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Some Hennepin County librarians, joined by patrons and paramedics, are urging county officials to allow willing library staff members to carry and use naloxone at work. The lifesaving medicine is used to reverse opioid drug overdoses.

The librarians say such a workplace policy is needed at a time when Hennepin County Library branches have become a haven of last resort for people who are homeless or addicted. Absent a policy that protects staffers from discipline, librarians who want to help a person who is overdosing must think twice about whether to intervene in a time-critical emergency.

"It's such a life-threatening situation. It's hard to be in those situations and not feel like you have clarity on how your employer is going to respond," said Emma Riese, a librarian at the Minneapolis Central Library.

Varying feedback

Drug use is prohibited at Hennepin County libraries but has become more apparent in the past five years, particularly in library bathrooms. The county recognizes that libraries serve purposes besides issuing books, and they become official warming centers at times of severe cold.

Riese said she and others began asking library officials several years ago for permission to carry Narcan — the brand-name nasal spray — in response to a visible rise in drug use at the libraries, including a 2018 death at Franklin Library in south Minneapolis. The county relies on security officers to administer naloxone at library branches and trains all other staff to call security in the event of an overdose.

Failing to get a conclusive answer, Riese started carrying Narcan anyway and in 2020 saved an individual overdosing just outside the library. One week later, she said, all naloxone supplies were removed from libraries that did not have a regular security presence. The episode was documented in a 2020 report assembled by a group of staffers critical of the county's policy allowing only security officers to handle naloxone.

Since then, library staffers who voluntarily carry naloxone say they've heard varying feedback from their supervisors, ranging from tacit approval to verbal warnings to take their supplies home.

The Library Patrons Union, a leftist organization of library patrons, has issued a demand that Hennepin County immediately update its naloxone policy.

"Just imagining a staff person being told they had to stand and watch and wait potentially while somebody overdoses, to me it's just unconscionable," said Erin Bogle, a former staffer at the county's Brookdale and Webber Park branches.

In response to the opioid crisis, Hennepin County has made it easy to learn how to use naloxone. The Sheriff's Office will train and supply any member of the public willing to help reverse overdoses in the community. The county's 2020 opioid response strategic framework encourages all "first responders, drug users, families and friends" to participate in the rescue effort, stating more responders "would result in more lives saved."

Shane Hallow, president of Hennepin County Association of Paramedics and EMTs, said it's important for laypeople — not just medical professionals — to have access to naloxone.

"It doesn't really make a ton of sense to me ... that a librarian could purchase it on their own at Walgreens, have it in their purse and use it anywhere in their daily life except for when they're at work, where they may be more likely to encounter it," he said.

Nathan Koranda of KOPI Medical, a group that trains first responders on incorporating mental health into emergency medicine, said he asked county commissioners in February to give library staff explicit permission to use naloxone at work, but he hasn't heard any updates since.

"I'm not even asking them to train everybody, I'm just saying don't restrict access," he said.

Policy change expected

A patchwork of state laws regulates the use of naloxone. Emergency medical responders, police and community health providers may use it if they are trained and party to a standing protocol issued by a licensed medical professional. Another law absolves any good Samaritan, including a fellow drug user, from criminal prosecution and liability if they administer naloxone to save a life.

Hennepin County spokeswoman Carolyn Marinan said the county has no policy against librarians carrying naloxone for personal use, but she stopped short of saying they are currently free to use it to reverse overdoses at work.

However, Marinan said, Hennepin County has begun to re-evaluate its naloxone policy in light of the U.S. Food and Drug Administration approving an over-the-counter naloxone nasal spray in March, citing the importance of having all forms of naloxone easily accessible for community use. She said an updated county policy is expected in the next several weeks.

According to a Friday memo from County Administrator David Hough, the policy will authorize and purchase supplies for any county employee to carry naloxone at work after they take a short training.

Hosmer librarian Lindsey Fenner, who is trained to use naloxone, acknowledged that not all library staffers want to take on a responsibility as serious as reversing overdoses. Staffers already keep an eye on bathrooms to make sure people aren't dying there, constantly worrying about patrons suffering from addiction without having much power to address its root causes.

But those who want to voluntarily intercede in overdoses need that new policy to ensure they won't get in trouble, she said.

"This policy is long overdue if it happens," said Fenner. "Libraries are really acting right now as de facto overdose prevention sites."