Service workers say supervised injection facilities could cut restroom overdoses

(Reuters Health) - During interviews about opioid overdoses in public restrooms, New York City service industry workers said they supported the idea of supervised injection facilities because such facilities might reduce injection drug use in their workplaces, researchers report.

Public restrooms are a popular location for injection drug use, so employees of coffee shops, fast-food restaurants and diners often find themselves acting as first-responders to a drug overdose, the study authors write in the International Journal of Drug Policy.

“They and customers are at risk for contracting diseases associated with used needles, which could reduce customers from frequenting these locations and cut into business profits,” lead study author Brett Wolfson-Stofko of the Center for Drug Use and HIV Research in New York City told Reuters Health in a phone interview.

About 120 supervised injection facilities exist in 12 countries around the world, according to the New York-based Drug Policy Alliance. They are legally-operated venues that allow people to consume pre-obtained drugs in a hygienic environment under the supervision of medical staff and harm-reduction workers who can manage overdoses and provide health and social service information. None legally exist in the United States.

“People who inject drugs use public bathrooms so they can have privacy and time,” Wolfson-Stofko said. “But as opioid use increases, businesses are responding.”

Wolfson-Stofko and colleagues interviewed 15 employees, including 10 managers and five staff, from coffee shops, music stores and laundromats. Questions focused on employee encounters with bathroom drug use, improperly discarded syringes and unresponsive customers, as well as the workers’ knowledge about overdose response, naloxone administration, safe needle disposal and supervised injection facilities.

During the interviews, 14 of 15 employees said they had encountered drug use in their business bathrooms, 11 had encountered syringes and three had found unresponsive people. Two had been trained in overdose response and naloxone administration, but most said they felt totally unprepared. Nikki, a coffee shop staffer, recalled being alerted about an overdose by a customer waiting in line.

“She had been in the bathroom 20 minutes . . . (I went in and) she was sitting kind of slumped on the toilet so I told my manager that we had an overdose in the bathroom,” Nikki told the researchers. “We called the police. We called EMS and they came and got her and took her out on the stretcher. I don’t know what happened to her.”

Most of the employees had also dealt with improperly disposed syringes, either on the floor or in trash cans. One coffee shop employee said they were hidden in ceiling tiles, and the business had to glue the tiles down. Frank, a manager at a cafe, said his staff member was stuck by a needle when collecting trash and went to the hospital for testing.

“A needle was thrown in the trash rather than in the (sharps container) . . . If that had been a random customer, it could have played out much, much differently and fortunately there were no long-term effects (to the staff person) from that incident,” he told the researchers.

More than half of the employees interviewed were familiar with the concept of supervised injection facilities, and after an explanation of how they operate, all but one worker supported them. They thought the facilities might reduce public drug use and move people off the streets, but the majority of workers also believed that their neighborhoods would reject the idea.

“A ton of older people have lived in the neighborhood a long time,” an employee named Jane said. “I bet there would be pushback to it, ‘not in my backyard,’ you know.”

Annual deaths from drug overdoses in the U.S. have nearly tripled between 1999 and 2014, rising to 64,070 deaths in 2016 with opioids involved more than three quarters of these fatalities, Wolfson-Stofko’s team writes.

“It’s important to consider innovative solutions to this complex problem,” said Alex Kral, a researcher with RTI International in San Francisco, who wasn’t involved in the study.

Several cities, including San Francisco, Seattle, Philadelphia, Los Angeles, New York and Denver, are talking about opening these sites, Kral noted.

“There will be barriers along the way with protecting these programs and the participants, but cities are going to begin starting these facilities,” he said in a phone interview. “Everyone in the community is affected by this issue, and I hope people realize that it affects them as well.”

SOURCE: International Journal of Drug Policy, online October 22, 2018.