Safety

Hospital bathrooms seen as prime spot for illegal drug use

Hospital Safety Insider, May 11, 2017

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Nationwide opioid crisis intersects with facilities management, safety in stalls of public restrooms

Standard equipment for security guards at many Boston-area hospitals now includes the powerful opioid overdose-reversing drug naloxone. That’s because the facilities these guards protect—the public restrooms, especially—are prime real estate in the eyes of those looking for a safer place to shoot up.

Seven or eight people have survived overdoses in the bathrooms at Massachusetts General Hospital since guards there began carrying naloxone 12 to 18 months ago, Boston’s NPR news station WBUR reported this week. The hospital began training guards at the urging of emergency physician Ali Raja, MD, MBA, who noticed that some overdose patients had come to see hospital bathrooms as a relatively safe place to 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 told WBUR, “and so we’re finding patients in our restrooms, we’re finding patients in our lobbies who are shooting up or taking their prescription pain medications.”

With that in mind, there are several things hospitals can do to maintain public restrooms that maximize safety for those who use drugs illegally and the general public at large, Alex Walley, MD, MSc, director of Boston Medical Center’s Addiction Medicine Fellowship Program, told WBUR:

  • Keep restrooms well-lit and clean
  • Use stainless steel surfaces
  • Minimize cracks and crevices where drugs or paraphernalia could be stashed
  • Provide a biohazard box for used sharps and related materials
  • Consider furnishing naloxone and sterile water
  • Ensure that doors open outward (so no one can block the door by collapsing in front of it)
  • Use locks that are easy to disengage from the outside
  • Assign a human to monitor the bathroom (preferably a nurse or EMT)

Bathrooms that meet the above criteria are far from common, and improving safety in these spaces will only go so far—which is why some are advocating for hospitals to go beyond managing public restrooms with drug users in mind. Some argue that providing a designated safe space to which users can bring their own drugs to inject themselves under medical supervision could dramatically improve safety.

A handful of cities across the U.S. are mulling the prospect of offering such “supervised injection facilities” (SIF). For a model, they’re looking to Vancouver, British Columbia, where the first SIF in North America was established in 2003, as The Seattle Times reported.



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