There is a growing acceptance and evidence that providing safe and supervised injecting centres is a recognised harm reduction initiative that can lead to saving lives, encourage engagement with treatment services, and help reduce HIV and hepatitis C infections. They also address public concerns about discarded needles and public injecting, and do not attract drug users en masse from other areas.
According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the first supervised drug consumption room was opened in Berne, Switzerland in June 1986, with further facilities following in Germany, the Netherlands, Spain, Norway, Luxembourg, Denmark and Greece. There are now 74 official drug consumption facilities operating in six EMCDDA reporting countries (following the closure of the only facility in Greece in 2014) and 12 facilities now operating in Switzerland.
The EMCDDA breaks this down further, to point out that as of February 2016 there are 31 facilities in 25 cities in the Netherlands; 24 in 15 cities in Germany; 12 in three cities in Spain; one in Norway; and one in Luxembourg (Norway and Luxembourg are both preparing to open a second facility in 2016); five in three cities in Denmark; and 12 in eight cities in Switzerland.
In January, French law approved a six-year trial of drug consumption rooms, expected to open by the end of this year. Outside Europe there are two facilities in Sydney, Australia and one medically supervised injecting centre in Vancouver, Canada.
There are plans to open the first centre in Dublin in later this year, and Scotland is also exploring the introduction of Medically Supervised Injecting Centre (MSIC). Even though there have been robust attempts to establish similar centres in the UK, there still no provision, despite the UK Home Affairs Select Committee recommendation ‘that an evaluated pilot programme of safe injecting houses for heroin users is established without delay and that if this is successful, the programme is extended across the country.’ The home secretary rejected this recommendation.
Wales is a country with a strong and unequivocal commitment to reducing the harm associated with substance misuse. The devolved Welsh government has harm reduction firmly embedded in its substance misuse strategy (Working together to reduce harm, 2008), which has led to a countrywide take-home naloxone scheme. It has also supported the set-up of Wedinos, a service to test substances to give individuals rapid and accurate information to reduce harms, and introduced and supported numerous harm reduction initiatives and projects. It is hoped that the Welsh government’s delivery plan (2016-2018) will reference the need to develop a case for MSIC.
Drugaid Cymru, Wales’s largest and leading third sector harm reduction agency, has started the work of developing the case for establishing MSIC provision in Wales. Not for a minute does anybody think this will be an easy task, and despite the evidence to support MSICs, winning the hearts and minds of politicians, law enforcement, businesses and neighbours is going to be a challenge. A multi-agency steering group has been established to progress this agenda in Wales, led by Drugaid Cymru, and includes leading figures from health, academia, PCC representatives, public health, Release and the Welsh Government.
Earlier this year, Drugaid Cymru’s chief executive Caroline Phipps visited Sydney’s Kings Cross centre and a deputation from Drugaid visited the Ana Liffey Drugs Project in Dublin who are close to opening Ireland’s first MSIC. While there might be a need for different models for different communities, there are a lot of commonalities and much that can be learned from those who are established or moving toward being operational. Wales is forming partnerships with others to develop the business case and propose the right model.
During the next six months the steering group will be engaging and consulting expert individuals and organisations in the UK and in other countries that have been involved in the research and development of MSIC provision. The work is at a very early stage in Wales and it is recognised that there are significant hurdles, but there is a commitment to develop a strong case for establishing MSIC as part of an overall comprehensive harm reduction approach – and to win over the hearts and minds of those with doubts.
Ifor Glyn will facilitate a workshop on MSICs at the upcoming conference SMTPC 2016: ‘The Post-War Dream’. To book your free place visit www.smtpc.org