Should we really be so worried about proposed “fix rooms” for Scottish drug addicts?

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Credit:Patrick Kovarik, Pool via AP

Hannah Donnelly
Writer

Glasgow is a city littered with leaves and blinking lights; walls crawling with street art. Here, life brews in every nook and forces its way through every crack and crevice in the pavements. Scattered throughout these streets, beneath the lights and sirens, are jagged points of discarded needles, left from users of heroin, morphine and other drugs. An estimated 500 people inject drugs on Glasgow streets, leaving over 2,400 needles on the pavement each year. An addiction that, under a new proposal, could see Glasgow join the handful of countries that provide government and church funded spaces for people to consume illicit substances, out of public view and under medical watch.

Consumption rooms are a controversial response to the escalating drug use throughout the city. The number of deaths from drug use has spiraled to record levels. In 2014, 613 drug-related deaths were registered, a 16% increase from the previous year, an increase of 46% from 2006, when 421 deaths were recorded, and more than double that of 2000. Heroine and morphine were linked to over half of these deaths, an increase of 40%, the highest spike since 2009. Last month, members of the Glasgow City Integration Joint Board, Health Board, City Council and Police Scotland approved plans for a safe drug consumption facility and heroin-assisted treatment in the centre of Glasgow. Under this proposal, the facility would provide a place for people with existing addictions to inject their drugs, with means for the supervised inhalation of drugs and, in some cases, the provision of medical-grade heroin. The facility will also provide additional services including health care, counseling, housing and welfare advice. The proposal has been approved, however the details concerning cost, locations and conditions of how the clinics would operate are still undecided.

Although the facility would be the first of its kind in the UK, similar services have already been implemented in more than 8 countries around the world. Countries such as Switzerland, the Netherlands, Canada, Australia and Germany, have been operating similar consumption rooms with a range of different regulations and services. In 1968 Switzerland opened an officially sanctioned drug consumption room. Health workers opened cafes that provided access to healthcare information and options to seek treatment after they noticed cafes and bars were rejecting drug-users, forcing them into the streets. When the cafes were recognised as a place to take drugs, rather than banning the practice, authorities legalised them as a means to monitor and provide users with clean environments. These facilities provide health and social care, including showers, clothing, cafeterias, and areas to inject, smoke and sniff drugs. They are subject to strict regulations that do not permit drug-dealing or alcohol consumption. Further, to access the rooms, people must be aged over 18 and have official drug dependency documentation, as casual users are not permitted.

Canada has a similar facility in Vancouver; it’s the only consumption room in North America and operates under exemption from the country’s drug laws. The facility, surrounded by controversy, was almost shut down in 2008, until the Canadian Supreme Court unanimously overruled the Minister for Health in favour of retaining the rooms. Users at the Vancouver facility are anonymous and do not have to meet any admission requirements: users can also elect to participate in research projects. Services include 12 injection rooms, equipped with syringes, cookers and tourniquets, and spaces dedicated to those who wish to detox before pursuing long-term rehabilitation. In 2010, it saw 458 admissions to rehabilitation programs that achieved 43% completion rates, as well as 221 overdose interventions, which avoided fatalities. On the other hand, drug consumption rooms in the Netherlands were run by a church-operated welfare institution in 1990, and not legally established until 1996. In 2010, consumption rooms operated throughout 25 cities, totaling 37 facilities, equipped with varying social and medical services.

Each facility requires people to acquire their drugs before their arrival and to sign contracts consenting to the “house rules”. These rules limit the time that can be spent in the areas, which are divided into specific “injecting” and “smoking” sections. After the clinic’s opening, only 4% of new diagnoses of HIV and other transmitted diseases were from unhygienic practices. Surveys also showed an 80% acceptance rate of the facility by neighbors of the facility and associated social and health workers. Australia only has one consumption room in Sydney, which is operated by a non-government Christian organization. It provides injections rooms with medical help in case of overdose and offers housing, welfare and legal services. However, the facility has strict regulations – it requires users to be over 18, not be intoxicated upon arrival, and not be accompanied by a child or be pregnant.

To access the rooms, people must be assessed on arrival, they must already have a drug dependency and have their personal information and medical history taken, which includes treatment and overdose history. Users are observed in aftercare rooms and are not immediately allowed to return to injection rooms. The Alcohol and Drug Foundation stated that in 2011 the facility recorded over 9,500 referrals to welfare services and 400 drug overdoses without a single fatality, as well as a 50% decrease in the amount of discarded needles on the streets .Despite Germany having consumption rooms in both Hamburg and Frankfurt before they were legalised in 2000, there are now 26 facilities that now operate throughout the country and enforce strict regulations. People who are undergoing replacement therapy, who are intoxicated or are new injectors are not permitted to use the rooms or services. Germany’s clinics include clean equipment for injections, such as syringes, and information on how to safely consume, as well as free sex protection and affordable meals, showers and laundry services. Germany consumption rooms also host on-site counseling services, which actively aim to refer users to rehabilitation programs. A study conducted in Hamburg reported 37% of users adopted more hygienic consumption habits and 30% of users claimed to be consuming less in public.

Because of the varying availability and services provided by consumption rooms, forming an accurate picture of their effects is difficult. Data collected is heavily shaped by the locality, in terms of public perception of drug use, prominence of drug use and previous approaches to managing drug use. Regardless, a common thread ties the facilities together. According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), “consumption rooms are protected places for the hygienic consumption of pre-obtained drugs in a non-judgemental environment and under the supervision of trained staff… The aim of consumption rooms is to reach and address the problems of specific, high-risk populations of drug users, especially injectors and those who consume in public.

These groups have important health care needs that are often not met by other services and pose problems for local communities that have not been solved through other responses”. They have also said that consumption rooms primarily try to reduce drug use-related health risks, such as the transmission of infectious diseases and overdose-related deaths. They also aim to protect, public health and safety by reducing concerns that arise from open drug scenes. The EMCDDA found that drug consumption facilities successfully “reach and maintain contact with high-risk drug users who are not ready or willing to quit drug use.” Although long term impacts on the general public are still unclear, consumptions rooms have reduced high-risk behaviours such as syringe sharing and the transmission of HIV and other diseases. They have also reduced emergency callouts for drug related incidents by up to 80% in Australia, and increased the use of long-term rehabilitation programs.

However, public attitudes towards the rooms are even less unclear. In Denmark, members of the public were concerned about the opening of a facility across the road from a high school. Despite the increased use of the rooms in countries such as The Netherlands and Germany, others see them as enabling people with drug dependencies to harm themselves more easily. What Glasgow’s consumption room will look like and what people will think of it is yet to be seen, despite the fact that it will be located in the city center.

The concept and practice of consumption rooms are a relatively new and controversy-riddled approach to drug addiction that is met with a range of responses depending on personal experiences and backgrounds. They have been described as the end of drug addictions, a dangerous normalising of drugs, recognition that drugs cannot be arrested out of major cities or, at the very least, a way to make the very desperate, a little less desperate. Regardless of opinion, the opening of drug consumption rooms has gained momentum and started overcoming political barriers in recent years, and with more injection rooms leaving their marks in major cities, the impact they will have in Glasgow is yet to be seen.