When the Independent Drugs Commission for Brighton and Hove reported earlier this year it made more than 20 recommendations, but the one seized on by the media – both liberal and conservative – was a feasibility study into the setting up of a drug consumption room (DCR) in the city.
Despite the existence of DCRs across the world – in Switzerland, the Netherlands, Germany, Spain, Australia, Canada and elsewhere – and a body of evidence on their effectiveness in promoting access to services and reducing both risk and public drug use, they remain a divisive issue.
Now an Independent Consortium on Drug Consumption Rooms (ICDR) has been established in Birmingham, with the aim of setting up a DCR in the city. Founded two months ago by outreach drug worker and trainer Philippe Bonnet – who is also deputy chair of the National Needle Exchange Forum (NNEF), chair of the Birmingham naloxone steering group and a trustee of homeless charity Birmingham Christmas Shelter – the consortium has already attracted some well-known names from the sector, including NNEF chair Jamie Bridge, Nigel Brunsdon of Injecting Advice, researcherNeil Hunt and Dr Judith Yates, who has more than 30 years’ experience working with Birmingham’s drug users.
Given the controversy around DCRs, what’s been the response from officialdom so far? ‘We’ve arranged meetings with Birmingham City Council, Public Health England, the health and wellbeing board and the police and crime commissioner, but unfortunately the council and Public Health England have said they won’t endorse the plan “for the foreseeable future”,’ he says. While police officers have told him off the record that ‘as a citizen it makes perfect sense, but as a police officer I can’t be seen to endorse it’, he points out that ‘police reports and attitudes from the DCRs operating worldwide are 100 per cent positive and officers are even pointing street users towards their local DCR’.
The next step is to find the local councillors most likely to adopt a sympathetic and pragmatic approach, he explains. ‘Dr Yates and I met with a councillor who said DCRs made perfect sense to him and that he’d speak to other councillors to try to gauge who would eventually support us – he’s aware DCRs aren’t a vote winner,’ But a growing number of organisations are already backing the campaign, including Release, the National Aids Trust (NAT), the Hepatitis C Trust, HIT, Swanswell and Inclusion Drug Alcohol Services in Birmingham.
Considering the reaction to the Brighton report, however, just how big an obstacle does he anticipate the media will be? ‘It could be massive, but my argument when I’m told that consumption rooms aren’t flavour of the month is that they never have been and never will be. I run clinics in the two busiest needle exchanges in Birmingham city centre and I see the damage of street injecting on a daily basis. Every single DCR caused controversy at first, but they’re all well embedded now and it’s not a big deal anymore – residents and the police are actually glad they exist. We need to take the sensationalist factor out of DCRs – you could even argue that pubs are kind of consumption rooms for alcohol.’
On the subject of sensationalism, getting a fair hearing is vital, he stresses, although not always easy. ‘When the Brighton thing kicked off in the press I was interviewed by the local BBC radio in Sussex and then I got a call from BBC West Midlands asking if I’d be prepared to do an interview. I said that what I would like is to have a televised debate that is actually a real, rational debate – us stating our case and people who are against stating their case – so that we can properly put counter-arguments and they’re not lost in the editing. We haven’t heard anything back as yet.’
Given the controversy and the reluctance from the authorities, how confident is he that he can actually pull this off? ‘Put it this way, I won’t rest until it’s in place,’ he states. ‘Commissioners and councillors come and go – they aren’t in post forever – and I’ll carry on until it opens. One of my mottos is that although I don’t necessarily condone drug use, I’ll fight until my death for the rights of people who use drugs to be able to do so as safely as possible.’
As an ex service user he’s speaking from personal experience, having spent about 12 years with a ‘heroin, crack and other pharmaceuticals’ problem followed by ten years in recovery. ‘I was an injector but I was lucky to have friends in the medical profession, which is why I was so good at injecting and why my skills now are around teaching safer injecting and other harm reduction interventions.’
Although French, he’s been in the UK for 25 years, but is in regular touch with key figures in the drugs sector in France, which will see its own first consumption room open near the Gare du Nord in Paris next month. ‘Bernard Bertrand is the French expert on consumption rooms and he created the Global Platform for Drug Consumption Rooms – I’m in contact with him regularly and we talk about what’s happening here and in France,’ he says. ‘It took ten years to get where they are now, and especially the last four years have been horrendous.’
Presumably that was because of the political climate under Sarkozy? ‘Yes, but now Marisol Touraine, the health minister [under current president François Hollande] has said “OK, I’ve heard a lot about the effectiveness of DCRs in other countries, I have enough evidence and I want to implement it as soon as possible”. But also the local mayors were very influential. The mayor for the 10th arrondissement, where the consumption room will be located, was all for it and other local mayors said they wanted it too, but because this was under the Sarkozy government they were told no. They said, “we’re the local councillors – we know DCRs are effective and we want them” but the ruling party said no.’
There’s now growing demand from other French cities with problems around street injecting, he says – particularly Marseille, Strasbourg and Bordeaux – and, perhaps surprisingly, once the new government was in place the plan for the Paris consumption room was agreed without significant opposition.
‘A Facebook page was created by people who were against it, but they only got about 200 members, and there were a couple of protests in the streets. The thing is that this is evidence-based – it’s not just some people saying it’s a good thing. There’s a mountain of evidence about the effectiveness of consumption rooms in reducing overdose deaths, injecting complications, needle litter and so on.’
Nonetheless, he’s fully aware that it’s going to be very much an uphill struggle in Birmingham. ‘The main barriers are going to be local politicians,’ he states. ‘Who will be willing to take the plunge and endorse DCRs? Who will be ready to perhaps risk losing a few votes but ultimately save a few lives and a vast amount of PHE money? Because we know DCRs are cost-effective as well.’
When it comes to funding, the consortium’s intention is not necessarily to approach PHE, he explains. ‘According to government figures, between 2007 and 2010 more than £90m was recovered from drug traffickers through confiscation orders. That could fund DCRs very nicely.’
And DCRs do fit with official policy, he stresses. ‘The drug strategy clearly states that the government is committed to reviewing evidence of what works from other countries and what can be learned from it, and that’s music to my ears. And let’s not forget as well that Public Health England has been mandated to look after the most vulnerable in our society. I don’t think in this day and age in England we should be allowing people to inject in the circumstances that they’re forced to – I think that’s pretty appalling and sad. We need to be more pragmatic and health orientated.’
Consumption rooms have also had some high profile support, he points out, with David Cameron a member of the 2002 home affairs select committee that recommended they be piloted in the UK. ‘Now, 11 years later, there’s even more evidence. I’ve written to him asking if he still stands by his statement, and I’m waiting for a reply.’