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Rethinking Access in the Opioid Epidemic

Published onMar 30, 2023
Rethinking Access in the Opioid Epidemic

Rural and urban libraries face many challenges regarding  the opioid epidemic, and it is time to think beyond a crisis-mindset and consider proactive approaches to support community well-being. Due to the stigma around substance use, libraries often take a defensive position when responding to difficult behaviors from patrons. Taking an empathetic approach that prioritizes relationship building, utilizes strategic community partnerships, and focuses on providing access, information and resources to those in distress can increase community awareness and support better experiences for both patrons and staff. It’s time for libraries to think of substance use as an access opportunity, replacing our previous reactionary approach that may prevent patrons from getting the information and resources they need. 

Public libraries often have hard-line approaches to drug use that don’t consider preventative strategies such as relationship building with patrons to prevent future escalations of behavior. It can be difficult to step out of the cycle of crisis response and incident report, over and over. Support systems and resources thinned for many communities during the pandemic, yet drugs’ impacts have only increased. It’s important to seek another approach that envisions support and breaking the cycles that lead to staff burnout with no solutions. While a patron’s behavior may be interfering with library usage on one day, it’s important that they be invited to return another day when they aren’t experiencing intense symptoms. While a matrix laying out how long someone’s library privileges should be suspended for various behaviors is a helpful tool, matrices don’t take into consideration the human factors that could lead to a crisis for a patron: Did the patron just get fired? Did the patron just lose custody of their children? By the time they get to us, multiple systems have often failed our patrons and we have an opportunity to be an understanding community hub that can connect them to resources and offer a safe space to return to for information or respite. 

We cannot strive for equity in public libraries without considering accessibility for the populations who are disproportionately affected by substance use disorders. Substance use is complicated, and influenced by many factors such as economics, access to healthcare, housing affordability, racial disparities, and more. In 2020 there were more than 100,000 drug overdoses in the United States, a 27% increase from the year before. Seventy-five percent of these were caused by opioids, according to the Centers for Disease Control (CDC).1 This number has exponentially increased since the 1990s and was exacerbated by the COVID-19 pandemic.

According to the National Institutes of Health (NIH), a substance use disorder (SUD) is a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications.2 The NIH has reported that many individuals who experience a substance use disorder have a co-occurring mental health disorder, such as anxiety or depression. There are disparities in treatment for SUDs—according to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), 23% of white individuals receive successful treatment, versus 18% and 17% for Black and Latinx individuals respectively.3 More than 11% of veterans who are newly seen by the Veterans Health Administration (VHA) meet the criteria for SUDs according to the NIH,4 and this number doubles to 2 in 10 for veterans with Post Traumatic Stress Disorder.5

At the Tacoma Public Library, we realized there were few community support systems available for patrons who were experiencing crises related to drug use, or who needed a connection to healthcare, housing, or general crisis support that was beyond what the library has the resources and skills to provide. We also recognized that our community, like many across the state, was experiencing skyrocketing overdose deaths due to an increase of fentanyl circulating, exacerbated by the COVID-19 pandemic. From 2019 to 2021, deaths from fentanyl overdoses increased four times in Tacoma and Pierce County.6 For these reasons, we sought out a partnership with the Tacoma Needle Exchange. Through this partnership we provided training for staff and managers on substance use disorders, the effects of fentanyl on communities, resources for our patrons, and the administration of NARCAN. In addition, we began adding peer navigation services through the Tacoma Needle Exchange to our libraries to connect patrons with housing, healthcare, crisis support, and more. In trying to respond to changing needs in the pandemic we also began partnerships with Tacoma Pro Bono across the library system to provide free legal aid, especially around eviction support, as well as bilingual housing, immigration, and social service support through a partnership with Mi Centro Tacoma. To help equip our community to support neighbors and loved ones, each library is fitted with a NARCAN box next to our defibrillators so staff could help reverse an overdose. Additionally, we host a free NARCAN vending machine in one of our libraries to provide easy access to lifesaving treatment. Public libraries have historically empowered their communities with information to help them improve their lives and communities, and we saw this as just another way to address a pressing community concern. 

The Naloxone vending machine at the Tacoma Public Library Moore Branch is black and orange and sits next to the copy machine.

Naloxone vending machine at the Tacoma Public Library Moore Branch.

Harm reduction is a strategy that encourages service providers to engage with people who use drugs to build relationships that prevent overdoses through low-barrier access to information and resources. The U.S. Department of Health and Human Services identifies harm reduction as an effective strategy in preventing death and improving wellbeing for those experiencing substance use disorders. Reframing policies, approaches to patron bans, training for staff, community partnerships, and services through a harm reduction lens can greatly expand access to information and resources

Training staff on empathetic approaches that emphasize factors that influence substance use and taking a holistic view of our patrons as complex individuals–rather than their behavior in a single moment they were under the influence–is key. Because substance use intersects with many areas we provide resources for, such as housing and legal help, many patrons can benefit from staff training on these resources and from partnerships such as pop-up events in their branches led by community organizations. This investment of time and relationship building can ensure patrons feel safe to return to the library and be connected to resources when they are in a better mental space. Relationship building can also help staff de-escalate difficult situations; when patrons have built relationships with staff, they are more likely to see the library as a valuable space for them. Many of our patrons have shared stories with us about loved ones who used, who they were afraid for, and some who are not with us anymore. The reaches of the opioid epidemic are far and wide in our community. 

The future of supporting our communities through the opioid epidemic could manifest in many ways. It could include building empathy and understanding among staff, reaching out to expand partnerships, and rethinking what safety means and who should respond. Are there alternative crisis responders to police and firefighters in your community that can bring resources and help de-escalate difficult situations? Do all bans need to default to a pre-set length or can staff be flexible and allow the patron to return another day when they are in a better space? Are staff well versed on available community resources, or what to do in the event of an overdose? Do staff have the tools they need, such as NARCAN, to respond to an overdose? Thinking of restorative rather than punitive approaches can support communities in moving toward healing. 

Broadening our scope with access can help expand services and awareness. It can also give us insight into other populations that are often underserved, such as formerly incarcerated patrons and  patrons who are housing insecure. When we understand substance use and mental health as part of our access landscape, we can better support the wellbeing of our communities and continue the work of closing information and resource gaps for our patrons. 

Headshot of Gabby Fuentes,  a tan person with short, wavy, brown hair, thick tortoiseshell glasses, and a slight smile wears a black shirt against a tan background with a window in view.
Gabby Fuentes is a Neighborhood Services Manager at Tacoma Public Library who focuses on equity and access. Gabby has experience managing community libraries, as well as previous experience as an adult services librarian, and an outreach librarian. Prior to libraries, Gabby worked supporting human trafficking and domestic violence survivors, and unsheltered persons in Washington state. Gabby is passionate about equity and access, and rethinking the ways that the public library functions as a community hub for patrons.
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