As libraries grapple with overdose crisis, Vancouver tells staff not to intervene

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Aili Meutzner was walking home from work last spring when she came across a man in his 50s, lying motionless outside a school on the east side of Vancouver. A shopping cart was parked beside him and his legs, protruding from under the building’s awning, were dampened from the rain.

Perhaps he was napping, she thought. But maybe not.

“I thought I’d say hi and see how he’s doing,” said Ms. Meutzner, a Vancouver librarian. “I noticed his fingers were looking blue, and his lips were blue. I tried to get a pulse. I shook him.”

The 36-year-old, who lives and works on the city’s east side, had sought out training to administer naloxone – a drug that reverses the effects of an opioid overdose – several years earlier. She recognized the signs of an overdose and carried a kit.

After calling 911, she opened her kit, drew up the life-saving liquid in a syringe and injected the man, who then came to before first responders arrived. The firefighters commended her for taking action.

Ms. Meutzner played down her response that day – “It’s really not a big deal” – and said she wouldn’t hesitate to do it again. But should that next overdose be at her place of employment, she could face disciplinary action.

Spaces for the homeless

Libraries across Canada have long served as valuable spaces for the homeless and otherwise vulnerable, offering respite from the outdoors; books and internet access; as well as a space to rest or socialize – all free of charge. As overdose deaths began to soar several years ago, fuelled by the arrival of illicit fentanyl, many libraries responded by introducing new overdose policies such as voluntary naloxone training.

But in Vancouver – which recorded an average of one overdose death every day last year, the most of any Canadian city, based on available data – library workers are prohibited from administering the drug, even if they have sought out training on their own.

Vancouver Public Library (VPL) staff are actively discussing the issue on an internal message board and have requested a review of the policy.

In response to requests to reconsider the policy, VPL’s departing chief librarian Sandra Singh in February issued an internal memo, viewed by The Globe and Mail, saying there would be no such change and for employees to adhere to the existing policy to call 911.

“Everyone’s quite upset about it but no one quite knows what to do,” Ms. Meutzner said. “What do we do when we’re facing the idea that something could be happening, and we have the kit, we have the knowledge and we’re barred from doing something?”

Librarians on the front line

Libraries big and small across Canada have introduced new overdose policies in recent months.

In Calgary, for example, the city’s public library last month began equipping private security guards at its four city-centre locations with naloxone. The Edmonton Public Library says it is set to do the same over the next month or so. And the Camrose Public Library in Camrose, Alta., approved a policy in November to provide naloxone training to employees who want it and have at least two kits on site at all times.

Camrose library director Deb Cryderman, who carries a naloxone kit in her purse, said the issue was first raised by a staff member with first responders in her family.

“We’re a community centre. We are a centre where community gathers. And that means everybody in the community is welcome here, including people who might have an opioid overdose. We want to be able to help them,” Ms. Cryderman said.

In Ontario, Toronto Public Health engaged the Toronto Public Library (TPL) to participate in the city’s overdose action plan in February, 2017. That resulted in mandatory overdose information and awareness training, which the majority of TPL staff have since taken.

The library initially decided against providing staff with naloxone, but reconsidered last September as overdose deaths in the region climbed. TPL now allows library workers already certified in first aid to receive voluntary naloxone training, and all branches have been supplied with intranasal naloxone. Dozens of staff have completed the training, the library says

The Ottawa Public Library has not yet introduced a new overdose policy but is in discussions with Ottawa Public Health about having naloxone available.

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Memo lists risks

In Vancouver, the employer’s position is that there have been so few overdose incidents at local libraries that there is no need to introduce naloxone training, which it says comes with risks.

At VPL, Ms. Singh’s Feb. 27 internal memo said there were a total of 18 incidents across its 21 branches last year in which patrons could not be roused by staff. Of those, paramedics administered naloxone in two cases.

“We recognize the humanitarian values that drive staff to want to assist in response to this community crisis,” Ms. Singh wrote. “In the rare situation that we encounter an unresponsive person, the urge to jump to a diagnosis and offer medical assistance is understandable and speaks highly to the compassion of staff.

“However, given the very low rates at VPL and the effectiveness of our existing procedures in relation to the risk to staff and supervisors, we will not be changing our procedures at this time.”

The memo listed risks to staff of administering naloxone, including assault by an overdose victim who becomes aggressive from opioid withdrawal; exposure to “opioid dust;” infectious bodily fluids and sharp drug paraphernalia; and potential liability claims from overdose victims.

Tim Gauthier, a registered nurse who has worked at Insite, Canada’s first public supervised consumption site, since 2008, said the risks described do not align with the evidence, or with his experience in managing opioid overdoses.

“Insite has managed thousands of overdose events, and I am unaware of a single episode that has resulted in an assault or injury from someone who was angry at receiving naloxone,” Mr. Gauthier said.

As well, the likelihood of overdosing from merely touching trace amounts of opioids is extremely low and has never been documented in practice. Naloxone kits also come with face shields and gloves, so direct skin contact with drugs or bodily fluids can be avoided. Sharps can be avoided through basic precautions.

B.C.’s Good Samaritan Act ensures that a person is not liable for damages for injury or death caused by rendering emergency medical services or aid, unless that person was grossly negligent.

Asked whether library workers who decide to administer anyway would be subject to discipline, VPL acting chief librarian Christina de Castell said that had not yet been discussed. She said VPL continues to monitor the situation and have discussions about the policy, but there are no plans to change it.

Aliza Nevarie, president of the Canadian Union of Public Employees local that represents more than 800 employees of Vancouver Public Library as well as library workers in Sechelt and Gibsons, said some staffers – particularly those who work at libraries on Vancouver’s east side – are “hyperaware” of the overdose crisis and want to be able to do more.

The union’s position, she said, is that while no worker should be required to administer naloxone, those who want to should be allowed to, so long as they are covered from personal liability.

Tense moments

Ms. Meutzner, who now works at the VPL’s Strathcona branch, said she comes across a patron an average of once every other week who seems to be passed out or otherwise unresponsive. Sometimes they are drunk or just sleeping; there have been tense moments where people will take five or 10 minutes to be roused. She worries that, at some point, it will be an opioid overdose.

“I’ve had to wake a lot of people up and we’ve had a lot of scares,” she said. “I would not be able to live with myself if someone died in our branch because I was too worried about my career or something.”