Tag: Narcan

Drugs, Health

In Reversal, Library Will Allow Staff to Use Narcan on a Voluntary Basis

Diagram showing how to administer Narcan to an overdosing personBy Erica C. Barnett

In a sudden reversal of longstanding policy (and after three years of dogged coverage by PubliCola), the Seattle Public Library announced Wednesday that it will stock its 26 library branches with Narcan (naloxone), a nasal spray that can reverse opiate overdoses. Each branch will get one two-dose kit of Narcan, and the downtown branch will get one for each floor, with a few left over for later distribution, a library spokeswoman told PubliCola.

Library staff who want to administer Narcan if someone overdoses will be able to go through voluntary training in how to administer the drug. Untrained staffers won’t be allowed to give the drug, according to the library’s announcement, meaning that if someone overdoses at a library with no trained staff, “there is no guarantee that a patron who overdoses on Library grounds will receive naloxone.”

This policy contrasts with other Seattle departments. Frontline Seattle parks workers, such as lifeguards, parks concierges, and park rangers, all carry Narcan and can use it without special training. Other library systems also supply Narcan to workers and the public. In Chicago, for example, all library staff are trained to use Narcan and the library distributes kits for free to anyone who wants one.

The library spokeswoman said she could not provide any details about why the department changed its policy. A blog post announcing the change said only that “over the last few months,” the library went through “a careful review process, which included updated guidance on liability from the City Attorney’s Office and an examination of other City departments’ practices.” We have reached out to City Attorney Ann Davison’s office for more information on the change.

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In July, as we exclusively reported, a staffer asked if it would be okay for him to carry Narcan at work. At the time, the library said it had been advised by the city attorney’s office that employees who administered the drug would be unprotected by the both state’s Good Samaritan law, which protects people who voluntarily render emergency care, and a separate law protecting Washington residents from liability specifically for administering Narcan. Any library employee who used Narcan to try to reverse an overdose, a union representative told staffers in an email, could be subject to discipline.

A spokeswoman for the library said that the library is “requesting that staff not use their own supply of Narcan while at work during this interim period” before staffers have gone through training. “After staff volunteers are trained, we may revisit that.” The spokeswoman said the library is “in conversations about training with several organizations.”

Previously, the library had varying reasons for not stocking Narcan, which works by restoring breathing in an overdosing person. Back in 2020, a library spokeswoman told PubliCola that putting Narcan in libraries would require bargaining with the library union, for example.

People die of opiate overdoses when they stop breathing, and emergency responders often prefer to perform rescue breathing or provide oxygen to an overdosing person because naloxone can send people into rapid withdrawal, an extremely unpleasant side effect that, in practice, sometimes leads people to refuse additional care. Narcan, however, is extremely simple to administer—you squirt it into one nostril—and can save a person’s life during the period after they stop breathing but before medics arrive.

According to the King County Department of Public Health, there have been at least 42 likely overdoses in or outside public libraries in King County since 2019, including 16 inside library branches. Since 2017, at least eight people have died of drug-related causes at libraries in King County, half of them in Seattle.

Drugs, Health, Mayor Harrell, Morning Fizz, Transportation

Ban on Narcan Continues Amid Overdoses at Libraries; Harrell’s Pick for SDOT Director Answers Council Questions

1. Last month, we reported on the Seattle Public Library’s directive telling staff not to carry or use Narcan, or naloxone—a nasal spray that can restore breathing in people overdosing on opioids—because of potential liability issues.

The state’s Good Samaritan law exempts people who provide emergency care from civil liability, but a library spokeswoman said City Attorney Ann Davison’s office advised the library that library staffers were “likely” not covered by the law. King County Public Libraries, which operates outside Seattle, also bars staff from using Narcan.

Public libraries are among the only indoor places where people experiencing homelessness can go during the day without being expected to make a purchase or explain why they’re there. They’ve also been the location for dozens of fatal and nonfatal overdoses in recent years. According to data provided by the King County Department of Public Health, there have been at least 42 likely overdoses in or outside public libraries in King County since 2019, including 16 inside library branches. Since 2017, at least eight people have died of drug-related causes at libraries in King County, half of them in Seattle, including at least four involving opiates like heroin and fentanyl.

Bans on using Narcan force library staffers to call 911 and wait for emergency responders to arrive, adding several potentially fatal minutes to the time an overdosing person is unconscious and not receiving oxygen to their brain.

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A review of recent fire department reports for overdoses at Seattle Public Library branches shows that it takes emergency responders between three and five minutes to arrive on the scene of an overdose and start administering aid. These reports also show that on at least one occasion, back in April, someone at the downtown Seattle library revived a patron with Narcan, the drug library staffers were formally barred from using just three months later.

The ban on using Narcan is based on the belief that library staffers, unlike other Washington state residents, are not protected under the state’s Good Samaritan laws when they administer aid. By that standard, library staffers shouldn’t be able to offer first aid to patrons experiencing minor medical emergencies, or attempt to assist people experiencing heat stroke when they come to the library to cool off in the summer. And yet they manage to do both. Why are overdoses categorically different?

2. Greg Spotts, Mayor Bruce Harrell’s nominee to lead the Seattle Department of Transportation, submitted detailed answers this week to a list of questions from the city council’s transportation committee about his goals for his first year, plan to get Vision Zero back on track, and ideas about how to create a more equitable transportation system. Spotts’ responses t check off a lot of boxes for people who support urbanism and alternatives to driving alone.

For example, in response to a question about creating “connected safe spaces for people to move throughout the city” without a car, Spotts noted that in many cases, “pressure to preserve just a few curbside parking spaces stands in the way of conveying cyclists safely across a busy intersection. Too many of our bike and pedestrian routes have discontinuities that render the route significantly less safe, useful and attractive than it could have been.” In 2019, former mayor Jenny Durkan killed plans to build a protected bike lane along a dangerous stretch of 35th Ave. NE after neighborhood and business groups argued that removing a few curbside parking spaces would devastate businesses in Wedgwood and Ravenna.

However, Spotts also hedged a bit when talking about commitments to new bike infrastructure, responding to a question about whether he would support creating new protected bike lanes as part of road resurfacing projects with an artful dodge. “I fully intend to support projects and routes as called for in the Council-approved Bicycle Master Plan; and will be engaging with staff, subject matter experts, and community as these projects are developed and constructed,” he wrote. As the Urbanist has reported, the city is currently working to integrate all its transportation related “master plans” into a single mega-plan, a move that some advocates worry could further reduce the city’s commitments to nonmotorized transportation.

He also ducked questions about whether parking enforcement officers belong at SDOT and if he would commit to removing the large concrete “eco-blocks” that business owners place illegally in the public right-of-way to keep people living in oversize vehicles from having a place to park. (Councilmember Sara Nelson, whose own business, Fremont Brewing, continues to flagrantly violate this law, is not on the transportation committee).

 

Previous SDOT directors learned the hard way that specific commitments can be tough to implement if they conflict with what their boss, the mayor, wants—which is probably why, when asked about equity in transportation investments, Spotts said only that Seattle’s most deadly streets for cyclists and pedestrians, Rainier Ave. S and Aurora Ave. N., “can potentially be reenvisioned to meet community needs.” Harrell has made it clear that his top transportation priorities include maintaining and repairing basic infrastructure like streets and bridges, not big-reach projects like protected bike paths connecting every part of the city.

Seattle will hear more from Spotts next month, when the transportation committee considers his nomination again after the council returns from summer recess.

Addiction, Drugs, Health, Schools

Amid Rising Fentanyl Deaths, Seattle Libraries Prohibit Overdose Reversal Drug
Public naloxone rescue kit in Boston, MA
Public naloxone rescue kit in Boston, MA

By Erica C. Barnett

The Seattle Public Library has advised library staff not to carry or use naloxone, the overdose-reversal drug sold under the brand name Narcan. As a matter of policy, the library does not stock Narcan or train workers to use it.

In an email to library staff last week, a representative from the union that represents most library employees, AFSCME 2083, wrote that “the City has been very clear that they believe Good Samaritan protections do not apply to public employees administering Narcan. In light of that liability concern, we have now been informed that any employees who administer Narcan on duty may be subject to discipline, unless they are explicitly directed to do so.”

“While these employer directives are in effect—in particular the new directive NOT to administer Narcan—Local 2083 cannot support member administration of Narcan on the job,” the email continued.

The union, which did not respond to a request for comment, sent the email to its members after an unidentified library staffer informed their boss that they were bringing Narcan to work. The drug, most commonly administered as a nasal spray, temporarily reverses the effects of an opiate overdose by blocking the effects of the opiate and causing an overdose victim to start breathing again.

“[The city attorney’s] legal guidance is that a staff member, who is in a paid capacity as Library employee, is likely not covered by the law and would subsequently expose themselves and the Library to liability for injury or death resulting from inappropriately administering Narcan.”—Seattle Public Library spokeswoman

Washington State’s original Good Samaritan law, adopted in 1975 and amended several times since, says that “Any person, including but not limited to a volunteer provider of emergency or medical services, who without compensation or the expectation of compensation renders emergency care at the scene of an emergency … shall not be liable for civil damages resulting from any act or omission in the rendering of such emergency care.”

A separate law adopted in 2015 created a “standing order” allowing “any person or entity” to obtain a prescription for opiate reversal medication, such as Narcan, and use it for overdose reversal without threat of criminal or civil liability for administering overdose-reversal drugs or for any outcome that happen as as result.

A spokeswoman for the Seattle Public Library, Elisa Murray, said the library asked the City Attorney’s Office if library workers would be protected by the Good Samaritan laws. “Their legal guidance is that a staff member, who is in a paid capacity as Library employee, is likely not covered by the law and would subsequently expose themselves and the Library to liability for injury or death resulting from inappropriately administering Narcan.” Murray said the initial advice came from former city attorney Pete Holmes’ office and was subsequently confirmed by the office of current City Attorney Ann Davison.

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“Bringing medicine to the workplace with the intent to administer it while working is outside of a staff member’s assigned work duties and against the Library’s direction related to Narcan,” Murray continued. The library has no plans to train staffers to use Narcan or stock the drug at library branches, “based on the Seattle Fire Department’s medical support expertise and response times.” In other words, it’s up to the Fire Department, which—like the police department—is facing staffing shortages, to respond to overdose calls on time.

The library gave a similar explanation for its decision not to stock naloxone back in 2020, when then-mayor Jenny Durkan handed out hundreds of naloxone kits to local businesses and schools in response to an uptick in overdoses from fentanyl, an opiate that is many times more potent than heroin. On Tuesday, the King County Council declared fentanyl a public health crisis. Last year, the county medical examiner confirmed that nearly 400 overdose deaths involved fentanyl; so far this year, the number of confirmed fentanyl deaths is 272. Overall, opiates have been implicated in nearly 450 deaths this year.

The Seattle Public School District stocks naloxone at every school and trains school nurses, security staff, and school administrators in how to administer the drug.

As public agencies go, SPL is in some ways an outlier. Staff at other public agencies in Seattle carry naloxone, as do other public libraries around the country, including Everett’s public library system.

For example, the Seattle Public School District stocks naloxone at every school, according to SPS prevention and intervention manager Lisa Davidson. The district also trains school nurses, security staff, and school administrators—along with anyone else who wants training—in overdose response. Most schools have multiple “designated trained responders,” according to Davidson, and district policy allows individual employees to get their own prescriptions for naloxone and use it as long as they’ve been trained to do so.

The school district’s policy also notes that under the state’s “standing order” law, “a person who possesses, stores, distributes, or administers an opioid overdose reversal medication is not subject to criminal or civil liability or disciplinary action if they acted in good faith and with reasonable care.”

The King County Library System’s naloxone policy, however, is similar to Seattle’s: “staff are not permitted to administer Narcan,” , KCLS spokeswoman Sarah Thomas said, and are supposed to call 911 if they see a patron in medical distress “KCLS does not have a policy on Narcan use,” Thomas said. Continue reading “Amid Rising Fentanyl Deaths, Seattle Libraries Prohibit Overdose Reversal Drug” →

Bikes, City Council, criminal justice, Drugs, Featured, human services, Mayor Durkan, Morning Crank, Transit, Transportation

Cyclists Pack Pedersen Forum, Libraries Still Lack Narcan, and an Update on LEAD

1. Bike and bus advocates showed up in force for a “town hall” meeting featuring District 4 city council member Alex Pedersen in Eastlake last night, but many said afterward that the moderators who chose the questions from a stack of cards submitted by the public—a representative from the Eastlake Community Council and a Pedersen staffer—rejected or ignored their questions.

I was live-tweeting the forum, and noticed early on that most of the questions seemed to be from people opposed to a planned protected bike lane on Eastlake, rather than the dozens of bike lane supporters in the audience. For example, early questions centered on how businesses were supposed to deal with the loss of hundreds of parking spaces directly on Eastlake Avenue; why cyclists couldn’t just ride on a parallel greenway somewhere near, but not on, Eastlake’s business district; and what can still be done to prevent King County Metro from replacing the milk-run Route 70 with a RapidRide bus route that will be faster and more frequent but won’t have as many stops.

During the meeting, I noticed that a pile of questions had been set aside, and that the moderator seemed to be favoring questions from people who opposed bike lanes and RapidRide over questions from the bike lane supporters who packed the room. So I asked via Twitter: If you were at the forum and asked a question that didn’t get answered, what was it?

Pedersen was fairly circumspect in his responses, suggesting repeatedly that people contact his office and promising he would get back to them by email. He did, however, say he supported changing the Eastlake bike lane plan—which has been debated, studied, and affirmed repeatedly over a period of several years—so that cyclists would have to shift back and forth between the arterial and short stretches of “greenway” on unnamed parallel streets. “I think [the Seattle Department of Transportation] should look harder at a combination of protected bike lanes on some part of it and greenways on some of it,” Pedersen said.

Invoking the specter of 35th Ave. NE, where a long-planned bike lane was scuttled after neighborhood activists complained that the loss of on-street parking would destroy local businesses, Pedersen added: “There was a lack of transparency” about the proposed bike lane, which he opposed. “People were just trying to figure out what was going on with it.”

“I think [the Seattle Department of Transportation] should look harder at a combination of protected bike lanes on some part of [Eastlake] and greenways on some of it.” — City council member Alex Pedersen

During the meeting, I noticed that a pile of questions had been set aside, and that the moderator seemed to be favoring questions from people who opposed bike lanes and RapidRide over questions from the bike lane supporters who packed the room. So I asked via Twitter: If you were at the forum and asked a question that didn’t get answered, what was it? Here are some of their (slightly edited) answers:

• Given that every study shows bike lanes make streets safer for everyone and are good for business (and that cyclists spend more than drivers), what data are you paying attention to? How will you incorporate the data that already exists about protected bike lanes around the world?

• Have you seen any analysis of the percentage of people who are NOT in Eastlake that commute to Eastlake for any of the businesses that are afraid of losing 320 parking spots? Do people drive to 14 Carrots from other parts of the city?

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• Have you seen any research about the actual impact of bike lanes on businesses?

• What options are you prioritizing to help my whole family get around without using a car?

• Many people bus and bike through Eastlake, but don’t stop because traffic is so dangerous. What can be done to make Eastlake more welcoming to visitors and encourage fewer single occupancy vehicles, supporting the goal of Vision Zero?

• When will the city consider a residential parking zone in Eastlake (which prevents people from commuting in by car and parking all day in neighborhoods)?

• Why is the RapidRide and bike lane project important for Eastlake and the surrounding area?

Jessica Westgren from Welcoming Wallingford, a group that supports housing density and alternatives to driving, asked Pedersen verbally why he wouldn’t return calls and emails from her organization. Pedersen responded that she should send him an email, ideally including specific information such as “I’m having this issue on my block.”

 

Mayor Jenny Durkan, flanked by parents who lost their son to an opioid overdose and local officials

2. Mayor Jenny Durkan announced that the city will be distributing 700 doses of naloxone (Narcan), a drug that can reverse opioid overdoses, in response to a surge in overdoses from fentanyl in counterfeit oxycodone pills—and, in particular, an increase in the number of teenagers who have died of fentanyl overdoses. Fentanyl is especially deadly, and overdoses happen quickly; an overdosing person can die long before first responders arrive, which is why having Narcan on hand (and knowing how to use it) is so critical.

Durkan said that kits will be distributed in schools, bars, and nightclubs—”any place where it is likely that someone might overdose.” The city is also planning 25 Narcan training workshops.

Since Seattle public libraries are among the places people use opioids—and are, because staff are always present, safer consumption sites than alleys or parks—I asked if the libraries would also start stocking Narcan, and if library workers would be trained to use it. (The library system has been slow to adopt harm reduction policies, and only added sharps containers in restrooms after I published several stories on the issue last year.) Durkan said “we’d like them in the libraries,” but her staff added later that this would be an issue for the library union to negotiate.

Library spokeswoman Andra Addison later confirmed that the library does not have current plans to stock Narcan or train library workers to use it. “The Library currently uses 911 for all medical emergencies. Use of Narcan in our libraries would involve union representatives, and those discussions are just under way,” Addison says. Asked to clarify what the issue would be for the library union, Addison said, “working conditions and the impact on working conditions.”

3. City council member Lisa Herbold has released a copy of the letter I mentioned on Wednesday, urging Durkan to confirm that she will release all the funding the council provided for the Law Enforcement Assisted Diversion program in its adopted budget no later than March 1, and to affirm that LEAD—which offers alternatives to arrest for people suspected of committing low-level crimes—is a crime prevention program, not a homelessness program. Durkan has hired a consultant to look at LEAD’s performance and to determine performance metrics for the program; currently, LEAD is classified as a homelessness intervention and required to meet housing goals, even though more than a quarter of its clients are not homeless. Continue reading “Cyclists Pack Pedersen Forum, Libraries Still Lack Narcan, and an Update on LEAD” →