Public libraries as partners in confronting the overdose crisis: A qualitative analysis

Abstract

Background

The overdose crisis is affecting public libraries. In a 2017 survey of public librarians, half reported providing patrons support regarding substance use and mental health in the previous month, and 12% reported on-site drug overdose at their library in the previous year. Given the magnitude of the overdose crisis and the fact that public libraries host 1.4 billion visits annually, our aim was to understand how libraries currently assist with substance use and overdose and how they can further address these issues. Methods: We conducted semi-structured interviews with 44 public library staff from across the U.S. attending a national meeting in March 2018. Interviews addressed attitudes and experiences regarding drug use, overdose, and overdose response in libraries. We analyzed interviews using thematic content analysis guided by the Consolidated Framework for Implementation Research. Results: Participants were from 26 states. Among libraries in this sample, 14% had experienced an on-site drug overdose and 7% stocked naloxone at the time of study. Nearly all participants reported substance use as a prominent concern among patrons and their families, as well as in the library itself. Many participants were willing to provide support to patrons and even administer naloxone, but they often lacked preparation, resources, or institutional support. Participants also expressed interest in providing information or referrals to people who use drugs (PWUD), but such efforts were often stymied by inadequate community resources. Finally, participants expressed interest in strengthening partnerships between public libraries and health and social service organizations. Conclusions and Relevance: Public library staff routinely engage PWUD, and based on prior studies, nearly 2,000 of U.S. public libraries can expect an on-site overdose in the next year. Findings from our work highlight the need for further study about how public libraries can act as part of comprehensive, community-based strategies to address the opioid epidemic.

Keywords:

• Overdose
• public health
• Substance use disorders
• determinants of health
• community partnerships

Author contriubtions

Dr. Lowenstein and Dr. Cannuscio had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Specific contributions are as follows: study concept and design: Lowenstein, Cannuscio; acquisition, analysis, or interpretation of data: all authors; drafting of the manuscript: Lowenstein, Cannuscio; critical revision of the manuscript for important intellectual content: all authors; data analysis: Lowenstein, Feuerstein-Simon, Sheni, Dupuis, Cannuscio; administrative, technical, or material support: Feuerstein-Simon, Dupuis; and supervision: Cannuscio.

Acknowledgments

The authors thank Dr. Andria Johnson for her contributions to the Healthy Library Initiative and to University of Pennsylvania students Jocelyn Afadapa, Maryam Alausa, Aminat Balogun, Vernell Brown, Lois Chapla, Taylor Cooper, Eiman Eltigani, Angela Gichinga, Margaret Hanna, Brandon Huffman, Jameira Johnson, Tyler Kotarski, Colleen McGrath, Samiza Palmer, Corey Robinson, Sarah Rowley, Gabrielle Stone, and David Thai for assistance with recruitment and interviews. The authors are grateful to the interview participants, who generously shared their time and thoughts, and to their partner, the Public Library Association for hosting our team at their annual meeting. Finally, the authors thank the Center for Public Health Initiatives, the Office of the Dean at the Perelman School of Medicine, and the University of Pennsylvania Prevention Research Center for support of the Healthy Library Initiative.

Additional information

Funding

Dr. Lowenstein is funded by the Department of Veterans Affairs through the National Clinician Scholars Program. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.