I never anticipated spending so much of my clinical time in bathrooms. But drug overdose is the leading cause of death among the homeless individuals I take care of at a health center in Boston—and without homes or access to supervised consumption sites, people who are homeless frequently inject drugs behind the closed doors of public bathrooms, including ours.
Despite the housekeeping staff’s relentless efforts to keep them clean, these bathrooms can be desolate spaces. I try to imagine what it might be like for a person as he or she approaches the restroom; it’s painful to think that this bleak space could be a person’s only sanctuary. A trail of desperate attempts at patient education and clinician preparation lines the hallway: a fentanyl alert poster several doors down; an overdose prevention fact sheet a little closer; another sheet asking, “Do you know what to do if a friend overdoses?” I imagine people shuffling past these warnings and pleas. As they enter, the bathroom door clicks decisively behind them. Escaping from the bustling clinic lobby, they are alone, finally hidden to do what their mind and body are demanding: dissolve the pain and stem the symptoms of withdrawal.
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Gaeta JM. A Pitiful Sanctuary. JAMA. 2019;321(24):2407–2408. doi:10.1001/jama.2019.7998
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