Safe Corner

What would persuade a city to accept a drug consumption room? Natalie Davies examines the argument.

Glasgow could become the site of the UK’s first drug consumption room (DDN, November 2016, page 4) in response to visible public injecting and a spike in HIV infections in the city. Brighton floated the idea in 2014, but despite 50 cities in mainland Europe having opened rooms, concluded that the time was not right. So what lay behind their decision, and how could the story end differently in Glasgow?

The decision on whether drug consumption rooms are introduced will come down to how the debate is framed, says Natalie Davies.

Brighton was known for having one of the UK’s highest rates of drug-related deaths, prompting its Independent Drugs Commission to recommend in April 2013 that ‘where it is not possible to stop users from taking risks, it is better that they have access to safe, clean premises, rather than administer drugs on the streets or in residential settings’. A working group was set up to investigate the feasibility, but a year later delivered their verdict that it was not a priority.

As well as other options to meet the needs of drug users and the wider community, there were, they felt, inconsistencies between drug consumption rooms and the prevailing policies of enforcement and abstinence-based recovery.

One critical issue for the group was whether a drug consumption room could operate legally in the UK, and if so, what would be required. The UK Misuse of Drugs Act makes it illegal to allow drug dealing or production on your premises, but when it comes to using drugs, only the smoking of cannabis or opium must be prevented – premises owners do not contravene the act by allowing the possession or injecting of controlled drugs like heroin or cocaine.

Yet, based on statements from Sussex Police (a key stakeholder), the Home Office, and the Association of Chief Police Officers (ACPO), the working group determined that drug consumption rooms were ‘unlawful’. The fact that the room’s potential users would be breaking the law by possessing controlled drugs was somehow conflated with the legality of the rooms themselves.

Sussex Police said officers could use their discretion, but had ‘fundamental concerns’. Deploying the pejorative term ‘shooting galleries’, ACPO feared such facilities could ‘impact on local communities as a whole, attracting drug users to one area and also create a hotspot for associated criminality and anti-social behaviour’. Though understandable, ‘hotspot’ fears have invariably been contradicted by the evidence; most consumption-room users live locally.

Without a ‘local accord’ between police and other stakeholders, the proposal failed the test of feasibility. Resistance was attributed partly to a ‘shift in focus for substance misuse services from harm reduction to recovery [which placed…] a greater emphasis on abstinence’. It was unclear whether stakeholders were themselves aligned with the values of abstinence-based recovery, or whether the policy and funding climate was forcing their hand. Brighton’s local paper The Argus reported that weeks after the feasibility study was launched, several stakeholders spoke out against drug consumption rooms, including Andy Winter, chief executive of Brighton Housing Trust, who wanted to see ‘something far more positive [done] with addiction and recovery’. Frustrated at what he considered a ‘distraction’ from ‘recovery, treatment and abstinence’, he resolved to ‘oppose any further waste of public funds, time and effort on exploring [their] feasibility’.

According to the final report of the Independent Drugs Commission in May 2014, the working group concluded that drug consumption rooms would have ‘little impact on the types of factors contributing to deaths in the city’. While some injectors could benefit, ‘the overall need for the local community’ did not warrant this new type of service – particularly as ‘the improvement in the number of drug related deaths [in Brighton] since 2009 suggested that the current strategies [were] having an impact’. Yet there was little appreciation that effective mainstream strategies may be inaccessible to people who would use drug consumption rooms, leaving a vulnerable cohort.

Drug consumption rooms are typically aimed at socially excluded drug users who would otherwise be injecting in public places or unsafe domestic settings. This includes sex workers, homeless people, and those who have never been in treatment. The bubble of acceptance within the four walls of a drug consumption room not only supports users to inject safely, but provides a link to vital health and social care services, including addiction treatment. Admittedly, this acceptance of drug-taking is not an easy message to sell, and even areas with flourishing needle exchange and naloxone programmes would probably consider drug consumption rooms a ‘big leap’. But what many struggle to understand is how consumption rooms can provoke more controversy than people dying from preventable fatal overdoses.

Drug consumption rooms may not be the answer to addiction, but they are a humane solution to public injecting. In the end, the decision about whether to introduce drug consumption rooms in Glasgow may come down to how the debate is framed – the extent to which local stakeholders are looking at the opportunities of extending harm reduction among vulnerable, marginalised, and socially excluded injectors. If, as in Brighton, they view them through the lenses of enforcement and recovery, the project could stop before it has started, and the human cost of public injecting will continue to stack up.

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Natalie Davies is assistant editor at Drug and Alcohol Findings,