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Harm Reduction for Business Bathrooms - Overdose Response and Naloxone Administration

Innovative training of service workers in New York City supports effective response to suspected overdoses in public restrooms

Harm Reduction for Business Bathrooms is an innovative strategy developed and evaluated by the Center for Drug Use and HIV Research at New York University to address the increasing prevalence of overdoses in public bathrooms in New York City.

In fact, a study surveying managers of business in New York City found that 58% encountered drug use in their business bathrooms, 34% found syringes, nearly 10% found someone unresponsive, and more than 90% had been trained in overdose reversal. The overdose response and naloxone administration (ORNA) module aimed to address this gap. 

The ORNA behavioral intervention trained 18 service industry employees (SIEs) in New York City to respond to suspected opioid overdoses in public restrooms of business establishments. Based on the Information-Motivation-Behavioral skills model, the intervention communicated information on opioids, recognizing opioid overdose, New York’s naloxone regulations and Good Samaritan laws, administration of naloxone, communication with emergency services, and the possible presence of fentanyl. The intervention lasted 1.5 hours and was preceded by a knowledge pre-test, then followed by a post-test and a focus group to get participants feedback on the acceptability of ORNA.

Service industry employees showed increased knowledge and more positive attitudes towards opioid-related overdose.

Continuum of Care
Harm Reduction
Type of Evidence
Peer-reviewed
Response Approach
Educational
Overdose prevention
Peer-reviewed Article
“Feeling confident and equipped”: Evaluating the acceptability and efficacy of an overdose response and naloxone administration intervention to service industry employees in New York City
Drug use in business bathrooms: An exploratory study of manager encounters in New York City
Related Resources
SAMHSA Opioid Overdose Prevention Toolkit
Opioid Epidemic Response: Employer Toolkit
Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery
Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States
Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States
A Systematic Review of Community Opioid Overdose Prevention and Naloxone Distribution Programs

Evidence of Program Effectiveness

A peer-reviewed evaluation found, using pre-/post-tests, that the intervention increased participants knowledge and attitudes towards overdose reversal.:

“SIEs demonstrated significant improvements…in opioid overdose-related knowledge as well as more positive opioid overdose-related attitudes…following the intervention. Participants also reported high levels of acceptability of the module and suggestions for improvement (i.e., more role-playing)…This study highlights …the evidence of efficacy of the ORNA module, as well as the utility of training SIEs in ORNA. The expansion of this training to other SIEs and public employees (librarians, etc.) who manage public bathrooms warrants further investigation.” (Wolfson-Stofko et al., 2018)