Once It Was Overdue Books. Now Librarians Fight Overdoses.

MIDDLETOWN, N.Y. — The director of the public library in this Hudson Valley town calls his assistant and security guard “Starsky and Hutch.” They have been trained to spot signs of overdose in library patrons — paleness and shortness of breath when it is heroin; sudden collapse when it is fentanyl — and administer the drug naloxone. They patrol the bathrooms and stacks at the Middletown Thrall Library, checking on anyone who is dozing.

“It’s easier to call the police, to wait for EMS,” said the library director, Matt Pfisterer, who had to decide whether to use the overdose-reversing drug himself a few years ago, after he found a woman lying in the grass outside, unconscious and covered with ants.

“You don’t know how they’re going to react,” he said. “But when it comes down to it, you ask, ‘Do I want to see this person dying in front of me?’ ‘No.’ So you take the leap.”

The opioid epidemic is reshaping life in America, including at the local public library, where librarians are considering whether to carry naloxone to battle overdoses. At a time when the public is debating arming teachers, it is another example of an unlikely group being enlisted to fight a national crisis.

Philadelphia became the poster child for naloxone-toting librarians last year after the Inquirer wrote about a library where one woman had revived several people. Cities including Denver and San Francisco have also started training library staff to use the drug, which comes in the form of a nasal spray and is commonly known by the brand name Narcan.

But outside major cities, librarians are weighing whether to stock the drug, too. Across New York state, like in much of the country, they describe struggling with overdoses — one more sign of the severity of the opioid crisis, which killed roughly 64,000 people in the United States in 2016, and of the rise in heroin and fentanyl abuse.

Rep. Sean Patrick Maloney, a Democrat from New York’s Hudson Valley, introduced the Lifesaving Librarians Act in Washington last fall after reading about Philadelphia and consulting librarians in his own district, which includes Middletown and Newburgh, in Orange County, where there were 88 overdose deaths last year.

The proposed legislation would offer libraries in high-intensity drug-trafficking areas access to naloxone kits and training, through a federal grant. Maloney said he expected the bill, which could be bundled with other anti-opioid legislation, to receive bipartisan support. “While it seems shocking to be finding heroin at the public library — that’s where we are,” Maloney said. “This is an all-hands-on-deck situation.”

The bill reveals just how much libraries, which are open to the public and welcome homeless people, have had to cope with the crisis: Library workers in towns and cities across New York describe finding used syringes and glassine envelopes in doorways and patrons slumped over in bathrooms. In Albany, libraries have started to keep files on some patrons and temporarily ban those who overdose. In White Plains, a man was arrested last year for selling heroin out of a library bathroom.

But the bill has also ignited debate about whether librarians, like police officers and emergency medical workers, should administer naloxone.

“It’s a perfect example of how time and time again, the government turns to libraries to step up and fill in,” said Jeremy Johannesen, executive director of the New York Library Association, noting that libraries distribute tax forms, and had assisted with enrollment for the Affordable Care Act.

“Librarians are routinely ready to step up and meet the needs of the community,” he added. “This definitely raises the bar.”

Christian Zabriskie, a library administrator for the Yonkers Public Library System and the director of a nonprofit advocacy group called Urban Librarians Unite, said the group supported the move as a first step but understood the reservations expressed by some librarians: “It’s like, ‘Geez Louise, can I just give people a mystery? Can I just help kids read?’ If you wanted to be an EMT, you would have been an EMT.”

A few weeks ago at the Newburgh Free Library, an airy building with tall windows that look out on the Hudson, parents played with babies and people studied amid Valentine’s Day displays. Then a loud noise broke the calm. A man had slammed open the bathroom door, and was dragging another man out, said the library director, Chuck Thomas. Newburgh, long plagued by poverty and crime, has been hit hard by the opioid epidemic. But it had been years since there was an overdose at the library, Thomas said.

A guard rushed over and found one man unresponsive; the other was shouting. “You could tell he didn’t want to lose a friend,” said the guard, Ruth Ramirez.

The guards cleared the area and called 911: the overdose drill. Police arrived in minutes and gave the man naloxone — once, twice. “It was amazing. I watched this man who I thought was dead open his eyes,” Thomas said. If his employees could administer the drug themselves — a decision that he said would be left up to his board — “We could be a minute quicker.”

New York City’s three library systems have not said that they will follow other cities in carrying naloxone, but parts of New York appear to be inching in that direction.

In Long Island’s Suffolk County, which has among the highest rates of overdose deaths in the state, some 200 library employees (out of thousands) have been trained to use naloxone, said the director of the Suffolk Cooperative Library System, Kevin Verbesey. “I have a pack of it right here in my L.L. Bean briefcase. My little blue OD rescue kit.”

Last year, Gov. Andrew M. Cuomo signed a bill into law that added libraries to a list of institutions such as schools that are authorized to possess and use naloxone. The proposed legislation in Congress would make it easier for libraries to stock the drug, especially as prices rise, Verbesey said.

Still, at libraries big and small, directors are weighing the potential consequences.

Bambi Pedu, the director of the library in Lake Placid, in the Adirondacks, worried that drug addicts would start to use in the small-town library if they knew it stocked naloxone. “You’re opening a can of worms,” she said.

In Albany’s libraries, drug use is already happening, which comes with its own issues, said Scott Jarzombek, the executive director of the state capital’s seven-library system. “We see people come in, they go straight to the bathroom stalls.” The library system changed its bathroom policy to require people to show identification, after a patron died in one branch.

But he had opposed asking staff to train to use naloxone, until he recently watched a woman revive a companion in a bathroom. “Seeing it happen in front of me made me think, maybe we should start training our staff and having the conversation about Narcan,” he said. “As great as our first responders are, they might not be able to get here in time.”

Pfisterer, in Middletown, keeps naloxone in his office, which is outfitted with monitors showing surveillance footage of the premises.

If patrons know that librarians are on alert for overdoses, he said, “My biggest fear is that people will stop coming to the library.” And yet, he said, it is only another indication of how widespread the problem has become. “It’s everywhere.” David Kirschner, a drummer in his early 60s, has spent winter days in the library in Middletown and nights in a warming station across the street, while he weans himself off heroin with the drug Suboxone.

“I think they go beyond their duties as a library to help people who are on drugs,” he said. “There’s always AA and NA and they can tell you where that’s at. The security periodically knocks on the door in the bathroom to make sure everyone is OK.”

In Newburgh, Thomas, the library director, said, “That’s what a library’s job is — to respond to the needs of the community.”

“Those are their needs now,” he added. “Later, they may need Shakespeare. But those are their needs right now.”