Day 6

How the opioid crisis could turn library workers into emergency responders

Opioid overdoses hit record levels in 2017. Now library workers are debating whether they should carry and administer Naloxone, a potentially life-saving antidote.

Library workers in Vancouver are debating whether they should carry and administer Naloxone

The Vancouver Public Library came under fire for directing staff not to use naloxone on an overdosing patient. (Rafferty Baker/CBC)

It may not be the stereotypical picture you might have of your local librarian — of someone rushing to the aid of an unconscious person, needle in hand. 

However, as deaths from opioid overdose reach record levels in Canada, some library workers are keeping tabs not just on the whereabouts of books, but also on their snoozing patrons, just in case someone has overdosed. 

"It's perhaps not a daily occurrence, but it does happen from time to time," says Aliza Nevarie, a Vancouver library worker and president of Local 391 of the Canadian Union of Public Employees, which represents the Vancouver, Gibsons, and Sechelt public library workers.

"Public libraries have become sort of a place for shelter, we have a lot of sleeping patrons," she tells Day 6 host Brent Bambury. "So there's often a sense of needing to be alert just in case."

Aliza Nevarie, the president of CUPE Local 391, which represents the Vancouver, Gibsons, and Sechelt Public Library workers. (CUPE BC)

The latest statistics in the opioid crisis

This week, the Public Health Agency of Canada revealed that opioid overdose deaths reached a record high between January and September of last year with 2,923 fatalities across Canada.

Between January and September 2017

  •  2,923 opioid-related deaths in Canada

  •  92% of deaths were accidental

  • 72% of deaths involved fentanyl

  • 1,076 deaths were in British Columbia

  • 76% of all opioid-related deaths occurred among males

Source: Public Health Agency of Canada

When the final numbers for 2017 are in, it's possible that overdoses will be among the top ten causes of death in Canada for the first time.

In British Columbia, the province with the highest number of opioid overdose deaths, the crisis is triggering a debate about whether library workers should intervene medically when someone is thought to have overdosed.

In overdose cases involving fast-acting opioids like fentanyl, which were responsible for 72% of opioid-related deaths last year, administering the overdose reversal drug naloxone right away could save lives. 

As one of the few public spaces where anyone can receive free services, libraries welcome a diverse range of patrons, including those who are struggling with substance abuse, Nevarie says. 

An emergency naloxone kit. (Sarah Penton/ CBC)

What role does the library play?

The Vancouver Public Library (VPL) recently revised its policy to allow library workers to administer naloxone in cases of suspected overdose — if they have their own kits and the training on how to use them. The change followed an outcry over VPL's old policy, which instructed workers to call 911, but not to approach the patron for safety reasons.

Aliza Nevarie, a library worker in Vancouver, says she'd be willing to administer naloxone once she gets the training for it. (Sylvia McFadden)

Libraries in other districts, including the Fraser Valley region and Langley, B.C., still have that policy.

In Toronto, overdose awareness training is mandatory for public library workers. In addition, the Toronto Public Library will provide training to administer naloxone via nasal spray, and kits to do so, for library workers who want it. 

In Vancouver, "the city now recognizes some staff may wish to be a volunteer responder," writes Jag Sandhu, communications officer for the City of Vancouver, in an email to Day 6

According to Nevarie, some of the Vancouver's library workers have advocated for their right to roll up their sleeves and administer naloxone as they wait for paramedics arrive.

"Those who are engaged in the issue are prepared, and it matters to them that they save a life," Nevarie says.

But not everyone is ready to jump in. For some, the idea of medically intervening in overdose cases is uncomfortable.

"More than any absolute, 'No I don't want to participate in this,' or 'I don't want to be delivering naloxone,' there is a sense of apprehension or or anxiety about it," Nevarie says.

Previously, this would have been a very random occurrence and one you wouldn't even think to prepare for.- Aliza Nevarie, Vancouver library worker

"So it's really about enabling them, through support and training, to feel more comfortable being in a situation like that and taking action."

The naloxone debate

The conversation around overdose in libraries highlights the changing role of public libraries in society, Aliza Nevarie says. (Jenny Cestnik/Flickr)

The union's position is that administering naloxone should not be an expectation of library workers, Nevarie also says.

"But if there's a possibility to do something safely and not take any personal liability for the action, then we would support it."

Vancouver Public Library does not expect its employees to put their own safety at risk, Sandhu says.

"This guidance is purely for those individuals who are trained and equipped to respond to medical emergencies and drug overdoses," he adds.

Nevarie, who works at a library branch in central Vancouver, says she would be willing to administer naloxone once she gets the training for it.

The conversation around overdoses in libraries highlights a shift in the role of public libraries, Nevarie also says.

"Previously, this would have been a very random occurrence and one you wouldn't even think to prepare for," she says.

Now, it's "possible, and in almost any neighborhood in the city."

With the reduction of social services and support for low-income communities, Nevarie says public libraries are having to play a greater role in society.

"That is a reality that we're facing," she says. "We service the community in all its vastness and complexity."

In cases of overdose, quickly administering naloxone could save lives. (Zoe Todd/CBC)

NOTE: A previous version of this story said that "In Toronto, public library workers are, in fact, required to take mandatory drug overdose prevention training." The story did not also say that the Toronto Public Library offers training to administer naloxone (and the kits to do so) on a volunteer basis for library workers who want it. The story has been updated to add that clarification.

To hear more from Aliza Nevarie, download our podcast or click the 'Listen' button at the top of this page.