Saving lives from BC’s overdose crisis, one bathroom at a time

Shannon Riley spent nearly a decade in survival mode when people overdosed in the bathrooms and showers at the drop-in center in San Francisco where she worked as a nurse.

“We often had to crawl under stall doors and pull people out,” says Riley, now a clinical educator on the Overdose Emergency Response and Prevention Team at Vancouver Coastal Health.

“And I didn’t have enough time to think there were other ways to take care of myself and my clients to improve response times.”

But after a close friend died of a toxic drug overdose in the bar’s bathroom in 2007, Riley realized that a simple design change could save her life.

At the time, no one knew that her friend, who was active in harm reduction, was using it. And when others at the bar realized he was missing and called for help, first responders found his collapsed body blocking the door that swings inward, thus leading to a small bathroom. Couldn’t open the door.

“If you can’t get on your hands or knees to pull it out, you’re less likely to survive,” Riley said.

Fentanyl, carfentanyl, benzodiazepines, and more, flooded with British Columbia’s increasingly potent and unpredictable supply of drugs, can mean a matter of minutes whether someone lives or dies after drug addiction. I have.

The Safer Bathroom Toolkit aims to help organizations make life-saving changes to washrooms in the midst of BC’s toxic drug crisis.

Co-developed by Riley, this toolkit teaches businesses how to assess washroom safety features and ensure staff are prepared to respond to toxic drug incidents.

Riley said that while bars and clubs are effectively safe places to consume alcohol, “there aren’t enough .125 safe places to consume .375 for people who use drugs.”

“In the meantime, we need to build safer toilets.”

According to 2018 data from BC Emergency Medical Services, approximately 50 people in BC overdose in public restrooms each month, but not all of these overdoses are fatal.

So far this year, 16 people have died in public restrooms, according to BC Coroners Service data.

This represents about 1% of the 1,644 poison-related deaths that have occurred in 2022 so far. This year there are more than last year.

But physical and technological changes could speed up response times and make bathrooms safer for everyone.

A sealed sharps container for needles and a door that opens outwards is essential, Riley says. A panic button to call for help, or a countermeasure that blocks the space between the toilet and the wall so that a person could be trapped in case of unconsciousness, can also save lives.

Businesses and organizations should ensure that all staff members have universal bathroom keys and know where to store and use the naloxone kit, she added.

Technical solutions can also help. Staff can be notified automatically if someone has been in the bathroom for an unusually long time, and an intercom can allow staff to check on who they are.

Riley and a team of colleagues released the toolkit online last month and it has already been viewed more than 2,000 times.

Marilou Gagnon, a harm reduction expert at the University of Victoria’s School of Nursing who worked with Riley on the project, said: “There’s a lot of important reporting and stories out there, but people and companies aren’t ready to respond.

“People want to help, but they just don’t know what to do.”

Many people choose to use drugs in public restrooms. Because it’s a quiet place away from the risk of being arrested, he says, Gagnon.

A 2016 paper from the University of Victoria found that public restrooms effectively become places of consumption when designated locations are inaccessible.

Gagnon noted that monitored consumption and overdose prevention sites are concentrated in a few locations, primarily in Vancouver and Victoria, and are not available to people living elsewhere in the state.

During the years Kali Sedgmore was homeless, public restrooms provided the only privacy they could find.

When sedgmores are inaccessible by staff, they are forced to use them in alleyways, where the stress of being exposed to the elements and being seen or arrested increases the risk of infection or injury such as a failed injection. .

“The washroom is a private place to be alone and to be yourself,” said Sedgemore, who now works as a peer harm reduction worker at Vancouver Coastal Health and co-developed the toolkit. “Being alone is important and everyone deserves dignity and access to washrooms.”

Access to bathrooms in Vancouver plummeted during the pandemic. Many companies see keeping bathrooms closed as a way to avoid people using drugs or overdosing inside.

Sedgemore says it’s frustrating that people and organizations complaining about public drug use and public urination and defecation don’t consider how few public toilets are available in Vancouver. .

“It’s the perfect storm to leave people with nowhere to go,” Gagnon said.

Some companies are installing neon blue lights inside bathrooms to make veins more difficult to spot and discourage people from using drugs inside. Gagnon explained that it moves to less safe areas, makes it more difficult to clean bathrooms, and can make it difficult for blind and disabled people to navigate bathrooms.

“This is a knee-jerk reaction. It’s unsupported and unsafe,” Gagnon said. “This is a great example of what happens when people don’t know what to do.”

Riley acknowledged that the job descriptions of many employees at these companies do not include responding to overdoses, but employers have equipped staff to respond to the realities of the toxic drug crisis. and said it was responsible for supporting them.

“How can we build resilience and give our staff all the tools they need to get through these challenging times?” Riley asked. “Instead of standing outside a locked door feeling helpless after they call 911, we need to share what they can do.”

And with improved safety, there won’t be an increase in substance use in the bathroom, Sedgemore said.

“Our toolbox doesn’t attract drug users,” they said. “It’s about paying attention to people who use drugs.”

overdose crisis