The opioid epidemic is so bad that librarians are learning how to treat overdoses

Philadelphia (CNN)A crowd hovered over the man lying on the grass as his skin turned purple. Chera Kowalski crouched next to his limp body, a small syringe in her gloved hand.

The antidote filled the man’s nostril.
The purple faded. Then it came back. Kowalski’s heart raced.
“We only gave him one, and he needs another!” she called to a security guard in McPherson Square Park, a tranquil patch of green in one of this city’s roughest neighborhoods.
“He’s dying,” said a bystander, piling on as tension mounted around lunchtime one recent weekday.
“Where is the ambulance?” a woman begged.
Squeeze.
Kowalski dropped the second syringe and put her palm on the man’s sternum.
Knead. Knead. Knead.
Nothing.
She switched to knuckles.
Knead. Knead. Knead.
Then a sound, like a breath. The heroin and methamphetamine overdose that had gripped the man’s body started to succumb to Kowalski’s double hit of Narcan.
With help, the man, named Jay, sat up. Paramedics arrived with oxygen and more meds.
Death, held at bay, again.
Kowalski headed back across the park, toward the century-old, cream-colored building where she works.
“She’s not a paramedic,” the guard, Sterling Davis, said later. “She’s just a teen-adult librarian — and saved six people since April. That’s a lot for a librarian.”

Libraries and a public health disaster

    Long viewed as guardians of safe spaces for children, library staff members like Kowalski have begun taking on the role of first responder in drug overdoses. In at least three major cities — Philadelphia, Denver and San Francisco — library employees now know, or are set to learn, how to use the drug naloxone, usually known by its brand name Narcan, to help reverse overdoses.
    Their training tracks with the disastrous national rise in opioid use and an apparent uptick of overdoses in libraries, which often serve as daytime havens for homeless people and hubs of services in impoverished communities.
    In the past two years, libraries in Denver, San Francisco, suburban Chicago and Reading, Pennsylvania have become the site of fatal overdoses.
    “We have to figure out quickly the critical steps that people have to take so we can be partners in the solution of this problem,” Julie Todaro, president of the American Library Association, told CNN.

    Though standards vary by community, the group is crafting a guide for “the role of the library in stepping in on this opiate addiction,” she said. It will include how to recognize opioid use — short of seeing someone with a needle — and how to address it.
    McPherson Square Library, where Kowalski works, has a wide, welcoming staircase punctuated by tall columns. It sits in the Kensington community, where drugs and poverty lace daily life.
    Residents drop into the McPherson branch with questions about doctor visits and legal matters. Children eat meals provided by library staff and play with water rockets in a Science, Technology, Engineering, Arts and Mathematics program.
    Kensington doesn’t host a civic institution, like a university, or a major company, said Casey O’Donnell, CEO of Impact Services, a Kensington community and economic development nonprofit.
    “In the absence of those things, the anchors become things like the library,” he said.
      In recent months, so-called “drug tourists” — people who travel from as far as Detroit and Wisconsin seeking heroin — started showing up in Kensington, which boasts perhaps the purest heroin on the East Coast, library staff and authorities said.
      Heroin userscamped out in McPherson Square Park and shot up in the library’s bathroom, where nearly a half-dozen peopleoverdosed over the past 18 months, said branch manager and children’slibrarian Judith Moore.
      The problem got so bad that the library was forced to close for three days last summer because needles clogged its sewer system, said Marion Parkinson, who oversees McPherson and other libraries in North Philadelphia.
      Since then, patrons have had to show ID to use the bathroom, she said. The library in October hired monitors to sit near the bathroom, record names on a log and enforce a five-minute time limit.
      Before the crackdown, library staff last spring discovered one man in the bathroom with a needle in his arm, Moore recalled. He toppled over and started convulsing.
      “I heard his head hit the floor,” she said.
      A city employee had left a dose of Narcan at the library. But the staff didn’t know how to use it. After that, Parkinson set out to get them trained.

      ‘It’s not normal’

      At 33 years old, Kowalski wears oversized sweaters and too-big glasses. She reads nonfiction about World War II and zones out on Netflix. She settles into work mode by listening to pop music on her train ride to work.
      She chose to work at the McPherson branch because she thought her own experience could help students who flock there after school.
        Kowalski’s parents used to use heroin. They’ve been clean for more than 20 years. Her mother earned a college degree in her 50s; and her father, a Vietnam veteran, worked steadily as a truck driver until retiring, she said.
        But before all that, Kowalski lived in the turmoil of addiction. “I understand the things the kids are seeing. … It’s not normal,” she said of her library charges. “It’s unfortunately their normal.”
        Now, when a drug user overdoses at or near the McPherson library branch, Kowalski takes a minute to “switch the headset” from librarian to medic, she said.
        When she got word that recent day that Jay had collapsed in the grass, Kowalski reached into a circulation desk drawer and pulled out a blue zipper pouch containing Narcan and the plastic components required to deliver it.
        Dashing out of the library, she asked if anyone had called 911. Someone had.
        The librarian got to Jay, crouched down, noticed his shallow breathing and discoloration.
        She tried to focus. Seconds ticked. Prepping Narcan takes four steps: unscrew the vial, put it in the syringe, screw on the nasal mister, squeeze out the medicine.
        “You’re under a time limit,” she recalled. “It’s how fast can I do this.”
        Kowalski recognized Jay’s face from the neighborhood. As she walked away from him, she felt relief. He would live.
        “I understand where they’re coming from and why they’re doing it,” she said of heroin users. “I just keep faith and hope that one day they get the chance and the opportunity to get clean. A lot of things have to line up perfectly for people to enter recovery long-term.”
        Back at the library, Kowalski tried to refocus. The phone rang. Just minutes earlier, she’d pulled Jay back from the edge. Now, she was helping a patron find the number for the US Treasury Department.

        ‘We want our libraries to be safe’

          When a man overdosed in late February in the bathroom at Denver Central Library, security manager Bob Knowles rushed to his aid.
          Just hours earlier, the branch had received its very first delivery of Narcan, which library workers sought after a fatal overdose earlier that month at their branch.
          Knowles, the inaugural hero of his team’s effort to stem the opioid scourge, lost a brother 40 years ago to an overdose.
          “I wish somebody had had Narcan for him,” Knowles said.
          Security staff, social workers and peer navigators former drug users who help current ones all learned to administer the overdose-reversal drug. The fact that it got used the day the first shipment arrived confirmed “we were on the right path,” said Chris Henning, director of community relations for the Denver Central Library.
          The branch is near Civic Center Park, a haven for homeless people and a market for street drugs. One recent morning, a self-described drug addict who prefers methamphetamine and the synthetic drug “spice” camped out near the library.
          Staff members at other Denver library branches are now also being trained to deliver the medicine, library officials said, adding that they’ve gotten calls about their regimen from libraries in Seattle, small Colorado mountain towns and parts of Canada.
          Meantime, a fatal overdose in February at a San Francisco library branch pushed officials there to forge ahead with Narcan training for security officers, social workers and employees who help the homeless, said Michelle Jeffers, a library spokeswoman.
          “We want our libraries to be safe for all visitors,” she said.

          Crisis in Philadelphia

          Drug overdoses nationwide more than tripled from 1999 to 2015. Opioid overdoses accounted for 63 percent of the 52,000 fatal cases in 2015 — or about 33,000 people, the Centers for Disease Control and Prevention reported. Across the country, 91 Americans die every day from an opioid overdose.
          Philadelphia last year saw about 900 fatal overdoses, up nearly 30% from 2015, municipal tallies show. Nearly half the deaths involved fentanyl, the powerful opioid that killed Prince. This year’s total could hit about 1,200 fatal overdoses, Drug Enforcement Agency Special Agent Patrick Trainor said.

          Battling prescription drug addiction, or know someone who is? CNN’s Impact Your World can help.

          “It is among the worst public health problems we’ve ever seen, and it’s continuing to get worse,” Philadelphia Health Commissioner Dr. Thomas Farley told CNN. “We have not seen the worst of it yet.”
          Opioids attach themselves to the body’s natural opioid receptors, numbing pain and slowing breathing. They can relieve severe pain — but also can spur addiction. Almost 2 million Americans abused or were dependent on prescription opioids in 2014, according to the CDC.
          Naloxone kicks opioids off the body’s receptors and can restart regular breathing. Hailed as a miracle remedy, the drug is squirted into the nose or injected into a muscle.
          Harm-reduction groups and needle exchanges started distributing naloxone two decades ago, and since then, more than 26,000 overdoses have been reversed, the CDC reports.
          The drug has become a staple for police, fire and medical professionals, who can buy it for $37.50 per dose. Retail pharmacies sell it over the counter. Coffee shop baristas have been trained to administer it.
          Philadelphia Fire and EMS used Narcan last year about 4,200 times, mostly in the Kensington neighborhood, Capt. William Dixon said.

          ‘I might need to take a mental day’

          Armed with Narcan, McPherson’s library employees keep an eye out for overdoses. When he spots one, Davis, the security guard, tries not to alert the children.
          Kowalski’s first save in the park, back in April, happened when a young woman overdosed on a library bench after school. One dose of Narcan revived her: She got up and walked away.
          But when Kowalski turned around, several kids — all library regulars — were standing on the steps watching.
          “I got really upset because I know what they were seeing,” she said.
          Weeks later, she revived a man who overdosed on fentanyl and fell off a bench in front of the library. “I might need to take a mental day tomorrow,” she told Moore afterward.
          But then her library regulars arrived after school. She played games with them and helped them on the computer.
          By the end of the day, “I felt good again,” Kowalski said. The next day, she was back at work.
          In the square, once dubbed Needle Park, library volunteer Teddy Hackett uses a grabber to pick up needles in the grass, near benches and in the rose bushes.
          “That’s my rose bush there,” he said one recent day. “I protect that rose bush.”
          Hackett, who beat drug addiction almost 20 years ago, said he once got mad when he saw a man shooting up on a bench in front of the library. Hackett chased him away, the needle still stuck in his arm.
          “God’s got me doing this for a reason,” he said, laughing. “For the little kids and the animals.”
          He reports his daily needle tallies to Kowalski. May set a record: 1,197 needles. The previous one, set last fall, was about 897.
          The increase might reflect the spike in drug use. It also could mean a redevelopment surge in the city has pushed a long-lingering problem out of the shadows, said Elvis Rosado, the education and outreach coordinator at Prevention Point, a local nonprofit that trained Kowalski and more than 25 colleagues to use Narcan.
          “They’ve been here for years,” Rosado said of drug users. “It’s just that they’ve been in abandoned buildings.”
          As evidence of addiction has spread, Philadelphia leaders have stepped up to counter it. Mayor Jim Kenney formed a task force to tackle the opioid epidemic.
          The city’s health department launched an ad campaign called “Don’t Take the Risk” to remind patients that a drug isn’t completely safe just because a doctor prescribes it. Officials mailed out more than 16,000 copies of the addiction warning.
          In McPherson Square Park, clean-up projects, a new playground and lights have improved the grounds. Police in mid-June increased patrols there and plan to install a mobile command center, which will also offer social services.

          ‘Call Chera’

          The day after Kowalski’s naloxone doses revived Jay, more drug users trickled into McPherson Square Park, where sirens whine like white noise. Nearby, a slender woman shot up heroin, then got up and walked away.
          Moments later, a former freight train operator who weeks earlier had overdosed twice in one day, sat down on his cardboard blanket and overdosed again. He’d gotten hooked on prescription pills after a leg injury. A heroin user gave him Narcan that she’d bought from another user for $2.
          An hour later, paramedics carried away a woman who’d overdosed while sitting on a bench, said Davis, the security guard.
          “I’m pretty sure we’re going to get one or two more people that’s going to OD out here today,” he said.
          An hour later, it happened: A woman who’d earlier been hanging out with the train operator slumped over on the ground.
          Davis didn’t flinch. Standing at the library door, he told the needle collector to find Kowalski.
          “Ted,” he yelled, “call Chera!”

          Read more: http://www.cnn.com/2017/06/23/health/opioid-overdose-library-narcan/index.html

          GOP bill says it covers pre-existing conditions. But some are worried sick

          (CNN)The new healthcare bill that passed the House has many very worried — particularly those with pre-existing conditions.

          Obamacare mandated that insurers charge everyone the same amount, regardless of their health history and cover essential health benefits, such as prescription drugs, hospitalization and doctors’ visits.
          This version says insurances companies can raise prices for those with pre-existing conditions and don’t have to guarantee that treatments are covered.
            Here is how some people think they will may be impacted:

            ‘The new health bill scares me’

            About 10 years ago, Alma Hayes-Belmont, 62, was diagnosed with asymmetric septal hypertrophic cardiomyopathy. The condition occurs when the heart muscle cells expand, causing the walls of the lower heart chambers to become thick and stiff.
            “I had no history of heart problems but nearly died several times that day,” Hayes-Belmont, who lives in Mahwah, New Jersey, told CNN. Doctors implanted her with a defibrillator by the end of the week.
            Over the years, her heart continued to weaken and walking up the stairs would leave her winded. Nearly three years ago, doctors implanted a device that is a combination of a pacemaker and defibrillator. It helps her to stay alive.
            But she’s worried about what will happen when it’s time to replace her device.
            She had insurance through her employer before she went on Medicare last year. She estimates she would have to spend more than $200,000 for the medical device, hospital stays and doctor visits if she didn’t have insurance.
            “The new health bill scares me,” she said.

            ‘I would end up having to stop going to college’

            Eliana Espinosa was diagnosed with Leukemia at 3 years old. The 19-year-old from Miami underwent chemotherapy and has been in remission for 12 years. She’s currently a mathematics major at St. Thomas University in Miami Gardens, and visits an oncologist once a year for a checkup.
            Now she’s concerned for her 57-year-old mother, who was diagnosed with Stage II breast cancer and gets treatment through the Affordable Care Act.
            “Right now we don’t make too much money, so if she loses her insurance, I would end up having to stop going to college so that I can get a job to help pay for her medical expenses,” Espinosa said.
            “My mom is really important for me because she was there for me through my entire sickness,” she said.

            ‘Should the circumstances of my birth determine all my future life decisions?’

            When Casey Green was born, she was purple and wasn’t breathing. She had cerebral palsy because of a lack of oxygen in her brain right before birth.
            She spent 11 days in the neonatal intensive care unit. But Green learned how to walk, talk and write with the help of a therapy program, the 30-year-old said.
            She is finishing a PhD and works at the Louisiana School for Math, Science and the Arts, a public boarding school for gifted students in Natchitoches, Louisiana.
            “I have good health insurance and am married to a wonderful man. Now, I am worried about our future,” said Green, who lives in Natchitoches, Louisiana.
            She takes four medications a day to manage her symptoms.
            “Without them I find it difficult to get through the day,” she said. “I take these medications, not because of anything I did, but because of a medical emergency as a result of my birth. Should the circumstances of my birth determine all my future life decisions?”

            ‘The drug we’re staking his life on is an off-label prescription’

            Tim Hayes of Dayton, Ohio is afraid that care for his 8-year-old son, Armand, will be cut under the new bill. Armand has a rare disease called GM1 Gangliosidosis, an inherited disorder that destroys nerve cells in the brain and spinal cord.
            “There’s no cure, but he’s on an FDA approved drug for Gaucher’s Disease to try and manage it until a cure might be found with some success,” Hayes said.
            Armand suffers from seizures, his father said. The boy eats through a feeding tube and relies on in-home nursing to manage his disease. Hayes fears that the new bill will threaten the care his son requires to live.
            “We will see the final bill, I suppose. The bill has cuts to Medicaid, and more than likely he could lose insurance over the cost of his care and the fact that the drug we’re staking his life on is an off-label prescription,” Hayes said.

            Read more: http://www.cnn.com/2017/05/04/health/house-health-care-preexisting-conditions-reaction-trnd/index.html

            Paintings reveal early signs of cognitive decline, claims study

            Psychologists believe they can identify progressive changes in the work of artists who went on to develop Alzheimers

            The first subtle hints of cognitive decline may reveal themselves in an artists brush strokes many years before dementia is diagnosed, researchers believe.

            The controversial claim is made by psychologists who studied renowned artists, from the founder of French impressionism, Claude Monet, to the abstract expressionist Willem de Kooning.

            While Monet aged without obvious mental decline, de Kooning was diagnosed with Alzheimers disease more than a decade before his death in 1997.

            Alex Forsythe at the University of Liverpool analysed more than 2,000 paintings from seven famous artists and found what she believes are progressive changes in the works of those who went on to develop Alzheimers. The changes became noticeable when the artists were in their 40s.

            Though intriguing, the small number of artists involved in the study means the findings are highly tentative. While Forsythe said the work does not point to an early test for dementia, she hopes it may open up fresh avenues for investigating the disease.

            I dont believe this will be a tool for diagnosis, but I do think it will trigger people to consider new directions for research into dementia, she said.

            William
            William de Koonings Woman 1, 1950 and Untitled XXVIII, 1983. Composite: Alamy

            The research provoked mixed reactions from other scientists. Richard Taylor, a physicist at the University of Oregon, described the work as a magnificent demonstration of art and science coming together. But Kate Brown, a physicist at Hamilton College in New York, was less enthusiastic and dismissed the research as complete and utter nonsense.

            Forsythe and her colleagues used digital imaging software to calculate how a mathematical feature called fractal density varied in artists paintings over their careers. The seven artists included Monet, Pablo Picasso and Marc Chagall, who all aged without obvious brain disease; Salvador Dali and Norval Morrisseau, who developed Parkinsons; and de Kooning and James Brooks, another abstract expressionist who was diagnosed with Alzheimers in 1985, seven years before his death.

            Fractals are geometric patterns that repeat themselves at different size scales. They are seen in nature in the branching of trees and rivers, and in the craggy contours of coastlines. In paintings, fractals appear when patterns made by the tiniest brush strokes repeat on larger scales. The fractal dimension is a measure of fractal complexity, where an artwork with a large fractal dimension has a high ratio of fine to coarse fractal patterns.

            Forsythe found that paintings varied in their fractal dimensions over an artists career, but in the case of de Kooning and Brooks, the measure changed dramatically and fell sharply as the artists aged. The information seems to be like a footprint that artists leave in their art, Forsythe said. They paint within a normal range, but when something is happening the brain, it starts to change quite radically.

            Writing in the journal Neuropsychology, the scientists claim that the fractal dimensions of paintings by Monet, Picasso and Chagall tended to rise as they aged. For Dali and Morrisseaus work, the fractal dimension followed an upside-down U-shape over time, at first rising and then falling. The most stark result was seen in the works of de Kooning and Brooks, where the fractal dimension started high and dropped rapidly from the age of 40.

            The work has echoes of previous studies that revealed early signs of dementia in the language used by the former US president Ronald Reagan, and the novelist and philosopher Iris Murdoch. Telltale hints of future dementia have also been spotted in autobiographical essays written by nuns in their 20s.

            Taylor pioneered the use of fractals to study and even authenticate drip paintings by the late US artist Jackson Pollock. He believes Forsythes research could do the same for other artists and save museums from being conned into buying fake artworks. But he also saw more important applications. This work could hopefully be used to learn more about conditions such as dementia, he said.

            To me, the most inspiring message to come out of this work is that beautiful artworks can result from pathological conditions, he said. When de Kooning was diagnosed with Alzheimers, some critics argued that he should stop painting, but as he slipped into dementia, his artwork changed and became more simple, Taylor said.

            To me, these more simple works conveyed a peacefulness that wasnt present in his nurture-dominated earlier work. It all goes to show that sometimes you can think too much about art. Sometimes you just need to tune into your inner self, the nature part, he said.

            But Brown disagreed. In 2006, she co-authored a paper in Nature that disputed Taylors research. She said that sketches dashed out on her computer had the same fractal dimensions as a Pollock drip painting and might be authenticated as the real thing.

            The whole premise of fractal expressionism is completely false, Brown said. Since our work came out, claims of fractals in Pollocks work have largely disappeared from peer-reviewed physics journals. But it seems that the fractal zealots have managed to exert some influence in psychology.

            Read more: https://www.theguardian.com/science/2016/dec/29/paintings-reveal-early-signs-of-cognitive-decline-claims-study

            Dads final, defiant Christmas was the best ever | Clare Allan

            An aggressive brain tumour meant that my family knew his time was short. We set out to make Christmas special

            It is hard to believe that its now 10 years since that last, defiantChristmas.

            In the summer, we had celebrated my fathers 70th birthday. In the autumn, he began to lose his words.

            He called me one day to say hed been having a few, sort of memory problems, and there was something in his voice beyond the usual mild-mannered hesitancy. Something that made me immediately take my dog and catch a train to Cambridge. My parents met us at the station. As soon as we got into the car, my dog scrambled over and climbed on to my fathers lap.

            The memory loss was particular and strange. It was as though certain words had become detached from the objects they signified. We were eating strawberries, I remember. Dad looked down at his bowl and frowned. Microphones? he said. A blood test, he described to me as them taking some ink from his arm.

            The impression was not of delusional thinking. Dad didnt believe the strawberries were actually microphones. Rather, he looked at the strawberries and the word for them wasnt there. He reached for another and tried it for fit. Microphones? It wasnt right, but he couldnt find the word that was. Strawberries? I said. And he laughed. Of course! Strawberries, he said. How silly.

            His GP had referred him to the memory clinic to be assessed for dementia. There was a three-month wait, but in any case, dementia seemed unlikely. We had known people with dementia and it did not present like this. My mother thought it might be psychological. Dad had retired in the summer from his readership in pure mathematics, and though, externally at least, this change had made little difference he still cycled in to his old department every day, where he was working on a book on Banach algebra, and he still played an active part in college life Mum thought the loss of his professional role might be having an impact on him.

            My sister and I were unconvinced, and so, I think, was she. We rang his GP and got put through to a different doctor, who agreed to see Dad that evening. At 8am the following morning, he was having an emergency scan.

            Glioblastoma multiforme is the most aggressive type of brain tumour. Thread-like tendrils burrow deep into the brain, making it all but impossible to remove the tumour completely. Dads was on his left frontal lobe, in the area responsible for expressive language. They operated to excise as much of the tumour as they could, and Dad came round to discover that, as if by magic, his words had returned. Still high from the anaesthetic, he lay, head bandaged, in his hospital bed, riffing with consummate fluency, this gentle, self-effacing man, unaccustomed to the centre stage and rather surprised to find himself enjoying it after all.

            There was no question of survival. A few weeks to a few months, they said. It was incomprehensible. But perhaps the finality of the prognosis was in some sense also a blessing. We did not invest our hopes in some percentage chance; there was no chance. We focused instead on the now.

            And so it was that we embraced that Christmas, in a spirit of neither despair, nor hope, but rather, of defiant celebration. We would enjoy the best Christmas ever. We would relish every precious moment. We would be happy, and we were. We didnt do anything different. The pleasure of Christmas is in the traditions. The same decorations hung on the tree. My sister and I joke-argued as we had every year over whose angels turn it was to top it. I cannot remember who won. We ate the same foods, played the same silly games word games mostly: consequences, drawing book titles. I can see Dad now, his scar extending from under his yellow paper crown, dabbing tears of laughter from his eyes at Mums attempts to guess Love in the Time of Cholera from his peculiar pencil squiggles. It was all the same, but the light at the heart had been turned up a notch.

            We went to midnight mass at the friary. My parents were Catholics; I am not, but there is comfort to be found in the rituals of Christmas, the line stretching forward and back. So too in the rituals of death. In a few months, my fathers coffin would sit in this chapel the night before his funeral. I did not consciously think of it, but I can see now it was an awareness of this, of the inevitability of the end, that made that Christmas so joyful. Christmas is about birth, of course, but it is also about death. You cannot have one without the other. Time is precious. Thats why the wise men bring myrrh.

            Read more: https://www.theguardian.com/commentisfree/2016/dec/26/dad-final-defiant-christmas-brain-tumour