A qualitative study of the perceived effects of blue lights in washrooms on people who use injection drugs

Abstract

BackgroundBlue lights are sometimes placed in public washrooms to discourage injection drug use. Their effectiveness has been questioned and concerns raised that they are harmful but formal research on the issue is limited to a single study. We gathered perceptions of people who use injection drugs on the effects of blue lights with the aim of informing harm reduction practice.MethodsWe interviewed 18 people in two Canadian cities who currently or previously used injection drugs to better understand their perceptions of the rationale for and consequences of blue lights in public washrooms.ResultsParticipants described a preference for private places to use injection drugs, but explained that the need for an immediate solution would often override other considerations. While public washrooms were in many cases not preferred, their accessibility and relative privacy appear to make them reasonable compromises in situations involving urgent injecting. Participants understood the aim of blue lights to be to deter drug use. The majority had attempted to inject in a blue-lit washroom. While there was general agreement that blue lights do make injecting more difficult, a small number of participants were entirely undeterred by them, and half would use a blue-lit washroom if they needed somewhere to inject urgently. Participants perceived that, by making veins less visible, blue lights make injecting more dangerous. By dispersing public injection drug use to places where it is more visible, they also make it more stigmatizing. Despite recognizing these harms, more than half of the participants were not opposed to the continued use of blue lights.ConclusionsBlue lights are unlikely to deter injection drugs use in public washrooms, and may increase drug use-related harms. Despite recognizing these negative effects, people who use injection drugs may be reluctant to advocate against their use. We attempt to reconcile this apparent contradiction by interpreting blue lights as a form of symbolic violence and suggest a parallel with other emancipatory movements for inspiration in advocating against this and other oppressive interventions.

Drug use in business bathrooms: An exploratory study of manager encounters in New York City

“…Some of the motivating factors for the use of this location is privacy and immediacy (Crabtree et al, 2013; Parkin, 2013; Parkin & Coomber, 2010). Many of these businesses, particularly fast food, are regularly understaffed making bathroom management difficult (Hart Research Associates, 2015).…”

“…Many of these businesses, particularly fast food, are regularly understaffed making bathroom management difficult (Hart Research Associates, 2015). The privacy afforded by public bathrooms reduces encounters with non-injectors, some of whom may perpetuate stigma or shame PWID, behaviours which have been associated with increased injection-related risk behaviours (Crabtree et al, 2013; Latkin et al, 2010; McKnight et al, 2007; Rhodes et al, 2006; Rhodes et al, 2007; Rivera, DeCuir, Crawford, Amesty, & Lewis, 2014; Strathdee et al, 2012). Additionally, privacy can minimize physical harms by providing PWID with adequate time for drug preparation and injection which can reduce the risk of, for example, abscesses and vein damage associated with rushed or interrupted injections (Bourgois, 1998; Cooper, Moore, Gruskin, & Krieger, 2005; DeBeck et al, 2009; Gibson et al, 2011; Marshall, Kerr, Qi, Montaner, & Wood, 2010; Parkin & Coomber, 2011b; Salmon et al, 2009; Small et al, 2007).…”

Perspectives on supervised injection facilities among service industry employees in New York City: A qualitative exploration

“…Reports suggest that public bathrooms 1 are among the most commonly used public injecting locations among PWID in NYC (Injection Drug Users Health Alliance, 2015; New York City Department of Health & Mental Hygiene, 2010, 2013). Some of the motivating factors for the use of this type of location are immediacy and privacy (Crabtree et al, 2013; Parkin & Coomber, 2010; Parkin, 2013) in addition to their cleanliness compared to other alternatives such as parks and alleyways. The privacy afforded by public bathrooms can minimize physical harms to PWID by providing them with adequate time for drug preparation and injection, which can in turn reduce the risk of abscesses and vein damage associated with rushed or interrupted injections (Bourgois, 1998; Cooper, Moore, Gruskin, & Krieger, 2005; DeBeck et al, 2009; Gibson et al, 2011; Marshall, Kerr, Qi, Montaner, & Wood, 2010; Parkin & Coomber, 2011; Salmon et al, 2009; Small, Rhodes, Wood, & Kerr, 2007).…”

“…The use of public bathrooms for injection drug use has become so common in some parts of the US and Europe that hospitals (Ramsay, 2002) and businesses (BBC News, 2003; Rubinkam, 2018; Steves, 2010; Watts, 2018) have responded by installing blue lights in an attempt to deter drug use though research suggests that this intervention is not effective in deterring PWID (Crabtree et al, 2013; Parkin & Coomber, 2010; Parkin, 2013). Other businesses have installed locks on bathroom doors that workers can unlock at their discretion, potentially exposing themselves and their business to discriminatory lawsuits.…”

Comparing different methods of learning in the development of social accountability and CanMEDS roles in medical students

“…Activities may include conducting a literature review, obtaining ethics approval, recruiting participants, conducting qualitative interviews and data analyses, and disseminating results. Examples of SDPO projects include a recent study of the effects of blue lights in washrooms on injection drug users [8]. These options allow students to have varied experiences to achieve the learning objectives of DPAS 420 and provide a unique opportunity to evaluate how these different methods of learning meet the objectives of the course, including social accountability and intrinsic CanMEDS roles.…”