August 2018 | Volume XXXVI. Issue 4 »

How the Opiate Epidemic Came to the Library

July 27, 2018
Trisha Noack and Roberta Koscielski, Peoria Public Library

As the opiate abuse epidemic exploded across the country in the past few years, Illinois was in the crosshairs and Peoria, as one of the largest cities between Chicago and St. Louis, was being rocked with overdoses. In December of 2015, Roberta Koscielski, deputy director of Peoria Public Library, received an invitation from Mayor Jim Ardis to attend a meeting intended to organize a way to fight back. He was forming the mayor’s Community Coalition Against Heroin, composed of elected officials, physicians, the media, the library, parents who lost children, and recovering substance abusers. He wanted the Peoria Public Library involved after the library’s successful involvement in a previous coordinated community action to fight gun violence. At this meeting he explained that every Monday morning he met with Peoria’s police chief and the state’s attorney and reviewed the significant events of the past week in terms of police calls. They noted the increased number of heroin overdoses, both in the city of Peoria and in nearby rural areas. 

It is a nationwide problem. According to the Centers for Disease Control and Prevention (CDC), every single day 115 Americans die from opioid overdose, now the leading cause of accidental deaths in our country, surpassing deaths from gun violence and car crashes. From 1999 to 2016, a period of 17 years, 630,000 people have died from a drug overdose. The numbers have been on the rise. In 2016 the number of overdose deaths was five times higher than in 1999 and included deaths from prescription opioids and illegal opioids such as heroin and illicitly manufactured fentanyl. The local spike in overdoses is what caught the attention of Peoria’s mayor.

It is not an issue libraries can ignore. Across the country, from New York to Denver to San Francisco and in hundreds of small towns, libraries are sites of overdoses. People with substance abuse disorder may purchase drugs near or on library property. They may then use the drug in the library or on the property. They may stop breathing and collapse in the easily accessible public restrooms or even while speaking to a staff member. If they are lucky someone will call 911 and naloxone HCI (commonly known trade name NARCAN®), which blocks the effects of opioids, will be administered. Libraries are responding by educating staff, stocking NARCAN® and sometimes providing needle disposal bins in restrooms. But little progress can be made if communities do not understand the root of the problem.

The Coalition had discovered the book Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones (Bloomsbury, 2015) and, as with the fight against gun violence, Coalition members felt it was important to get as many people as possible to read the book and gain an understanding of why there was an explosion in opiate abuse. The library, as lead partner in Peoria Reads!, coordinated a visit to Peoria by Quinones during summer 2016. Dreamland looks into how the opiate crisis came to be, outlining three distinct waves. First, in the 1990s with increased prescribing of opioids with the overdose deaths involving prescription opioids, including natural, semi-synthetic opioids and methadone; in 2010 a second wave began with rapid increases in overdose deaths involving heroin; and a third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl (IMF). The IMF market continues to change, and IMF can be found in combination with heroin, counterfeit pills, and cocaine.

As the summer of 2016 continued, so did opiate awareness events in Peoria, including two community forums hosted by the Coalition. During these forums the mayor, the sheriff, and the state’s attorney noted that opiate abuse is a community health issue, not just a law enforcement issue. “We can’t arrest our way out of the problem,” was the refrain as community education continued. As the Coalition moved to help the community understand that the face of addiction had changed they showed the film Chasing the Dragon, a documentary released by the FBI and CDC that features first-hand accounts by addicts and family members of addicts; and heard a recovering substance abuser speak. The examples shared via the film and presentation broadened viewers’ perceptions of addicts to include people such as an injured high school athlete or construction worker, or a mom hurt badly in a traffic accident who became addicted only after prescribed use of opioids. Dreamland outlines the potent trap of addictive prescribed opiates and easy access to illegal ones. Chasing the Dragon shows the desperation of people whose brain chemistry, against their will, has been altered and can’t easily be returned to a former state.

The community forums examined the current situation in Peoria. The questions asked were, “Who are those who are overdosing and what exactly are they overdosing on?” Overdoses come from abuse and in 2016 more than 11 million people in this country abused prescription opioids, according to the CDC. People who overdose are using a variety of drugs, but most common are methadone, oxycodone (commonly known trade name OxyContin®), and hydrocodone (commonly known trade name Vicodin®). It is a common misconception that people who are addicts got that way by abusing drugs on purpose, but the truth is that anyone who takes prescription opioids can become addicted to them. 

As previously mentioned, the first introduction to opioids is often through medical treatment for an injury or recovery from surgery. Research from the CDC has revealed some risk factors that make people particularly vulnerable to prescription opioid abuse and overdose, even when they have been prescribed the drugs for legitimate reasons. Some of those risks are heightened when people obtain overlapping prescriptions from multiple providers and pharmacies or are given high daily doses of prescription pain relievers. Another common risk factor is if there is a mental illness or a history of alcohol or other abuse. Those who live in rural areas and have a low income are also at risk for easily becoming addicted to powerful opiates.

It was a problem that needed to be addressed on many fronts. In Peoria, the Mayor’s Community Coalition Against Heroin organized a Physicians’ Summit, and it was at this event that the Coalition and Peoria Public Library began to build community contacts. As the Coalition spread its message, Peoria Public Library coordinated the reading of Dreamland at Notre Dame High School via an ongoing partnership with the high school librarian. The audience for this educational effort was approximately 70 junior and senior students from the Human Body Systems, American Legal Issues, and AP Psychology classes. Not only did the students read and discuss Dreamland, they heard from the mayor, the president of OSF Healthcare System (also an emergency room physician) and State’s Attorney Jerry Brady. Bradley University nursing teaching staff presented a lesson on the topic of addiction and the opiate epidemic and some students viewed Chasing the Dragon, which helped engage them further.

In the fall of 2016, Illinois Humanities funded a series of four Illinois Speaks discussions, one at each of the four largest library branches in Peoria, on the heroin and opiates epidemic and what can be done to solve it. A local recovering addict stepped forward to participate. An engaging speaker with a passion for preventing others from overdosing, he has been clean for six years and is brave enough to share his experience.

Community education continued at Osher Lifelong Learning Institute in early 2017 with a six-week, 12-hour study group on the heroin and opiates epidemic. After a two-hour background session, the group attended five presentations presented by local elected officials, the police chief and the captain who spent most of his career in the vice and narcotics unit, physicians, the CEO of Peoria’s Human Service Center, a recovering addict, and a mother who lost her son to addiction. A Skype session with author Quinones stressed that silence, isolation and shame compound the problem. He pointed out that if your child dies of cancer you get casseroles and if your child dies of overdose no one knows what to do or say. Quinones urged the audience to start using a scientific approach in seventh grade to teach kids the effects on the brain of using drugs. Simply telling kids how terrible drug abuse is, according to him, does nothing. Explaining that heroin and opiates fit perfectly into receptors in the brain shows them what drugs do and how it works.

As interest in the topic grew, the library stepped into its natural and expanding role. In addition to providing meeting space, staff created two bibliographies and a special page on the website that also contains FAQs and where to call for help. In anticipation of having an overdose in the library, as was being experienced in so many other communities, a voluntary training for staff was offered. Within days of offering the training to staff, emergency personnel were called and administered a dose of NARCAN® at Main Library for the first time to a male found unresponsive in a restroom. After the incident, 25 library staff members asked to be trained to administer NARCAN®. While library staff members Roberta Koscielski and Trisha Noack were presenting a session on how libraries can help with the opiate epidemic at the Illinois Library Association’s Annual Conference in fall of 2017, a second overdose occurred at Main Library and the victim was again saved with NARCAN® by emergency workers.

Other Illinois public libraries have also had to respond to the heroin and opiates epidemic. In April 2016, a man died from a heroin overdose in an Oak Park Public Library restroom. At Decatur Public Library, a library staff member administered NARCAN® until emergency services responded to an overdose at the library. As librarians began to read about overdoses occurring in public libraries across the United States, they are making sure that their staff and their community members are informed about the problem. Many central Illinois public libraries are working with the Human Service Center in Peoria, which received a $687,000 federal grant in August 2017 as part of a grant to the state of Illinois of $16.3 million from the Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) in 21st Century Cures Act-authorized funding under the State Targeted Response to the Opioid Crisis Grant (Opioid STR) program. The program aims to address the opioid crisis by increasing access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder (OUD), including prescription opioids as well as illicit drugs such as heroin. Through this grant, opioid overdose kits are being distributed, along with the appropriate training, to 38 counties in central and northwestern Illinois. Chillicothe Public Library, for example, has worked with the Human Service Center to provide NARCAN® training for their staff members and for their community. These trainings include the effects of opioid use, the scope of the problem, symptoms of overdose, and how to respond to an overdose. Peoria Public Library continues to work with community partners to offer information and develop new programs to help educate staff, the wider library community and the public.


Resources

Prevention First offers free downloadable print materials featuring two campaigns, “Guard and Discard” and “Every Opportunity Matters,” available online at
https://www.prevention.org/EOMPosters
https://www.prevention.org/GuardandDiscardEnglish
https://www.prevention.org/GuardandDiscardSpanish

For more about Dreamland by Sam Quinones (Bloomsbury, 2015) and to contact the author visit
http://www.samquinones.com/books/dreamland/

The Chasing the Dragon documentary is available on YouTube: https://youtu.be/lqdmWRExOkQ

The Centers for Disease Control and Prevention’s information about opioids:
https://www.cdc.gov/drugoverdose/opioids/index.html

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