall, and we've started a Facebook group, Libraries and the Opioid Crisis for further information and resource sharing. We invite you to join us there to continue the conversation. 

 

Endnote:
1. Drug overdose deaths in the United States continue to increase in 2015. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. Accessed: September 21, 2017.

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