The critical role librarians play in the opioid crisis | Chera Kowalski

When you walk into your neighborhood public library,

you expect the librarian to help you find your next favorite book

or some accurate information on a topic at interest.

You don't probably expect the librarian

to come running out from behind the reference desk with Narcan,

ready to revive someone overdosing on heroin or fentanyl.

But this is happening at some libraries.

Public libraries have always been about community support

with all kinds of services and programs

from assisting with job seeking efforts

to locating resources for voter rights

to providing free meals to kids and teens even.

But what we think of as community support takes on new urgency

when you're in the middle of an opioid and overdose crisis.

I work at the McPherson Square Library of the Free Library of Philadelphia.

It's located in Kensington,

one of the lowest income communities in Philadelphia,

with a long history of being isolated from resources and opportunity.

And because of that,

it has been the center to the city's drug trade and drug use for decades.

And so inside the neighborhood,

our library is nestled inside of a park,

which has unfortunately garnered a reputation

for being a place to find and use drugs,

especially heroin,

out in the open,

putting us and the community in direct contact

with the drug trade and use on a daily basis.

And so inside the library,

it is routine to see people visibly intoxicated on opioids:

eyes closing, body swaying slowly.

It is routine for me to ask them if they are OK,

but at the same time remind them

if they can't keep their eyes open,

they have to go.

It is routine for our volunteer, Teddy,

to pick up dozens of discarded needles on our property and throughout the park.

And it is normal for kids to come into the library

to tell me or our guard, Sterling,

that someone is outside using,

which typically means finding someone injecting on our front steps,

benches

or near the building,

then asking them to move along because kids see them.

And it is normal for the community

to see people in various states of intoxication and withdrawal,

to see people buying and selling,

and to see people act and react violently.

I'm not sharing this to sensationalize Kensington.

I'm sharing this because this is the reality of a community

that is constantly striving to move forward,

but due to factors like structural racism,

urban segregation,

the cyclical nature of poverty,

of trauma --

the community has inequitable access

to education, health care, employment and more.

And this is also what it's like when the drug trade and use

affects every aspect of life in the neighborhood.

And the opioid epidemic has only amplified that stress.

When I was hired by the Free Library in 2013,

I specifically chose to work at McPherson

because I understand what it's like to grow up in an environment

where substance use disorder shapes the everyday,

and I wanted to use those personal experiences

as a guide for my work.

But before I get to that,

I want to share what it was like

to witness this epidemic grow in Kensington.

Like many other communities, we were just not prepared.

We began to take notice of IDs we were seeing:

addresses from nearby and upstate counties

and then slowly out-of-state ones.

People from Arkansas, Ohio, South Carolina, Alabama

coming to Philadelphia for cheap heroin.

People began to linger longer and longer in our public restroom,

causing us to pay more attention to the restroom

than to our daily responsibilities

because it was an accessible place to use drugs just purchased.

One day our toilet clogged so badly in the restroom,

we were forced to close our library for two days

because the culprit of the clog was discarded needles.

For a while prior to that incident,

we had been asking for a sharps container for the restroom,

and after that,

the library administration quickly approved installing one

along with hiring bathroom monitors.

And as the weather warmed,

we struggled to respond.

People began camping out in the park for days, weeks.

You could walk outside on a sunny, warm day

to find multiple groups of people in various states of intoxication

and children playing in between them.

The amount of needles collected by Teddy on a monthly basis skyrocketed

from 100 to 300 to 500 to 800,

to over 1,000,

with many found on our front steps and the playground.

Then there were the overdoses.

So many occurred outside in the park,

some inside the library.

Sterling, our guard, would spend his time walking in and out of the building

and throughout the park,

constantly making sure everyone was safe,

because at times,

our fear of having someone overdose and die came close.

One overdose in particular occurred after school,

so the library was full of kids, noise and commotion.

And in all of that,

we heard the thud from inside the public restroom.

When we opened the door, we found a man on the floor, unresponsive.

He was pulled out in plain sight of everyone --

kids, teens, adults, families.

Someone on staff called 911,

someone else escorted the kids and teens downstairs,

somebody went to flag down the ambulance in the park.

And the rest of us --

we just waited.

This had become our overdose drill

because at the time, it was all we could do.

So we waited and we watched this man lose air --

seize up.

He was dying.

I don't know how many of you have witnessed an overdose on opioids,

but it's horrific

because you know the gasping for air,

the loss of color in someone's face,

is a timer running down on the chances of this person surviving.

But luckily for this man,

the ambulance arrived

and he received a dose of naloxone through injection.

And I remember he jolted like he was electrocuted,

and he pulled the needle out,

and he told the paramedics to back off.

And then he stood up, and he walked out.

And we --

we went back to work

because people were still asking for time on the computers,

kids still needed help with their homework

and this was our job --

our purpose.

I think that incident stays with me because of the waiting.

It made me feel helpless.

And it was that feeling of helplessness that reminded me so well of my childhood.

Before I was born, both of my parents began using heroin.

It made our lives chaotic and unstable:

promises being made and constantly broken,

their fighting, the weight of their secret --

the weight of our secret kept so much so-called "normal" out of our lives.

Every time we'd be dropped off at our grandparent's house,

I'd be stuck on the thought that I was never going to see them again.

Every time we'd be left in a car, at a house, at a store,

I'd cry.

And every time I saw those El tracks --

the same ones I take to work now to McPherson --

from the backseat of a car,

I'd be angry,

because even kids know

when their parents are trying to score drugs.

There was so little I could do to control what was going on around me,

that that feeling of helplessness was overwhelming.

I struggled in school, struggled to read,

I was prone to anger and depression.

When I was 11 years old, I started smoking,

which shortly after led to my own experiences with drugs and alcohol.

I convinced myself that my parents' past would be my future.

But eventually both of my parents entered recovery

and maintained recovery from opioid use.

And their strength and their commitment

provided support and stability for me and my siblings,

and it was those personal experiences that brought me to McPherson.

Choosing to be a librarian

and choosing to be at McPherson

was me letting go of that feeling of helplessness

and finding ways to be supportive to others.

And one way to provide support

was learning how to administer Narcan.

Public libraries respond to the needs of their communities,

and not knowing how to utilize Narcan

was a disservice to the needs of our community.

We were on the frontlines

and desperately needed access to this lifesaving tool.

So finally in late February of 2017,

after much advocating,

we finally received training from Prevention Point Philadelphia

and about a month of so later,

I utilized Narcan for the first time to save someone's life.

It was after school again,

and Teddy came into the library

and said someone was overdosing on a front bench.

Someone on staff called 911 again,

and I grabbed the Narcan kit.

The woman was barely in her 20s and barely breathing.

Her friend was frantically slapping her in the face

in hopes of reviving her.

I administered the Narcan nasally,

and thankfully she came to.

But before the ambulance arrived,

she and her friend ran off.

And when I finally turned around,

I saw the kids --

kids that come into the library on a daily basis,

some that I have known for years --

standing on the steps of the building.

They saw everything.

And they didn't seem like they were visibly upset or in shock,

and so I walked into the building,

right into our workroom, and I cried.

I cried partly from the shock of what just happened

because I never thought I'd be saving anybody's life ever,

but I mostly cried because of the kids.

This is their normal.

This is the community's normal.

This is a catastrophic normal,

and in that moment,

I was forced to confront once again that this should never be normal,

and as with my childhood,

when you're in it, you just accept it.

The opioid epidemic is not just about those living

with opioid use disorder

because the reach of the epidemic goes well beyond those living with this

and their families.

It impacts the entire community.

Kensington was a community in crisis before this

for reasons that are endemic and intertwined,

and anyone familiar with the neighborhood can think of why:

racial disparities,

failure of local and federal government to properly fund schools,

lack of economic opportunity.

And what we're trying to do at McPherson

is find ways to support this community out of crisis.

And perhaps now, because of the epidemic,

more people are paying attention to Kensington.

But regardless of that,

at McPherson,

we will continue to do what we can with the resources we have

and we will continue to provide whatever help we can

in hopes of keeping our community safe and healthy

because public libraries have always been more than just books.

We are physical shelter,

a classroom,

a safe haven,

a lunch room,

a resource hub

and yes,

even a lifeline.

Thank you.

(Applause)