Pubdate: Mon, 07 Mar 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Katharine Q. Seelye

USE OF HEROIN IN PUBLIC VIEW ACROSS THE U.S.

CAMBRIDGE, Mass. - In Philadelphia last spring, a man riding a city 
bus at rush hour injected heroin into his hand, in full view of other 
passengers, including one who captured the scene on video.

In Cincinnati, a woman died in January after she and her husband 
overdosed in their baby's room at Cincinnati Children's Hospital 
Medical Center. The husband was found unconscious with a gun in his 
pocket, a syringe in his arm and needles strewn around the sink.

Here in Cambridge a few years ago, after several people overdosed in 
the bathrooms of a historic church, church officials reluctantly 
closed the bathrooms to the public.

"We weren't medically equipped or educated to handle overdoses, and 
we were desperately afraid we were going to have something happen 
that was way out of our reach," said the Rev. Joseph O. Robinson, 
rector of the church, Christ Church Cambridge.

With heroin cheap and widely available on city streets throughout the 
country, users are making their buys and shooting up as soon as they 
can, often in public places. Police officers are routinely finding 
drug users - unconscious or dead - in cars, in the bathrooms of 
fast-food restaurants, on mass transit and in parks, hospitals and libraries.

The visibility of drug users may be partly attributed to the nature 
of the epidemic, which has grown largely out of dependence on legal 
opioid painkillers and has spread to white, urban, suburban and rural areas.

Nationally, 125 people a day die from overdosing on heroin and 
painkillers, and many more are revived, brought back from the brink 
of death - often in full public view. The police in Upper Darby, Pa., 
have even posted a video of another man shooting heroin on a public 
bus, and then being revived by Narcan, which reverses the effects of 
a heroin overdose, to demonstrate the drug's effectiveness.

Some addicts even seek out towns where emergency medical workers 
carry Narcan, "knowing if they do overdose, there's a good likelihood 
that when police respond, they'll be able to administer Narcan," said 
Special Agent Timothy Desmond, a spokesman for the New England region 
of the Drug Enforcement Administration.

In Linthicum, Md., Brian Knighton, a wrestler known as Axl Rotten in 
Extreme Championship Wrestling, died last month after overdosing in a 
McDonald's bathroom.

In Cincinnati in 2014, an Indiana couple overdosed on heroin at a 
McDonald's, collapsing in front of their children in the restaurant's 
play area.

In Niagara Falls, N.Y., a man was accused in October of leaving a 
5-year-old boy unattended in a Dairy Queen while he went to the 
bathroom; he was later found on the floor with a syringe in his arm.

In Johnstown, Pa., a man overdosed on heroin on Feb. 19 in a bathroom 
at the Cambria County Library.

"Users need the fix as quickly as they can get it," said Edward James 
Walsh, chief of police in Taunton, Mass., a city 40 miles south of 
here that has been plagued with heroin overdoses in recent years. 
"The physical and psychological need is so great for an addict that 
they will use it at the earliest opportunity."

That reality has taxed law enforcement and city services across the 
country, and has stretched the tolerance of businesses that allow 
unfettered access to their bathrooms. Legal liability is an increasing worry.

"Overdosing has become an issue of great societal concern," said 
Martin W. Healy, chief legal counsel for the Massachusetts Bar 
Association. "I'm not aware of any seminal cases so far, but this is 
likely to be a developing area of the law."

After shooting up in public places, people often leave behind dirty 
needles, posing a health hazard. In response, some groups have called 
for supervised injection facilities, like those in Canada and Europe, 
where people can inject themselves under medical supervision. The 
goal is to keep them from overdosing and to curb infectious diseases. 
Such facilities are illegal in this country, although the mayor of 
Ithaca, N.Y., recently suggested opening one.

In Boston, where pedestrians step over drug users who are nodding off 
on a stretch of Massachusetts Avenue known as Methadone Mile, an 
organization for the homeless has planned what it calls a safe space, 
where users could ride out their high under supervision; it would not 
allow actual injection on site.

New England has been a cradle of the heroin epidemic. Middlesex 
County, which encompasses Cambridge, a city of 107,000 just west of 
Boston, has the highest number of overdose deaths from heroin and 
prescription pain pills in Massachusetts. From 2000 to 2014, 
Middlesex, which also includes the city of Lowell, a major heroin 
hotbed, had 1,634 opioid deaths.

No one keeps track of how many deaths occur in public spaces, but law 
enforcement officials agree the number is high.

"We quite frequently see folks using public areas," said Robert C. 
Haas, the Cambridge police commissioner.

It was the fear of someone dying in their bathrooms that led 
officials at Christ Church Cambridge to close public access to them 
in 2012. By doing so, the church did not experience the kind of 
tragic scenes that are occurring around the country, but the decision 
was difficult.

The church, which opened in 1761 and has a long history of social 
activism, had kept the bathrooms open to accommodate the homeless 
people around Harvard Square. But addicts were also using them. 
Closing them after decades of serving the public represented "a 
retreat from our ministry," Mr. Robinson said. But in consultation 
with the Cambridge police, the church reluctantly concluded that 
leaving the bathrooms open only enabled drug users.

Because there were no free-standing public toilets in Harvard Square, 
a popular shopping, culture and dining destination that is visited by 
eight million tourists a year, the absence of the church bathrooms 
was felt right away.

"Almost immediately, we began receiving calls saying, basically, 
'What the hell just happened?' " said Denise Jillson, executive 
director of the Harvard Square Business Association. "They were 
saying, 'Our doorways and alleyways have become public urinals, and 
people are defecating everywhere.' "

After a campaign by business owners and local activists for a public 
toilet - which included stickers that read "I Love Toilets" and 
"Where Would Jesus Go?" - the City of Cambridge spent $400,000 to buy 
and install Harvard Square's first free-standing public toilet. It 
was unveiled on Feb. 12. Free to use and open 24 hours a day, it sits 
in a kiosk on a busy traffic island between the stately brick 
buildings of Harvard Yard and the weathered headstones in the Old 
Burying Ground, which dates to 1635.

The kiosk, called the Portland Loo and made in Oregon, was designed 
specifically to discourage drug use. It has slanted slats at the 
bottom that allow the police - or anyone - to peer in and see if 
someone has passed out on the concrete floor. It has no heat, air 
conditioning or noise insulation, all meant to foil anyone from 
getting too comfortable inside. The hand-washing faucet is outside, 
and an attendant cleans four times a day.

The outcome pleased Mr. Robinson, who said the anguishing decision to 
close the church bathrooms had "led to a broader response to the 
needs of the homeless in our neighborhood."

While the new toilet may improve life for some in Harvard Square, 
many restaurants, parking lots and other public spaces here and 
elsewhere remain potential sites for drug activity.

"Until we get a handle on the drug problem," said Capt. Timothy 
Crowley of the Lowell Police Department, "I think this is an issue 
we'll be dealing with for a long time."
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MAP posted-by: Jay Bergstrom