Policy on Naloxone Administration Services at Library Sites

Issued: 12/2023

Mission:

The Mission of Monterey County Free Libraries (“MCFL”) is to bring ideas, inspiration, information, and enjoyment to our community.

Opioids (including Fentanyl) cause overdoses and deaths in Monterey County. State agencies, such as the California Departments of Health Care Services and Public Health, offer assistance to local governments, such as MCFL and the County Health Department Behavioral Health Bureau through the Board of Supervisors. MCFL seeks to obtain and maintain a supply of naloxone, also known as Narcan, to reverse opioid overdoses, and to train staff volunteers on how to identify overdoses and safely administer naloxone.

MCFL may obtain and deploy naloxone at library locations throughout the County. The administration of naloxone by staff in the event of an emergency overdose is strictly voluntary. Training to administer naloxone will be made available to all library staff. This training is optional and appropriate for staff at all levels.

Naloxone is a life-saving medication that works almost immediately to reverse overdose by blocking the effects of opioids. Naloxone is a drug which is available “over the counter.” Naloxone does not require a prescription. Naloxone is not a controlled substance. Naloxone has few known adverse effects, no potential for abuse, and can be rapidly administered through nasal spray.

At the onset of this program, each site will receive five (5) units of naloxone, each of which contains two 4mg dose nasal sprays. Library managers are responsible for determining an appropriate area to store their supply of naloxone. It may be stored in an unlocked area of the staff workroom, in a cabinet behind a customer service desk, or another conveniently accessed location, for example next to a first aid kit. A small supply of nitrile gloves should be kept adjacent to the supply of naloxone.

Naloxone has a shelf life of approximately 3 years. Each naloxone unit contains an expiration date prominently displayed on the packaging. The Department Safety Coordinators or other designated staff member should request new supply prior to expiration so that additional units may be obtained. After expired units of naloxone have been replaced with unexpired doses, the expired units should be disposed of at Safe medication disposal sites.

Training is available and strictly optional for all Library staff. Training is available online and will take about 20 minutes to complete. Training must be completed in a single setting to receive a course completion certificate (system will automatically generate).   Training will include an overview of opioids, understanding naloxone and how it works, how to recognize and distinguish an overdose from impairment, and how to respond to an overdose and administer naloxone.

The administration of naloxone should only be handled by staff who have completed the County- authorized training, and who volunteer to do so. Staff considering the administration of naloxone should be aware of any personal physical limitations or restrictions and only perform intervention activities that are within their physical capabilities.

After any incident, immediately report it as follows:

An overdose incident including the administration of naloxone may be upsetting for any staff who participates in the response or witnesses the event. Managers should offer any involved staff Employee Assistance Program (EAP) or other resources and are encouraged to reach out to Regional Administration and/or Library Human Resources for any additional support needed for their teams.

In response to an increase in Fentanyl and other opioid related overdoses and deaths in the County, the MCFL has asked the Board of Supervisors authority to work in partnership with the Monterey County Office of Education to obtain and maintain a supply of naloxone (Narcan) to reverse opioid overdoses, and to train staff volunteers on how to identify overdoses and safely administer naloxone.

Staff will be provided the opportunity to participate in an online training on how to recognize an overdose and safely administer naloxone.

The training for naloxone administration is optional, and staff are encouraged to take it so that they can make an informed decision about whether they would want to volunteer to administer naloxone in the event of an overdose on library premises.

Yes, the training is appropriate for staff at all levels.

Yes, staff are not required to administer naloxone to anyone suspected of having an overdose.

No, California has a Good Samaritan Law that is designed to protect those who assist others during an emergency. Conversely, there is no legal obligation to help, even if you have been trained, if you choose not to.

Yes, California does have a Good Samaritan law, which is meant to protect those who assist others in need during emergencies from lawsuits as long as they: 1. Act in good faith; 2. Act within the scope of their training; 3. Act to the best of their abilities; and 4. Act without expectation of reward.

No. Staff training and participation is strictly voluntary. You may want to take on another task, like calling 911, to allow another person to administer naloxone.

Yes, staff should immediately call 911 for any medical emergency. Naloxone only temporarily stops an overdose; individuals should receive medical care following an opioid overdose and should be encouraged to wait for emergency personnel, however staff should not insist if the person wants to leave the library.

No, not for receiving naloxone. Customers may have other outstanding legal or criminal issues involving law enforcement. Please follow law enforcement direction in this matter.

Staff should always call 911 if there is a medical emergency in the library. Staff are encouraged to participate in the naloxone administration effort, but not required to do.

A patron can be given a dose of naloxone to administer to another customer.

Minors are allowed to request and administer naloxone.

Please maintain situational awareness while administering naloxone and give person space as they come to. Another call to 911 may be appropriate.

Naloxone does not need special storage but should be kept at room temperature. It is not necessary to keep it in a locked location, and in fact, it is preferable to keep it in a location where it is easily accessible during an emergency.

Community Librarians will identify the best location for storage where doses will be accessible to staff to use in case of emergency. Suggested locations include near a first aid kit in an easily accessible place in the staff workroom or in a cabinet behind a customer service desk. Please ensure that the location is clearly labeled and is made known to all staff working in the building.

Yes, naloxone has a shelf life of approximately 3 years. Managers are responsible for notifying the Monterey County Office of Education before the expiration date so that a new supply can be obtained. Once replacement naloxone arrives, the expired units should be disposed of at Safe medication disposal sites.

The Library will only maintain a small supply of naloxone for emergency use on site.

Naloxone will have no effect on individuals not experiencing overdose. It will not harm them.

The naloxone stocked in libraries will be a nasal spray.

Prepare an Incident Report to County Counsel.

If the County 1) administers naloxone provided from the California Department of Health Care Services (CDHS) Naloxone Distribution Project, and 2) applies for additional naloxone from that Project, the State requires the County disclose the number of interim opioid overdose reversals to the State.

Please alert the MCFL Director if you need to request additional doses.

No, naloxone is safe to administer and receive for all ages.

Yes, staff should use gloves to administer naloxone. As a best practice, libraries should keep a supply of nitrile gloves near their supply of naloxone.

Will more people at risk of overdosing come to the library because we have this program? No. There is no data to support that there is an association between sites that administer naloxone and an increase in overdoses.

The supply of naloxone for this program is being funded through a variety of government and/or non-profit sources, including the California Department of Health Care Services (CDHS).

Yes, the unions have been consulted and worked with administration to develop the approved staff volunteer model.

The Board of Supervisors has authorized MCFL to support addressing the rising opioid epidemic. There is no data to support that there is an association between sites that administer naloxone and an increase in overdoses.

Yes, it is okay to administer naloxone in the parking lot or outside on the library premises in an emergency.

Follow the same guidelines for an overdose by the member of the public.

Dispose of the naloxone dispenser and packaging in a waste basket in an area of the library not accessible by children.