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

Abstract

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.

“Feeling confident and equipped”: Evaluating the acceptability and efficacy of an overdose response and naloxone administration intervention to service industry employees in New York City

“…Participants were recruited through convenience sampling and through contacts from previous studies focused on drug use occurring in business bathrooms (Wolfson-Stofko et al, 2017) in February 2017. As part of recruitment, researchers explained the intervention to an SIE who agreed to act as a liaison between researchers, business owners, and their fellow SIEs.…”

“…Variables in regards to the participant’s encounters with drug use, unresponsive individuals, etc. in their business were derived from a previously conducted by our study team (Wolfson-Stofko et al, 2017). Pre-/post-test scores were compared to determine significance, confidence intervals, and effect size.…”

“…A previous study conducted by our team focused specifically on business managers’ encounters with drug use in NYC and revealed that many (58%) had encountered drug use in their business’s public bathroom (herein referred to as ‘business bathrooms’) within the past 6-months and that approximately a third (34%) of them had also encountered improperly disposed syringes (Wolfson-Stofko et al, 2017). Additionally, almost all (90%) had no training in overdose response and naloxone administration (ORNA), though a substantial minority (14%) had encountered someone who was unresponsive, presumably due to drug use, within the previous 6-months (Wolfson-Stofko et al, 2017).…”

“…Additionally, almost all (90%) had no training in overdose response and naloxone administration (ORNA), though a substantial minority (14%) had encountered someone who was unresponsive, presumably due to drug use, within the previous 6-months (Wolfson-Stofko et al, 2017). These findings suggest that business managers and staff (herein referred to collectively as a ‘service industry employee’ (SIE)) unwittingly become first-responders in the event of an opioid overdose and are not trained on how to respond to an overdose and administer naloxone.…”

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

“…Many states have instituted policies to encourage wider provision of naloxone through pharmacies. Other venues that warrant special consideration and innovation include public bathrooms, which are commonly used as drug consumption spaces (Wolfson-Stofko, Bennett, Elliott, & Curtis, 2017). With the rapidity of fentanyl overdoses, these are the places where people increasingly overdose.…”