Opioid users are flocking to libraries in droves. Here's what happens when they overdose.

Last month, someone had a medical emergency at the Philadelphia Public Library, and distressed onlookers struggled with how to help.

Thankfully, someone who knew what to do rushed to the scene — another overdose, another librarian at the ready.

Ben, a librarian at a Midwestern public library, sees such overdoses on a weekly basis. "There are times it's happening multiple times a day," he says. "Not too long ago, we had two in the same restroom at the same time. We call security; security calls paramedics. Of course they always find somebody lying there."


Many of the people being asked to respond in the moment — to think clearly and decisively in a life-or-death situation, and sometimes even to administer life-saving treatment — are librarians.

But do we have a right to expect that of them? Do we have any choice?

While opioid overdoses happen everywhere, it's been impossible to miss the stories of overdoses happening in the restrooms of public libraries.

Boston. Cleveland. Chicago.

Curious as to why libraries have been so hard-hit, I reached out to librarians in several different cities, starting with Vermont librarian Jessamyn West.

"There are a lot of places that are de facto public meeting spaces because of how they're used. People hang out at the baseball field, or the Cumberland Farms, the bar, the church," West tells me.

But most of these places require people to be a client or established member of the community in order to belong. "The library doesn't," she says. "It really strives to be available to everyone."

Libraries are quiet, private spaces you can stay for extended periods of time and not be questioned. While you might need an access code to use a Starbucks bathroom, that's not a barrier you'll encounter at a library.

Ben has another theory as to why addicts head to the library: "If something happens, someone will alert the authorities."

"They know someone will have Narcan and help them out," he adds. Narcan (also known as Naloxone) is an opioid antidote.

I asked Dr. Chad Brummett, assistant professor of Anesthesiology at the University of Michigan School of Medicine, what happens without access to Narcan or knowledge of CPR. How much time does one have?

"With oral pills, the onset might be much slower. Unfortunately, a lot of overdoses we’re seeing right now are from heroin, fentanyl, or carfentanil, and that can be incredibly fast, like minutes, a minute," Brummett says. "If somebody has just shot up fentanyl, your timeline might be incredibly short."

Within the library community, boundaries are always being discussed and redrawn around which services libraries can and should provide.

Debate and dissent are common. While the American Association of Libraries states it is "crucial that libraries recognize their role in enabling poor people to participate fully in a democratic society," that doesn't mean every librarian will feel equally comfortable in that role.

"Being a librarian now implies being an expert in way too many fields: social work, child development, health care," wrote one member of a Facebook group for librarians.

A public librarian in Maine who spoke under the condition of anonymity shared that they "have found needles throughout the building (namely in the bathrooms, but not always)."

Another librarian at an urban branch told me, "This happens with great regularity here. I doubt, however, that you will get anyone in authority to talk honestly about it."

Annoyed Librarian, an anonymous Library Journal contributor, spoke for many when they expressed concerns about stepping into a first responder role: "Is the goal just to make sure that people don't die of overdoses in the library? Or is it to help them before they overdose?" they asked. "Or is that the social worker's job? It's hard to tell anymore."

Between January and March 2017, the Denver Public Library's Central Branch experienced six overdoses, including one death.

In a move that's made national headlines, its administration decided to stock Narcan and offer voluntary training to staff members who want to learn how to administer it. Chris Henning, a spokesperson for the Denver Public Library, says that while the administration expected some public resistance, they've received only positive feedback.

One of the reasons Denver has had such success rolling out their program is that they're among a growing number of libraries employing on-site social workers. Aside from their other duties, social workers at their branches offer daily drop-in hours. Their primary clients are homeless people seeking help with shelter, medical issues, and veterans benefits.

But social workers are a strategic investment, one not all library systems can afford or are willing to make.

If Denver and Philadelphia are arming staff with Narcan and training, should other cities follow their lead?

Why wouldn't they?

Based on what librarians shared with me, the most likely reasons are a mixture of bureaucratic inertia, ignorance of the true scope of the problem, and fear of negative publicity. "The administration seems [to have] turned a blind eye to it," says Ben, of his city's library system. "They don't have to deal with it. We deal with it on a very personal level because we see it every day and they don't."

It's worth noting that those heroic Philadelphia librarians didn't wait for Narcan training, instead reaching out to a local a needle-exchange program to show them how to administer it.

But even Narcan isn't a perfect fix: The antidote is effective at blocking the opioids only for a short time — typically less than an hour — so it's still critical to get someone who has overdosed to a hospital so they can be properly treated.

Ultimately, even with training and better resources, libraries are not well equipped to address the root cause of the epidemic.

And as long as they remain on the front lines, witnessing overdoses on the job, feelings of sadness and helplessness will weigh on some librarians.

"None of us [are] trained social workers," says Ben. "To maintain a certain level of empathy when you're seeing this day in and day out [is] taxing and difficult."

Is it fair to ask librarians to step into the chasm between where the social safety net ends and their real job — that is, the one they went to school for — begins?

After speaking with so many librarians, I still don't know the answer. What I do know is that many librarians are willing to do their best to help in these frightening and sometimes tragic scenarios, and for that they deserve not just our support, but that of their administrators, too.

"[Opioid addiction is] a tragedy," says West. "Everybody has to take partial responsibility for the fact that we have an overdose problem. The big thing is that librarians really care, and caring is hard when people are in pain."

This article originally appeared on Catapult and is reprinted here with permission.

Family

Whenever someone's words or behavior are called out as racist, a few predictable responses always follow. One is to see the word "racist" as a vicious personal attack. Two is to vehemently deny that whatever was said or done was racist. And three is to pull out the dictionary definition of racism to prove that the words or behavior weren't racist.

Honestly, as soon as refers to the dictionary when discussing racism, it's clear that person has never delved deeply into trying to understand racism. It's a big old red flag, every time.

I'm not an expert on race relations, but I've spent many years learning from people who are. And I've learned that the reality of racism is nuanced and complex, and resorting to a short dictionary definition completely ignores that fact. The dictionary can't include all of the ways racism manifests in individuals and society, and the limitations of dictionary definitions make it a poor tool for discussing the topic.

Since "racism" is such a loaded term for many people, let's look at such limitations through a different complex word. Let's take "anxiety." According to Merriam-Webster, "anxiety" is defined as "apprehensive uneasiness or nervousness, usually over an impending or anticipated ill."

Now imagine thinking that you understand everything that encompasses anxiety from reading that dictionary definition. Imagine thinking you could recognize the signs of anxiety in someone based on that definition alone. Ridiculous, right? The dictionary doesn't explain that some people's anxiety manifests as anger, even though it does. It doesn't say that anxiety sometimes manifests as withdrawal or aloofness. It doesn't say that you often won't see obvious signs of fear or nervousness in someone experiencing anxiety.

The dictionary doesn't offer anything close to the reality of what anxiety is or looks like. It would be silly to say that someone isn't experiencing anxiety because they're not clearly showing signs of nervousness like the dictionary definition implies. Just as the dictionary definition of anxiety is not comprehensive, neither is the dictionary definition of racism. Yet people keep using it to "prove" that something or someone isn't racist.

Fox News analyst Brit Hume just pulled that trick on Twitter to try to back up his claim that Donald Trump's "go back to" statements to four Congresswomen of color weren't technically racist.


The first Merriam-Webster entry for "racism" reads "a belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race."

Merriam-Webster

First of all, I'm not sure how this definition actually makes Trump's statements not racist. A belief is not always conscious, so even assuming that his racism is unconscious, a white man telling four women of color to "go back to" their countries of origin—despite three of them being born in the U.S. and the fourth being a naturalized citizen of the U.S.—is pretty objectively racist. No one knows exactly what is going on in the President's head, but such statements only being made to women of color would certainly be consistent with the behavior of someone with a belief in white people's inherent superiority.

But that simple definition isn't truly definitive, either. Shortly after Hume's tweet, Merriam-Webster pointed out a usage note for the word "racism," which clarifies that dictionaries do not provide the be-all-end-all definition of words.

Anti-racism advocates have tried time and time again to explain that racism is not as straightforward as someone saying, "I think I'm superior to people who don't share my skin color." Racism is almost never that blatant, and yet oodles of Americans refuse to call anything less than that kind of bold statement "racism." We have a long history showing exactly how white supremacy—the origin of racism in the U.S.—exerts itself in both strong and subtle ways, and thousands of hours and pages of education from experts describing how racism works on an individual and societal level. But people still insist on the simplistic narrative of "Racism=hating people of a different race."

I've seen many people, including Brit Hume, argue that the word racism has lost all meaning. Frankly, that's a copout. Racism—as both a conscious or unconscious belief of racial superiority and as a system of racial prejudice blended with power dynamics—has a broader meaning than one person hating another person for the color of their skin. But that doesn't make it meaningless.

I've also seen people complain that "everything is racist these days," but no, it's really not. We simply understand more about racism now, thanks to the field of race studies and to people of color offering their time and energy to explain it, so it's easier to identify in its various forms. In my experience, when someone's understanding of racism reaches a certain stage, they start recognizing it in places where ignorance or unconscious bias may have caused them to miss it in the past. That's not imagining racism where it doesn't exist or "calling everything racist these days"; that's simply seeing reality more clearly.

When you really dive deep into the historical, psychological, and sociological reality of racism in America, it becomes painfully obvious that racism is far more prevalent and enmeshed in our society than most people think. Until defensive, mostly-white folks stop automatically denying racism every time the word is used and stop throwing around dictionaries to avoid having to do that deep dive work, we're not going to make real headway on this issue.

Let's stop pretending that the definition and supposed overuse of the word "racism" is the problem, when the problem is racism, period.

Democracy
Photo by Hunters Race on Unsplash

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