16 October 2019
Photo: Ulli Hansmann, Pixabay
How can the city tackle its ongoing problem of the number of people dying from drug use? Drug Consumption Rooms have been proposed as one method to help those in need and stem the number of unnecessary deaths. They’ve been proven to work in other cities across the globe. Can they work in Glasgow?
The figures released by The National Records of Scotland (NRS) on the 16 July relating to the number of drug-deaths in the country came as no surprise – after all it was the fourth year in a row in which they had increased – yet the furore created by the release of the figures was palpable.
It is a reputation that has haunted Scotland and particularly Glasgow for such a long time now. The figures just confirmed what everybody already knew.
Not that Scotland hasn’t tried to shed its reputation and support those suffering with addiction. Needle exchange systems, which operate out of chemists in most major cities, distribute sterilised equipment free of charge in exchange for used needles that would otherwise find their way onto our pavements, parks, and tenement stairwells.
And in the wake of the NRS data that revealed a 27% increase in the number of people dying from taking drugs, the majority of those from injecting them, the Scottish Government is once again seeking approval for a pilot scheme for Drug Consumption Rooms (DCRs) to help combat the issue.
Joe Fitzpatrick, the public health minister called for Scotland to be granted permission from Westminster to open the UK’s first DCR in response to the figures.
But how effective could DCRs be and how likely are we to see one established? Are they a pragmatic and compassionate response to an ongoing problem or will they have no effect on the number of lives torn apart by substance abuse?
Austin Smith, the policy officer at the Scottish Drugs Forum (SDF) was sceptical about the proposals, saying that even if they were approved: “I suspect it would take years to open the proposed one in Glasgow and, in that sense, this is a red herring in terms of what we do now to reduce the number of overdose deaths in Scotland, which is a public health emergency.”
But whether or not they prevent drug deaths immediately or not, are they a useful tool in tackling the issue in the future? After all, just because something is difficult to establish doesn’t mean that it shouldn’t be done, right? Governments and campaigners can simultaneously pursue opening DCRs as well as other methods.
Let’s look at the case for DCRs.
DCRs have been in existence for over 40 years, the first opened its doors in 1986, in Berne, Switzerland. Since then over 80 sites have opened worldwide in countries such as Germany, Netherlands, Spain, Norway, Luxembourg, Denmark, Greece, France, and Portugal. With plans for another in Ireland.
In Australia, where centres now operate in both Sydney and Melbourne, they were set up in response to campaigns by advocates within the local community — residents who had direct experience with the chaotic, difficult, and challenging situation already on their doorsteps, where street-based injecting occurred (with the inherent risks of overdose) and syringes discarded publicly.
Insite Drug Consumption Room, Vancouver. Photo: Vancouver Coastal Health
The rooms typically consist of roughly 10 private booths where people can inject their drugs with two medical professionals overseeing the actions of those in the room, intervening when necessary.
They’ve been successful in most areas they’ve been set up, helping to reduce the number of people dying as a result of their addiction, putting them in contact with support groups, and reducing stress on the emergency services in the vicinity of the DCRs.
Evidence from DCRs across the globe record many instances of overdosing in their facilities, but not a single death from those overdoses. Members of staff are there to administer naloxone to counter the effects of opiate overdose and thus prevent an almost certain death.
The European Monitoring Centre for Drugs and Drug Addiction say that the DCRs in operation enable healthcare professionals to reach and stay in contact with a highly marginalised portion of society. Through contact, they are seeing improvements in the hygiene of clients as well as wider public health and public order benefits.
They also report reductions in the sharing of needles, a behaviour that has reduced the risk of users contracting and spreading HIV.
Glasgow’s most recent brush with an HIV epidemic came in 2017 when an outbreak had the National AIDS Trust calling for DCRs and more needle exchange services to stem the spread of the disease.
Another potential positive is revealed by a study of the effectiveness of the first DCR in the English speaking world, Uniting MSIC (Medically Supervised Injecting Centre), Sydney, Australia, which showed that there were fewer overdose related callouts to emergency services during the hours that the facility was open.
The study showed that there were 80% fewer cases related to overdoses in the area surrounding the facility, 230 fewer call outs each month.
Speaking to the Sloth, Dr Marianne Jauncey, the director of Uniting MSIC said that DCRs are “a pragmatic and compassionate response to an existing problem: high numbers of people injecting drugs in public, high numbers of overdose deaths and marginalised people in need of health and community support.
“There have been more than 8500 occasions where we have needed to intervene for overdose. But no one need ever die of an overdose if they are supervised, because early intervention will save their life. This has been clearly documented throughout the multitude of supervised injecting facilities or drug consumption rooms that now operate around the world, where no one has ever died of an overdose.”
The centre doesn’t merely offer a safe space for people to shoot up, it is a bridge for people who want help with their addiction.
“Over more than 18 years, Uniting Medically Supervised Injecting Centre staff have done so much more than merely provide clients with clean injecting equipment – it’s about connection, building a therapeutic relationship and referring on to other health and welfare services. It’s also about peace of mind, because during that time, no-one has died on our premises.”
“Importantly, the centre also provides an opportunity to link people with health and counselling services and other community supports, which they would otherwise not have had access to.”
Dr Jauncey was keen to stress the important role the centre plays in connecting clients with treatment programmes such as detox and rehab, housing support, and counselling. Unite has made more than 16,500 referrals to support and care services since opening in 2001.
One DCR in Vancouver called Insite has been open since 2003 and actually houses the detox and rehab facilities in the same building, meaning that clients can access the services immediately.
Tiffany Akins, from Vancouver Coastal Health, who manage the site said: “Insite provides a harm reduction programme aimed at reducing harm to a client’s health while connecting them to care and recovery.
“At Insite, clients develop relationships and build trust with health care workers which makes clients more likely to pursue withdrawal management (detox), addiction counselling and other addiction recovery services.
“When users are ready to access withdrawal management, they can be immediately accommodated at Onsite, where people can detox in 12 rooms with private bathrooms.
“Mental health workers, counsellors, nurses and doctors work together to help people stabilize and plan their next steps. Once stabilized, clients can move to the 3rd floor transitional recovery housing for further recovery and connection to community support, treatment programs and housing.”
Onsite detox facility next to Insite, Vancouver. Photo: Vancouver Coastal Health
Not only are there numerous health and social benefits, but proponents say that the plans also make sense economically.
The business case put forward by Glasgow City Council in 2017 showed that a relatively small group of 350 people who inject their drugs, were recorded over the course of a year to monitor the cost on public services totalled more than £1.7milliion. That is before you factor in the costs of the criminal justice system and other health and social care.
In contrast, the cost of running a DCR was anticipated to work out much cheaper. A facility in Vancouver saves the public purse four dollars for every one it spends, thanks to the DCR.
It’s not the first time the Scottish Government has sought the approval of such a scheme. In 2017, the lord advocate James Wolffe, the most senior legal officer of the Scottish Government, rejected the proposed site in Glasgow on the basis that it contravened UK drug law.
In an article from The Herald, he said: “I can make decisions as to whether or not a criminal offence will be prosecuted, I cannot alter the basic quality of the activity as criminal in law. Nor, for that matter, can anything I say or do affect the question of civil liability.”
The issue being that consuming illicit drugs is still a criminal act and to do so would be in breach of the law. So there would need to be some kind of pardon issued for those using the facilities or the law would have to be changed.
Those with the power to amend the Misuse of Drugs Act reside in Westminster, drug policy not being a devolved issue, and so if the proposal is to be approved it will need to be approved by the UK Government.
As reported in The Scotsman, Sajid Javid, home secretary at the time, came out in opposition to the proposals, saying: “I think I would be very hesitant to look at anything that might increase drug usage. Anything I do would be designed to get people completely off drugs, because they are a cancer on our society.”
But DCRs, as well as offering sterilised equipment and a safe environment with trained professionals on hand to offer support in the event of a user finding themselves in trouble, also provide an intermediary link between those who use drugs and support services to help get people off the drugs that are negatively impacting their lives and in many cases, killing them.
In fact, a study on Insite that sought to evaluate the effectiveness of the site showed that those who used the centre at least once a week, were 1.7 times more likely to go on and seek withdrawal management than those who visited less frequently.
Insite supply sterilised cookers, needles, filters, water, and a tournaquet. Photo: Vancouver Coastal Health
Niamh Eastwood, the executive director of drugs and drugs law charity Release, said in a press release in response to the figures released last month: “This decision by Westminster has contributed to the increasing drug related deaths in Scotland and has tied the hands of Holyrood and drug treatment experts in Scotland. With drug related deaths at an all-time high in Scotland the UK Government must now give the green light to the establishment of an overdose prevention site or risk responsibility for further deaths.”
The majority of those speaking openly about their disapproval of DCRs are Conservative councillors and MPs. Several Scottish Conservative councillors have spoken out about the DCRs.
Their issues with the plan stem from the fact that they see the establishment of DCRs in this country as a pipe dream, they consider the legal stickiness of the issue to be insurmountable.
A group of public health experts operating in the Glasgow area published an article in the medical journal the Lancet in August calling for a health emergency to be announced. They suggested the legal sticking points could be easily averted by granting Holyrood emergency powers to tackle the crisis.
However, Thomas Kerr, a Conservative councillor in Glasgow, told Scotland on Sunday: “What we need to do as a city is stop calling for more powers and instead utilise the ones we currently hold to their fullest.”
With regard to DCRs he added: “We said that they should only be considered if the necessary steps had been taken to allow them to operate in a legal manner.
“The Lord Advocate has since issued advice confirming that these facilities are not permissible within the current legal framework, and the Westminster Government has confirmed that they have no plans to change the law in this area.
“Therefore, if this issue came back to the council I cannot see circumstances where my group would give our support to such a policy.”
And Adam Tomkins, a Conservative MSP has said: “My own view is that making it easier for people to take heroin is not the answer and that we need a massive re-investment in rehab and abstinence based programmes.”
But he also says: “We’ll never solve this unless we attack the drivers that push folk to drugs in the first place.”
This approach suggests abandoning those who have succumbed to addiction and ignores the relationships between users and health services that could be developed through DCRs. Whilst, it is of course important to address the issues that drive people to addiction, what can be done if that doesn’t work?
Much of the public are also ambivalent towards the proposals. People are worried that having such a facility will encourage drug use in the area surrounding it and lead to drug related crime. Yet studies of Insite have shown the centre has had absolutely no effect on the rate of crime in the area.
There were fears about the creation of Uniting MSIC too, with the public believing the establishment of a DCR as a radical solution. Yet, the politicians in Sydney agreed to go ahead despite the objections and fears of many. Today, the centre has bipartisan political support, as well as the support of the police, local council and the community.
Dr Jauncey said: “We know from regular national surveys of the Australian public that the majority of Australians support such services (National Drug Strategy Household Survey data from 2016). And we know from local surveys of residents and businesses in Kings Cross that a large majority support the continued operation of our service (78% residents, 68% businesses).”
Ireland has had problems establishing its own DCR, which was due to open in September of last year. The law was amended so that those working at and those using the DCR would be safe from legal prosecution but the plans were put on ice after members of the public and local businesses close to the proposed site voiced their opposition to the DCR.
Before the DCR can open, Merchants Quay Ireland, who are behind the proposals will have to prove that the centre will not be detrimental to the safety of the area.
But the fact that the Irish were easily able to adjust the law to accommodate DCRs and that many other countries (not least France, which has very strict drug possession laws) have shown leniency, suggests that the issue in the UK is not so much with law, but with attitudes.
What more can be done?
Firstly, there needs to be a shift in attitudes, as suggested by Austin Smith from the Scottish Drugs Forum, who says the stigma attached to drug users is part of the problem:
“This is all stigma. As a society we have categorised a group of substances with little in common as ‘drugs’ and we have burdened these with stigma. We have criminalised the people who use them. This spreads stigma from the substances to the people who use them. This stigma is intensified for people who have a problem with substances – despite the fact that they actually, in the short term, have no real choice in using them. We then stigmatise services that work with and support people with a problem. We stigmatise treatment so that somehow, bizarrely, people view methadone – a World Health Organisation ‘essential medicine’ as the problem! We then tell people that the only way they can disburden themselves of some of this accumulated stigma is to be abstinent… a state not expected of anyone who uses legal substances – like alcohol, for example.
“Problem drug use is not a lifestyle choice or a bad decision, it is a way of dealing with psychological pain, trauma, ill health and terrible personal and social circumstances. People don’t like to think about these things much and prefer to believe that some people are morally weak or stupid.”
To deal with the issue more immediately, Smith suggests:
“The only evidenced means to prevent this are ones available to us now – educate users about the risks of overdose and how to avoid them; supply naloxone (that reverses opiate overdose); provide methadone, buprenorphine or diamorphine as a safe pharmaceutical alternative to street opiates. All these things work and we are doing them but not in the necessary scale. We have 40% of people with a problem in treatment – the other 60% have often been in treatment but have left or been forced out. That is our chief problem.”
But, Dr Jauncey argues that the establishment of Uniting MSIC actually led to a decrease in the stigmatisation of drug users. People come to understand the way the facility works, and they see it as not just as some kind of glorified youth club where you can shoot up free from persecution and hang around doing nothing, but as a centre for preventing death and encouraging treatment.
She said: “I think people recognise that the Uniting Medically Supervised Injecting Centre is an effective and compassionate way to prevent drug overdoses and help people into treatment. It is making a difference to the lives of our clients, and the community. The statistics speak for themselves.
“Because of the external evaluation of the service that occurred over the first decade of its existence, we know that the support in the local community actually increased, and the feedback is that seeing firsthand the positive impact and understanding the service lead to this increase in support.”
So whilst DCRs are not likely to be making an appearance on our high streets any time soon, they are certainly something that could help reduce the rate of people dying from taking illicit drugs. They’ll not be a complete cure, as pointed out by Smith, but could be part of a wider strategy to address the stigmatisation and death of those struggling with substance abuse in our city and the UK.