ROBERT SIEGEL, HOST:
A public restroom is one of the few places where a drug user can find privacy. And that has meant businesses and communities are confronting the country's opioid crisis in an unexpected way. People who use drugs and sometimes overdose have been found in the restrooms of fast food restaurants, city buildings, even hospitals. WBUR's Martha Bebinger brings us this story which begins on Mass. Ave in Cambridge, Mass.
EDDIE: So we're going to go check out the place we talked about. It's this way.
MARTHA BEBINGER, BYLINE: A man named Eddie guides me through the mid-afternoon crowd toward a sandwich shop. We stop in front of big glass windows.
EDDIE: With these bathrooms here, you don't need a key. You just - if it's vacant, you go in. And then the staff just leaves you alone. I know so many people that get high here.
BEBINGER: At the fast food restaurant right across the street, it's much harder to get in.
EDDIE: You don't need a key, but they have a security guy that sits at the little table by the door directly from the bathroom.
BEBINGER: Some guards require a receipt for admission to the bathrooms, Eddie says, but you can grab one from the trash. Eddie, who's 39 and homeless, works in a restaurant himself. We're only using his first name because he's admitting to illegal drug use. Our next stop - a national restaurant chain.
EDDIE: You have to get the code to use their bathroom, but if you go in there and sit on that side by the bathroom, if you wait long enough, someone's going to use that bathroom. And then you'll say hey, hold the door for me. And then you're in.
BEBINGER: So you know which bathrooms you can...
EDDIE: I do. I do. I know all the bathrooms that I can and can't get high in. Even in the train station downstairs, you can use that bathroom most days and not be bothered. So...
BEBINGER: But that's not good in some ways, right?
EDDIE: It's not good at all. Who's keeping an eye on them? That's why you have to have somebody with you to make sure that you don't overdose. It's unfortunate that it's come to that, but that's the way it is.
BEBINGER: You can understand why the restaurants might be freaked out about this, right?
EDDIE: Absolutely. I mean, these businesses primarily are like family businesses, they don't expect to find somebody dead. So I get it.
BEBINGER: At one of those family businesses, the 1369 Coffee House, Joshua Gerber and his staff have found several people on the bathroom floor not breathing.
JOSHUA GERBER: And it's very scary, you know?
BEBINGER: Gerber has installed key codes on bathroom doors and metal boxes for needles, so users don't flush them and clog pipes.
GERBER: In an ideal world, users would have safe places to go that it didn't become the job of a business to make sure that they were OK.
BEBINGER: Gerber is taking the unusual step of training his baristas to use naloxone, the drug that reverses most opioid overdoses. He sent a training invitation to all employees. And within 10 minutes, he had about 25 replies.
GERBER: Mostly capital yes, I'll be there for sure, just thrilled to figure out how they might be able to save a life.
BEBINGER: Naloxone has become standard equipment for security guards at many Boston hospitals. At Massachusetts General Hospital, emergency room physician Dr. Ali Raja realized bathrooms had become a magnet for drug users.
ALI RAJA: There is an understanding that if you overdose in and around a hospital that you're much more likely to be able to be treated. And so we're finding patients in our restrooms. We're finding patients in our lobbies.
BEBINGER: Speed is critical, especially now when heroin is routinely mixed with fentanyl which is even more potent. Some clinics and restaurants knock on bathroom doors after five or 10 minutes. One clinic has installed an intercom and requires people to respond. Another designed a reverse motion detector that sets off an alarm when there's no movement in the bathroom. But Boston Medical Center's Dr. Alex Walley says no one wants to talk about their strategies in public.
ALEX WALLEY: It's against federal and state law to provide a space where people can use knowingly, so that is a big deterrent from people talking about this problem.
BEBINGER: As more libraries, city halls and businesses close their bathrooms to the public, drug users are moving to parks and city streets. But keeping bathrooms open by stocking naloxone and monitoring who goes in and for how long is a challenge for many businesses. For NPR News, I'm Martha Bebinger in Boston.
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SIEGEL: And that story is part of a reporting partnership of NPR, WBUR and Kaiser Health News.
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