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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.

Identity

Celebrate International Women's Day with these stunning photos of female leaders changing the world

The portraits, taken by acclaimed photographer Nigel Barker, are part of CARE's "She Leads the World" campaign.

Images provided by CARE

Kadiatu (left), Zainab (right)

True

Women are breaking down barriers every day. They are transforming the world into a more equitable place with every scientific discovery, athletic feat, social justice reform, artistic endeavor, leadership role, and community outreach project.

And while these breakthroughs are happening all the time, International Women’s Day (Mar 8) is when we can all take time to acknowledge the collective progress, and celebrate how “She Leads the World.

This year, CARE, a leading global humanitarian organization dedicated to empowering women and girls, is celebrating International Women’s Day through the power of portraiture. CARE partnered with high-profile photographer Nigel Barker, best known for his work on “America’s Next Top Model,” to capture breathtaking images of seven remarkable women who have prevailed over countless obstacles to become leaders within their communities.

“Mabinty, Isatu, Adama, and Kadiatu represent so many women around the world overcoming incredible obstacles to lead their communities,” said Michelle Nunn, President and CEO of CARE USA.

Barker’s bold portraits, as part of CARE’s “She Leads The World” campaign, not only elevate each woman’s story, but also shine a spotlight on how CARE programs helped them get to where they are today.

About the women:

Mabinty

international womens day, care.org

Mabinty is a businesswoman and a member of a CARE savings circle along with a group of other women. She buys and sells groundnuts, rice, and fuel. She and her husband have created such a successful enterprise that Mabinty volunteers her time as a teacher in the local school. She was the first woman to teach there, prompting a second woman to do so. Her fellow teachers and students look up to Mabinty as the leader and educator she is.

Kadiatu

international womens day, care.org

Kadiatu supports herself through a small business selling food. She also volunteers at a health clinic in the neighboring village where she is a nursing student. She tests for malaria, works with infants, and joins her fellow staff in dancing and singing with the women who visit the clinic. She aspires to become a full-time nurse so she can treat and cure people. Today, she leads by example and with ambition.

Isatu

international womens day, care.org

When Isatu was three months pregnant, her husband left her, seeking his fortune in the gold mines. Now Isatu makes her own way, buying and selling food to support her four children. It is a struggle, but Isatu is determined to be a part of her community and a provider for her kids. A single mother of four is nothing if not a leader.

Zainab

international womens day, care.org

Zainab is the Nurse in Charge at the Maternal Child Health Outpost in her community. She is the only nurse in the surrounding area, and so she is responsible for the pre-natal health of the community’s mothers-to-be and for the safe delivery of their babies. In a country with one of the world’s worst maternal death rates, Zainab has not lost a single mother. The community rallies around Zainab and the work she does. She describes the women who visit the clinic as sisters. That feeling is clearly mutual.

Adama

international womens day, care.org

Adama is something few women are - a kehkeh driver. A kehkeh is a three-wheeled motorcycle taxi, known elsewhere as a tuktuk. Working in the Kissy neighborhood of Freetown, Adama is the primary breadwinner for her family, including her son. She keeps her riders safe in other ways, too, by selling condoms. With HIV threatening to increase its spread, this is a vital service to the community.

Ya Yaebo

international womens day, care.org

“Ya” is a term of respect for older, accomplished women. Ya Yaebo has earned that title as head of her local farmers group. But there is much more than that. She started as a Village Savings and Loan Association member and began putting money into her business. There is the groundnut farm, her team buys and sells rice, and own their own oil processing machine. They even supply seeds to the Ministry of Agriculture. She has used her success to the benefit of people in need in her community and is a vocal advocate for educating girls, not having gone beyond grade seven herself.

On Monday, March 4, CARE will host an exhibition of photography in New York City featuring these portraits, kicking off the multi-day “She Leads the World Campaign.

Learn more, view the portraits, and join CARE’s International Women's Day "She Leads the World" celebration at CARE.org/sheleads.


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Over or under? Surprisingly, there actually is a 'correct' way to hang a toilet paper roll.

Let's settle this silly-but-surprisingly-heated debate once and for all.

Elya/Wikimedia Commons

Should you hang the toilet paper roll over or under?



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Photo via iStock.

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Photo via iStock.

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