Public Libraries are Key Players Fighting the Opioid Crisis. Here’s What Other Organizations Can Learn From Them.

The Middletown Thrall Library in New York is minutes from the nearest police and fire stations. So when drug overdoses in the library’s bathrooms started to become a recurring issue in late 2013, emergency response times were not a problem.

Still, library director Matt Pfisterer and some of his staff received training to administer naloxone, an opioid overdose antidote, in case they could help revive someone who had overdosed sooner.

“We just felt like, let's be Boy Scouts or Girl Scouts,” Pfisterer said. “Let's be prepared.”

Three weeks after he went through the training, Pfisterer used naloxone to help resuscitate a woman who overdosed outside the library—and he went on to do the same for two more people after that incident.

The helper mentality shared by Pfisterer and his peers has positioned public libraries as key players in combating the opioid epidemic. Many libraries stock naloxone, offer information about addiction treatment, and train staff and community members to revive overdose victims.

While libraries are far from the only spaces that have become entrenched in the opioid crisis, they are among the few that have publicly assumed responsibility to attempt to stem the swell of overdose deaths.

“Many businesses and organizations in the community have an opportunity to see themselves as a community resource, and that might just mean being a resource for their own staff and their own customers,” said Jill Hurst-Wahl, a professor of practice at Syracuse University’s School of Information Studies.

Beyond Books: How Libraries Serve Their Communities

Libraries have long served as hubs for community services—providing public health resources, coworking space, social services, financial literacy information, food, and other services that go beyond books for their surrounding communities.

“The first thing that libraries need to do is to tailor their services to their community,” Hurst-Wahl said. “If they don’t do that, then they can’t do anything else.”

In Syracuse, Hurst-Wahl has watched local libraries offer initiatives like community gardens, cooking classes, rain barrel workshops, yoga classes, and sessions with social workers.

Librarians may not enter the field with the intention of serving their communities in ways that transcend directing patrons to literature or reference materials. But service often comes naturally to them, Pfisterer said.

“They have a strong customer service orientation, and they kind of have that helper gene imbued in them,” Pfisterer said. “Libraries also, as an institution, have always demonstrated an incredible ability to morph and adapt to the needs of their communities.”

For some libraries in areas hit hardest by the opioid epidemic, that has meant publicly addressing overdoses.

Hurst-Wahl said, in a sense, that it’s “in a library’s DNA” to assist people in the community with the things that they need and want. “And because we know that people come into the libraries with a variety of different life experiences and conditions, we’re ready to help,” she said. “If a person has an overdose in a library, we’re ready to help that person.”

Nearly 68,000 people in the United States died as a result of drug overdose in 2018, according to provisional drug overdose death count estimates from the Centers for Disease Control and Prevention.

Because overdoses can occur anywhere, it’s appropriate for library staff and people in other public spaces to be trained to administer naloxone (commonly known by the brand name Narcan), just as they would learn to operate a fire extinguisher, give CPR, or use an automated external defibrillator. Hurst-Wahl said naloxone training fits into the skills people might learn to handle emergency situations.

“What you see in Narcan training is that the health profession is reaching out to people broadly in communities to receive this training,” Hurst-Wahl said. “It’s not just libraries. ... The more people who are trained, the more likely that lives will be saved.”

Lessons Learned from Libraries Combating the Opioid Crisis

Libraries aren’t the only public spaces that have dealt with frequent opioid overdoses.

“People can overdose anywhere,” Hurst-Wahl said. “They can have taken a drug someplace else and have wandered into ... a store, a restaurant, a library—and then that’s where the effect really happens. You can’t always rely on emergency services getting there in time.”

Other public-facing businesses and organizations can learn from the ways libraries have embraced the fight against opioids. 

Identify and meet community needs.

“Really, the first thing a library needs to do is understand who it’s serving and what their needs are. Not only the people who come to the door, but the other people in its service area,” Hurst-Wahl said. “What are their needs, and how can it meet those needs?”

Librarians often want to share information about how people can access a variety of assistance programs.

“We can direct people to all kinds of drug treatment, emergency housing, food stamps,” Pfisterer said. “We have all that information readily available on the reference desk, and we do get people in here in crisis.”

Start small.

“Don't worry about it being perfect,” said Kendra Morgan, senior program manager for WebJunction, a research program of the global library cooperative Online Computer Library Center.

Morgan oversees a project that examines how eight public libraries have dealt with the opioid epidemic.

The Kalamazoo Public Library in Michigan is one of those libraries that Morgan said exemplified the power of starting small with its response to the opioid epidemic. The library began by hosting peer navigators—people who have experienced addiction or homelessness—from the Recovery Institute of Southwest Michigan five hours a week. After about six months, the library was able to show the value of the program and expand it.

Partner with social workers, health departments, and other experts who are better equipped to handle the problem.

Libraries provide space where other organizations that focus on opioid addiction and treatment can effectively reach at-risk populations.

In addition to hosting peer navigators, libraries from San Francisco to Washington, D.C., employ social workers who can assist patrons with a broad range of needs. And in Salt Lake City, libraries partnered with Utah Naloxone to provide naloxone and information about addiction recovery. Health departments across the country have also partnered with libraries to increase access to addiction treatment.

“Partnering with a library provides you access to people who are used to and very skilled at finding and sharing information with the public, and they want to do that,” Morgan said. “So when you empower a librarian with more information about what's available in their community, it's a win-win.”

Make naloxone and information about addiction treatment accessible.

Some people who struggle with addiction may not consider walking into a health department to seek services. Libraries, however, are open spaces where people might feel safer about seeking assistance.

Libraries are also among a number of organizations that qualify for free and discounted naloxone. Emergent BioSolutions, which makes Narcan nasal spray, offers two free doses (one carton) of Narcan to public libraries and YMCAs. High schools are eligible for four Narcan doses, and Emergent BioSolutions offers qualifying colleges and universities up to eight free doses. The company also provides educational resources to libraries on understanding opioid overdoses.

“It's a public location. You don't have to have a specific membership; anyone can walk in. So if somebody is in a nearby area [and experiencing] an opioid overdose, they can run in the library and get access to naloxone,” said Emergent BioSolutions spokesman Thom Duddy.

Reduce the stigma around treating opioid overdoses and addiction.

Emergent BioSolutions began its public library partnership in October 2018. Of more than 16,500 public library locations in the United States, only 268 had ordered the free doses as of September 2019, Duddy said. Seven libraries have ordered additional Narcan.

Duddy said the uptake has been lighter than his company expected.

“Stigma plays a big role,” he said.

Casting naloxone training as a lifesaving mechanism and pairing it with other training, such as CPR and AED use, may reduce the stigma around opioids that prevents organizations from stocking naloxone or understanding how to use it. Morgan pointed to “bystander training” in New Orleans that combined trainings for administering CPR and naloxone as a good example.

Make naloxone training optional for staff, and structure policies around it.

Pfisterer didn’t require his staff to complete naloxone training, but several of them volunteered.

“When you try to save someone’s life, you become instantly invested in action,” Hurst-Wahl said. “Being willing to make that investment no matter what happens is important, and it can be difficult.”

Morgan said of the libraries surveyed in her project, most of those that offered naloxone training to their staff did not require participation.

Many libraries have introduced emergency protocols that outline exactly who will administer care to people experiencing overdoses. Hurst-Wahl reiterates the importance of this.

“Having to have policies is something that you don’t always think about,” she said.

Provide support, such as therapy or time off, and encourage self-care for staff members who engage in overdose reversals.

Pfisterer said that the three overdose reversals in which he participated were intense.

“You have somebody in distress in front of you. You don't know if they're going to live or die,” he said.

However, he didn’t take time off or specifically seek self-care after those experiences.

Hurst-Wahl said that after such an emotional experience, it’s important to offer staff the support they need, including downtime, before coming back to work.

“Maybe there’s a resource that they can connect within the library or elsewhere that can help them kind of re-center themselves after that experience, and for other staff, too, because that can be truly emotional,” she said.

Continue with your organization’s central mission.

“Even at the height of the opioid problems in this building, we never stopped functioning as a top-notch informational place to meet, do your work, check out materials,” Pfisterer said. “I have witnessed the resiliency of both library staff and patrons.”

Pfisterer recalled a time when a man burst through the library’s doors seeking assistance because he thought he was experiencing an overdose. He collapsed at the circulation desk. While first responders treated him, other patrons were a few feet away, checking out library materials.

Legislation to Protect Librarians from Liability

Most states offer legal protection—known as Good Samaritan laws—for people who try to help someone experiencing an opioid overdose.

“We know that things can go quite well when you help someone who’s having an overdose, but we also know that things don’t always go well,” Hurst-Wahl said. “Having legal protection from the state can be really helpful for library staff.”

New York and Michigan are among the states with laws that specifically allow libraries to possess and use naloxone and protect staff from liability when treating overdoses.

“There’s a line that we have to be careful about, because when we cross that line, we’re crossing into another profession, and we’re not that profession,” Hurst-Wahl said. “We don’t have those licenses and that insurance to back us up.”

Duddy would like to see more legislation to protect companies that stock naloxone. Some public places, like coffee shops for instance, are resistant to have it on hand because they are not protected if something goes wrong, he said.

“That's the biggest hurdle that we're seeing for public placement of naloxone,” he said. “Good Samaritan laws … protect the individual, but they may not protect the corporate entity.”

Resources for Opioid Awareness

Additional resources for opioid awareness/overdose reversal training and addiction treatment are available here:

Locate your nearest public library using LibWeb and call to see if they offer opioid addiction services and information.

Citation for this content: Syracuse University’s online Master of Science in Library and Information Science program.