Addressing the Opioid Crisis

Last week, I attended my college’s Spring 2020 convocation for faculty, staff, and administration. One of the presentations really struck a solemn chord with me and had a profound effect on how I view our current opioid crisis. The presentation was titled “H.O.P.E. Heroin and Opioid Prevention Education” and given by Lisa Wolff, M.Ed, of the Center for Humanistic Change. Her focus was mainly on the prevalent use of heroin and the resulting fatal overdoses of very young people in their late teens and early twenties.

The opioid crisis is rampant in Pennsylvania. According to the National Institute on Drug Abuse, the opioid-related overdose rate in the United States is 13.3 deaths per 100,000 people. However, in Pennsylvania, the opioid overdose rate is 18.5 deaths per 100,000 people.¹ Pennsylvania opioid abuse has led to the state having a higher number of overdose deaths because of opioids than the national average. Another source found that from January 1, 2018 to December 7, 2019, there were 19,652 emergency room visits from opioid overdoses in Pennsylvania.² Another startling fact is that the Centers for Disease Control and Prevention actually lists Pennsylvania as the state with the third-highest rates of drug overdose deaths (behind West Virginia and Ohio) at 44.3 per 100,000 people with a 16.9% increase from 2016 to 2017 alone.³

Having worked in three public libraries before my current position in a community college’s library, I had heard much of the opioid crisis and had read my fair share of articles concerning librarians becoming administrators of NARCAN® (naloxone HCl), which frankly, terrified me. Fortunately, I never encountered any patrons overdosing or had to administer NARCAN®, but after listening to Wolffe’s presentation, I now wish to learn this critical and life-saving task. In my ignorance, I failed to realize that the opioid crisis can hit the very library at which I work. It never dawned on me that our students could be overdosing on heroin and other opioids in our very bathrooms. (But please do not think I am ignorant about opioids in general; sadly, I have lost close family members to opioid overdoses in Schuylkill County.)

Wolffe brought forward a lot of useful information in just why opioids such as heroin are so addictive. The science behind these harmful drugs is that they attach to parts of your brain and body to block pain and anxiety and induce a feeling of calm and euphoria. Consequently, the brain begins to produce more and more receptors to which the opioids can attach themselves, thereby creating a cycle of addiction and actually changing the way your brain works. Depravation and withdrawal from opioids will cause seriously unpleasant side effects as the brain’s receptors continue to demand their fair share of euphoria. This short YouTube video gives a more scientific analysis of just how opioids affect the brain.4

What are some of the types of popular opioids? In addition to heroin, there are the ones that are often prescribed for patients undergoing (usually major) surgical procedures, or for those in the ending stages of cancer to alleviate the pain. These are morphine, codeine, and oxycodone. Additionally, there are more easily prescribed painkillers which unfortunately are far more accessible to our youth. These are the ones such as OxyContin®, Percocet®, and Vicodin®, which are often prescribed for sports injuries or dental surgeries such as wisdom teeth removal. But one opioid has recently grown in popularity according to Wolffe, and that is fentanyl. Fentanyl is a synthetic opioid that is 80-100 times stronger than morphine. Pharmaceutical fentanyl was developed for pain management treatment of cancer patients, applied in a patch on the skin. Because of its powerful opioid properties, Fentanyl is often abused. Fentanyl is added to heroin to increase its potency, or be disguised as highly potent heroin. Many users believe that they are purchasing heroin and actually do not know that they are purchasing fentanyl – which often results in overdose deaths.5 Wolffe tragically recalled an incident which happened to a young man in his late teens; he had been doing well and had been trying to stay clean, but one night at an arena where he and his mother worked (which is only about two miles away from me), he finished his shift and went to administer to himself what he thought was heroin. He ended up injecting himself with 100% fentanyl, which instantly ended his life.

Wolffe pointed out some interesting signs which you might observe in someone who is using heroin. Besides the obvious, tell-tale sign of a person slouching over and oblivious to his or her surroundings, rocking to and fro, then swinging upright in a moment of consciousness, only to repeat the cycle, there is also a rather unusual one. An unusual amount of plastic water bottles – usually in a person’s vehicle – might point to heroin addiction. Heroin is often placed in the bottle cap of a plastic water bottle and mixed with a little bit of water. To extract the impurities out of the heroin, a tad of cotton from a q-tip is also added to the bottle cap. From there, a person is able to withdraw the mixture from the cotton with a syringe. Referring to the case above, Wolffe mentioned that the mother often had to buy her son q-tips; she just assumed he was using them for personal hygiene.

As overwhelming and tragic as these statistics can be, I am now fully aware that a person can overdose in my library. I would like to be trained on how to administer NARCAN® safely and efficiently. This part of being a librarian has always terrified me. I often used to tell myself, “I did not sign up for this when I decided to become a librarian.” I assumed that only urban (and mainly public) libraries in center city Allentown or Philadelphia have to deal with this crisis, and not a community college library in a semi-rural setting. Moving forward, I am determined to make others aware of the importance we faculty, staff, and administration can play in the lives of students dealing with opioid addiction.

1. National Institute on Drug Abuse – Pennsylvania Quick Facts

2. opendataPA – Opioid-Related Overdose Death

3. Centers for Disease Control and Prevention – Drug Overdose Deaths

4. “2-Minute Neuroscience: Opioids” YouTube, uploaded by Neuroscientifically Challenged, 16 November 2018, https://www.youtube.com/watch?v=NPlNCqBHPnE.

5. United States Drug Enforcement Association – Fentenayl Fact Sheet