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Public Bathrooms Ground Zero in Opioid Crisis

C-stores, other retailers on front line of overdose epidemic

CHICAGO -- Calling them an “invisible haven,” the Chicago Tribune reported that public bathrooms “have become a clandestine epicenter of the opioid crisis, serving as the setting for numerous fatal overdoses and close calls.”

Detailing recent overdoses in bathrooms of Cook County businesses such as quick-service restaurants (QSRs), coffee shops, grocery stores and gas stations, the report echoes CSP’s May 2018 cover feature “Opioid Epidemic: Crisis in the C-Store,” which looks at the issue through the lens of the convenience-store industry.

Drug overdoses claimed more than 63,600 American lives in 2016, according to the National Center for Health Statistics. Opioids, including heroin, fentanyl and oxycodone, were to blame for about 66% of those fatalities.

The opioid crisis has turned the c-store industry’s restrooms, one of its greatest assets, into a risk-management nightmare.

Finding hard numbers quantifying the frequency of drug use at c-stores is difficult. And only a few retailers contacted by CSP would go on the record about the issue. CSP also contacted many retail and petroleum associations for comment about the opioid epidemic and its effect on their members. NACS said it does not have a policy recommendation on the issue. Other associations either declined comment or said they were not following the issue.

To get an idea of the scope of the problem, CSP conducted an online survey that asked retailers about their experiences with drug use in their stores. Nearly 94% of the respondents to the survey said they see evidence of drug use in their stores, especially in the restrooms, and most said the activity has increased in the past five years. Few said they are taking steps to address the problem.

Tough Spot

With lockable doors and stalls that shield people from prying eyes, public bathrooms have long harbored illicit drug use, the Tribune said, citing research in the late 1990s that examined hundreds of heroin deaths in San Francisco and discovered that 5% of them took place in restrooms.

In response, some building managers have restricted access to their bathrooms, tried design tweaks to discourage drug use or equipped their security guards with naloxone, an overdose-reversing medication.

Brett Wolfson-Stofko, a public health researcher with the National Development and Research Institutes in New York who has examined drug use in public bathrooms, said business owners are in a tough spot. If they’re too restrictive, they risk discrimination complaints. If they turn a blind eye, bad things can happen. “They can lose customers because of what’s happening in their bathrooms,” he told the newspaper. “The staff is also at a lot of risk for needle sticks and other things. The business community is a stakeholder in all this.”

Nasr Ali, co-owner of the Chicago gas station where a 36-year-old man fatally overdosed in a portable toilet last year, said employees now give customers about three minutes before knocking on the door. If they detect signs of possible drug use, he said, they call police. “We find that method has helped a lot,” he told the Tribune. “We haven’t had another incident like that.”

In Boston, the public health commission has alerted business owners about the danger of overdoses. It has handed out posters that say, “Check your restrooms: Your actions could help save a life,” and offered to train employees to use naloxone. Devin Larkin, director of the commission’s recovery services bureau, told the paper that it’s hard to gauge the impact of the campaign, though some businesses have restocked their naloxone after using up their allotment. Chicago’s Department of Public Health has distributed the medication in neighborhoods hit hard by opioids but hasn’t targeted businesses specifically, said the report.

Take Action

CSP’s report offered these suggestions to retailers to help fight the opioid epidemic in stores:

  • Install blue or dim lighting to discourage intravenous drug use.
  • Lock bathrooms at night or install “doorless” restrooms.
  • Drug test job applicants and advertise drug-free workplaces.
  • Conduct criminal and civil background checks on potential hires.
  • Consider stocking the opioid antidote naloxone in stores and train employees on how to administer it.
  • Cut power to exterior outlets.
  • Encourage employees to call police at the first sign of opioid abuse and continue to call for repeat offenders.
  • Demand conservative prescribing guidelines for pain treatment from all healthcare providers.
  • Cover physical therapy and substance-use treatment programs.
  • Provide employee assistance programs.

Click here to read the full CSP report.

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