>> Betha: Thank you so much, Jennifer, for all that wonderful introduction.
As Jennifer mentioned, we have been collaborating with PLA because we recognize the urgency of this topic for public libraries in our country.
Want to give a call out to Scott Allen, the deputy director of PLA.
He's in the audience here today.
One of the panelists and part of the team helping to facilitate this conversation.
So he will be listening with big ears as we all share the issues, the concerns, questions and hopefully solutions around this.
We are collecting resources.
I just want to give a little mention.
We have quite a few people who have registered for this.
I think it was well over 900 which is just a really good acknowledgement of how many people in libraries are feeling the urgency of this topic.
A number of those who registered and filled out the survey were from organizations.
So I just want to call out a few of those of the many.
In particular, the national network of libraries of medicine is prime to help with supporting resources around this topic.
We also have registration from the centers for Medicare and Medicaid services.
Various DHS offices, multiple state libraries.
The national library of medicine, office of minority health, multiple academic libraries.
We have someone from IMLS as well.
So lots of organizations that are really already involved and ready to increase their support as we all face this national crisis.
So as Jennifer was mentioning, we are collecting -- and it's a growing collection as things hit the news on an almost daily basis.
There is that resource on web junction.
And we've created a Facebook group so we can have an on-going conversation about this topic.
So lots to cover in 90 minutes.
Just a brief overview.
And we really want to open up the conversation with everybody.
So engaging our panelists who are here to share their experiences and expertise.
But then also have a real conversation with everyone in the audience.
And I see we're getting close to 400 of our people who have registered and joined.
So thank you, all, for showing up today and being willing and engaged.
And really encourage you to share in chat what you know, what your experience has been, what resources you might have.
We will capture the chat and share it back after the webinar.
So this is always a really important resource for us and for all of you to share our knowledge and experiences with each other.
So I am Betha Gutsche on the left and Jennifer Peterson to give a face to a name.
We are going to be your primary moderators.
And we are very fortunate to have amazing group of panelists who have agreed to give their time and energy and share their experiences with us.
So we have Rachel who is central library administrator at the Denver public library.
Kim, director public library of Cincinnati and Hamilton county.
Vanessa, assistant director at the Santa Barbara public library.
And recently she was at Humboldt county public library.
She shares that experience with Dana who is the senior program manager with public health, healthy communities with the DHHS.
And we have Shawn, director of communications and strategic initiatives at Multnomah county public library in Oregon.
And Hadi who is the associate legislative director for justice and public safety at the national association of counties.
So we'll be hearing from all of these wonderful exper panelists and -- expert panelists.
So I'm going to give a very brief overview of the opioid crisis.
It is just so far out of scope for us to really go into the full story.
Very complex deeply rooted story.
A lot of convoluted factors that have all intersected and intertwined to create the situation that we find ourselves in today.
And this particular town hall is looking at the crisis through the lens of libraries.
It is national and I think that's a testament by a number of you joining us from all over the country.
Just some very high level data points that since 2013, overdose has surpassed car crashes as leading cause of preventable death.
So car crash has held that top spot.
But now it's been surrendered to overdose.
There are a lot of convolutions in how you calculate overdose deaths.
Not going to go into those details right here.
But, in general, 61% of overdose deaths involve an opioid.
We'll hear more about this later from Dana who is going to give us more specific information about what the opioid family includes.
And at least half overdose deaths involve a prescription opioid.
So as I said, lots and lots behind this.
And I encourage everyone to follow the resource page.
We're going to post in in-depth understanding.
So libraries are on the front lines.
Whether you like it or not.
This is the reality.
There is drug use happening in and around the library.
Library staff are finding discarded needles and on-site overdoses and fatalities.
This is front and center in the library world.
And I like the quotation from a very recent American libraries article.
Libraries are just because of a number of factors.
They are uniquely vulnerable to those seeking a place to use drugs.
We're going to ask each of our panelists for just a very brief view of how is your library or your community impacted by the opioid abuse epidemic?
And I encourage our audience to enter in chat your experience.
How has this arrived at your doorstep?
Beginning with our panelists, I I would like to call on Dana.
If you could give us a really quick two minutes or less response to this question.
>> Dana:  Sure.
So I work in public health and we recognize that, like many public employees or agencies, the librarians end up being front line on this issue.
And we ended up being involved through, actually, the bookmobile service in our county which provides services to our rural out lying areas.
And Adrian used to run the mobile and asked us to set up a training so library staff could be trained.
And that was a wonderful experience for us.
We gave them evsio kits, auto injectors administered in the thigh.
Within a month's time, they had an opportunity to reverse an overdose at the main branch of the library and save someone's life.
So that's one example of how we are impacted by this issue. 
>> Betha: Thank you so much, Dana.
I know all of the stories are deep and wide.
We're keeping these very brief.
It's just really starting to build a good picture.
So I would like to call on Hadi.
I know you are not at a library.
How are you feeling the impact of this opioid abuse epidemic?
Please remember to unmute so we can hear you.
>> Hadi:  Thank you.
And thank you all for convening this great conversation.
We definitely commend you all for prioritizing this.
And I think both the scope of the conversation so far and the number of attendees you have speak to how big of a national issue this is.
And this is really something that through our organization driven by our members, this is something that came to our attention as a true national crisis a couple years ago.
Where we heard not only about the overdoses in deaths but also the resulting strain the epidemic was having on all of the county functions across the board.
Whether it was hospital s being overflowing with overdose victims and not being able to properly serve those individuals but having less services for individuals struggling with other issues coming into the emergency rooms.
Also jails.
We were in Kentucky which I'm sure you all know is one of the epicenters of this issue.
And we heard from the jail director in one of the counties there that nearly 70% of the individuals in their jails, and this is a men's jail, were dealing with issues that stemmed from an addiction to prescription painkillers or heroin.
And then 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.
Because of the breath and variety of county functions, which I'm sure many of you all are intimately familiar with, we kind of see the impact of this from overdose all the way to death and the work of coroners and morgues.
and I think it's been a sobering reminder for us of the importance of prevention.
Importance of local infrastructure sinfrastructures against drug abuse.
Those local infrastructures are reliance on the participation of many different Stakeholders across the communities.
As you all are highlighting today and as we have worked to highlight through a couple articles we've written in the last couple of months highlighting the great work in the Humboldt county library system.
Libraries are important part of this infrastructure against drug abuse and the fatalities that are happening at a really staggering rate across the country.
So we're happy to be a part of this conversation and, again, we commend you all for prioritizing this issue within your networks.
>> Betha: Great.
Thank you so much, Hadi.
And I really appreciate calling in to focus that this is a strain on all community functions.
So the library shares this experience with pretty much every agency in your community, probably.
So Kim, what can you tell us about how you are feeling the impact?
>>  Kim:  So in Cincinnati, this is more of a problem for our main library than for our 40 branch library network which does make it a little easier to, at least, deal with.
We're not trying to fight this fire on 41 fronts.
But really can focus our efforts at our main library.
That's where it's the primary place that this is happening.
And interestingly enough, our whole region is really seeing this, not just the city.
So typically, we would think of overdoses as happening downtown in the city itself.
This is something that's happening in the suburbs and the smaller cities and villages all around our region.
You mentioned Kentucky being one of the epicenters.
Cincinnati shares a boarder -- 
border with Kentucky.
We're kind of getting both groups taking part in this. 
>> Betha: Great.
Thank you so much.
This is just really building a vivid picture.
Rachel, what can you tell us?
>>  Rachel:  Hi.
Well, here in Denver we're really experiencing this downtown in a big way.
In February, we had an overdose death at the library.
So that kind of kicked off the library's real immediate response to the epidemic.
Including training.
We've trained about 90 staff members so far to deploy narcan for people experiencing an overdose.
And we also have been working with a lot of different city agencies to do needle counts throughout the city so we can start to track where this is really a big deal, where we need more resources.
So we're seeing a lot of it within the library and throughout the city.
So that's kind of our big deal.
>> Betha: Okay.
Thank you so much.
Shawn, what's your experience over there?
>>  Shawn:  Hi.
Thanks for having me.
Multnomah county like other areas across the country is really struggling with this.
The particular challenge that it's a complex problem that doesn't have easier straight forward solutions.
So we're really focused on working with a wide range of partners to address this issue on many fronts from staff at a particular location who arrive at work to find needles in the landscaping to other locations where people are really concerned that the bathroom is an area where people could be using the restroom inappropriately.
To providing direct support in the moment for people clearly experiencing some sort of crisis.
So really our focus is on a set of conversations across our community and ways we can plug in and ask critical partners to help support our efforts as well. 
>> Betha: We're going to be expanding on some of these comments in our sections as we go forward.
So we'll hear more from each of these panelists.
Last but not least, Vanessa.
What is your experience with the opioid epidemic?
>>  Vanessa:  Hi.
So Dana is going to get into the specifics of our community.
It really is the library is one of the few front facing institutions that are present throughout the complex geography.
the problem we experienced in our main library and another library that's in a larger hub community.
We have people who come down into these hub communities for services because they don't get services in their areas.
so that's where we experience quite a lot of it.
And I'm he can knowing what a lot of the other libraries are saying.
It's just multi facetted.
For me, a lot of it is facilities management.
Our bathrooms are just a hot spot.
We've had to actually hire desperately find the funds to hire full-time security guard.
We've gone through the training and have the supplies to reverse overdoses. 
Around the library, there is a death behind my office on the periphery of the library as well.
For us too it's the capacity to handle it because as a rural library, obviously, the funding isn't really there for us to be able to have what we need to have.
I've worked on a lot of other systems.
We used to have people to call upon to have the hazardous materials clean up in another system.
Our front line staff are really putting themselves at risk in a lot of ways to handle this to the best of their capability.
Not only responding to the problems but finding the way to build that capacity to continue to respond to the problems.
>> Betha: Yeah.
Thank you so much.
I'm seeing a lot of great comments and chat.
A lot of shared experience around the use of library bathrooms as a real target for those people who are addicted and finding locations and the library is part of that being so vulnerable because it's open to all and is considered by many to be a safe haven.
Just want to call out a couple comments.
One, this is not combined to large urban areas.
Impacting small libraries.
You experience an epidemic two years ago and living in fear of the return.
Hopefully, as we through the program, understand more of the complexity of the pictures.
Questions came up about use of Naloxone.
We're going to go into that a little bit more.
The good samaritan laws that are behind that.
So a lot of questions.
This is reflecting comment about the strain on all community functions.
Somebody mentioned that in Kentucky which as we all know is one of the more harder hit areas of the country, that the communities are also be stressed financially.
There's an up tick in 911 calls and emergency healthcare and all of this at a time where you are facing other financial issues.
like you have a state pension crisis.
So the ramifications of this problem is really far and wide.
And I think there are all kinds of reasons to look to communities to work together to really start to address this.
I also want to appreciate a comment from a state library.
You are not immediately directly impacted.
Because you work with and support all the libraries in the state, you are feeling that on a multiplied level.
So lots of reinforcement of this or echoing of this experience that you are having at least trafficking drug paraphernalia and lots of problems walking right into the library.
So I think some of your questions will be answered in the next section.
We'll also have time to look at some of these topics more individually.
So they did fill out a survey.
These are pulling out some of the statistics that we heard from that registration survey.
so 33% of you are providing referrals, which is great.
Those of you -- and this was a check all that apply kind of survey.
So a significant number, over a quarter do not yet have a response.
Not sure whether you have not felt the direct impact or haven't figured out how to formulate a reasonable viable response to what you are experiencing.
So then a range of other responses.
Training staff, interpreting that as trained staff on the actual use of Naloxone is relatively small at this point.
So hopefully we can give you support to come up with good responses for your situation and your library.
So this is a town hall discussion meaning we have expert panelists here.
We've tried to divide this up.
We'll have pairs of our panelists discuss and open it up to your comments and questions.
We do want to hear from you.
And get some of your questions at least out into the air and surface them and we can pursue this conversation further beyond.
Knowing in advance there's a lot of intersection and overlap.
So there's no way to neatly divide.
So we want to start with what I consider as the fundamental level of your interaction with the patrons in crisis coming into your library or on to your grounds.
And then moving into the second where we'll be talking more specifically about direct intervention solutions.
And this is training staff on the use of Naloxone.
And we'll hear more around the details on that.
And third, working with your community agents and partners and seeing how you can be integrated into that network that is addressing the opioid crisis on the large scale national level.
The city county local national level.
So as I said, this is the fundamental how you are interacting with patrons.
Are your staff able to recognize and assess the situation?
And what are the kinds of appropriating engagement.
How do you protect confidentiality?
So those kinds of issues that are first and foremost.
And I'm going to invite Rachel to give us her insights and experience with this.
>> Rachel:  Hi.
So yeah, like I said earlier, we really kind of started with this very early this year with an overdose death that happened in the library.
And we've been working with a number of city agencys and a number of larger efforts taking place throughout Denver and throughout Colorado.
We've been working closely with the department of environmental help.
Sharps containers in our library as well as branch libraries.
That's been an effective partnership including the library being included on their task force to count needles and do a hot spot tracking throughout the city.
They just hired an opioid specialist who has been working on a health assessment at the library.
To talk about what we're experiencing here.
We also work closely with an agency called the harm reduction action center.
They provide clean needles to people.
And that's about a block away from the library.
So they are open five days a week.
And there's a lot of referrals back and forth between our agencies.
Recently, the Denver police department has been piloting a co-responder program.
So that's a pretty interesting partnership.
They were awarded $500,000 to work with several city agencies and primarily goes through Denver human services.
They provide not only -- when police are called for incidents throughout the city, they will send out a social worker or someone who has skill in kind of connecting people with resources to go along with the officer who responds.
And this is helping to divert some people from jail and get them into programs that are beneficial to them.
We're also part of this kind of growing group, unfortunately, of agencies that meet every a week at the mayor's office so we can talk about what's happening, are we getting appropriate resources?
Public works is there.
Denver parks and rec is there.
Environmental health.
All these agencies, as you were talking earlier, about strain on city budgets.
We talk about what we're doing and what's working.
That's been a really beneficial meeting that we have so that we can all be addressing these problems together.
We also have a team of community resource specialists.
We have two social workers on that team who lead the charge.
So as we're talking about privacy and library ethics.
We have these other professionals that have a different set of ethics and a different -- their mandatory reporters and things like that.
They really have a better connected network to help people get into services and can do a lot of warm hand offs.
We also just learned today that we are funded for two additional social workers.
So we will have four on our team at the library.
Very excited about that.
We have five peer navigators.
They are people who are in recovery or those who have experienced homelessness or other life challenges like that.
They are better able to connect with people throughout the library.
in fact, one of our navigators last week got two people into treatment.
Able to do a warm hand off and really knows her way around that.
Able to reassure our customers she was given good information. 
They also provide a bunch of training for our staff. 
So our training for staff includes trauma informed systems of care where we talk about approaching people who seem to need some help.
But approaching them from a compassionate stand point and not a punitive stand point.
We have a class called finding resiliency.
What a lot of our staff experiences is kind of second-hand trauma.
They come across all kinds of stuff in the library.
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.
Just starting a class called homelessness 101 that's going to talk about those challenges and mental health first aid.
So giving staff those tools so they can identify when people need help and start to connect them with our social work team.
The other things we're doing are related to more of our city agencies and what they are working on so our facilities team used to be anything that's hazardous materials training.
And require most of our front line staff to go through a sharp's training.
The bathroom especially.
We need to make sure staff are appropriately trained for that.
We have a class called safety at DPL where we talk about emergency responses.
This has been a topic for that class.
We are over 62 staff members trained.
We are about 90 staff members.
And we are up to 8 branches.
So we have 26 locations at the Denver public library.
8 locations are ready to go with that.
Opt in for branch staff.
But the security staff are required to have Narcan training.
The other big thing that has been a real shift in our culture and has been helpful in dealing with all these situations is our social workers work closely with our security staff.
So if someone is found in a bathroom injecting, our social workers respond with the security officer.
And they can both kind of have that intervention conversation, the customer is then banned from the library until they can set up a meeting from our 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.
That's been really effective.
It's also changed the environment with our security staff to one of more compassion and more kind of Tom a-informed approach.
So those are the things we're doing right now.
>> Thank you so much, Rachel.
I'll echo her chat.
And I think it's a very good and inspiring example for all libraries.
I want to shift over to Kim from Cincinnati and Hamilton county.
You have a little different experience.
And may be able to address the question that's come up about what kind of a bad rep it gives to your library with having to meet this need.
So Kim.
>> Yes.
Actually, I'm glad somebody can bring that up.
The perception that coming to the library may not be safe or might not be family friendly.
That it's filled with people who are using drugs and homeless and that kind of perception that people give around downtown main library or some of the more urban branches.
our library has a main library in 40 branches.
We're not part of the city of Cincinnati or Hamilton county despite our name.
We serve all of Hamilton county.
That means we serve 49 different political jurisdictions.
So we have a lot of different cities, villages and townships that are in our service area as well.
So doing things like attending a weekly meeting with our mayor would be a full-time job for several people to go to all of those different locations.
So as far as the perception goes, that is very much of a challenge for people especially dealing with where do I park, how heavy is the traffic going to be. 
So we do have to help with that perception and I think the articles and there was a link in here a couple different times in the chat box about the article about the drug overdoses where 60 reporters from the Cincinnati inquirer spent 7 days out in communities all of our region looking at what the epidemic was doing to the community.
And during that time period, there were 180 overdoses and I believe 18 fatalities from those overdoses.
What was interesting was the highest number of those occurred in butler county which is a neighboring county and not in downtown Cincinnati.
Those things help people to get rid of their perceptions of where this is taking place.
So we've taken a more laid back approach to it.
That's kind of unusual for Cincinnati.
But I think that although these numbers seem really high to us, compared to what the rest of you are experiencing, it has not been that much of an issue.
Our staff does not administer Naloxone or Narcan.
We have relied on our first responders including a special detailed police officer in our main library afternoons and evenings.
We have our own 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.
So we have a much smaller group of staff in a crisis situation.
And sometimes that is an overdose and sometimes it's a seizure or a heart attack or some other diabetic situation.
So we have a lot of different kinds of episodes that happen in a public building.
We are fortunate our first responders are about a block and-a-half to two blocks away.
Takes very little time for them to get to the main library.
So that helps us with that time.
I think I need to go to the next slide.
Thank you.
So as I said, our overdoses are almost exclusively at the main library.
We average one per week.
The summer we've only had one all summer.
When the weather changes again or something else happens, we'll probably have four or five in one week and we might go two or three weeks where we don't have any.
It will feel like some days every time I turn around, may be hearing about an overdose.
Only two of our branches have handled overdoses.
One of those is mentioned in the inquirer article.
What we're seeing is that these overdoses are becoming more public.
They are not just happening in the restrooms.
So we'll get a call that someone in the restroom or security staff.
They'll respond to the restroom and the person will be like I'm fine, I'm fine.
I don't know what they are talking about.
And they'll walk over to get on the elevator and collapse.
So they clearly were not fine.
And then we had at situation where a truck drove up and dumped a person out on a street who overdosed.
Our security staff then ended up calling for emergency responders to come and do that.
The person is neither arrested or transported for medical care.
We are working to give them referrals to a facility that can provide them with a voluntary help.
They cannot come back into the library.
Other than that, they walk out of the building as if there had been no illegal drug use at all.
We now assume that everyone who is nonresponsive has overdosed.
We understand that administering Naloxone, even if the person has not had a drug overdose generally does no harm.
Since we're not doing that, we can rely on the first responders to make that call and decide what to do.
We have been working on some partnerships.
Even though our numbers are significantly smaller than many of the other large libraries for which we are very grateful.
And I didn't really realize it until I saw all of these other comments from people here.
The police see this as criminal activity.
They want to treat it as a criminal behavior.
And that does cause some conflicts.
So similar to another person, they are wanting us to make modifications to our bathrooms to reduce the number of bathrooms that we have.
Building code requires us to have a certain number of bathrooms.
So we can't necessarily do that.
We're working with them on solutions that would further reduce that number.
The one suggestion they have that I have been horrified by is to install scanners at all our doorways and require everyone to scan an ID to enter the library.
Then give the police access to that database.
And we have refused to even consider that.
I think that's outrageous.
And then the Hamilton county coalition was a loose group of people in the community primarily law enforcement and medical care providers that meet on a monthly basis to talk about what changes we're seeing.
I'm glad somebody said oh, my God that's nuts.
I couldn't agree more.
Thanks.
>> Betha: That sums up the situation.
I really appreciate hearing all this experience from you.
We're going to move on to our next topic.
I appreciate everyone who is responding to questions and sharing your own experience.
This is really building a rich resource right here.
I encourage all the panelists.
There were particular questions Kim or Rachel could answer about funding.
How do you fund a special detail officer and somebody had a question about who funds the maintenance of the containers in the restroom.
There are quite a few comments and that is the topic -- focus for our next topic is that direct intervention.
And we're going to start with Dana who can share some of the more tactical information about that topic.
>> Dana:  Hi.
So first off, in listening to the panel speak and seeing the comments, I just want to encourage everyone if you have not yet done so to reach out to your local health department for some technical assistance and free training on how to administer Naloxone which is known as Narcan and Evzio.
I'll give a couple resources for Naloxone training and where in your community you might be able to get your hands on some Naloxone.
There's a free app as well.
Really appreciated Kim's comment about perception in the community.
Working in a rural community.
Sometimes the opioid epidemic is dealt with from anus and them perspective.
Which really isn't founded or based on reality.
We know the opioid epidemic impacts us all.
And yet, even so sometimes there is that 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.
many of those you've heard of things like Oxycontin, Codeine.
Fentanyl.
Now being used to manufacture synthetic opioids.
Pills that might look like Vicodin.
50 to 100 times stronger than heroin.
You know what, for some reason my computer logged off.
I am going to log back on.
>> We can still hear you.
We'll move the slides forward.
Feel free to just keep speaking.
>> I shall.
So now is a good time for me to mention a couple of the resources that exist out there.
The city of Baltimore is pretty notorious for having a huge opioid problem.
A huge overdose problem.
And they've created a web site that is cowled dontdie.org.
There is a video of how to administer Naloxone.
And it's a really good one.
As well as lots of other important information about opioids and overdose prevention essentially.
The other resource is a free app.
It's called Narcan now.
It's on androids and iPHONES.
You can watch a video of how to administer Naloxone CHLT
And you can also find pharmacies in your area where you can purchase Naloxone.
So there is no adverse effect.
One of our staff members accidentally administered Naloxone to themselves.
Nothing happened.
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.
It doesn't work if someone has overdosed on a drug other than an opioid.
And that includes alcohol.
so unfortunately, we don't have an overdose reversal tool for meth, for example.
It would be wonderful if we did.
It is effective for opioids.
We can go to the next slide.
So in Humboldt county, we started deliberating Naloxone in 2003.
And at that point, our overdose death rate was 18 times higher than the national average.
After one year, our overdose deaths decreased by 42%.
those affiliated with opioids.
And another statistic here is we administered 1500 Naloxone kits and we had 116 overdose reversals reported.
So we do outreach to rural areas.
We also provide technical assistance training to public institutions.
We really are trying to focus on law enforcement agencies and first responders right now.
Oftentimes, we are the first on the scene.
So important for them to have Naloxone in their hands.
We were able to train local University police as well as tribal police.
One of the large must anies -- 
municipalities here.
Fingers crossed, I'm hopeful it will happen soon.
We also tried to target public agencies like the libraries, for example.
And places where people who are high risk for overdose might frequent.
So recovery houses.
People who are getting out of jail are vulnerable simply because they haven't used in a long time.
People being released from the hospital and may have a new medication.
They are also at high risk for an overdose.
So someone, for example, who may have had hip surgery is a perfect case example.
And the web site I mentioned also has a risk factor tool.
So I encourage people to take the risk factor test.
It's very surprising how easy it is to become vulnerable to overdose.
And circling back to that notion of people's perceptions, oftentimes, when speaking to members of the public, people have this motion.
Only people injecting drugs and living on the street who are vulnerable to overdose.
At one of our recent coalition meetings, we have medical providers in the room as well.
The emergency medical services tracked all of the calls for the past quarter.
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 was 87 years old.
What's on the next slide?
Okay.
So here in California we have several laws that protect doctors and license professionals and medical providers from any kind of civil or criminal liability.
And there's another law.
Assembly bill 472.
the California good samaritan law.
That's an important law.
Protects people who call 911 at the scene of an overdose for being prosecuted of possession for a useable amount of a controlled substance.
So one thing that we go over which might not be obvious to everyone is it's not possible to administer Naloxone to yourself if you are overdosing.
Someone has to give it to you.
If you are at the point of an overdose, you are not going to be able to administer it to yourself.
People need to have an understanding if they are helping their friend or relative recover from an overdose and there are some illegal drugs on site, they have some protection in place at least here in California.
Elsewhere, people would need to investigate their own laws.
And same goes -- we have a senate bill that protects law enforcement officers from administering Naloxone from being prosecuted.
And believe it or not, those are concerns for people.
They can present barriers to people being willing to carry Naloxone.
There's no need for concern.
And I think that's the last slide.
>> That's wonderful.
I want to move on to Vanessa very shortly.
Because there's so many questions that came up around fentanyl which I know to be so much more potent than other opioid forms.
That were questions about level of concern of skin contact.
if you can address that briefly, that would help our undering.
>> Sure.
I didn't actually see the question.
What was it about skin contact?
>>  There's concern because fentanyl is such a potent form of an opioid that casual skin contact can have a very dilatory effect on the staff person that's going to help the person in crisis.
>> Meaning someone is overdosing and actually has ingested fentanyl, that's the concern?
>>  Yes.
>> Okay.
>> So just verifying if that's a valid concern or not.
>> You know, I'm going to say I would like to get back to you all on that after conferring with our health officer who is actually a medical doctor.
It's not common in our region that heroin is cut or laced with fentanyl.
we started hearing reports of that occurring.
You know we deal with from a prevention angle as well.
So we tried to warn people that if their heroin looks in any way different, they need to not ingest it.
But from the perspective of someone coming on the scene of someone overdosing and being harmed by touching someone's skin, I have not ever heard of that occurring and I don't want to say that it shouldn't be a concern.
And I would like to provide a real medical response to that question.
Can we do follow up?
>>  Yes, absolutely.
I appreciate your caution.
Others have shared really good links about the risk of fentanyl and overdose deaths.
We have some resources but would appreciate following up with you later on more definitive information about that.
In the meantime, I would like to remove on and invite Vanessa to give us her perspective.
>> Vanessa:  Hi.
As Dana let everybody know, Humboldt county has identifying partners to provide training.
Expressed an interest from DHHS.
They'll find a way to distribute Naloxone after everybody's properly trained.
I think that collaboration and leads a committee of community partner spartners who are really interested and focus on this topic.
It's been critical to us.
the county library was in the news quite a bit for a reversal in the library around a year ago.
It wasn't somebody lurking in a bathroom.
It was at a public computer visible to everybody.
We have Naloxone available.
Right now, it's in a secured container at our reference desk and available on the bookmobile.
The fabulous bookmobile driver was really the one who started this.
She does go to rural communities, tribal communities that are really at the -- really impacted by this.
Since we were an early adopter of this, I want to talk about sustainability of these types of programs in a library that has such limited resources or financial resources that sometimes it's hard to find the staff time to do our day-to-day tasks and continue to be educated and on top of these types of issues.
So we did have a staff member who initiated this.
But as it happens quite a bit in libraries, eventually, the staff training program really became housed in one of our departments and one of our public facing departments.
And it really became a project of one or two staff member s which is fantastic because the staff members were really engaged with this.
One of the concerns I had coming in is that there wasn't a lot of system wide sharing or distribution of information once it evolved to be a project of one public facing department.
So my advice to you if you want to embark on creating this collaboration and some sort of a training program for your staff is that it's important to have kind of a coalition of staff members, particularly, ones public facing.
So having someone from circulation, technical services, just with that acknowledgement this is a system-wide community wide issue.
This knowledge should not live in one particular niche area of your library.
One that happens as we had occurred to us very recently, that staff person moved on to another position.
While we do have little -- sorry to talk about this.
they are not as comfortable with it any more.
And almost to the point we're going to need to start over from scratch with a brand new training, brand new distribution of Narcan.
And the information that these folks were taking from their own community involvements.
It wasn't being distributed back to the library.
Ultimately, the buck stops with administration.
Should have been better promoted.
And that's something we all take responsibility for.
So it's such a vital asset to our community and something that if you are thinking of starting your own program, you need to ensure it's a broad coalition in staff and it's properly supported and properly communicated.
And also setting up systems for training and staff turn over.
It does quite often happen particularly in rural communities where you get people who want to move to another system.
You need to have everything properly documented.
All of the community resources properly documented.
It shouldn't just be a passion project.
It should be a systematic training program within your organization.
And I think I'm on to the next slide.
So some other things I wanted to talk about within the confines of the library.
And I think there's been a robust discussion of a lot of these elements in the comments.
First is kind of the messaging to Stakeholders and the public.
The whole perception problem that there are libraries and people reluctant to talk about this.
Speaking to community members who stopped visiting the library, people who just moved into the community from other places, I had one of my friends tell me that their real estate agent told them not to go to the main library because that's just a place where people go to shoot up.
Hearing secondhand that other people are spreading that message in the community, that's really troubling.
But what I found outside of library staff there hadn't really been any messaging that yes, we are a microcosm of what's going on in our community and we're experiencing this along with everybody else.
And when I first started going out to the community groups to talk about the library because we were also in desperate need of fund-raising as well. I was approached by the president of my foundation to basically tell me we love the library and need help fund-raising.
But can you downplay some of these issues.
We don't think it's going to be helpful for our fundraisers if it's openly acknowledged there are issues going on in the library.
And I really appreciate.
We have such an active foundation that I can understand why they would have this perception.
If this is truly a community-wide issue, people are going to know anyway.
It's going to be something that is well acknowledged by a lot of different groups in your community.
So you need to -- essentially denying it's a problem.
Denying that the library staff have been trained.
Denying anything that's going on is not to 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.
And that's really dangerous.
Any kind of PR media training will tell you that you need to find a way to productively shape the message.
Yes, we're going through this issue.
Here are all the wonderful things we're doing to be a community partner to help solve this issue and the library is transformed into an active vibrant community partner which has helped us to get funding.
We had staff go through mental health first aid training.
We had staff who we were able to leverage public safety funding to get increased security guard presence.
And we wouldn't have been able to do that without talking openly throughout multiple community members to acknowledge this problem and talk about what we're doing to solve it.
Yes, it is a concern that the library has a bad reputation.
It's better for you to be active in shaping that message rather than letting people do it for you.
And you are able to transform that into being a conduit for community education.
Something that I know the library is working to do as well.
We're working with -- because it is such a pervasive issue in our community and becoming a political issue.
We have one of our supervisors working to organize a community forum and bringing in author Sam Qui NSHGSQuinonez.
And we're making sure the library is at the center of the discussions.
Do I have another slide?
>>  I believe that's it.
I really appreciate the message about owning it.
This is a national crisis.
We all need to own it nationally and trickles on down to every level of the community.
This is a great segue to that community education piece.
That moves us beyond the immediate crisis response and whether to train or not to train staff.
And moves us very nicely into our next topic focus which is tapping into the community support networks.
And I'm going to call on Shawn first to share your insights and experience.
>> Thanks.
I think Vanessa is touching on some of the basis of what I want to talk about.
This is a particular challenge for public libraries.
They are among the most open institutions we have in our communities.
Issues that manifest in our community will be present within the library.
I think it's important that we get to a point where we don't have the expertise or the resources to deal with this on our own.
So we need to look for where we can leverage other expertise or resources within our community.
I think it's also really important to look beyond the immediate fear of a negative public perception that people are doing bad things in the library.
It's more important than that.
this is really a national crisis.
A national epidemic.
And so we need to look for new ways to address this using every tool available to us.
And that takes a lot of thoughtful coordination.
In Multnomah county, we are fortunate to have the leadership of our key elected official chair helped us initiate a bunch of vital conversations with mayors in our service area and law enforcement agencies and municipal partners, our health department, the agency that provides mental health services really to sort of get this out in the open and start to look for ways we can work together more effectively.
And we've partnered with our health department to continue training regiment for our persons in charge.
We're looking to possibly partner with the health department to address some of the potential cost issues.
And I would suggest people look toward their facilities departments as a key partner.
We are working with our facility's department to start installing sharps containers in the bathrooms.
And look for ways to address issues around landscaping.
And how we have outdoor spaces less conducive to the kinds of behavior we want to deter.
And this calls for a set of new approaches and different kind of thinking.
This is a really important conversation we're having here today.
Libraries are about sharing.
And there's a lot of knowledge and experience to be shared.
I can think of a few great examples off the top of my head of other systems we've looked to for various approaches.
San Francisco, Philadelphia and Denver have all tried innovative things.
And there's no shame in borrowing ideas from other systems.
So along those lines we have added social workers and we're looking at potentially expanding that.
We're looking toward a peer counseling model.
And San Francisco has a similar problem.
We're partnering with our department of community justice agency.
To spend some time in libraries just doing office work.
In addition to that about perceptions that some of our community members might have being cognizant but it is a way we can have presence that we hadn't really had or looked to before.
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 are needles in the landscaping or it's addressed before the patrons visit that location.
Or addressing the schedules of the night patrols.
And making sure those are happening at a time that's more likely to disrupt inappropriate behavior on library property.
And then I think it's also really important to remember staff to provide information and support for staff.
Because they are navigating this reality too.
It's new, it's scary.
And it's very complex.
So we like to remind people of the resources available through our employee assistance program.
We have a lot of training offerings that support our efforts here.
And we've also partnered with local agency 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 I think also it's really important to keep our focus on solutions and not blame.
I think one of the things that people dislike the most about government agencies handling certain kinds of issues is when they point fingers.
That's not a great place to start.
I think I would point to Denver and public handling is one that reflected a call for assistance and aid and really looking to other agencies as keys to addressing these issues and not a place to assign or point blame.
They are relationship driven enterprises.
So different kinds of conversations and different groups, we're also being relationships be in closer communication, have better response and more coordinated in our efforts.
When neighbors are having challenge schallenges with behavior and other things happening, that's a real challenge.
And I understand when we're approached by someone who thinks the library should be doing more.
A key part of that conversation is not only sharing what we are doing but being candid it's a complex and critical problem.
We have limitations and we're trying to look beyond those.
And then I think really just 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 better service to our communities.
communities.
>> Thank you so much.
Resilience is one of my key theme sthemes.
Libraries have shown resilience throughout our history of being in service to the public.
And I think we've met other rapid changes very heroically.
So this is another opportunity to display that and figure out where we're going.
So I want to bring Hadi to the microphone now to look at that bigger picture from the community, that city county community perspective and share with us your insights.
>> Hadi:  Thank you so much.
And thank you for a great conversation thus far.
I want to build on a couple things that have been said and add a little bit to the conversation as well.
I could not echo that recommendation enough.
And I think a particular part of that book is he called the opioid epidemic the quietest epidemic.
it's not attached to violence as much as some other epidemics and doesn't arouse outlooks as much as it allows them to sleep.
But called it the quietest epidemic.
It strengthened and gained steam because of the stigma that's been attached to it.
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.
I think that's an important point to keep in mind here.
Is there some risk in becoming attached to that stigma when you undertake efforts in this arena?
As has been said on the call already, until you take control of the problem within your libraries, you are not going to be able to define it and run a much larger risk.
And libraries are quiet spaces.
So I think it's fitting to have this conversation.
So just to tell you a little about our work.
what to see on the screen there, the report was the culmination of an effort we undertook last year.
We brought 10 county commissioners together with police chiefs and others.
And we traveled around the country and tried to observe the impact of the epidemic and how it was impacting local governments and how local governments can respond to it.
The report that you see is available at opioidaction.org.
I'm not going to walk through the whole thing.
I want to highlight three or four items quickly.
One that Shawn just touched upon and has been discussed is the importance of convening community leaders.
And I think Sha wn mentioned the chairwoman as the champion leaders in this space.
Encourage your county commissioners, your mayors to become a champion of this issue and to inform them if they are not already aware that the libraries are becoming a front line for this epidemic and you need their leadership and you need their support.
We've talked about some of the solutions that different counties are implementing.
And I'm sure it goes without saying cities and counties can help implement those solutions.
I want to highlight one organization and that's the community antidrug coalition with America.
They have a proven exper -- 
expertise that come up with community specific prevention to drug epidemics.
And that takes me to my second point.
The importance of Tayloring solutions.
And I think you come about by bringing together the individuals within your community that are dealing with that.
And this has been touched upon throughout this conversation.
A solution and a rural area is not going to work in an urban area and vase versa.
You might have some libraries that are 60 seconds away from first response and maybe it's not so important for them to have Naloxone on hand versus a library that has much more incentive to do that.
And what is politically feasible in one place is not feasible in another place.
So again, a particular impact of convening community leaders is to find the solutions that are palable, feasible and effective in your local communities.
Another point I want to highlight is even in an epidemic where people are overdosing left and right and our morgues are struggling to deal with the after effects, it's important not to lose sight of prevention and education and for you all 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 prevent them from becoming addicted in the first place.
I think libraries and local leaders can play a huge part in educating individuals about the dangers of drugs starting with prescription painkillers or whatever you define that to be in your community and moving on up.
And finally, something that might not seem optimistic but it ultimately is.
This is an epidemic as Sam and others layout.
This is an epidemic that has developed overtime.
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 resolving door of individuals becoming addicted.
And again to work with others within the community not just to come up with solutions but measure your success and measure your progress and find the areas which you can continue to work.
So I commend you all for the work you all are doing.
We are a resource to each and every one of you whether you are county library or not.
And that information I've shared already has all our contact information.
Reach out to us whenever we can be helpful.
>> Thank you so much, Hadi. 
I appreciate what you said about prevention and education.
We are very wrapped up in immediate responses because we can really feel the urgency and criticalness of the epidemic when it's in the stacks and in our libraries.
Libraries, as you say, have a really important role to play in the larger network and working with community agencies to really focus on that prevention and education.
And hopefully turn it around.
The problem is only getting worse.
So wonderful information being shared in chat.
Thank you for everybody.
We're going to do a quick wrap up round with our panelists.
I'm going to start back at the top of the list.
Give us a key phrase on what do you think is the single most important response that a public library can make in this crisis.
So very short really quick because we only have a few minutes left.
If you are not in the library, think about your community or organizational response.
I encourage everybody in the audience to put in your key words and your first things as your next steps of maybe where you want to focus in your library after this conversation.
So let's start with Dana.
What would you come up with?
>>  Education. 
>> Education.
Wonderful. 
My list has scrambled.
Hadi you are next in my view.
What's your key word or phrase?
And remember to unmute so we can hear you.
>> Sorry about that.
My key phrase is partnerships across the community.
>> Perfect.
Okay.
Kim how about you. 
>> I was not ready.
I would say really an understanding of the problem.
>> Very good.
Rachel.
What about you?
>>  Compassion and connection. 
>> Two potency words.
Shawn. 
>> I'll say resilience.
This is something that we have to address today and will have to wake up again tomorrow and do more of the same and try some new things.
Really important thing for us to keep in mind.
>> Absolutely.
And resilience transcends crisis.
And Vanessa.
>> I'm going to say radical transparency.
It's important to leverage that to serve your community.
>> Wonderful.
Did I miss anybody?
I hope not.
If I did, speak up. 
That brings us close to the end of this time together.
As I said at the beginning, this is really just to start the conversation beginning to build awareness wherever you are, wherever your library is on the spectrum of response.
The spectrum of figuring out what your sponges -- response to the crisis is.
Building that awareness step by step so we all have more tools and more resources to really get to the problem in ways that are appropriate to our individual circumstances.
But the idea of stigma came up quite a few times.
And it's a very complex subject.
When it relates to opioid abuse and overdose.
I highly recommend looking more at some of the root causes and factors that contribute to this serious situation we find ourselves in.
I read the book dream land that Hadi mentioned.
It's fascinating and horrifying at the same time and understanding how complex this situation is and how complex the solutions to it will be.
Key to that is working together and working with community networks and building awareness on that national level.
So thank you so much for being part of this to start the conversation.
And I'll echo all the thanks to you.
And as one last little message before I turn it back to Jennifer, we will take all the insights that were gleaming and we will share them.
We capture the chat.
You will be able to access all of the conversation.
There was a lot going on today.
And the links that have been shared, we'll pull those out and put them into our rapidly growing list of resources.
And also want to steer you to our new Facebook group, the libraries and the opioid crisis to continue the conversation.
Obviously, there were some questions we didn't get to.
I appreciate all the answers you gave to each other.
This is really, as we said over and over, this is just the beginning.
So please go to the Facebook group and continue talking and we are working toward an evolving solution.
So thank you, again.
>> Yeah.
I've been approving multiple requests to join the group.
So keep sending colleagues that way and we'll definitely connect to there.
Just a quick note on today.
I will send you an email once the recording and the resources we've collected are all posted.
For those that need it, I will send a certificate for attending today's session within a week.
And extra special thank you to PLA.
There were many of them on the call and chat as well.
Thank you to all of the PLA team for working with us on this town hall.
And we look forward to continuing to work together.
And thank you so much to Betha and thank you so much to our panelists again for bringing your experience and expertise and insights into this town hall conversation today.
Everyone have an excellent day and thank you to our captioner as well.
Have a good day.
We'll stay in touch.
Thank you for your great work at your libraries. 
[ End webinar ]