Drug Consumption Rooms
In this blog, Tony Mullaney, Hep C U Later’s High Intensity Engagement Coordinator, explores the innovative, but possibly controversial world of Drug Consumption Rooms.
There are over 100 Drug Consumption Rooms (DCRs) in 17 countries across the world.
Overdose prevention rooms, safer injecting sites and Drug Consumption Rooms are several names given to these spaces but they all have similar aims: to limit the harm from taking illicit drugs, reduce the increasing trend in drug related deaths, and to take the intravenous use of illicit drugs out of the public eye.
There are 2 types of facility that allow the consumption of drugs on the premises:
- One type is a service where the prescribing and self-administration of Diamorphine is delivered, only accessible to those who are actively in treatment. This in essence is a drug treatment service intervention, rather than a DCR.
- The other form of DCRs are the more common open access spaces where people are free to use their drugs in a professionally monitored environment.
I had a great opportunity to attend a session at INHSU 2023 involving a tour of Geneva’s DCR. The DCR has been in operation since 2001, is open to people aged 18 and over, and is a place for people to use drugs in a safer way.
Free sterile injecting equipment is available to everyone who attends the DCR, with individual areas for a person to inject their drugs in, minimising the risk of onward transmission of blood borne viruses (BBVs). Injecting advice is on hand from the staff team, which includes nurses and a doctor. Diamorphine and other forms of substitute prescribing are not available at the DCR but can be provided by local clinics.
In this DCR heroin and cocaine is allowed to be injected, however, crack is no longer allowed to be smoked on the premises. When a person enters the centre they must show staff the substances they will use, they are issued sterile equipment and given their own area in which to use drugs. No drugs are allowed to be sold or shared inside the DCR.
When the question of opioid overdose was raised, the staff informed us that they experience on average one overdose per week but have never experienced a fatality. All the staff at the DCR are overdose and CPR trained, Naloxone is not administered by staff but they have access to oxygen which is used while awaiting the paramedic’s arrival which is always prompt.
Hepatitis C and other BBV testing is available on site for people who request it and referrals for treatment can be made by staff. GPs are also on-site for wound care and other primary care needs alongside a social work team for wrap around support. Access to housing support is available plus there is limited space available on-site for people who need to be housed overnight.
Closer to home:
The go ahead has been given for the UK’s first DCR based in Glasgow, Scotland, expected to be launched in 2024. This has been agreed in response to the high numbers of people who inject drugs on the streets of Glasgow, rising drug related deaths and the transmission of HIV and Hepatitis C amongst Glasgow’s community of people who inject drugs. A report on the proposed DCR was completed by officials from the NHS and Glasgow City Council stated it aimed to meet the needs of approximately 400-500 people inject drugs in Glasgow city centre on a regular basis.
Several other countries in Europe and further afield have DCRs in operation. Europe has the highest concentration of DCRs but notably Canada has 39 currently in operation in response to the opioid drug related death crisis. Australia has 2 DCRs, one in Sydney and one in Melbourne.
France:
France which has 2 DCR’s, one in Paris and another in Strasbourg, with another centre planned for Bordeaux. The French Drug Consumption Rooms offer a safe space for 12 people who inject drugs and 4 spaces for people who smoke. The service offers in-house testing for Blood Borne viruses and have safe storage for anti-viral medication for people who are affected by homelessness and wish to keep their medication safe.
Holland:
Holland has 25 DCRs, the first one opening in 1994. Holland led the way in regards to liberal attitudes towards drug use, allowing large amounts of flexibility to reduce harm.
Portugal:
Portugal is well known for its decision to decriminalise drug possession and invest in rehabilitation and healthcare instead of the criminal justice system. Though the policy towards drugs changed in 2001 Portugal did not see its first DCR until 2019 when it launched the MDCR (Mobile Drug Consumption Room) which has served two boroughs of the city of Lisbon for the past 4 years. In 2021 a centre was opened in Lisbon which is attended by between 160 and 300 people who use drugs and the centre is staffed by doctors, nurses and psychologists.
The Number of Drug Consumption Rooms in Europe |
|
| Country | Number of DCRs |
| Belgium | 2 |
| Denmark | 4 |
| Germany | 26 |
| France | 2 |
| Greece | 1 |
| Luxemburg | 1 |
| Holland | 25 |
| Portugal | 3 |
| Spain | 16 |
| Iceland | 1 |
| Ukraine | 1 |
The possible benefits of Drug Consumption Rooms:
- Reduction in overdose risk as people are not using alone, emergency services and interventions can be provided promptly
- People can connect with social support and advice from staff and peers
- The option to be referred into drug treatment services is provided
- Reduction of drug use in public spaces as well as a reduction of discarded equipment
- Access to sterile injecting equipment and spaces, reducing the risk of onward transmission of BBVs such as Hepatitis C and HIV
- Reducing the pressure on emergency services
- Gaining knowledge on reducing risks related to the use of drugs
- Increased access to healthcare such as wound care interventions
- Increased access to other wrap-around interventions that might reduce harm such as housing, counselling and benefits advice
The possible objections to Drug Consumption Rooms:
- The cost of running a DCR
- Public opinion/concerns around the perception of supporting the use of drugs
- Fear around an increase in antisocial behaviour
Summary
In conclusion, Drug Consumption Rooms, though controversial and posing questions for many, have proven to be a successful harm reduction tool internationally, although we currently have no Drug Consumption Rooms in England. This leads us to question if DCRs are another step which can support the hepatitis C elimination goals through providing BBV prevention, testing and treatment, whilst reducing health inequalities, something we are committed to tackling as a team alongside our focus on hepatitis C.
We live in a changing landscape in regard to drug treatment investment with a shift back to a harm reduction focus, evident in pilots of HAT (Heroin Assisted Treatment) that have taken place, blood borne virus elimination projects, and additional public health funding for homeless outreach services. Taking these factors into account, there may be a change in policy regarding DCRs and we may see one in the near future.