If your firm serves the public, in a retail environment or as part of a nonprofit or government agency, you already know you must have plans, policies, procedures, and patience when dealing with their occasional behavior issues. These can range from theft, violence threats, crimes, or even on-site medical emergencies. With opiate use and addiction rates overwhelming our medical systems, the possibility for your employees to discover a customer who has overdosed on opiates is a real concern.
A report from the National Institutes of Health reveals that 256 million prescriptions were written for opiates in 2015 (and revised in January 2018). With an average prescription providing from 6 to 30 pills, the numbers of opiates in circulation and subsequent abuse is staggering. Substance abuse treatment professionals warn that up to 80% of current heroin addicts began with opiate prescriptions. Since opiates are becoming more difficult to obtain, as the Drug Enforcement Administration (DEA), the Food and Drug Administration (FDA), and the medical community are tightening their scrutiny of prescription abuse, even well-meaning pain patients can become desperate. Their switch to heroin makes it easier and cheaper to get their drug of choice from street dealers.
This transition from opiate pills to heroin brings with it needles, burnt spoons, and related drug paraphernalia, which often get left in the restrooms of public businesses. The overdose deaths of two heroin users, both in February 2017, at the San Francisco Public Library Civic Center branch and the downtown branch of the Denver Public Library, has forced library officials to consider providing “Narcan” training to its employees. Narcan® is the trade name for Naloxone, an opiate antagonist, which can be administered by people with no medical training, either through one or two pumps into the patient’s nostrils or via a spring-needle injection into the leg muscle. The results from Narcan are immediate and often bring heroin or opiate addicts who were near death back to life. The city of Baltimore, MD, Public Health Department even offers a free online training course for all citizens who want to learn how to give Narcan.
Why heroin users choose public restrooms in city and county buildings, libraries, restaurants, malls, and retail stores remains puzzling. Addicts with substantial habits—typically 1 gram a day—means they need to inject themselves about four times per day, about once every 6 hours, every day. Since many addicts shoplift to support their habits, it’s not surprising they may use the same stores they steal from to take their drugs.
Employees can encounter opiate and heroin users at either end of a spectrum, from withdrawal to near-overdose, in what’s known as “opiate narcosis” or “being on the nod.” Heroin addicts in the withdrawal stage are highly agitated and even dangerous as they seek their drugs or the money to get them. Physical symptoms that a public-contact employee might see include anxiety, anger, jittery movements, rapid speech, sweating, runny nose, or vomiting. Conversely, heroin addicts who have used the drug to near-overdose levels will be “asleep on their feet,” scratching, sniffing, with hooded eyelids, and pin-dot pupils. The first concern is for the safety of all employees who encounter these people. The second concern is a medical one, where the employees should directly ask the person if he or she needs an ambulance, before he or she slips into unconsciousness.
With deaths by opiate overdose rising in nearly every city in the United States, and the prevalence of heroin as a substitute for prescription pain pills, security directors and managers of public facilities should discuss the value of providing Narcan training to their employees, on a voluntary basis. These sessions can help employees save the life of an overdose patient before the arrival of paramedics. More and more city and county public health departments are providing this training, seeing it less as a moral or legal debate and more about just saving the lives of an already high-risk population.