On the 11th September 2023, it was reported that Scotland’s Lord Advocate, the countries chief law officer who sets the legal tone for the nation, said it would not be in the public interest to prosecute users of drug consumption rooms for simple possession offences. Fast forward just a few weeks, and the establishment a drug consumption room in Glasgow, the first (legally sanctioned) in the UK, has been approved to go ahead. This is a pivotal moment in UK drug policy.
Drug consumption rooms (DCRs), Overdose Prevention Centres, or however you like to term them, provide a space where people can consume their substances under the supervision of trained individuals. Most notably, such consumption of substances tends to be via injecting, but some facilities also allow for the inhalation of drugs too. The type of drugs being used depends on what the trends are for that location. If an overdose was to occur, under current evidence, this will be reversed, and the person’s life will be saved.
Many still may ask why such facilities should be implemented in the UK. The body of evidence for their effectiveness in line with their aim and objectives, is comprehensive. It is important to note that we continue to see people in our towns and cities consume substances in highly risky environments, including on the streets and in alleyways. DCRs not only allow for those disenfranchised by current treatment systems, to engage with services, but also shows them that they are cared about, diminish the feeling of being abandoned by society and provides them with a level of dignity and respect that they may not have experienced in a long time. They also improve the local community where public drug use may be an issue, as well as improve residents’ experience of accessing their public amenities by not witnessing people injecting drugs on their local streets and noticing a potential, significant reduction, in discarded paraphernalia left behind. It is also important to highlight that such facilities are often accessed by those that are also already accessing other forms of treatment or have never engaged with services previously.
Image: Discarded paraphernalia behind a house in a well known ‘public drug use’ spot in one of Wales’ cities.
The concept and idea of their implementation within the UK drug treatment framework has often polarised opinion and continues to do so. Even within the last few days, Minister for Policing, Chris Philp, suggested that DCRs ‘encourage drug use’, a statement founded on pure belief. Evidence overwhelmingly contradicts such claims. Overall, the public is often overwhelming supportive of introducing enhanced harm reduction initiatives, such as DCRs, something we discovered when we ran a public survey in 2017. From the two hundred and sixty-eight (268) responses, 98% supported the establishment of a DCRs in their area, with many believing it would help promote access to social, health and drug treatment services, as well as reducing drug-related mortality. Of those that responded, over 80% were impacted directly by drug use within their local area / area of residence. One issue that does tend to be experienced by those fighting for such spaces is the NIMBY effect, ‘Not In My Back Yard’. We often hear people provide support for such facilities, but don’t want it near them and their home. While many will resonate with this, DCRs tend to be implemented in areas where there is already a significant amount of public drug use taking place.
But more evidence is required than just the amount of public drug use in certain locations, to provide a strong argument to change hearts and minds about the need for DCRs. Scotland, unfortunately, has this in relation to its drug-related-death figures, often reported as the highest rate in Europe, as well as HIV cases among people who use drugs. This, I am sure, is backed up by a body of other evidence to formulate a compelling, and now successful, case to establish the UK’s first such facility. But where does this leave Wales?
In short, it leaves us lagging behind the evidence and practice. We do have some excellent harm reduction interventions in place in Wales, from Spike on a Bike and national naloxone programmes, some rarely seen elsewhere across the world, while continuing to deliver basic interventions such as needle and syringe programmes (NSP). It is with the latter that I often struggle with, in the form of what happens next. Under current policies, it seems that we should happily relinquish any form of duty of care to an individual, once that transaction, and interaction, has ended in an NSP, regardless of where and when that person decides to utilise the clean and sterile equipment. It has never sat right with me that we can offer effective harm reduction interventions, up to a certain point. While 82.5% of drug related deaths in Wales occurred in the private residence of the individual, this highlights that not only would a DCR need to make itself a ‘desirable’ location for someone to move away from the comforts of their own home to use substances, but also that a DCR could potentially have saved all those lives, especially if they were alone at the tragic moment of taking their last breath. Something that has been reiterated many times by family members who have lost loved ones to a fatal drug poisoning.
Currently, there are already sixteen countries across the world that support the facilitation of DCRs within its drug treatment framework and implementation, with over a hundred DCRs currently in operation. From the first in Berne, Switzerland in 1986 to the latest in Manhattan, NYC in 2021, you can soon add Scotland to that list. I firmly believe Wales will not be far behind, but we do need to get our house in order, to an extent. As part of the National Enhanced Harm Reduction Centre’s steering group, and as its former chair, we submitted Freedom of Information (FOI) requests to all local authorities across Wales regarding data relating to public drug use. It was hoped that such data could be used accordingly with other publicly available data, to help formulate a business case for the need of a DCR. The evidence was damning. It was damning in the sense that the recording and reporting of such data, from discarded paraphernalia and drug litter to incidents of public drug use, was so varied from one local authority to another. For example, one such area, upon response to the FOI, stated “The Authority can confirm that it does not record any information regarding the removal of discarded needles or drug related issues as outlined in the request, therefore, no recorded information is held”. And there were other areas who’s recording was either non-existent or poor. While other data, such as drug-related-deaths, is required to build a business case, the significant gap in such information is a concern. We can, quite rightly point to the fact that DCRs save lives and can help reduce other associated issues, such as behaviour that can increase the risk of infections, based on existing facilities outside of Wales. But the fact of the matter is, we need to ‘prove’ the current issues and how DCRs can be part of the process to alleviate these, in Wales. This, for me, is where we need to get our own house in order.
Back in 2017, the now defunct Advisory Panel on Substance Misuse (APOSM), at the time chaired by Barod’s CEO, Caroline Phipps, submitted a report to the then Cabinet Secretary for Health in Welsh Government, outlining the numerous benefits of what a DCR would bring to areas with high rates of illicit public drug use. The report recommended the development and completion of a feasibility study, to help inform decisions about possible implementation, as well as “provide a description of the criteria for running and assessing the results of a pilot implementation”. Six years later and not for the lack of trying, this report continues to not be formally discussed and such recommendations unfulfilled. Specification of a feasibility study is ready and waiting to be utilised.
Image: Ragazza e.V. consumption room in Hamburg, Germany. This facilities is a multi-disciplinary, low-threshold and acceptance-orientated service that is available to female sex workers who use substances.
There are new threats on the horizon, that may or may not come to fruition. There is a significant concern within the substance use field that synthetic opioids, such as Nitazenes, will become more common within our illicit opioid market, especially considering the current ban on opium production in Afghanistan, the main source of the UK’s heroin supply. The potential unintentional consumption of such toxic and lethal substances could escalate an already significant public health issue. We have seen the impact that such substances, like fentanyl, can have on people, families, and societies in North America, and we need to act quickly to ensure we don’t see a similar fate in Wales or across the UK.
One mitigating factor could be the implementation of DCRs, in combination with established treatment services and other ‘new’ initiatives, such as community-based drug checking. However, concerns and questions remain regarding how such facilities would be funded. There is also a worry that, given the Welsh Government is led by Welsh Labour, their rhetoric regarding drug policy may continue to align with UK Labour. Kier Starmer recently said that, if he was to end up in Number 10, he would have “no intention” of changing the UK’s drug laws and wouldn’t consider policy reform.
However, recent developments in Scotland potentially sets the scene for the fall of the house of cards, in current UK drug policy. Especially as the UK Government outlined it would not intervene in Scotland going ahead with the UK’s first DCR, something that may seem a bit out of place given their stances on other initiatives outlined by devolved governments previously. In Wales, it is now up to those who have the responsibility, the position, the might, and the will, to fight on behalf of those who society has so often failed. People continue to die from preventable drug related overdoses across Wales. Families continue to be heartbroken by the loss of loved one’s. It is up to us to gather that evidence and convince policy makers that what is happening in Scotland should be followed up in Wales once again. As for the Wales’ national Enhanced Harm Reduction Centre’s steering group, it may be time to get the band back together.
Rob Barker is the campaigns and communications lead for Barod. Rob previously undertook a Churchill Fellowship in 2017 researching the policies and procedures of establishing a drug consumption room. This research took Rob across North America and Europe. Twitter: @RobBarkerW