Guidance for Implementing Opioid Overdose Prevention Measures in Public Libraries

BACKGROUND

To combat the continuing rise in opioid-related deaths in New York State (NYS), laws were recently enacted allowing schools to provide and maintain non-patient specific opioid antagonists (naloxone) on-site in each instructional school facility to ensure ready and appropriate access for use during emergencies to any student or staff suspected of having opioid overdose whether or not there is a previous history of opioid abuse.  This protects the lives of students, staff and visitors whether or not there is a history of opioid use.

These laws were recently amended to allow New York State’s public libraries [1] to participate in opioid overdose prevention programs by partnering with a New York State Department of Health (NYSDOH)-registered opioid overdose prevention programs operated other organizations. Public libraries which choose to participate and whose personnel are acting reasonably and in good faith, shall not be subject to criminal, civil or administrative liability solely by reason of such action and may maintain on-site, opioid antagonists in adequate supplies and types deemed by the Commissioner of the New York State Education Department (NYSED), in consultation with the Commissioner of the New York State Department of Health (NYSDOH). Choosing to participate as an opioid antagonist recipient permits employees who volunteer, and volunteer workers to be trained in accordance with Public Health Law §3309 to administer an opioid antagonist in the event of an emergency without liability.

 As part of a coordinated State effort, the NYSED, the NYSDOH, the New York Library Association (NYLA), the New York State Center for School Health (NYSCSH) and the Harm Reduction Coalition have collaborated on statewide communications, guidance and training as defined by Public Health Law §3309.

  • Education Law §922 and Commissioner’s Regulation §136.8 permit school districts, boards of cooperative educational services (BOCES), county vocational education and extension boards, charter schools, and non-public elementary and / or secondary schools to participate in these programs.
  • Education Law §922, as added by Section 4 of Part V of Chapter 57 of the Laws of 2015, was amended by Chapter 68 of the Laws of 2016 to include New York State Public Libraries as eligible participants in the opioid overdose prevention programs.
  • Public libraries may maintain on-site, opioid antagonists in adequate supplies and types deemed appropriate by the Commissioner of the New York State Education Department, in consultation with the Commissioner of the New York State Department of Health.
  • Public Health Law §3309 and its implementing regulations (10 NYCRR §80.138external link) establish opioid overdose prevention programs, which allow trained individuals to administer naloxone in an emergency to persons suspected of having an opioid overdose.  The law provides that the use of an opioid antagonist pursuant to this section shall be considered first aid or emergency treatment for the purpose of any statute relating to liability.  
  • Education Law §6509-d provides protection from liability for professional misconduct to a person who is licensed to practice a profession under title eight of the Education Law, if the person would otherwise be prohibited from prescribing or administering drugs and the person administers an opioid antagonist in an emergency. For information on licensed professionals under title eight of the Education Law, visit the NYSED’s Office of Professions website.
  • Education Law §6527 and §6909 and Commissioner's Regulations §64.7 authorize registered professional nurses (RNs) to administer opioid-related overdose treatment pursuant to a non-patient specific order and protocol prescribed by a licensed physician or certified nurse practitioner.

Terms

  • NYSCSH - New York State Center for School Health is a contract office of the New York State Education Department, that provides technical resource assistance to school health professionals.
  • NYSDOH – New York State Department of Health whose mission is to protect, improve and promote the health, productivity and well-being of all New Yorkers.
  • NYSDOH Registered Opioid Overdose Prevention Program - A NYSDOH registered program trains individuals to identify opioid overdoses and to intervene appropriately.  These appropriate interventions include the administration of naloxone.  A NYSDOH registered program is to have both a Clinical Director and a Program Director.
  • Public Library partner/part of/participating with a NYSDOH Registered Opioid Overdose Prevention Program – A public library that has policies and procedures in place for an opioid overdose prevention program, has a Library Liaison, can receive naloxone kits and hands on training from a NYSDOH Registered Opioid Overdose Prevention Program, can store and administer kits, and are to report and document use of naloxone in accordance with the partnering NYSDOH Registered Program.
  • Clinical Director – a New York State (NYS) licensed physician, nurse practitioner (NP) or physician assistant (PA) responsible for clinical oversight and liaison regarding medical issues related to an NYSDOH Registered Opioid Overdose Prevention Program.
  • Program Director - person responsible for managing the opioid overdose prevention program at a NYSDOH Registered Opioid Overdose Prevention Program.
  • Library Liaison –person(s) identified by the public library as being responsible for planning and communication with the NYSDOH Registered Opioid Overdose Prevention Program Clinical and Program Directors.
  • Opioid antagonist - A Federal Drug Administration (FDA) approved drug that negates or reverses the effects of an opioid on the body
  • Naloxone – FDA approved opioid antagonist that reverses the effects of other narcotic medicines. 
  • Intranasal (IN) - Naloxone administration nasally.
  • Intramuscular (IM) –Naloxone administration intramuscularly by injection.

I. PROVIDING OPIOID ANTAGONISTS IN PUBLIC LIBRARIES

Participating with a NYSDOH Registered Opioid Overdose Prevention Program Operated by Another Organization

The public library can participate through an existing NYSDOH Registered Opioid Overdose Prevention Program.

Directory of registered programsexternal link

All existing NYSDOH Registered Opioid Overdose Prevention Programs have a Clinical Director, who is responsible for prescribing naloxone kits for the public library at no cost, and a Program Director, for management of the opioid overdose prevention program.  The Library Liaison, as outlined in the library policies and procedures, is the person responsible for working directly with the Program Director of the NYSDOH Registered Opioid Overdose Prevention Program and   may assist libraries with policy and procedure development however; it remains the responsibility of the library’s Board of Directors to approve policies and direct the library director/manager in developing procedures prior to program implementation.

As responders under an already existing NYSDOH Registered Opioid Overdose Prevention Program, and pursuant to Education Law §922 employees who volunteer, and volunteer workers are required to complete a NYSDOH approved training program pursuant to Public Health Law §3309.

It remains of critical importance that clear communication along with clear delegation of program responsibilities is outlined in the public library policies and procedures when participating with a NYSDOH Registered Opioid Overdose Prevention Program operated by another organization.  The NYSDOH Registered Opioid Overdose Prevention Program may assist public libraries with policy and procedure development. The NYSL and NYLA are also developing sample policies and procedures that will be available soon. However, it remains the responsibility of the public library Board of Trustees to have approved policies in place prior to program implementation.  Prior to participation in an opioid overdose prevention program and providing an opioid antagonist in a public library, it is strongly recommended that a library Board of Trustees develop policies consistent with the laws and regulations of the State of New York.

Steps for implementation

  1. The library identifies a Library Liaison that contacts a NYSDOH Registered Opioid Overdose Prevention Program that is operated by another organization and ascertains its willingness to partner with that library.
  2. The library Board of Trustees develops and approves policies, and directs library director/manager in developing procedures to participate in an opioid overdose prevention program with a NYSDOH Registered Opioid Overdose Prevention Program.
  3. The public library works with their NYSDOH Registered Opioid Overdose Prevention Program on providing the NYSDOH approvedexternal link training and to receive opioid overdose prevention kit(s).
  4. The Library Liaison oversees on-site inventory and reports back to the Clinical and Program Directors at the partner NYSDOH Registered Opioid Overdose Prevention Program on various aspects of the program including whenever naloxone is administered or needs to be replaced because of expiration.

II. MAINTENANCE OF OPIOID ANTAGONISTS IN PUBLIC LIBRARIES

Participating public libraries will receive free naloxone overdose kits through their partner NYSDOH Registered Opioid Overdose Prevention Program. This distribution of opioid antagonists shall include an information card or sheet with the following: how to recognize symptoms of an overdose; steps to take prior to and after an opioid antagonist is administered, including calling first responders; the number for the toll-free Office of Alcoholism and Substance Abuse Services (OASAS) Hopeline (1-877-846-7369), and how to access the OASAS website.external link

The NYSDOH Intranasal (IN) Naloxone Kit contains: two Naloxone Hydrochloride 2mg per2ml pre-filled syringes and two Mucosal Atomization Devices; two needle-free syringes, one pair of latex glove, alcohol pads and a disposable face shield to use as a barrier for rescue breathing. It also has instructions of what to do in English and Spanish. Two doses of naloxone are provided as the victim may require a second dose. Gloves are provided to so that responders can maintain universal precautions if there is contact with body fluids. For additional product information see the NYS Center for School Health website.

Note: Administration of Intramuscular (IM) naloxone is only recommended for appropriately licensed medical professional whose scope of practice includes medication administration.

Naloxone should be stored in secure but accessible locations consistent with the library’s emergency response plan. Naloxone should be available to ensure ready and appropriate access for use during emergencies. For those libraries with an Automated External Defibrillator (AED), a naloxone overdose kit may be stored inside the flap of the AED case. Naloxone and the AEDs are both heat and cold sensitive.

ACCOUNTING/INVENTORY/PLACEMENT IN PUBLIC LIBRARIES

All NYSDOH Registered Opioid Overdose Prevention Programs are required to file quarterly reports to the NYSDOH to track individuals trained and naloxone provided. The Library Liaison placing the naloxone in the storage area must keep a log of expiration dates and other information required by their NYSDOH opioid overdose registered program and will need to monitor expiration dates. The on-site inventory and placement of naloxone is recommended to be accounted for weekly by the Library Liaison. Accounting for naloxone in AED cabinets could occur at the same time the check of the AED is performed. Once again, the public library should clearly detail in their policies and procedures the role of the Library Liaison in working on naloxone inventory with the NYSDOH Registered Program.

The on-site inventory and placement of naloxone is recommended to be accounted for weekly and counted by the Library Liaison.

The NYSDOH Registered Opioid Overdose Prevention Program Clinical and Program Directors should be notified by the library liaison(s) whenever naloxone is administered and when replacements are needed.  The clinical director will be the prescriber for the NYSDOH Registered Program.  New kits should be ordered prior to the expiration date of existing stock.  Even if only one naloxone dose is used, it should be replaced.

STORAGE OF NALOXONE IN PUBLIC LIBRARIES

Naloxone is to be placed in a location ensuring it is ready and accessible to trained staff members.  If placed in an AED cabinet, a plastic break-away lock could be placed on the cabinet. The remaining stock of naloxone could be stored in a locked cabinet in a secure office, but easily accessible to designated staff members. The medication will be stored in an environment as outlined by the manufacturer’s guidelines.

Inventory of naloxone and accompanying overdose kit supplies (gloves, disposable face shield, alcohol pads and instructions in English and Spanish) are to be routinely counted, with a recommended frequency of weekly, to determine whether there are any discrepancies between documented inventory and actual inventory and check that the solution in the vial is clear and not discolored. Naloxone has expiration dates, which should be checked as a regular part of any library protocol –similar to checking the AED.  The expiration date should be recorded at the time the kit is received and monitored so it is appropriate for emergency use. Used nasal atomizers and/or syringes can be given to Emergency Medical Services (EMS) personnel upon arrival, or disposed of under Public Library policies and procedures.

DOCUMENTATION

Any administration of naloxone requires appropriate follow-up documentation.  Naloxone use is to be documented consistent with applicable policies and procedures for care administered to staff and library patrons.  Documentation should be developed following the requirements set down by the NYSDOH Registered Opioid Overdose Prevention Program and the library’s policies and procedures and signed by the person completing the documentation.  

Reporting

The library liaison should report all administrations of the naloxone to both the clinical director and the program director at the partner NYSDOH Registered Opioid Overdose Prevention Program.

  • Incident reports should be completed as per the public library policy.
  • Libraries should keep a copy of reports to allow evaluation of opioid overdose prevention.

NOTIFICATIONS

Someone experiencing opioid overdose needs immediate medical attention and emergency response intervention.   

  • Call 911 immediately.  Be sure to state that an overdose is suspected.
  • Implement library’s emergency response procedures and opioid overdose program procedures.
  • Follow the Public Library policy of emergency notification, reporting and documentation. about naloxone administration, along with planned transport to the emergency room. 

III. REQUIRED TRAINING FOR PERSONNEL WHO VOLUNTEER AND VOLUNTEER WORKERS

The public library will work with their NYSDOH Registered Opioid Overdose Prevention Program so that personnel and volunteer workers who volunteer can become trained overdose responders in the library setting and be able to administer IN naloxone in a public library.  

The NYSDOH approved training curriculum for volunteer library personnel and volunteer workers pursuant to Public Health Law §3309 is titled, “Opioid Overdose Training for School Personnel & Public Library Personnel and Volunteer Workers: Recognizing a Life-Threatening Opioid Overdose and Using an Opioid Antagonist.” For volunteer library personnel to become trained overdose responders in the public library setting and be able to administer IN naloxone in the public library setting the following are required:

  • Completion of NYSDOH approved training webinar,
  • Attainment of 100% accuracy on post-test,
  • Successful completion of the Skills Compliance Checklist for Administering Naloxone by a trained individual representing the NYSDOH Registered Opioid Overdose Prevention Program the library is participating with.
  • Public libraries participating under an established NYSDOH Registered Prevention Program are required to participate in the NYSDOH approved training; “Opioid Overdose Training for School Personnel & Public Library Personnel: Recognizing a Life-Threatening Opioid Overdose and Using an Opioid Antagonist.”  This is the NYSED training that has been identified for school personnel and public library personnel utilizing the NYSDOH approved curriculum.

After successful completion of this training the individual will receive a certificate of training in opioid overdose prevention valid for 2 years.  The NYSED strongly encourages an annual review to ensure that understanding and skills in opioid overdose response are current and timely. The public libraries must maintain a current list of its trained personnel and volunteers. This list will be maintained in a location designated by library administration, and/or the library liaison.

*Please note, the New York State Library is working with the NYSDOH and the rest of NYSED to develop a webinar that can be used by personnel and volunteer workers who volunteer to become trained overdose responders in the library setting and be able to administer IN naloxone in a public library. 

IV. RESOURCES

The NYSL and NYLA will have Sample forms and resources to assist all libraries in providing opioid antagonists in libraries available soon.

V. PUBLIC LIBRARY POLICY DEVELOPMENT

Prior to participation in an opioid overdose prevention program and providing an opioid antagonist in a public library, the public library Board of Trustees are strongly recommended to develop policies consistent with the laws and regulations of the State of New York.  It is the responsibility of the public library electing to participate in the opioid overdose prevention program to create policies and procedures aligned with NYS laws and regulations. The New York State Library and New York Library Association will have available sample policies to use as examples when a library is developing their own policy.

DISCLAIMER

This document provides public libraries with a framework for developing an Opioid Overdose Prevention Program, along with the requirements for an approvable plan for training participating public library personnel and volunteer workers.  Every attempt has been made to ensure the information contained in this document is accurate and reflects current best practices.  This document is to be used for guidance purposes only with any local policies and procedures developed based upon this document, in whole or in part, to be consistent with federal and state laws, to be approved at the local level and remain consistent with local community values and needs.   Any outcomes resulting from this guidance should be reviewed through normal library procedures, which may include review by library administration and legal counsel.

Footnotes

[1] The use of “public libraries” in the legislation is intended to refer to both association and public libraries. The New York Library Association will be proposing an amendment to the legislation to specifically name association libraries, along with public libraries. [back] 

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Last Updated: November 7, 2017