Opioid overdoses in public toilets: service workers respond

In 2014, the Boston Public Health Commission created a series of initiatives to educate business leaders and local employees about common signs and actions to take in case of overdose, including the distribution of naloxone. After three years, says BPHC spokesperson Erin Curran, they developed an online course because companies often face labor problems and scheduling or union problems.

In his new study, published Friday in Addiction to alcohol and drugsWolfson-Stofko and other New York University colleagues offered a similar in-person training program to workers in the New York City service industry without prior medical training. For about 20 minutes, workers learned to identify and treat overdoses, including naloxone administration exercises. They also received communication strategies with emergency services and meetings with drug users.

Before and after the training, Wolfson-Stofko and his colleagues tested participants to help with the scale of knowledge about opioid overdoses and the scale of attitudes at the clinic. In respect of opioid overdoses. They found that participants' scores increased by several points on their ability to administer naloxone and almost two points on the recognition of signs of an overdose. The workers "demonstrated significant improvements in opioid overdose knowledge, as well as more positive attitudes related to opioid overdoses after the intervention," the researchers write. They report that one participant told them, "The way I would find these instructions on this subject [naloxone kit], someone could die. The practical instruction is so super good.

The study has its limits. The sample size was small – 18 workers had been trained – and researchers had recruited contacts in previous work. As participants volunteered to learn, they may have been more receptive to public health interventions from the start. In addition, Wolfson-Stofko stresses that initiatives such as this short training are not intended to completely replace emergency medical services or the formal health care system.

The new study "will not take away the pressure that exists to really take care of fundamental problems," says Lisa Parker, director of bioethics and health law at the University of Pittsburgh. "It will only benefit those who are clearly at risk of harm."

He also seems to be asking a lot of often low-paid workers, often young, to double as medical responders. This is not what most people expect when they apply to Starbucks or Target. If companies were to train their employees on how to respond to an overdose, it would raise questions about how service workers could interact with EMTs and how companies could provide psychosocial support to workers.

"It's undeniable that there was secondary trauma when there were overdoses and people were dying of death," says Wakeman. Yet, she notes, "I find it much more traumatic to find someone in the bathroom and not be able to help them."