As the US harm reduction community grapples with the legal, cultural and political challenges to implementing the nation’s first legal safe consumption space, some innovative designers are playing their part to help mitigate historic overdose levels right now. They are bringing safety interventions to the public restrooms where injection drug use is already occurring.
A contractor in Boston recently incorporated what he believes is the first company dedicated to create overdose-proof bathrooms—or as close as he can get to that—by installing motion detectors.
“I really knew nothing about IV drug use, but of course I knew we were encountering a big problem, especially here in New England, with the introduction of fentanyl,” said John King. He was doing contracting work for the Boston Health Care for the Homeless Program when he was approached in late 2016 by the group’s Chief Medical Officer, Jessie Gaeta, with a question.
“She said they had seen an increase in overdoses in their bathrooms,” he told Filter during a recent phone call. “Can you help?”
A lifelong tinkerer, King went to work developing a bathroom that would alert staff if an individual inside needed help. King acknowledges that his system could apply to a number of potential medical emergencies, but preventing drug overdoses from turning fatal is the primary goal. The highly sensitive motion detector he designed alerts staff by sounding an alarm if someone falls to the floor and remains there.
“It was a learning curve,” he said. “We started at four minutes, but within a week Jessie called me and said, ‘John, four minutes is too long, can you set it to three? But that was too long too. Now it’s two minutes.”
Early this year King officially launched Lifesaver Alert, LLC to replicate the model, which he describes as overdose intervention, not prevention. As far as he knows, LifeSaver Alert is the first commercial business to attempt to mass produce overdose-proof bathrooms. The video below shows King’s system in action:
Gaeta says the system has been a resounding success.
“We have about five overdoses a week in our facility, and since we installed John’s system none have been fatal.”
However, a variety of similar mechanisms have been quietly used for years in a more unofficial capacity in syringe exchange programs in cities like New York.
During a recent visit to one of them, a staff member showed me a clean, well-lit bathroom with a small stool beneath a stainless steel shelf. A mirror and a sharps container hang on the wall nearby. The system is simple: When the door locks, a timer starts. At any point a bathroom monitor can engage the individual inside via intercom; but after 10 minutes the door unlocks, allowing staff inside.
But the issue of public injection is not confined to facilities that cater to people who are homeless and addicted. As cities like Philadelphia have begun aggressively targeting “blight” (usually as a pathway to gentrification), the number of abandoned row homes has dwindled, as have the de facto consumption spaces and “hit houses” that relied on them.
Numerous studies have found that in lieu of a safe place to inject, many IV drug users opt for public restrooms in fast food restaurants, convenience stores or coffee shops. With the introduction of fentanyl to the heroin supply, Starbucks baristas are now finding themselves dealing with overdoses on a regular basis.
“We can’t wait any longer to start doing something new.”
King acknowledges that convincing a for-profit business to install one of his systems is likely to be challenging, for reasons that speak to the cultural difficulties of embedding a harm reduction approach.
“We live in a litigious society,” he said. “If someone goes into a bathroom with an expectation of being revived if they overdose and they die…well, businesses are afraid of being sued.”
His clientele is so far largely confined to hospitals; Temple University Hospital in Philadelphia recently installed King’s system in its emergency room. Pathways to Housing—a housing-first organization also based in Philadelphia—is also currently looking into outfitting seven of its bathrooms with an overdose intervention system.
Pathways Clinical Director Matt Tice told Filter that while the organization has never had a fatal overdose at its offices, “We see dozens of clients a day and I think about it all the time. We just can’t keep an eye on every person who uses our restroom or how long they’ve been in there.”
He also emphasizes the dehumanizing aspect of being compelled to ask clients to request a key to use the restroom—which is currently the only way to keep track of how many (and which) restrooms are occupied.
King is currently working on his first “multi-stall” system—designed for bathrooms that are not single-occupancy units.
Meanwhile, in Vancouver, a group called Brave Cooperative is just weeks away from piloting what it describes as a “digital supervised consumption platform” at two sites—including a commercial coffee shop. According to founder Gordon Casey—an attorney and entrepreneur—unlike King’s bathrooms, Brave’s “Response” platform uses radar technology to calculate breathing rates and notifies trained community health workers through an app they can install on their phone.
He says that he chose the radar because in some cases overdosing individuals can spasm or even have a seizure, particularly with new potent synthetic drugs.
“We’re really on the ground floor here,” Casey told Filter. “Are there kinks to be worked out, a learning curve? Of course. But we can’t wait any longer to start doing something new.”
Photo via Wikimedia Commons