Becker's Clinical Quality & Infection Control

28 SPOTLIGHT ON THE OPIOID EPIDEMIC Drug Users Increasingly Injecting in Hospital Bathrooms: What Hospitals Are and Aren't Doing About It By Tamara Rosin D rug users are increasingly slipping into hospital restrooms to take heroin and other narcotics, rea- soning their chances of accessing timely lifesaving medical attention in the event of an overdose are higher in such an environment, reports NPR. "ere's an understanding that if you overdose in and around a hospital that you're much more likely to be able to be treated," Ali Raja, MD, an emergency room physician at Boston-based Massachusetts General Hospital, told NPR, "and so we're finding patients in our restrooms, we're find- ing patients in our lobbies who are shooting up or taking their prescription pain medications." In Boston hospitals, naloxone — the antidote for a heroin overdose — has become standard equipment for hospital security guards so they can act quickly if they discover someone who has overdosed. Treating an overdose fast is critical, especially because heroin is oen mixed with fentan- yl, a highly addictive narcotic, which is far more potent and deadly. Hospitals have also begun taking other measures to more closely monitor their bathrooms. One clinic installed an intercom system and requires people in the restroom to respond to indicate they are still conscious. Another installed a reverse motion detector that triggers an alarm if there is no movement in the bathroom, according to the report. Although many have taken the initiative to address the issue, few hospital officials are willing to discuss it in public, Alex Walley, MD, director of the Addiction Medicine Fellowship Program at Boston Medical Center, told NPR. "It's against federal and state law to provide a space where people can use [illegal drugs] knowingly, so that is a big deterrent from people talking about this problem," he said, according to the report. Dr. Walley and other addiction specialists said there are many ways to make bathrooms safer for both the public and drug users, according to the report. ey describe a model restroom as being clean with adequate lighting, stainless steel surfaces and few cracks where people could hide drug paraphernalia. It would also contain a biohaz- ard box for needles, naloxone and sterile water. Bathroom stall doors would open out so a collapsed body would not prevent someone from entering, and they would be easy to unlock from the outside. Additionally, the bathrooms should be monitored, preferably by a nurse or EMT. How- ever, few public restrooms in the U.S. include these features, according to the report. n 20% of Weight-Loss Surgery Patients Still on Opioids 7 Years After Surgery By Brian Zimmerman T he percentage of adult bariatric surgical patients using opioids dips in the initial postoperative months, but increases years later, according to a study published in the journal Surgery for Obesity and Related Disease. For the study, researchers analyzed data on more than 2,000 bariatric surgery patients who participated in an observational study initiated in 2006 and backed by the National Institutes of Health. Prior to surgery, 14.7 percent of the participants reported regularly using prescription opioids. Six months after the procedure, this figure dropped to 12.9 percent. However, seven years after surgery, the amount of patients regularly taking prescription opioid medications increased to 20.3 percent. "Recent reports have suggested that bariatric surgery patients are at elevated risk of chronic opioid use," said study author Anita Courcou- las, MD, chief of minimally invasive bariatric and general surgery at Pittsburgh-based UPMC. "Our study does not prove that bariatric sur- gery causes an increase in opioid use. However, it does demonstrate the widespread use of opioids among post-surgical patients, thereby highlighting the need for alternative pain management approaches in this population." n HHS Makes $70M in Grants Available to Address Opioid Epidemic By Brian Zimmerman H HS Secretary Tom Price, MD, said May 31 the agency will offer more than $70 million in grants designed to curb rates of opi- oid-related deaths and expand access to treatment for opioid addiction. HHS will allocate the funds over multiple years. The grants will address the deadly drug epi- demic on three fronts: • Delivering up to $28 million to five grantees to improve access to medication-assisted treatment for addiction, which includes behavioral health therapy • Making $41.7 million over four years available to approximately 30 grant- ees to train first-responders and other members of community sectors that may encounter an overdose on administering overdose reversal products • Providing up to $1 million over 5 years to one grant- ee to expand the availability of opioid overdose reversal medications in the healthcare setting "We are committed to bringing everything the federal gov- ernment has to bear on this health crisis," said Dr. Price. "The purpose of these grants is to empower the heroes in this fight — the men and women on the forefront of supporting preven- tion, treatment and recovery initiatives in their communities." States will be eligible for the new funds, along with $485 mil- lion in grants rolled out in April as part of the 21st Century Cures Act to fund evidence-based pre- vention and treatment initiatives to combat opioid addiction. n

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