Over a three month period last year, one emergency room in Everett, Washington treated 253 people who had overdosed. And in 2016, which is the most recent data available from the state, Snohomish County had one of the highest opioid death rates in Washington.
Everett is trying new ways to manage this problem and to prevent it from getting worse. One institution that could see this storm brewing years ago, was the library.
The two libraries that make up the Everett Public Library System have been quietly dealing with people who are addicted to heroin using these safe, public spaces to shoot up. The Everett Library System is accepting this as the new normal. But, at the same time, it is playing a larger role in getting people the help that they need.
One example of how Everett is thinking out of the box is a gathering that happened back in December, at the Evergreen Branch, in South Everett.
Librarians on the Front Lines
On this morning, a small, carpeted room that will soon be filled with toddlers for story time, is occupied by middle-aged women sitting in folding chairs. They are librarians, the people who help you find information. But, right now, they’re not here to talk about that.
“You are all here for a Narcan training today. Does everybody know what Narcan is? Yes? Naloxone is also what it’s referred to,” says Amy Austin. She’s an Opioid Outreach Specialist for Snohomish County, here to teach this group of librarians how to deliver a dose of Narcan.
If you can get to someone in time, Narcan can pull a person out of a drug overdose, and save their life. But, first, what does an overdose even look like?
“Their skin will be pale and clammy. Their breathing -- if they’re breathing -- will be very infrequent. There will be a deep snoring, or like a gurgling sound, kind of like a death rattle,” Austin tells the group.
Now, it’s time for the librarians to get comfortable with taking the little squirt bottle holding the Narcan, and test out what it’s like to shoot it up someone’s nose. Library Technician Margo June gives it a try on a willing volunteer.
“Okay, so do it so everybody can see,” says Austin as she guides Margo.
Some of the dose squirts onto the volunteer’s glasses, but most of it makes it inside his nose.
“Then I flip him on the side?” asks Margo.
Yes, it has come to this: Librarians getting training on how to reverse a drug overdose.
'It Could Have Been My Son'
Everett is one of the first library systems in the state to offer Narcan training to its staff. It’s not a requirement: These librarians are opting to do this,
So far, there are no reports of anyone actually dying of an overdose inside either of Everett’s two libraries. However, people have been caught shooting up heroin in the bathrooms, used needles have been tucked behind toilets and left around the properties. Librarians suspect that some patrons use the library’s computers to arrange drug deals that take place in the library’s parking lot.
Librarian Margo June is frustrated by people making her library a part of their drug habit or business. But, she has a lot of empathy too.
“My heart is broken to see these people, because it’s kind of close to home. It could have been my son,” says Margo.
Margo’s son was addicted to opioids. She says today, he’s clean. Her son’s friend wasn’t so lucky.
“He was a young promising smart kid and he overdosed. He was probably 19 years old, and came from a good home. So it does cross all the different barriers that we hear about.”
Acknowledging the Problem
The Narcan training for the librarians is just one small piece of a much larger overdose prevention effort underway in Everett, called the Safe Streets initiative. We’ll get to more on that in a bit.
First, let’s meet Abigail Cooley. She’s the library’s director and gives me a tour of the main branch. We stand on a second floor walkway and look down.
“This is one of my favorite views from the second floor, looking down onto the open reading room,” says Cooley.
The reading room has comfy chairs, floor-to-ceiling windows, live ficus trees. This brick building is in the heart of downtown Everett. It was built in the 1930s and it is beautiful.
We head to the bathrooms. To make the bathrooms less inviting to hang out in, the library has removed a few things and made a few adjustments. The main doors to the bathrooms now have windows.
“So there’s still privacy, but not quite,” says Cooley. “And then the stall heights, I call them the high school middle school stall heights. So you still have privacy, but you can’t really camp out in there. And we also added the sharps container to prevent people from depositing sharps where maybe they shouldn’t be found. Trying to keep people safe.”
Several library systems in Washington State have added these used needle repositories to their bathroom.
Abigail says the sharps containers are a hard thing to wrap your head around, “Are you saying by putting those there, you know, we’re not condoning it, but we are acknowledging it.”
Acknowledging that people are shooting up in the bathrooms, just steps away from the resource desk, and they need a place to put their dirty needles.
How the Patrons Feel
Rick Mower, a 63-year-old retired Boeing engineer, has been coming to this library since he was a small boy. When I meet him, he’s browsing the DVD section.
“The library is doing, I think they’re doing the best job that can to not make it a scary place for everybody,” says Mower.
Rick noticed the sharps containers and has a pretty matter of fact attitude about it.
“Unfortunately it might encourage people to shoot up in the stalls, but at least it gives them a safe place to do it. But uh, not exactly for it and not exactly against it. But if it works it works.”
Over in the children's section I talk with Margo Dahl. She homeschools her seven children, so she is here a lot. She’s not so sure that putting sharps containers in the bathrooms is the way to go.
“If I was in charge, I don’t think I would be so accommodating. Because it seems like if you are going to make it easier, to use the public spaces for drugs, it’s just going to increase drug use. Instead of, you know, a city has to have rules that work for everybody,” says Margo.
Everett Is Not Alone
The Everett libraries are not alone in dealing with this problem. The problem is a lot more dire in other places. Last year a librarian in Philadelphia prevented at least six overdose deaths by using Narcan. A Pennsylvania congressman has written a bill that would use federal money to pay for Narcan training in libraries across the country that are in opioid hot spots.
In Everett, I ask library director Abigail Cooley if she’s worried that her two buildings places will become de facto supervised injection sites.
“Not really, because people are going to use where they want to use and I don’t think I’ve seen any increase. I just feel like we have the tools to handle it now. But I wouldn’t say that’s a worry that they’re going to rush here as a safe place to inject,” she says.
Cooley says the library is a gracious space, and that it needs to be a gracious space for everybody.
“Obviously, I want my families who are coming in here with children. I want them to feel safe and comfortable and welcomed and feel that they can use the library services. But that doesn’t mean I can’t allow access for people that might have drug addiction issues or don’t have homes. So I need to provide that balanced spectrum. And I think too, it’s that, until you acknowledge your problem, until you analyze the problem you can’t really address or solve the problem. So, I don’t think the appropriate solution is to keep a blind eye to things,” says Cooley.
'We're Not Going to Tolerate That'
While the library is trying to meet the needs of all of its patrons, there are serious consequences if you are caught using drugs on the premises.
“If you do your drugs here, in our public spaces, we’re not going to tolerate that. You will go to jail,” says Hil Kamen, the director of Everett’s Department of Public Health and Safety.
And in jail, you’ll be offered addiction treatment.
Hil Kamen used to be Everett’s lead prosecutor. He could see that prosecuting the problems of addiction, homelessness and mental illness was not going to work.
“So I just saw people again and again, go to jail, serve time be put on probation. Not show up for treatment, come back, and get more jail time.”
Today, with the office of Public Health And Safety, Kamen's main focus is getting all of the city’s departments to work together to address homelessness, addiction and mental illness; problems that often go hand in hand with each other. The effort is called the Safe Streets Initiative.
The work the Everett Public Library is doing around opioids is done hand in hand with Safe Streets. According to Kamen, to make a dent in these three main problems requires a constant balance between enforcement and treatment.
“You can’t just enforce against people and use a heavy hand and get them to stop behaving in ways that you don’t want them to behave, without also having that outreach, without also embedding social workers in our police, We want people to have that doorway into services, that doorway into community that doorway into health and healing,” says Hil.
What the Library Does Best
Since the library is that safe place where everyone goes, it’s a perfect location to try and reach the people who need the most help and to deliver information, which is what libraries do best.
The library has hosted speakers who are experts on addiction, it’s brought in medical professionals in to help patrons find access to treatment, and it has chosen books about the opioid crisis for community reading events.
Margo June, the librarian we met earlier at the Narcan training, says confronting this opioid crisis is testing her patience for people struggling with addiction.
“It challenges me to be kind to people, because there’s another side of me that’s like, darn you anyway, what are you doing?” she says.
The Everett Public Library isn’t just training its staff on how to use Narcan. Last week the main branch held its first Narcan training open to the public. Fifty-nine people showed up.