Supervised Drug Consumption Room Debate: Saving lives, improving policing and communities
“Insite (Drug Consumption Room) has saved lives, prevented infections, promoted and facilitated addictions treatment, and saved public dollars.”
Canadian Journal of Infectious Diseases and Medical Microbiology
Ahead of the debate on Supervised Drug Consumption Rooms in the Scottish Parliament today at 2:30pm (19/04/18), we have prepared a briefing on the subject to make Parliamentarians and the public aware of the subject.
As with all drug treatment facilities, there can be local opposition to Supervised Drug Consumption Rooms, but when placed in a location with an existing visible problem, experience shows communities and businesses soon support them as street use, and drug litter, fall. The most recent Government response to the ACMD’s call for DCRs does not dispute that they save lives, reduce disease transmission, and are cost-effective. Instead it focuses on challenges around policing, and the law. However these have been successfully overcome in every country that has them. So the only real barrier is political. But with cross-party support growing, including unanimous support in Glasgow City Council, it is surely only a matter of time before the first DCR in the UK opens.
What is a Supervised Drug Consumption Room (DCR)?
Supervised drug consumption rooms (or supervised injection facilities, enhanced harm reduction centres) are legally sanctioned facilities where people can inject their own pre-obtained drugs, under medical supervision. Some also allow drugs to be smoked. They can be in permanent clinics, mobile ambulance style units or temporary structures. They typically provide: sterile injecting equipment; a hygienic space to use illicit drugs under medical supervision; primary medical care, and emergency care in the event of overdose; a gateway to drug treatment, counselling, social and health-care services.
Are Supervised Drug Consumption Rooms Effective?
The extensive evidence supporting DCRs was reviewed by the Government’s official advisers, the Advisory Council on the Misuse of Drugs (ACMD), which backs them:
“Research on the effects of medically-supervised drug consumption clinics has shown that they reduce injecting risk behaviours and overdose fatalities (Potier et al., 2014). They have been estimated to save more money than they cost, due to the reductions in deaths and HIV infections that they produce (Andresen & Boyd, 2010; Bayoumi & Zaric, 2008; Pinkerton, 2010). Such facilities have not been found to increase injecting, drug use or local crime rates. In addition to preventing overdose deaths, they can provide other benefits, such as reductions in blood-borne viruses, improved access to primary care and more intensive forms of drug treatment. No deaths from overdose have ever occurred in such facilities (Potier et al., 2014; NHS Greater Glasgow and Clyde, 2016).”
Where are DCRs in operation?
Over 100 now operate in 66 cities, in 10 countries - Switzerland, Germany, the Netherlands, Norway, France, Luxembourg, Spain, Denmark, Australia and Canada. The Irish government will open one in Dublin in 2018. The number in Canada is growing rapidly, with several US cities also exploring this option.
Are there downsides?
Use is restricted to existing dependent users, and a review by the European Monitoring Centre for Drugs & Drug Addiction (EMCDDA) concluded:
“There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry, and do not result in higher rates of local drug-related crime.”
DCRs can require significant funds to set up and run, depending on what form they take, hours of operation etc. However, cost benefit analyses, including for NHS Glasgow (where there are 500 people street injecting), have shown they are good value for money, and engage hard to reach populations. Given the cost of treating diseases like hepatitis C and HIV, avoiding even small numbers of infections from needle sharing can mean a DCR pays for itself rapidly.
What serving police say about DCRs
Arfon Jones, North Wales Police and Crime Commissioner
"As an elected Police and Crime Commissioner I believe that one of my principle responsibilities is to provide an effective and efficient Police Force, and the protection of life is paramount in discharging my responsibilities. Drug Related Deaths are on the increase and evidence from around the world categorically show that Drug Consumption Rooms are an effective harm reduction measure and is a natural progression from needle exchange schemes which proved so effective reducing the incidences of blood borne virus diseases over the last two decades. It is the duty of government to protect its citizens and not to collude in their deaths through dogma and inaction."
Drug Policy Recommendation on DCRs from David Jamieson, West Midlands Police and Crime Commissioner
"Evidence suggests that potential clients for these facilities will not travel very far at all, so there is not a risk of attracting new drug users into areas where a problem already exists. DCRs can reduce encounters with the police and street disorder. They also increase the number of people accessing primary health care and drug treatment, especially among the hard to reach homeless populations most likely to be street injecting. No-one has ever died from an overdose in a DCR at any time, anywhere in the world, despite millions of injections and numerous overdoses occurring in them. A DCR could offer a new opportunity to engage the drug using homeless population in treatment, who would not have a GP or access to services through conventional means."
Chief Inspector Jason Kew (Thames Valley Police):
"I have sadly seen drug related deaths in each of my 23 years of Police service, with the fatality rate increasing each year. It is my duty and the Peelian principle to preserve life. I am fully supportive of a supervised injection facility to reduce harm to a vulnerable and hard to reach drug using community... Experience from Policing a DCR in Frankfurt and Hamburg is positive and Policing made easier due to concentrating drug users thus maximising opportunities to engage. In reality, drug use is occurring openly, the drug market size is like nothing I have seen before. Surely, the ethical and moral response is to empower a safety partnership to Pilot a DCR based on evidenced need and academically evaluate it. We are a learning and evolving society, together we will reduce the number of fatalities via a DCR with a suite of other harm reduction opportunities."
Detective Chief Superintendent Lars Küthe, Polizeipräsidium Frankfurt am Main
"As a liaison officer for drug help facilities in Frankfurt, it is my personal opinion that the DCRs are indispensable for the following reasons. The DCR with the associated help offers has reduced the number of deaths, minimized illnesses and reduced crime in the open drug scene. The city has become cleaner in the area of the open drug scene and by the syringe exchange also safer for the citizens."
Holger Alfer, Hamburg Polizeikommissariat
"From the perspective of the Hamburg Police the risks of DCR can be managed by good policing. Harm for drug users can be reduced. The number of drug related deaths can be reduced. The opportunities of a DCR allow the Hamburg Police to effectively and efficiently reduce dangers and enforce the law."
A more comprehensive solution
As groups like the Royal Society for Public Health argue, the UK approach to drugs needs a fundamental overhaul to put health and harm reduction not punishment and criminal justice at its heart. While DCRs would be an important, life-saving step, regulating drug supplies as well, so users know what they are taking, do not overdose, or fund criminals would be better. In fact, the Government supports heroin prescribing clinics for that reason. Which begs the question, if this is logical for heroin, what about other drugs?
For more information contact Martin Powell firstname.lastname@example.org 07875 679 301