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January 24, 2019

This doctor's workplaces: A bathroom, a van, and the streets

Daily Briefing

    As the number of overdoses in public spaces continues to rise, physicians such as Jessie Gaeta are treating patients far outside the traditional exam room—including in bathrooms and on the streets, Felice Freyer reports for the Boston Globe.

    Today at 1 pm ET: How to tackle the opioid crisis and drug diversion

    Why bathrooms are an emerging battleground in the opioid epidemic

    Opioid overdoses can happen almost anywhere, but in Boston and elsewhere, an increasing number occur in public bathrooms. The privacy of a bathroom attracts people who misuse opioids—but it also creates challenges for first responders, who may not even discover that an overdose has occurred until it's too late.

    Some buildings have responded by simply closing their bathrooms to the public. According to Alex Walley, director of the Addiction Medicine Fellowship Program at Boston Medical Center, "[I]t's against federal and state law to provide a space where people can use (illegal drugs) knowingly," so closing bathrooms can reduce legal risk.

    But other buildings in Boston are instead trying to respond more effectively to those who might overdose in their bathrooms. At Massachusetts General Hospital, for instance, security guards—who often are the first people to discover overdose victims—carry naloxone, an overdose reversal drug. Other hospitals monitor bathroom stalls by knocking on the door if someone has been using the space for more than 10 or 15 minutes.

    "If [overdoses are] going to happen, then we'd like to be prepared to help them and save them and get them to the (ED) as fast as possible," said Ryan Curran, police and security operations manager at MGH.

    As the epidemic rages on, creative ways to emerge to detect overdoses

    Some facilities are addressing the problem in outside-of-the-box ways. In the bathrooms at the Boston Health Care for the Homeless Program, a "reverse motion detector" triggers flashing lights and a "piercing" alarm to alert CMO Jessie Gaeta when an individual has been motionless for two minutes and 50 seconds, Freyer reports.

    Frequently, Gaeta discovers that the bathroom occupant is unconscious from a drug overdose, and quickly administers Narcan, which she wears on a lanyard around her neck.

    Two days a week, Gaeta also can be found in the Kraft Center for Community Health's Care ZONE van—a "fully equipped medical clinic on wheels," Freyer reports. The van was created to serve people who live outside and inject drugs, a "difficult-to-reach population" that Gaeta said she previously saw only if "they ended up very sick in the hospital."

    The van, which runs on a regular schedule, brings a clinician and three outreach workers to Boston neighborhoods with high rates of overdose deaths, including the Fenway and Downtown Crossing. It's equipped with a fully functioning sink, exam chair, and cabinets stocked with health supplies. While clinicians treat patients, outreach workers take backpacks with food, water, and clean syringes to search for people who might need assistance.

    Gaeta said it's not uncommon for people to be waiting in line when the Care ZONE van arrives. In its first nine months, Care ZONE clinicians contacted almost 3,500 people who misuse substances and hosted 250 medical care visits inside the van—131 of which involved treating opioid use disorders with buprenorphine.

    While it's unclear how many of the treated patients have remained sober, Gaeta said she sees inherent value in treating people with substance use disorder "outside of the health care setting."

    "I figured out so much more about them, even about their health, than I could see in the snapshots in a clinical setting. It felt like a deeper connection with people" (Freyer, Boston Globe, 1/16).

    Access our new resources on the opioid epidemic

    The opioid epidemic is a complex, multi-dimensional public health problem. Use this list of helpful resources on how hospitals and health systems can play a role to treat opioid addiction and prevent further increase in opioid abuse.

    Access our Opioid Resources Here

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