Abstract
Most US drug use events that lead to a fatal overdose are unwitnessed. Given the scale of the overdose crisis, interventions to help detect and respond to overdoses in community settings are urgently needed. Overdose detection technologies (ODT), including reverse-motion restroom sensors, are a promising set of interventions that are underutilized. This study explored the perspectives of frontline harm reduction workers, clinicians, housing shelter staff, and their clients on restroom sensors.
Staff and program client focus groups conducted between December 2022 and January 2024 discussed prior experiences of responding to overdoses and existing organizational overdose policies and procedures. A verbal and visual description of restroom sensors was given and supplemented with brief captioned educational videos to assess the feasibility and acceptability of restroom sensor implementation.
We conducted N = 8 discussions (n = 40 participants total). Staff described the anxiety and cognitive burden of monitoring client restrooms and the trauma of witnessing and responding to overdoses. Sites varied in their safety procedures, ranging from manual door knocks every 5 minutes to every 24 hours. Participants embraced the prospect of restroom sensor implementation in community drop-in centers, housing programs, and public restrooms (eg, food service). Perceived benefits of restroom sensors, in addition to saving lives, included the low-threshold and automated nature of the technologies and potential reductions in stress, anxiety, and trauma. However, participants shared concerns surrounding data confidentiality, potential legal repercussions of being found onsite after overdosing (eg, loss of housing, job, children, freedom), stigmatizing attitudes among first responders, reactions to ODTs among clients who mistrust technologies, corporations, and the government, staff fatigue, and technology maintenance.
Our findings demonstrated high acceptability of ODTs among staff and patients but revealed several programmatic and policy considerations that could support future implementation efforts.