This is the third in a blog series based on the findings of the 2015 annual European Drugs Report published by the European Monitoring Centre for Drugs and Drug Addiction. In it, I explore the growth of drug consumption rooms across the continent.
What is a drug consumption room?
Supervised drug consumption facilities are places where illicit drugs can be used under the supervision of trained staff. These facilities primarily aim to reduce the acute risks of disease transmission through unhygienic injecting, prevent drug-related overdose deaths and connect high-risk drug users with addiction treatment and other health and social services. They have been operating in Europe for the last three decades. The plan to launch a drug consumption room in Brighton following an independent report in April 2013 has not been implemented.
Which countries have drug consumption rooms?
The first supervised drug consumption room was opened in Berne, Switzerland in June 1986. Further facilities of this type were established in subsequent years in Germany, the Netherlands, Spain, Norway, Luxembourg, Denmark and Greece. A total of 74 official drug consumption facilities currently operate in six EMCDDA reporting countries, following the closure of the only facility in Greece. There are also 12 facilities in Switzerland.
Breaking this down further, as of June 2015 there are 31 facilities in 25 cities in the Netherlands; 24 in 15 cities in Germany; 12 in two cities in Spain; one in Norway; one in Luxembourg; five in three cities in Denmark; and 12 in eight cities in Switzerland.
In a recent development, as of April 2015 a six-year trial of drug consumption rooms was approved in France and it is expected that facilities will be opened in three cities in the coming months. Outside of Europe there are two facilities in Sydney, Australia and one medically supervised injecting centre in Vancouver, Canada.
Characteristics of drug consumption rooms
Three models of drug consumption rooms operate in Europe: integrated, specialised and mobile facilities. The vast majority of drug consumption rooms are integrated in low-threshold facilities. Here, supervision of drug consumption is one of several survival-oriented services offered at the same premises, including provision of food, showers and clothing to those who live on the streets, prevention materials including condoms and sharps containers, and counselling and drug treatment.
Specialised consumption rooms only offer the narrower range of services directly related to supervised consumption, which includes the provision of hygienic injecting materials, advice on health and safer drug use, intervention in case of emergencies and a space where drug users can remain under observation after drug consumption.
Mobile facilities currently exist in Barcelona and Berlin; these provide a more geographically flexible deployment of the service, but typically cater for a more limited number of clients than fixed premises.
Do they work?
The effectiveness of drug consumption facilities to reach and stay in contact with highly marginalised target populations has been widely documented. This contact has resulted in immediate improvements in hygiene and safer use for clients, as well as wider health and public order benefits.
Research has also shown that the use of supervised drug consumption facilities is associated with self-reported reductions in injecting risk behaviour such as syringe sharing. This reduces behaviours that increase the risk of HIV transmission and overdose death. Nevertheless, the impact of drug consumption rooms on the reduction of HIV or hepatitis C virus incidence among the wider population of injecting drug users remains unclear and hard to estimate.
Some evidence has been provided by ecological studies suggesting that, where coverage is adequate, drug consumption rooms may contribute to reducing drug-related deaths at city level.
In addition, the use of consumption facilities is associated with increased uptake both of detoxification and of drug dependence treatment, including opioid substitution. For example, the Canadian cohort study documented that attendance at the Vancouver facility was associated with increased rates of referral to addiction care centres and increased rates of uptake of detoxification treatment and methadone maintenance.
Evaluation studies have found an overall positive impact on the communities where these facilities are located. However, as with needle and syringe programmes, consultation with local key actors is essential to minimise community resistance or counter-productive police responses.
The EMCDDA concludes that drug consumption facilities have the ability to reach and maintain contact with high-risk drug users who are not ready or willing to quit drug use. In a number of European countries supervised consumption has become an integrated component of low-threshold services offered within drug treatment systems. In Switzerland and Spain some drug consumption rooms have been closed, primarily due to the reduction in injecting heroin use and a decline in the need for such services, but also sometimes due to cost considerations.
The emergence of new forms of stimulant injection, including new psychoactive substances, has resulted in potentially increased risks for drug users. In this context, drug consumption rooms are currently the subject of political discussion in some European countries as calls for their implementation are debated. As frontline, low-threshold services, drug consumption rooms are often among the first to gain insights into new drug use patterns and thus they also have a role to play in the early identification of new and emerging trends among the high-risk populations using their services.
You can see a summary of the main issues in this EMCDDA video which focuses on the Baluard Drug Consumption room in Barcelona: