MIDDLEBURY — Middlebury’s Ilsley Public Library shelves a variety of books about opioid addiction and the recovery process for those held in its insidious grasp.
Now the library has a more immediate lifesaving tool on hand for patrons who suffer an overdose during visits.
It’s called Narcan, the brand name for Naloxone, which can be given to someone suffering from an overdose to bring them back from the brink. 
Ilsley Public Library Director Dana Hart and about a half-dozen Ilsley employees voluntarily took training through the Turning Point Center of Addison County on how to recognize the symptoms of someone having an opioid overdose, and how to administer Narcan in such cases. Turning Point Director Stacy Jones recently spent an hour at Ilsley training employees, who will get annual refreshers.
The pharmaceutical Naloxone is used to treat respiratory depression caused by opioids, such as heroin, morphine, oxycodone, methadone, hydrocodone, codeine and other prescription pain medications. Naloxone — in this case administered as a nasal spray — quickly and temporarily reverses the effects of opioids in overdose patients, to the extent they can be brought back from the edge of death and then placed into recovery programs in order to kick their addiction before it’s too late.
“For us, looking around and knowing that opioid addiction is a problem in Vermont, we just wanted to be prepared in any way we could be — and (having Narcan on hand) was one way of doing that,” Hart said on Thursday.
Turning Point is providing Ilsley with its Narcan supply at no cost. The library has two kits, both of which are kept in a medical case to which Ilsley employees have exclusive access.
Hart ran the Narcan idea through town officials before implementing it. Officials reviewed Middlebury’s municipal insurance policy and determined storage and use of Narcan at the Ilsley in emergency situations would present only “minimal liability,” according to Hart.
“The feeling is, it’s a very small risk for something that’s a life-and-death situation,” she said of potential legal repercussions. “There’s pretty broad protection under Vermont’s Good Samaritan law.”
It should be noted that Narcan can’t produce a high in the user and is only effective in treating an opioid overdoses. It’s also not harmful if mistakenly administered to someone who is not overdosing on opioids, officials said.
“We have happily not had an overdose in the library, and I’m hopeful we never will,” said Hart, who is pleased to also have Middlebury Regional EMS and Middlebury police on her team. “But realistically, there’s an opioid crisis in this country. As with most social and public health crises in this country, libraries are often at the forefront in dealing with them.”
Narcan is commonly stocked in many large urban libraries in recognition of patrons who might have an opioid addiction and could — at any moment — experience an overdose at a time when emergency responders aren’t nearby.
“I know there’s been libraries around the country … where there have been overdoses and even deaths, as a result,” Hart said. “So some of our colleagues around the country and in the state have started stocking Narcan as a way to be prepared for that.”
That preparation began last November after an Ilsley-based community forum on the opioid epidemic in Vermont and Addison County. Hart decided Narcan would be a helpful supplement to the library’s print resources on opioids and the staff’s willingness to point patrons to places they can get help.
Middlebury is Addison County’s service hub. It also hosts the Charter House Coalition’s warming shelter, whose homeless clients include some folks dealing with addiction. The shelter provides food and overnight accommodations for clients, some of whom depend on public venues — like the Ilsley — to stay warm and occupied during the day until the shelter opens for the evening.
Hart was pleased to report she’s seen no evidence, during her tenure, of used needles or other drug paraphernalia in the library. But she knows that doesn’t mean it isn’t happening. For example, the library restrooms aren’t located within supervisors’ sightlines.
“Restrooms have the potential to be used for drug abuse,” Hart acknowledged.
STATEWIDE PREPARATION
Lara Keenan is governance and management consultant with the Vermont Department of Libraries. She’s been leading workshops throughout the state for library officials seeking more knowledge about the opioid epidemic and how public venues can be prepared to help those with addiction issues.
Keenan said libraries should look upon Narcan as another emergency tool, such as a heart defibrillator.
“It’s something (library officials) should talk about,” she said. “They can work through the stigma and see if it makes sense for them.”
The Department of Libraries has no official count on how many libraries in Vermont are storing and administering Narcan; it’s a decision made at the local level. Keenan said she’s only aware of Narcan being used at Ilsley and the Kimball Library in Randolph, but she’s confident the substance is available at other Vermont libraries. And Keenan knows, from her workshops, that other libraries are seriously considering it.
Narcan isn’t currently being stocked at either the Bixby Library in Vergennes or the Lawrence Memorial Library in Bristol. But directors of those two organizations said they’re open to pursuing the idea if there’s an appeal from their respective constituencies to do so.
Bixby Director Masha Harris said there was an overdose at the library prior to her arrival around a year ago. And there have been a few cases of hypodermic needles being found in the Bixby restroom, she added. But Harris said she doesn’t believe the issue has gotten to a point where the Bixby should be stocking Narcan.
She’s pleased with the professionalism of Vergennes’ emergency responders who would answer an overdose call at the library.
“Vergennes has an excellent police force; if we need them, they’re here right away,” Harris said.
Longtime Lawrence Memorial Library leader Nancy Wilson is also confident in Bristol’s emergency responders’ ability to respond quickly to a call, so Narcan isn’t — for now — being offered on-site.
Some of her library staff have voiced concerns about potential liabilities in handling Narcan, according to Wilson.
She has helmed Lawrence Memorial for three decades, during which there’s not been an overdose. She added drug paraphernalia has never been found in the library’s restroom.
“It’s a tough call, but for now we’ve decided not to do it,” Wilson said. “But we’re definitely open to it.”
Hart said she understands why some of her colleagues have elected not to green-light Narcan for their libraries. But she looks at it as an extra precaution Ilsley Library can take.
“I hope to God we don’t have to use it,” said Hart. “But I feel better knowing that if something were to happen, we would be able to do something.”
Reporter John Flowers is at [email protected].