Narcan: What Every Librarian Needs to Know About Opiate Overdoses

The number of fatal overdoses due to opiate use (heroin, fentanyl, pain pills) continues to surge in the US, as does the record amounts of fentanyl powder and pills seized at the southern border. A recent arrest in Arizona revealed the driver was transporting 340 packages of fentanyl pills, weighing 187 pounds, and worth an estimated $4.3 million. (A fatal dose – injected, swallowed, or inhaled – can be as small as a dozen grains of sand.)

A news release from the Biden White House on August 26, 2022 echoes this grim tale:

“As the overdose epidemic has evolved, synthetic opioids – particularly illicitly manufactured fentanyl — now drive the majority of overdose deaths. In 2021, more than 100,000 people died from an overdose, an approximate 15 percent increase from the previous year. Every loss is a painful reminder that, now more than ever, we must address our Nation’s overdose epidemic.”

The number of overdoses leading to death averages about 275 people per day. The majority of these people are young and many are POC. According to a CDC report:

“Drug overdose data show troubling trends and widening disparities between different population groups. In just one year, overdose death rates (number of drug overdose deaths per 100,000 people) increased 44% for Black people and 39% for American Indian and Alaska Native (AI/AN) people. Most people who died by overdose had no evidence of substance use treatment before their deaths. In fact, a lower proportion of people from racial and ethnic minority groups received treatment, compared with White people. Some conditions in the places where people live, work, and play can widen these disparities. For instance, areas with greater income inequality—a larger income gap between the rich and the poor—have higher rates of overdose deaths. Comprehensive, community-based prevention and response efforts should incorporate proven, culturally responsive actions that address disparities in drug overdose deaths and the inequities that contribute to them.” (

Since libraries are public places, the likelihood of opiate drug users coming to the facility to either use drugs, buy or sell drugs, or rest while under the influence, means that the possibility of a medical emergency due to their overdose is a reality.

A patron who appears to be “just sleeping” could really be in respiratory failure and on the way to passing out. It’s important for all library employees to recognizer the warning signs of a possible overdose. The person may:

• appear “asleep on his/her feet” (known as “opiate narcosis”);
• stand and sway, having trouble with balance and coordination;
• have problems breathing or stop breathing (and a low pulse);
• have slurred or low speech, with a raspy voice;
• have trouble swallowing;
• have cold, clammy skin;
• have blue lips or nails or hands/feet;
• have a noticeable nasal drip;
• show excessive scratching;
• have pin dot/very small pupils;
• actually pass out and fall forward in a chair (which constricts their breathing even more) or onto the ground.

Anytime a person starts to or actually loses consciousness, it’s a real medical emergency that requires you or other staffers to call 9-1-1 and get paramedics en route. If they suspect an opiate overdose, they will give the person a nasal spray injection (or less commonly, a thigh injection using a small needle) of Narcan (naloxone). They may also begin CPR or rescue breathing to help the person survive. Narcan works in one to two minutes and last for about 90 minutes, long enough to get the person to the hospital for further treatment. If the person is not under the influence of an opiate, the Narcan spray or shot will have no effect. It’s an opiate antagonist, meaning it seeks out opiate molecules to destroy them. No opiates on board; no harm to the person.

While no one needs an “official Narcan training program certification” to give Narcan, it can help to watch many of the training videos on YouTube that describe the process when someone is down on the ground and in what looks like an opiate overdose emergency. The official site for Narcan – www.narcan.com – is a good place to start for more information. (Their “Peel – Place – Press” instructions can walk you through the process of safe and effective Narcan nasal spray use.)

Many state health agencies and local county health departments offer online training and advice about opiate overdoses. All 50 states allow people to buy Narcan at their local pharmacy, without a prescription. Many people who have family members, loved ones, or partners who are opiate users, now buy and carry Narcan for that “just in case moment.”
While no library employee should be required to give first aid and/or administer Narcan to an overdosing patron, two facts make their move to voluntarily get involved more likely: 1) there are good faith/Good Samaritan laws in all 50 States, meaning you cannot be sued or faulted for trying to save a life, as long as you acted reasonably; and 2) no one wants to have a patron die in their library from drug use.”