Tag: overdose reversal

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.

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.

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.

“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”

Universal Naloxone? Experts Say It’s Not that Simple.

Toronto Public Health

Naloxone, the overdose-reversal drug that can bring unconscious opiate addicts back from the brink of death in moments, has been widely heralded as a miracle drug, one that can bring overdose victims back from the dead and that’s credited with saving seven lives since Seattle Police Department bike patrol officers started carrying naloxone nasal spray earlier this year. Daniel Malone, head of the Downtown Emergency Service Center, told me he was “stunned” when he learned that Seattle firefighters, who are all trained as EMTs, don’t carry naloxone; DESC itself has used the drug to reverse about a dozen overdoses since a new state law allowing agencies to get prescriptions for naloxone nasal spray went into effect last year.

Opiates slow down the respiratory system, causing a user to breathe more slowly; they kill when the respiratory system slows down too much and a person nods out, then stops breathing. Naloxone, also known by the brand name Narcan, works by stymieing the impact of heroin on opiate receptors in a person’s brain, allowing a person having an overdse to start breathing on their own.  Since SPD distributed Narcan to 60 bike officers this spring, they’ve reversed seven overdoses with the drug, celebrating each reversal as a “save.”

It’s indisputable that Narcan works. What remains in dispute is whether buying and widely distributing the drug among all first responders, including the entire police, is the best use of limited resources and  political capital, and whether Narcan actually saves as many lives as the Seattle Police Department, under intense pressure to do something to address the heroin epidemic in Seattle, has claimed.

Seattle Fire Department medical Dr. Michael Sayer sighs with exasperation when I ask him why firefighters don’t carry Narcan nasal spray. “Frankly, Narcan doesn’t really save lives,” Sayer says. “To the best of my knowledge, we have had zero cases where someone died because they had an overdose and the EMTs didn’t have naloxone.” That isn’t because Fire Department EMTs do nothing, he says; rather, it’s because EMTs get overdose victims breathing through other means, either by rescue breathing (perhaps better known as mouth-to-mouth resuscitation) or by giving the person oxygen; once they’ve started breathing again, Sayer says, the EMT can start administering a low dose of naloxone through an IV–enough to get the person breathing on their own, but not enough to send them into acute heroin withdrawal. 

“There’s different ways to do a medical intervention; naloxone isn’t the only way,” says Dr. Caleb Banta-Green, a member of the county’s Opiate Addiction Task Force and a UW addiction researcher who’s studying the results of the SPD pilot project. Sitting in his paper-strewn office a few blocks from the UW campus, Banta-Green showed me several different Narcan systems, including two kinds of nasal spray and an injection kit like the one used by SFD. In his observation of fire department medics, Banta-Green says, he saw that “they didn’t just slam [overdose victims] with a bunch of naloxone; they were very careful about how they did it, and they also monitored them really carefully and provided other medical support” to make sure they didn’t immediately go back into an overdose after the drug wore off.

Using Narcan judiciously has another side benefit, Banta-Green and Sayers say; it gives responders a better shot at getting a user to the hospital and potentially connecting him or her with services like treatment and medication.

“If we’re waking up people and we’re putting some fraction of them into withdrawal and then we’re leaving them there, I don’t feel like that’s really solving their problem,” Sayer says. 

Banta-Green is blunt about the shortcomings of an approach that starts and ends with overdose reversal. “Great—so you’ve reversed an overdose. You’ve just bought them 90 minutes. Then what? You still have an opiate-addicted person who’s at continuing risk for overdose.” Waving a bottle of the one-step nasal spray, he continues, “It’s really easy for me to give you this and you go reverse an overdose and [say] we’re good. It’s a lot harder to say to someone, ‘I hear you’re opiate-addicted. Would you like some bupenorphine?” (Bupenorphrine, in combination with naloxone, is sold as the highly regulated addiction maintenance medication suboxone).

“‘Yes, I’d like some bupenorphine,'” Banta-Green continues. “Okay, we need to find you insurance and a medical provider and a pharmacy and figure out a way to keep you on this for the next 20 years. I acknowledge that’s a much harder problem, but that’s the long-term solution.”

Banta-Green says police officers tend to be “stunned” when he tells them naloxone “may or may not be the best intervention,” that the evidence to prove it works better than other interventions just isn’t there yet. Lisa Daugaard, another heroin task force member and director of the Public Defender Association, recalls a conference in Washington, D.C. at which Banta-Green, “Mr. Empirical,” responded to police departments bragging about their number of “saves”—OD reversals that departments count as saved lives—by telling them, “‘You have no idea whether those people would have died. Those aren’t saves—compared to what? Maybe that’s not the most effective thing and maybe most of those people wouldn’t have died if you hadn’t administered naloxone.’ And people were like, ‘Shut the [heck] up, because I don’t want to hear that.'”

Daugaard says that compared to the fire department, which doesn’t have a history of enforcing the punitive war on drugs, SPD may find it “hard to bring a healthy skepticism to bear on specific strategies.  Replacing the instant fix of an arrest with the instant fix of a nasal spray has an appeal that harder, deeper solutions lack.

“This is not to be critical of programs in which officers carry naloxone–I’m not clear what the opportunity costs are,” Daugaard continues. “But I do appreciate first responders who set aside how good it makes them feel to ‘save’ someone and ask harder questions about what is most effective.”

With the jury still out on whether naloxone is a good investment for police in Seattle, everyone I talked to agrees on two types of places where having the spray on hand is a good idea: In the homes of opiate users, and in rural areas, where it may take half an hour for medics to respond to 911.

Banta-Green says his primary concern is choosing the best tools for combating opiate overdose and addiction while people are still paying attention to the “opiate epidemic”—a window that may already be closing. “I’ve worked in this area for 20 years, and it’s so rare that you get to actually talk about addiction or overdose that you want to make sure you have the most impactful way to do it, and that may not be police carrying naloxone. It might be telling people about the good Samaritan laws,” which ensure that people won’t be arrested for drug possession if they report an overdose. “Naloxone has really taken up the vast majority of the attention, and the problem has been that it can deprioritize or even remove attention and funding from other solutions, like syringe exchanges,” Banta-Green says.

In reporting this story, I also talked to one person who is an unequivocal advocate of naloxone distribution, and for very personal reasons: Penny Legate, founder of the Marah Project and the mother of Marah Williams, who died in 2002 at just 19 after fighting heroin addiction for seven years.

Legate says that even if naloxone isn’t a panacea, the risks of not having it on hand outweigh the possibility that overdose victims won’t seek long-term help. “There’s no down side to administering naloxone,” Legate says. “If a person is in a heroin overdose and you have precious minutes to revive them, I don’t know why anyone would object to a police officer or a bystander or anybody administering naloxone. It’s a matter of minutes to return oxygen to the brain.  Are you just going to stand there and say, ‘This person’s not going to get help, we’ve seen it before,’ or ‘Geez, heroin withdrawal is really tough,’ or ‘Let’s just sit here and wait for the medics to show’?”

“The hope,” Legate says, “is that they will allow themselves to be transferred to Harborview, where there are social services available, and that through the process they can be convinced to get help.” But even if many don’t, “is that any reason not to give [the drug] to somebody who isn’t breathing?”