In 2014, the Boston Public Health Commission created a Safe Bathroom Initiative, a series of trainings that teaches local-business owners and employees about the common signs and what to do when someone experiences an overdose, including how to distribute naloxone. After three years, says Erin Curran, a spokesperson for the commission, it developed an online course because businesses often face shifting workforces and scheduling or union issues.
In his new study, published on Friday in Drug and Alcohol Dependence, Wolfson-Stofko and his colleagues at New York University offered a similar short in-person educational program to service-industry workers in New York City with no prior medical training. Over about 20 minutes, the workers were taught how to identify and treat overdoses, including exercises in naloxone administration. They were also given strategies for communicating with emergency services and de-escalating encounters with drug users.
Before and after the training, Wolfson-Stofko and his colleagues tested the participants using the Opioid Overdose Knowledge Scale and Opioid Overdose Attitudes Scale. They found that participants’ scores jumped several points on their ability to administer naloxone and almost two points on recognizing the signs of an overdose. The workers “demonstrated significant improvements in opioid overdose-related knowledge as well as more positive opioid overdose-related attitudes following the intervention,” the researchers write. They report that one participant told them: “The way that I would figure out these instructions on this [naloxone kit], someone could die. So the hands-on instruction is super good.”
The study has its limitations. The sample size was small—18 workers were trained—and the researchers recruited contacts from previous work they’d done. Since the participants volunteered to learn, they may have been more receptive to public-health interventions from the start. Moreover, Wolfson-Stofko stresses that initiatives like this short training aren’t meant to fully replace emergency medical services or the formal health-care system.
The new study is “not going to take off any of the pressure that exists to really take care of the fundamental problems,” says Lisa Parker, the director for bioethics and health law at the University of Pittsburgh. “It’s only going to benefit those who are at clear, present risk of harm.”
It also seems like a lot to ask often low-paid, young service workers to double as medical responders. That’s not what most people expect when they apply to Starbucks or Target. If businesses were to train their employees on how to respond to an overdose, it would raise questions about how service workers might interact with EMTs and how businesses might provide psychosocial support for workers.
“There’s definitely secondary trauma to witnessing overdoses and seeing people near death,” Wakeman says. Still, she notes, “I think it’s much more traumatizing to find someone dead in the bathroom and not be able to help them.”