Background Though public bathroom drug injection has been documented from the perspective of people who inject drugs, no research has explored the experiences of the business managers who oversee their business bathrooms and respond to drug use. These managers, by default, are first-responders in the event of a drug overdose and thus of intrinsic interest during the current epidemic of opioid-related overdoses in the United States. This exploratory study assists in elucidating the experiences that New York City business managers have with people who inject drugs, their paraphernalia, and their overdoses. Methods A survey instrument was designed to collect data on manager encounters with drug use occurring in their business bathrooms. Recruitment was guided by convenience and purposive approaches. Results More than half of managers interviewed (58%, n = 50/86) encountered drug use in their business bathrooms, more than a third (34%) of these managers also found syringes, and the vast majority (90%) of managers had received no overdose recognition or naloxone training. Seven managers encountered unresponsive individuals who required emergency assistance. Conclusion The results from this study underscore the need for additional research on the experiences that community stakeholders have with public injection as well as educational outreach efforts among business managers. This research also suggests that there is need for a national dialogue about potential interventions, including expanded overdose recognition and naloxone training and supervised injection facilities (SIF)/drug consumption rooms (DCR), that could reduce public injection and its associated health risks.

Background and AimsNumerous states in the United States are working to stem opioid‐involved overdose (OD) by engaging OD survivors before discharge from emergency departments (EDs). This analysis examines interactions between survivors and medical care providers that may influence opioid risk behaviors post‐OD.DesignQualitative stakeholder analysis involving in‐depth interviews with samples from three groups.SettingTwo hospitals in high OD‐mortality neighborhoods in New York City (NYC), USA.ParticipantsTotal N = 35: emergency medical services personnel (EMS; n = 9) and ED medical staff (EDS; n = 6) both working in high OD‐mortality neighborhoods in NYC; recent opioid‐involved OD survivors who had been administered naloxone and transported to a hospital ED (n = 20).MeasurementsEMS and EDS interviews examined content of verbal interactions with survivors and attitudes related to people who use opioids. Survivor interviews addressed healthcare experiences, OD‐related behavioral impacts and barriers to risk‐reduction post‐OD.FindingsBoth EMS and EDS stakeholders described frequent efforts to influence survivors’ subsequent behavior, but some acknowledged a loss of empathy, and most described burnout related to perceived ingratitude or failure to influence patients. Survivors reported being motivated to reduce opioid risk following a non‐fatal OD and many described successful risk‐reduction efforts post‐OD. Intentions to cease opioid use or reduce risk were complicated by unmanaged, naloxone‐related withdrawal, lack of social support and perceived disrespect from EMS and/or EDS.ConclusionsEmergency department interventions with opioid‐involved overdose (OD) survivors may benefit from training emergency medical staff to assure a continuity of non‐judgmental, socially supportive remediation attempts throughout contacts with different care‐givers. Brief interventions to educate emergency medical staff about current theories of addiction and evidence‐based treatment may achieve this goal while reducing care‐giver burnout and improving the uptake and efficacy of post‐OD interventions delivered in emergency departments.