Abstract
Setting
In British Columbia (BC), over 11,000 people have died of an overdose since 2016. Recently, an all-party standing committee on health tabled a report identifying several gaps in BC’s overdose response. Chief among these is the inequitable distribution of supervised consumption and overdose prevention services across BC and barriers to accessing services that are currently available. In this context, public bathrooms continue to act as consumption spaces and contribute to overdose-related risks and fatalities.
Intervention
The Safer Bathroom project sought to address long-standing policy and practice gaps by developing a toolkit to improve bathroom overdose prevention and response. Activities included a literature review and cross-sectoral, province-wide consultation (Fall 2021), the creation and launch of the Safer Bathroom Toolkit (Fall 2022), and knowledge transfer activities (ongoing).
Outcomes
The toolkit meets four objectives. First, it provides a bathroom safety checklist that helps identify and, most importantly, mitigate safety risks. Second, it offers organizational guidance on developing a bathroom safety policy and procedure. Third, it includes practical resources such as staff training material and signs that communicate bathroom safety messages in a non-stigmatizing manner. Finally, it identifies bathroom architecture and design features that can increase or decrease overdose-related risks.
Implications
The Safer Bathroom Toolkit is a highly comprehensive resource developed in response to the overdose crisis. However, significant reporting, research, policy, and practice gaps remain. This paper concludes with an overview of recommendations for advancing overdose prevention and response efforts within and beyond the bathroom context.
Résumé
Lieu
En Colombie-Britannique (C.-B.), plus de 11 000 personnes sont décédées d’une surdose depuis 2016. Un comité multipartite en santé a récemment déposé un rapport identifiant plusieurs écarts dans la réponse du gouvernement de la C.-B. face aux surdoses. La distribution inéquitable des services de consommation supervisée et de prévention des surdoses ainsi que les barrières d’accès aux services qui sont disponibles constituent un écart important. Dans ce contexte, les toilettes publiques servent d’espaces de consommation et contribuent au risque de surdoses ainsi qu’aux surdoses mortelles.
Intervention
Le projet visant à améliorer la sécurité dans les toilettes publiques avait pour but de répondre à des lacunes de longue date en matière de politiques et de pratiques et ce, en proposant des outils pour prévenir les surdoses et faciliter les réponses aux surdoses en cas d’urgence. Les activités réalisées dans le cadre de ce projet incluent une revue de la littérature et une consultation intersectorielle à l’échelle provinciale (automne 2021), la création et le lancement d’une trousse d’outils (automne 2022), et les activités de transfert des connaissances (en cours).
Résultats
La trousse d’outils répond à quatre objectifs. Premièrement, elle contient une liste de vérification permettant d’identifier, et surtout, de diminuer les risques à la sécurité dans les toilettes publiques. Deuxièmement, elle offre des directives aux organisations qui souhaitent développer une politique et une procédure pour améliorer la sécurité dans leurs toilettes publiques. Troisièmement, elle propose des ressources pratiques pour la formation du personnel et des affiches permettant de communiquer des messages ayant pour but de promouvoir la sécurité sans toutefois stigmatiser. Finalement, elle décrit les caractéristiques architecturales pouvant augmenter ou diminuer les risques associés aux surdoses par le biais d’une fiche d’information.
Conséquences
La trousse d’outils que nous avons développée contient des ressources complètes qui répondent à la crise des surdoses. Toutefois, des lacunes importantes en matière de surveillance, de recherche, de politiques, et de pratiques demeurent. Nous proposons certaines recommandations pour améliorer la réponse aux surdoses et les efforts de prévention dans les toilettes publiques et de façon plus large en conclusion de cet article.
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Notes
Disclaimer: This statistic is based on 9-1-1 calls to BC Emergency Health Services where it was specifically documented to have occurred in a washroom and is likely an undercount of all drug poisonings that take place in washrooms in BC.
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Acknowledgements
We thank Alayna Payne and Emily Hazlehurst for their support during the development of the toolkit and Sean McEwen for his helpful feedback on the design fact sheet.
Funding
This study was funded by Michael Smith Health Research BC (Reach Grant, RA-2021–2318).
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MG: writing, editing; TG: writing, editing; SR, KS, HL: editing. All authors approved the final version for publication.
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Gagnon, M., Goodyear, T., Riley, S. et al. Addressing overdose risks and fatalities in public bathrooms: insights from the development of a Safer Bathroom Toolkit in British Columbia, Canada. Can J Public Health 114, 934–942 (2023). https://doi.org/10.17269/s41997-023-00810-4
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DOI: https://doi.org/10.17269/s41997-023-00810-4