Librarian Chera Kowalski has learned to scan the room for signs that someone is overdosing on heroin.
They usually nod off, get droopy-eyed or “look like they're about to fall — but they never fall.” If the heroin has been laced with the powerful, deadly drug fentanyl, Kowalski said, the user “just drops; or sometimes their body seizes up.”
Six times in the past two months, Kowalski, who runs teen and adult enrichment programs at Philadelphia's McPherson Square Library, has shot a dose of the overdose-reversing drug naloxone up a person's nose and watched as they seemingly came back to life.
With the city in the throes of an opioid epidemic, she and several other employees at the library took a voluntary training class with Prevention Point Philadelphia, learning how to administer the lifesaving agent. The center also provides the librarians with the naloxone, which is also known as Narcan. Their story was first reported by Philadelphia Inquirer columnist Mike Newall.
Kowalski doesn't have any formal medical training, but she's often the closest available help for a person overdosing in the library or in the grassy area outside, nicknamed Needle Park.
“We call 911 when things happen to make sure that trained professionals are on their way,” the 33-year-old librarian told The Washington Post. “But in this neighborhood, there's a lot going on with drug use, drug overdoses. Sometimes there’s a wait time. So we found that sometimes this is the best way to keep someone else alive.”
The librarians have long since gotten over any apprehension they had about administering the drug — especially after encountering dozens of addicts on the verge of death, Kowalski said.
Staff members used to routinely find addicts using in the library's semiprivate spaces, but security guards have cracked down on drug use in the library's walls.
Still, they haven't been able to keep the deadly drug epidemic entirely out of the building, because after using in Needle Park, most addicts want to go to a peaceful place and just be high, Kowalski said. What better place than the century-old public library that's nestled in the epicenter of Pennsylvania's heroin epidemic?
Philadelphia's McPherson Square Library is in an area of the city that's widely known as “the Badlands.” Increased competition between heroin dealers and the area's proximity to Interstate 95 has given the Badlands a reputation for some of the best heroin in the region, according to DEA Special Agent Patrick Trainor. Agents have recovered heroin that was 93 percent pure, a potency Trainor called “astronomical.”
The heroin attracts “drug tourists” from as far away as Michigan and Arkansas, seeking out highs that are as potent as they are cheap, Trainor said.
People have died by the hundreds. In 2015, according to DEA numbers, there were 702 fatal overdose deaths in Philadelphia. Last year, 907. “And this year,” Trainor said, “I've heard some figures, we may be on track to top 1,200. Is it getting worse? Yes, it is. There’s no question it’s getting worse. The numbers aren't anywhere near remotely slowing down.”
The spike in Philadelphia overdose deaths mirrors a jump across the state. The Centers for Disease Control and Prevention deems the state's rate “statistically higher” than the national average.
In 2015, Pennsylvania coroners reported more than 3,500 overdose deaths, a 30 percent jump from 2014, the Patriot-News reported.
Last September, Gov. Tom Wolf (D) told lawmakers that the opioid epidemic facing Pennsylvania is “a public health crisis, the likes of which we have not before seen. Every day, we lose 10 Pennsylvanians to the disease of addiction. This disease does not have compassion, or show regard for status, gender, race or borders.”
Across the country, opioids killed more than 28,000 people in 2014, more than any year on record, according to the Centers for Disease Control and Prevention.
As the epidemic sweeps the nation, American libraries have become a pit stop of sorts for drug users, according to the Associated Press, which reported that “they’re free and open for whoever walks in, and lingering is welcome, no transaction or interaction required.”
The neighborhood around San Francisco's Main Library, for example, has seen a surge in the use of heroin and prescription painkillers, according to the San Francisco Chronicle. And the drug use that has trickled into the library has officials mulling whether staffers should be able to administer Narcan.
At McPherson Square Library, Kowalski said, staff members have already amended library policies and procedures to stop addicts from using there. The Narcan training, which was voluntary, was the next step after staff members routinely encountered people who'd turned blue and lost consciousness.
There was the man who told the Philadelphia librarians who resuscitated him that he was on a cocktail of heroin, suboxone and methamphetamine. Or the many, many people who librarians found unconscious in the bathroom, surrounded by needles and drug bags.
One time, a child coming to the library after school ran to Kowalski and told her “a man had fallen” outside. She grabbed the Narcan and sprinted.
“Usually someone says something and I’ll just grab the kit and head out,” she said. “I'll make sure somebody calls 911, and administer [Narcan] and hope that everything goes well.”
Narcan, which can reverse the effects of a heroin overdose, is widely viewed as a stopgap measure.
Communities across the nation have put it into police patrol cruisers, firetrucks and ambulances, hoping first responders can get to overdosing people before it's too late.
But Trainor, of the DEA, said he's talked with more and more people in the private sector who come into contact with addicts on a regular basis and are thinking about equipping their workers with the kits, just in case.
The special agent thinks making Narcan kits as ubiquitous as defibrillators is a prudent idea in areas ravaged by drug addiction, like Philadelphia.
Kowalski said she and the other librarians pushed for Narcan kits and training to help in an emergency, though they realize the epidemic is a much, much larger problem.
For now, they'll keep sprinting to people who nod off in Needle Park or the library bathrooms.
“I think it’s keeping people alive until a solution is found,” she said. “Because if you’re using, that doesn't mean you just want to die. It's addiction.”
So, she said, administering Narcan “kind of gives people a second chance or a third chance if they need it … but we know it's a Band-Aid on a gaping wound.”
This story has been updated to note that the Philadelphia Inquirer was the first to report on the McPherson Square Library's role in helping heroin addicts.