3 tips for increasing harm reduction potential in AOD treatment environments
Today’s article is a back to basics look at how the environmental design of our workplaces can help to reduce the potential for drug related harm. While this information may not be new for many of us, you would be surprised at the number of Alcohol and Other Drug services that do not adequately consider the implications of our environment. Drug related harms often result from a complex interplay between factors associated with the individual, the drug and the environment. This article offers 3 ideas for increasing the potential to address drug related harms by solely addressing environmental factors.
Tip 1: Make potential injecting locations accessible to staff
Drug injectors need a private space to undertake the procedure of injecting. While this is not necessarily a lengthy process, it does quite often require a process of mixing and dissolving the substance and preparing it for injecting. Then there is the actual act of injecting, the time of which is required to undertake, will vary from person to person dependent upon their technique and the health of their veins. All of this of course is necessarily hidden, as the act they are undertaking is not legal and not permitted on treatment services premises.
Regardless of this, people will from time to time try and find a hidden space within alcohol and other drug treatment services where they can inject drugs with some level of privacy. While privacy may give the person a level of protection from legal harms unfortunately the same feature is also a key factor that increases the likelihood of an overdose resulting in fatality. It is for this reason the alcohol and other drug organisations need to consider carefully the physical environments in which their services are delivered with a mindfulness of potential injecting locations. An audit of organisational sites identifying where litter associated with drug injecting can be a useful way of identifying such locations within the organisational environs. Assessing spaces that have infrequent passing traffic and/or means to make the areas secure (e.g. a door or gate that can be locked), yet is also accessible by members of the public visiting the organisation can also be useful. Once these areas have been identified it is then possible to ask two very important questions:
- Can staff get to somebody who is overdosed in this location?
- How would staff know if someone was there?
One of the most frequently utilised locations for public injecting is of course the toilet cubicle. Toilet cubicles offer a lockable door and a modicum of privacy and therefore are often utilised in public injecting practice. Poorly designed and located toilets however can contribute to fatal overdose.
When considering the design of toilet cubicles in alcohol and other drug treatment agencies (and indeed anywhere else the potential for public injecting is identified) ensure:
- That the toilet door can be unlocked from outside of the cubicle allowing staff to gain entry;
- That the toilet door provides a space between the bottom of the door and the floor so that staff can establish whether a person is unconscious or otherwise incapacitated;
- That the cubicle door can either be opened outwards or be lifted off its hinges by one person. This allows for the fact that the person experiencing the overdose or other medical emergency may be slumped in the way of a door that swings into the cubicle.
Additionally it is important that the toilets are monitored regularly. This last point seems a bit Orwellian I know, however it is far less uncomfortable tapping on a cubicle door and enquiring whether somebody is alright than it is to manage the aftermath of a fatal overdose.
Tip 2: Strategically place disposal bins
Because of course you will have already undertaken Tip 1 and embarked upon an audit of potential locations utilised by injectors you will have a good idea of any places around your building where non sterile injecting equipment has been inappropriately discarded. Guess what, these are the best spot for placing secure disposal bins. Making such bins available close to the points where people are injecting is likely to increase appropriate disposal of equipment, reduce the potential for accidental needle stick and improve the general amenity of the organisation. Furthermore appropriate placement of such bins decreases the need for staff to manually handle inappropriately discarded equipment, freeing their time up to undertake other activities.
Tip 3: Don’t install blue lights
Most alcohol and other drug services and needle syringe programs actively discourage injecting on site, however putting into place deterrents without thought to how they may contribute to harm is not a great idea.
Blue lights which are often are used in public spaces (like public toilets) lower visibility and impair people’s ability to find a vein when injecting. While the purpose of the lights may be to deter injecting, they often don’t and can potentiate increased harm as people struggle to find a vein. Rather than cover the specifics of how infective such a measure is, I instead commend to you the excellent article written by Dr Stephen Parkin and published by Injecting Advice on just this issue.
A s we can see being mindful of the design of the environments that we work within we can significantly reduce the potential for drug related harms in our workplaces. Even basic considerations can do much to reduce drug related harms and potentially save a life.