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On May 6, a 33-year-old man was found unresponsive in the second floor bathroom of the Madison Central Library. Staff suspected the man had overdosed on opiates. Paramedics arrived in minutes, but it was too late — the man was dead.

Greg Mickells, director of the Madison Public Library, says the likely overdose (an official cause of death has not yet been released) has him reexamining whether Madison libraries should supply and train staff to administer the life-saving drug naloxone, more commonly known as Narcan.

“Last year, we investigated whether it would be beneficial to have [Narcan] available. At that time, we decided not to adopt a policy,” says Mickells. “However, with this recent incident, I’m going to reopen that conversation.”

A week after the death, a 22-year-old man nearly died of an overdose at the Central Library. A security staff member provided CPR until paramedics arrived and the individual was revived. A similar close call happened on Jan. 6 when a 29-year-old — who police say was in possession of heroin — was found passed out in a library bathroom. He survived.

Wisconsin has recently passed a number of laws making it easy for government agencies and the public to obtain Narcan, which is a prescription drug. Michael Spelman, director of the Central Library, says libraries across the country are grappling with how to respond to opiate overdoses.

“We are open to everyone. That’s one of the great founding principles of libraries,” Spelman says. “Sometimes that means people have substance abuse issues and we want to make sure we respond appropriately to that.”

But Mickells says the library already puts “a lot of demands” on staff.

“I think some individuals might be comfortable with [Narcan training]. And some might not be. That would all have to be worked out,” Mickells says. “What would be the best way to put a policy in place and at what scale? Who would receive the training and what would the expectations be?”

Madison Detective Dan Swanson says police are routinely called for overdoses in public places, most often in bathrooms and parking lots. In 2017, police responded to 259 overdoses. Swanson says there was a slight dip earlier in this year. But in recent months, overdose calls have “skyrocketed.” Overdoses have become so common that all Madison police officers started carrying Narcan in 2017, he says.

“We see a lot of overdoses in Woodman’s parking lots and in the mall parking lots. In particular, East Towne Mall because it’s so close to the major highway system. We have lots of people come in from the smaller suburbs to meet their drug dealer,” usually in a public place, Swanson says.

“The craving is so bad, people use right away,” he says. “Typically, if you’re going to overdose it occurs very quickly, which is why you see overdoses in public areas.”

Public Health Madison & Dane County wants everyone to learn what to do if someone overdoses on opiates. The agency released a public service video on May 16 to “teach people how to provide help in an overdose situation and potentially save a life.” Swanson says the video was created, in part, to train employees at businesses on how to spot someone who has overdosed and how to help.

“We’d love to give those businesses Narcan. The issue is cost, who pays for it, and sorting out the policy,” Swanson says. “It’s available to the public through a pharmacy but it is still a medicine. I think it can be done but the mechanism to do so would have to be figured out.”

Central Library director Spelman says security staff already have CPR training. The city also mandates that automated external defibrillators be in every city facility.

“I really want to be comfortable that we could provide adequate [Narcan] training and that we’d be able to use the drug properly if we go that route,” says Spelman.

Swanson says Narcan — especially the nasal spray variety — is simple to administer and won’t harm recipients even if they don’t need the drug. He thinks it’s a good idea that the library consider having Narcan. So does Assistant Chief Ché Stedman with the Madison Fire Department.

“From my perspective, it would be great if everyone in the community carried Narcan,” Stedman says. “When someone is overdosing, they need it immediately.”

Swanson says when first responders arrive on the scene of an overdose call, “more often than not” the individual’s heart has stopped beating.

“The police and fire department both have very good response times,” Swanson says. “But when somebody’s heart has stopped and they are not breathing, three or four minutes is past the point of no return. Quite literally, seconds count.”