A Quiet Public Bathrooms Crisis Unfolds As U.S. Opioid Epidemic Rages
What can municipalities and businesses do to improve safety as the opioid epidemic presses overdose and drug use incidents in public bathrooms?
A quieter result of the opioid epidemic is that libraries, town halls and businesses are closing their public bathrooms. Businesses are also pressed to limit use as bathrooms have become "ground zero" in the opioid epidemic, according to a recent report by National Public Radio.
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,” said Dr. Alex Walley, director of the Addiction Medicine Fellowship Program at Boston Medical Center.
The fear is that by eliminating these spaces so commonly relied on by those with opioid addiction, drug use and discarded needles will increase in city parks and on streets. At places like Massachusetts General Hospital, where opioid users reportedly shoot up in bathrooms or sit in lobbies while consuming prescription medications, security guards are trained to administer naloxone and carry it daily.
Making Public Bathrooms Safe
At one popular coffeehouse in a busy section of Cambridge, Mass., owner Joshua Gerber said he removed a dropped, or floating ceiling when he noticed a tile was shifted and drug paraphernalia placed inside the space. He also added a metal box on the bathroom wall so people will not flush items, like needles, that clog pipes. And when he invited staff to train in administering naloxone, more than 25 responded.
“It’s a tricky thing, managing a public restroom in a big, busy square like Central Square where there’s a lot of drug use," Gerber told NPR, noting that his employees have found people unconscious inside his cafe's bathroom.
Walley and other physicians who work with addiction patients say there are lots of ways to make public bathrooms safer for everyone. A model public restroom would be:
- Have stainless-steel surfaces that offer few places to hide drug paraphernalia
- Be accessible with a door that only opens out, so a collapsed body cannot block entry, and easily unlocked from the outside
- Contain a biohazard box for needles and bloodied swabs
- Be stocked with naloxone, and even sterile water
- Be monitored, perhaps by a nurse or EMT
However, “there are limits to better bathroom management,” said Daniel Raymond, deputy director for policy and planning at the New York-based Harm Reduction Coalition.
Supervised Injection Facilities Alternatives
Some public health professionals say that to address the opioid epidemic, supervised injection facilities (SIFs) must be part of the solution.
“In an ideal world, users would have safe places to go [where] it didn’t become the job of a business to manage that and to look after them and make sure that they were OK,” said Gerber.
Massachusetts General Hospital, and businesses like the Cambridge coffeehouse, do not advertise their efforts to make bathrooms safer or save the lives of people who overdose, but they could reach a breaking point in the opioid-induced public bathroom crisis. That could lead to growing support for SIFs from business communities.