May 18, 2017

How some hospitals are fighting the opioid epidemic—in bathrooms

Daily Briefing

    Few hospitals or businesses want to talk publicly about overdoses occurring within their buildings' bathrooms, but it's a growing problem in the Boston area—and a small number of facilities are quietly working to respond more effectively to individuals who misuse drugs in restrooms, Martha Bebinger reports for NPR's "Shots."

    No safe spaces

    According to Bebinger, Canada and several European countries have created dedicated safe-use spaces for people who misuse drugs. But the United States has not yet legalized any such areas, and people who misuse drugs increasingly are using publicly accessible restrooms as a place to take drugs.

    Providing aid to such individuals is complicated by federal and state policies against safe-use spaces, Alex Walley, director of the Addiction Medicine Fellowship Program at Boston Medical Center, said. He explained, "It's against federal and state law to provide a space where people can use (illegal drugs) knowingly, so that is a big deterrent from people talking about this problem."

    Lacking any public guidance on the issue, many public spaces—such as libraries, town halls, and businesses—are closing their bathrooms to the public. Others have implemented tactics to deter people who misuse drugs, such as by installing blue lighting in bathrooms (which makes it difficult to spot a vein) or posting a security guard to keep an eye on who enters the restroom.

    Turning against the tide

    But other spaces are quietly working to respond more effectively to those who misuse drugs, Bebinger reports. At Massachusetts General Hospital, for instance, it has become standard for security guards to carry naloxone, an overdose reversal drug. The hospital started training security guards to use the treatment after ED physician Ali Raja realized that hospital bathrooms were perceived by some patients as a relatively safe place for drug use.

    "There's an understanding that if you overdose in and around a hospital that you're much more likely to be able to be treated," Raja said, adding, "We're finding patients in our restrooms, we're finding patients in our lobbies who are shooting up or taking their prescription pain medications."

    Ryan Curran, a police and security operations manager at Massachusetts General Hospital who carries naloxone with him, noted, "We don't want to promote, obviously, people coming here and using it, but if it's 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."

    It's one of several strategies medical facilities have employed, Bebinger writes. Other clinics have staff knock on the bathroom door if someone has been using the space for more than 10 or 15 minutes. At least one clinic has installed an intercom in the bathroom and requires people to respond to inquiries, she adds, while another has installed a reverse motion detector that sets off an alarm if there's no movement in the bathroom.

    Bathrooms can be made safer—but there are limits, experts say

    Walley and other physicians who work with patients with substance use disorders say there are several ways to make bathrooms safer for drug users and the rest of the public.

    For instance, according to Walley, a "model restroom" would be clean and well-lit, with stainless steel surfaces and without cracks for storing drug paraphernalia. The door would open out—so that a body could not keep it from opening. The room could be unlocked easily from the outside and monitored, ideally by an EMT or nurse.

    But Daniel Raymond, deputy director for policy and planning at the Harm Reduction Coalition, argued that "there are limits to better bathroom management," suggesting that "having dedicated facilities like safer drug consumption spaces is the best bet for a long-term structural solution that I think a lot of business owners could buy into," Raymond said (Bebinger, "Shots," NPR, 5/8).

    Learn the 8 steps for deploying clinical pharmacists in ambulatory care

    As the number of medications rises, so does the opportunity for medication errors, such as incorrect dosages, drug interactions, and serious side effects. By some estimates, the U.S. spends as much money correcting these medications problems as we do on the drugs themselves.

    Check out our infographic to learn eight steps for how to deploy clinical pharmacists in outpatient clinics.

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