Often, the discussion of whether drug consumption rooms (DCRs) should open or not are left to policymakers, leading to political resistance and delays in implementation. And while these facilities are proven to reduce drug related deaths and promote safer use and injecting, those that would benefit the most from DCRs – people who use or inject drugs – are often left out of discussions on their purposes, values, and uses.
Our recently published research, based in the UK, explored the topic of DCRs with those who are likely to use them: people who inject drugs, specifically heroin and/or crack cocaine. It comes at an important time, published just before the opening of the first British DCR in Glasgow, the city with the highest drug deaths rates in the Europe.
Other European countries have had drug consumption rooms for several decades, opened more recently in Australia and Canada. But the UK has remained reluctant to implement such facilities even though they have an evidence base for reducing harm.
Harm reduction built momentum – until austerity hit
Harm reduction has been a long-established practice in the UK, especially since the AIDS epidemic in the 1980’s, where the government approved the distribution of sterile injecting equipment. The AIDS crisis helped shift government thinking, which finally recognised the need to embed pragmatic strategies that respond to the needs of those using drugs. This approach would help reduce the likelihood of the transition of blood borne viruses including HIV.
Since the 1980s, the British harm reduction movement has grown from strength to strength, engaging and responding to the needs of varying groups of people who use drugs – from recreational club attendants to those injecting drugs – listening, and responding, to the needs of those who are using. The financial crisis that led to the austerity measures in 2012, meant that many of the harm reduction services were cut. The British focus was now on getting people into recovery rather than keeping them in treatment services as previously approached. This has meant that treatment spaces became less welcoming for those not yet ready to move to “recovery” or drug abstinence.
Harm reductionists are a difficult group to keep quiet though; they are knowledgeable, realistic and practical, often raising concerns on behalf of their people within treatment services and at political levels. Over the last decade, the importance of opening DCRs in the UK has grown, as they provide spaces to protect people injecting drugs from marginalisation and criminalisation.
We interviewed nine people who were injecting drugs as well as four drug workers, but we only included the voice of the service users in the findings. This was never meant to be a large research project, meant instead to mostly capture the voices of those most likely to use a DCR. Most were interviewed in treatment-based needle exchanges, with a few seen within pharmacy-based exchanges. We wanted to ask them what they had heard about DCRs and how they worked, whether they would use one if it existed, and what services they would like to see within them.
Our local area has no immediate plans to open a DCR and everyone who took part was told this. But as the conversation and momentum grew nationally, we wanted to capture the voices of people who injected drugs from the very beginning of any such discussion. We believed that this type of research could help shape any future services that may come to be, ensuring people’s perspectives were well represented.
DCRs: more than just clinics
Most people had heard about DCRs and thought they were a good idea. They felt a DCR could help resolve some of the recurring issues they had with pharmacies: with 16 across the city, they each had different opening times which varied according to staff capacity; stocks of injecting equipment differed greatly between them, with no consistency on what was offered for use. People also felt that pharmacy staff often lacked knowledge on injecting practices, meaning they offered little support or assurances for those injecting drugs. Treatment-based needle exchanges, however, were felt to provide better services, although they faced similar issues with equipment consistency.
As one respondent put it:
“If someone …had taught me … my veins might be alright now”
We also asked what they would like to see if such a facility was to open. The participants gave pragmatic responses, expressing that they wanted a safe space where people ultimately could be supported, whether this is injecting practice advice, overdose prevention and education or wider social support relating to both their drug use (with access to treatment if they wanted) and assistance for their living situations.
Interestingly, the idea that a DCR should be “more than just a clinic” came up more than once. These spaces can offer safer injecting advice, provide counselling services embedded within trauma-informed practices; they could connect people with housing, benefits, financial support or help moving homes. Health services responding to injecting-related harms were also seen as important to reduce wounds and improve people’s understanding of how to look out for their body. As one participant put it:
“A lot of people that I’ve been in contact with have been a mess… I’ve seen people who I look at their bodies and I think you must have been using as long as I have, they’ve been using two years and it’s like how do you look like that? How have you lost all your veins?”
One final issue that frequently surfaced was around improving their community by reducing the risk of drug injecting to the wider public. Participants wanted DCRs to have a space to dispose of used injecting equipment, to keep people from using in isolation or in unhygienic conditions.
“Personally, I wouldn’t like to see anyone taking drugs, because I’ve lived that life myself and it’s not a nice way to live, but if it’s going to keep people… in a safe environment to take it in front of professional people then I’m all for it really”.
Whilst it will take time to see the improvements that the Glasgow DCR will bring, it is promising to see its implementation finally happening. Our research was a reminder of how it is important to consult with people using drugs about what they want from services that are supposedly shaped for them. This can in turn highlight the reality that those marginalised by society don’t want to be a risk or burden for others. What they want is a space to keep them safe, alive, and provide support when needed.
