"It's Something Like a Living Room": My Experience of a Safe Drug Use Room in Amsterdam

The contents of a needle exchange kit

The contents of a needle exchange kit. (Source: Wikimedia)

At the end of October 2016, members of the Glasgow City Council, the health board and Police Scotland agreed to plans for opening the first safe injection facility in the UK. Earlier that month, the first safe injection room opened in northern Paris. Meanwhile, the Mayor of Seattle, Ed Murray, has declared that there is a consensus on opening a facility in his city.

The number of safe drug consumption rooms has already approached one hundred worldwide.  Georgiy Vanunts, reporter of the Russian media outlet FurFur visited  AMOC Center run by the Rainbow group in Amsterdam, which has one of the oldest and one of the most appealing safe injection rooms in the world.

This article was first published (in Russian) by FurFur. You can read the original here.

It is a spacious room with a sculpted ceiling and windows overlooking the Singelgracht Canal. In the room there are four large desks and two sofas. Posters of "2001: A Space Odyssey" and "A Clockwork Orange” hanging on the walls, along with and a blackboard with the cheerful slogan "Don't underestimate the power of positive thinking!" written in chalk. Three middle-aged men neatly arrange their tools at one of the tables: syringes, spoons and tourniquets. A Ziploc baggie with a white substance lies in front of one of them. I'm at a safe injection room in the AMOC Center in Amsterdam.

Actually "safe injection room" is not the term that is used here. It is called a “users room”, but people here can also inject, unlike in some other sites in the Netherlands. For the past twelve years the Dutch Ministry of Health has been successfully promoting smoking rather than injecting, although according to one theory, there was no need for such effort as smoking as Surinamese pushers already popularized this method with the locals in the 1980s. 

"The Dutch really prefer using foil rather than needles, but we only work with foreigners and they bring their habits with them," says Arkady, the user’s room administrator with a curled mustache, who speaks perfect Russian. "That's why the room is kind of divided into two parts — one for injectors and another one for smokers. Basically the most popular drugs here are heroin and cocaine, sometimes speed and methamphetamine.”

So far, the smokers’ tables remain unoccupied.

This site on Stadhouderskade street has already been operating for 20 years and was opened in 1998, on the second floor of the day care center for homeless people run by the Regenboorg Foundation  (Regenboorg means "Rainbow" in Dutch). The Foundation is financially supported by the municipal social services and not only provides food, clean second-hand clothes, laundry services and Wi-Fi, but also low-paid work that can be legally combined with receiving social benefits (approximately 950 euros a month per person). Although it's not very clear where clients come from, bearing in mind that the Dutch authorities also provide social housing for the homeless, and sleeping on the streets of Amsterdam leads to an 80 euro fine.

Drug consumption rooms are part of the national public health policy focused not at the war on drugs (which has already proved to be impossible to win) but at reducing harm for the society and for the users themselves. Amsterdam residents get cleaner streets and greater control over the spread of HIV and hepatitis. In turn, socially vulnerable drug users received clean and safe space with qualified personnel to perform their small injection rituals. The Netherlands hold a world record for the number of drug consumption sites with 37 safe use facilities in 25 cities. There are about 90 similar sites in Europe, while the rest of the world has only three of them: two in Sydney and one in Vancouver.  

Visitors are given everything they need: water, band aids, syringes of different kinds and even vitamin C as unlike the heroin found in Russia, local product is more difficult to dilute. The clients are only allowed to inject themselves in the arms and legs; the neck, groin and other unsafe areas are unequivocally banned. Used syringes are put through a narrow slit into closed containers that are then disposed of as hazardous waste. Unlike many other rooms, this one is focused not only on the safety of drug users, but also on their socialization: you won't be hurried away half an hour after the injection, you can stay there all day if you want until the Center working day ends at 17:30 on weekdays and at 20:00 on weekends. 

The rules here are simple; they are printed in capital letters on the contracts that each client has to sign. Arkady repeats the three key rules several times: safety, hygiene and stress-free environment. Sharing or selling drugs inside the facility is prohibited, as are dangerous injections or meeting dealers near the center. Aggression is also not tolerated. Clients store their personal belongings (spoons, tourniquets) in distinctly marked packages, bring their health examination reports every half a year and help to wash dishes after lunch.  

"Breaking the rules isn't worth it for anyone who comes in – and most people come here very regularly, some of them have been our clients for years. For now we have contracts with 34 clients,” Arkady explains. In order to get the contract, social workers must be convinced that the use of hard drugs is an integral part of the potential client’s lifestyle.

“How do we make a contract? When potential clients comes in, they talk to a social worker in order to determine whether they need the day shelter services. The day shelter provides basic services such as shower and laundry, Internet access, a place to stay and drink tea or coffee, snacks and food. Over time this person says, or we see ourselves, if they also use drugs. We have a conversation with the client; ask questions like what drugs they use, for how long, and so on. Our clients are not in the process of quitting drugs, they either have no opportunity or no desire to stop it.”

"If a person uses drugs it's better both for the city and the person to do it here, where we can guarantee hygiene, security and a quiet place, rather than doing it somewhere in a boat or under a bridge. Neighbours don't complain: once a month the Neighboring Committee and the administrators of the center have a meeting, where representatives of City Hall and the local police department also take part. We do that in order to get feedback from the people who live in the area and inform them about any changes in our work. The local police officer has been working in the neighborhood for 20 years. He knows this place perfectly and our clients also know him well. Sometimes he just comes by, says hi and leaves – there is no police monitoring of the site.”

“And there's no pressure from the neighborhood residents whatsoever?” I ask him.

“This place has been operational for a very long time already,” Arkady explains. “Sometimes new, more conservative, residents come around and some of them don't like what’s going on. They don't like that AMOC attracts homeless people. I have been working here for about 10 years, until 5 years ago there was no tension whatsoever but recently we experienced some of it and now we're constantly working with the neighbors and we have formed a special commission.”

Arkady has worked at the site since 2007, after he moved to Amsterdam from Bulgaria, where he had coordinated a project for HIV-positive sex workers.

"This area of work was very similar, we worked with one of the foundations from Amsterdam, so when I came here and was looking for a job, it was the first place where I decided to try my luck,” he says.

Speaking Russian was a significant advantage at the time as a substantial part of clients were natives of the former-USSR countries. Now there aren't as many of them among the clients, but I was lucky: all three men at the table, once they learned that I'm from Russia, welcomed me in my mother language. 

It wasn’t so easy to establish a conversation with them. Oleg, Michael and Peter (names changed), each looking between 35 and 50 years old, were busy with their own stuff, twisting tobacco rolls and giving only very short replies to my attempts to get them to reveal their life-stories. Arkady gave me some strict looks, concerned about the privacy of his clients, and I had to give up my interrogation very quickly, realizing that this time I will not be writing an article about social drama of drug users in Amsterdam. Michael, the most talkative and charismatic of them, moved to the Netherlands from Volgograd, Russia 17 years ago. He is jokingly addressed as "the chief of political information" – he is an ardent socialist who bitterly observes the "sunset" of social policy in Europe. He also gets very excited once mentioning his hero, Vladimir Putin. It is almost impossible to argue with him — in his words you can feel a weary, dogmatic wisdom, indisposed to irony. He spent a great part of his life in the Netherlands without a roof over his head, but a few years ago the government assigned him accommodation in addition to the social benefits. 

“They won't leave you here without a piece of bread, it's true. When were you born?” he asks me.

“In 1990.”

“So you didn't get to live in the socialist society. But I did! Europe is also socialist-ish. It was even more so before, but now there's something I don't particularly like.”

”What is that?"

“Well, they're closing all the social programs bit by bit and not all the changes are very positive... Now they want to introduce euthanasia. I mean it's a sin to kill the elderly. Although I think homosexuality is the most terrible sin of them all and there's a lot of it going on here.”

“But you can inject yourself in quite comfortable conditions. You won't get that in Russia”

“I won't need it there. People in Russia are different - they wouldn't even come to such rooms.”

“At least we could start with substitution therapy. Do you get methadone?”

“No, I don't. If you enroll into this program, all of this stuff, - you'll have to visit the clinic. That's for addicts, I use drugs only when I want to, so I don't need that. I come here more to talk, to smoke [tobacco].”

Michael is right in his own way. Substitution therapy with methadone or heroin (both are available in the Netherlands) involve systematic, disciplined attendance, changing the user's life to a semi-recuperating mode. Safe injection centers in Europe are also very often medicalized: in Copenhagen, for example, you won't get to stay longer than 30 minutes after the injection, because they see over 150-200 clients a day. Photos of the centers in Luxembourg, Sydney or Bern remind one more of tidy public restrooms, and the one in Vancouver brings to mind a scene from an unfilmed David Cronenberg movie, where a dozen drug users sit in separate compartments under a dim light, injecting themselves right in front of their own reflection in the mirrors. AMOC is very different from these model and is closer to a cozy community center for people with certain habits. 

"Our clients are often homeless, they often don't speak Dutch, and they can be very isolated," Arkady explains, "our idea is to provide a space where they can communicate. They can spend the whole day here, they don't need to go away. Not only can they take drugs here, but also hang out and socialize. It's something like a lounge. But we also don’t deny people of a possibility to be alone.”

Anya Sarang, an anthropologist and the President of a Russian NGO Andrey Rylkov Foundation, has been volunteering for AMOC for the last 6 months and believes that this room is one of the most appealing among those that she got to see before coming to Amsterdam:

“Before I came here as a volunteer, I visited several safe consumption rooms – in Canada, Spain and Denmark. They are all pretty impressive and people in those countries have done fantastic jobs to get them going and approved by the local governments, but in my opinion, AMOC has the most appealing model of them all. There are no isolated desks here, no atmosphere of a sterile hospital environment, or strict semi-medical supervision or restrictions on the length of stay.”

“Yes, I expected everything to look more like a depressing social ad.”

“Drug dependence often indicates more in-depth problems that are rooted in the capitalism’s induced alienation, loneliness and separation. This alienation is also signified and partly produced by all those social and physical spaces with eternal partitions, walls and boxes that separate us from each other. People suffer from the lack of social ties, the disruptions of the social fabric, lack of mutual support and connection. You must have heard about the experiment by Bruce Alexander known as “The Rat Park”. It illustrated that drug dependence is not less a product of a chemical reaction than of the social isolation.”

"Social interaction is as essential for our health and well-being as doctors and medications. That's the special idea of the users room in AMOC - to make it possible for people to come here and feel at home; people can just chat, make jokes, laugh, discuss politics and arts, tell stories about their past and current life, speak about their families, share their problems and experiences, give advice on how to survive and get help. Or sometimes, they would ask to leave them alone so they could watch TV or browse the Internet in peace.”

The Netherlands really stands apart even alongside the other pioneers of humane drug policy. Firstly, the problems related to use of hard drugs are almost completely solved here: only 15% of drug users inject drugs (it is the lowest level in the EU) and only 11% of all new cases of HIV infection or AIDS are detected among injecting drug users (this is also one of the lowest percent in Europe). The number of deaths related to drug use is 0.5 at 100 thousand people, which is almost three times lower than in Germany (1.3), five times lower than in the UK (2.7) and four times lower than in Sweden (1.9), whose government is famous for its prohibitionist approach to hard drugs. Perhaps this is another reason why AMOC and other safe drug consumption sites do not have to handle a large number of clients and furnish their facilities like a surgery room.

As a natural-born activist, Anya talks bio-politics: "It is such a pity that the model like AMOC’s is not yet possible to implement in other countries -- because of the wider politics, because we still have to prove both to the government and society that consumption rooms are primarily a medical intervention, another point of surveillance of a person's life. That's probably why all those symbols of control have to be in place: the separate compartments, the nurses, restricted time of visits and limited communication. I hope that with time and advancement of humane and rational drug policy worldwide, the safe injection facilities will evolve more in the direction of the AMOC model. People need a friendly environment that provides for communication, mutual support and nurturing human connection, not that of a barefaced protocol."

While recording her speech, I overhear snatches of conversation between Oleg and Michael, who discuss the most important [at the time of my visit] news – the death of Motorola (Arsen Pavlov, also known by his nom de guerre Motorola, was a Russian citizen who led the Sparta Battalion, an armed group fighting the Ukrainian army in the ongoing conflict in the Donbas). When I come in, Michael with a cigarette in his mouth has already risen from the table ("to go to work"). Saying goodbye, he finally asks:

“Did you know that here in Amsterdam they also have special rooms for alcoholics, where they can get free beer?”

“Well, now you are making me consider immigrating!”

“You like beer? It's crap! I quit drinking because if you drink a lot everything goes to hell. Look how many good men go to prison because of alcohol or get killed or just die.”

Suddenly Oleg, who was silent before, wraps it up: "Yes, if people in Russia smoked weed instead of drinking, everything would be completely different"

-----

This article was written during a visit to Amsterdam that was organised with the help of the Andrey Rylkov Foundation for Health and Social Justice (ARF). While I was finishing the article, somebody complained to the Prosecutor's office about ARF’s social workers who do outreach work around pharmacies and provide clean syringes, condoms, HIV testing and health services to people who use drugs every evening. The parents of the kids attending one of the dancing schools in one of the neighborhoods where ARF works are afraid of people who use drugs gathering near the local pharmacy.  Although it is clear that the social workers of the Foundation can't affect the number of service users in the area, and that they will gather there regardless of the presence of the social workers, local police officer demanded that the Foundation stop its HIV prevention work in the neighborhood.

That's exactly a situation in which most of the safe consumption rooms opened and started to work: concerned citizens cooperated with the police and social services and sought solutions to the local problems. such as people who use drugs gathering on the streets, scattered syringes everywhere, or frightened children. The solution in many other countries was to open safe consumption facilities.

During their existence, such rooms showed greater effectiveness in solving all these problems. They provide comfortable and hygienic environment for people who use drugs (as well as constant access to health and social services), reduce the harms of drug use, and give peace to the society. But the Russian Ministry of Health, takes a completely different view and doesn't recognize even basic harm reduction programs, so the only thing that we can do here is to take a trip to Amsterdam.