Harm Reduction: Public Toilets (Podcast)

I live on 103rd Street in East Harlem, near the 6 train subway station. It’s become part of my commute while I wait on the platform to notice and sometimes even count the syringes that cover the tracks, the orange caps standing out against the gray and brown, like sprinkles on a really gross sundae. According to a data brief by the New York City Health Department, “Bronx and Harlem neighborhoods have [the] highest rates of overdose death.” On my podcast today, I’ll be talking about an area of harm reduction that is often misunderstood and forgotten: public restrooms.

One of the reasons why there are so few public bathrooms available in New York City is because people believe it deters drug use. However, in reality, the lack of public bathrooms only further endangers people who use drugs. Instead of closing or changing bathrooms to deter drug use, we should embrace and improve public restrooms as a form of harm reduction for people who use drugs.

It’s disappointing how little has been done to address the lack of public restrooms. In my opinion, there should be a legally required number of public restrooms per/neighborhood, and those bathrooms should be built and operated to help protect people who have substance use disorder.

According to a proposal from 2020 that was created by members of Urban Design Forum’s Shelter For All fellowship, there are only two public bathrooms open 24/7 in the entire city: one at Penn Station and the other at Port Authority Bus Terminal.

That’s two bathrooms in a city of around 8 million people.

And city officials have done very little to remedy this public health crisis. An article in The City said that former Mayor Bloomberg formed a partnership with a company that is now owned by JC Decaux to add 20 automatic public toilets throughout NYC. The partnership ends in 3 years and only five of those toilets have been installed since the agreement was made in 2006.

Reports suggest that bathrooms are one of the most commonly used locations to inject in NYC.

Once the bathrooms become inaccessible, people who inject drugs will turn to less safe options. A study from 2017 on drug use in NYC business bathrooms pointed out that compared to other public spaces, bathrooms are typically “cleaned regularly, provide running water for drug preparation and hand washing, adequate lighting, flat surfaces, have locking doors for privacy, and are frequented regularly by staff and customers who can contact emergency services in the event of an overdose.”

Since some places can’t close their restrooms, they’ll try other methods to deter drug use that are often dangerous not only for people who use drugs but for anyone using the bathroom. For example, some have put lubricant on flat surfaces which is ultimately unhygienic. Another dangerous method that’s been used is adding blue lights to make it harder for people to see their veins. For people who inject drugs, this puts them at greater risk for injury and infection. For other people using the bathroom, it means that it’ll be harder for them to see health indicators like changes in skin tone, or even the color of their pee.

Instead, bathrooms should be embraced as a method of harm reduction by employing bathroom attendants who are trained in Opioid Overdose Prevention and have access to Narcan, adding sharps disposal containers that are regularly emptied, and displaying the Never Use Alone hotline.

Oftentimes, people will overlook the topic of public bathrooms and dismiss it as unimportant or treat it like a joke. It’s essential that we prioritize making bathrooms accessible and safe for everyone, especially for the vulnerable members of our community like people who have substance use disorder.