Debates over "consumption rooms" in France

Prime Minister François Fillon recently has refused to consider the idea of opening drug consumption rooms in France against the advice of his Health Minister, Roselyne Bachelot.

There are debates in France about so called "supervised injections sites " or " drug consumption rooms " " injection rooms " or even "a clinic for assisted injections".  However, the French media refer to them as "shooting rooms". This semantic difference illustrates the gap between the fears of the people and the reality of medical practice.

 Roselyne Bachelot first floated the idea of “supervised consumption centers” in July, saying they would address “crucial sanitation issues.” Her announcement followed a report by the INSERM, the national health and medical research institute, which claimed that consumption rooms already installed in over 45 cities in 8 countries had proved their worth in terms of reducing drug-related crime, overdoses, infection and death.
Fillon’s declaration has dealt a severe blow to her hopes. His office issued a statement yesterday saying that he would not tolerate “shooting rooms”, claiming that they were “neither useful nor desirable. The Prime Minister’s priority is to reduce drug consumption, not to accompany or organize it.” Fillon immediately came under fire from his own supporters, including State Secretary for Families Nadine Morano, who argued that the debate needed to be opened up in order that all options designed to fight drug addiction be considered. She declared during an interview with radio station RTL that “When drug addicts are able to take their drugs under supervision and if we manage to get them off drugs, I think we will have won a battle.”
Drug consumption rooms exist in eight countries, Holland, Switzerland, Germany, Spain, Luxembourg, Norway, Australia and Canada. Between the late 1980s and early 2000s Germany, the Netherlands and Spain gradually developed a network of centers generally located in major cities. In 2004, there were totally 62 centers in four countries (EMCDDA, 2004) . In 2005 Norway set up the first supervised injection service in Oslo, followed the next year by Luxembourg.

These European experiences are different in their objectives (e.g. limiting the presence of users in the streets in Switzerland , to improve health conditions of injection drug users in Spain and Germany, strong support  of socially marginalized people in the Netherlands) and their conditions applied ( e.g. entry requirements in the centers, types of drugs allowed, administrative rules). The most of existing reports, however, allow making some reassuring answers to major questions arise about the consequences of the implementation of such practices while raising some doubts about their effectiveness.

• The positive aspects

+ No increase in drug use

The centers do not encourage drug taking by a population of non-users. The most users inject drugs several years before attending these centres. They usually have tried drug dependence treatment without much success several times. On the other hand the presence of qualified personnel (nurses, doctors) can reduce the frequency of overdoses and associated mortality. The decrease in current usage, however, has not been demonstrated.

+ Decrease in impact on public places without increasing crime around

The centers are mostly located in areas where there injecting drug use practice already existon the streets. By attracting users in these controlled spaces , the impact on neighborhoods is reduced. Several studies even show a decrease in drug user`s attendance in delinquency centers around after the introduction of drug consumption centres there.

+ Positive impact on injection practices

By providing clean needles, clean equipment and safe place, these centres make every day injections practice relatively healthier. Contact with professionals seems to favor the development of good practice outside the center.

+ hard to reach marginal populations can be referred to other social services

Those who does not have an access to social services can be rehabilitated through a referral to a treatment center for dependence or service for general care. Homeless people who attend these centers are between 20 and 60% of the number of users.

• Doubts raised

- No proven impact on reducing the number of users affected by HIV or hepatitis C

The fight against HIV and hepatitis C in this population at risk is a major issue of public health policies that affect them. The apparent lack of effectiveness on this issue is an obvious impediment to their implementation in France.

- Complexity of the implementation and the lack of acceptance by the community

The current controversies are the proof. The establishment of supervised injecting facilities has resulted in almost permanent debates and often in opposition. However, all reports point to the importance of dialogue. Participation of local residents, traders and public authorities is an essential element of projects functioning and effectiveness.

- Development of one-time small-scale drug trade around the centres

Some small-scale trafficking of drugs has developed around certain centers, particularly in Switzerland. It was, however, resale of user networks that could exist prior to the establishment of centers (whose locations are often former places of consumption).

The INSERM report compiled a list of the benefits and negative effects of the introduction of consumption rooms in other countries. Meanwhile supporters of the idea say they will continue to lobby.