The Right Fix?

We need to talk about safe injecting sites, says Nick Goldstein.

Safe injecting sites, drug consumption rooms, safe injecting facilities, fix rooms or the rather more grandiose medically supervised injecting centres are just some of the many labels applied to legally sanctioned medically supervised drug consumption sites – places where drug users can inject their drugs safely

Read the full article in DDN Magazine

The laudable purpose of these sites is to reduce BBVs and overdose, while also reducing the nuisance caused by drug users injecting in public. They also offer users a route into a variety of mainstream services they otherwise might not have come in contact with.

Sounds super great, right? So, why do I always feel so uneasy when the subject comes up? I have to say, part of the unease comes from the reaction to anyone questioning the virtue of safe injecting sites – a reaction which ranges from scorn to outright hostility. Consequently an orthodoxy is being created around the subject, and in my experience unquestioned orthodoxies tend to lead to poor policy – and there’s more than enough of that out there already!

My unease, however, goes beyond a personal dislike of the virtue signalling and group-think that cloud the issue. There are several concrete reasons for concern regarding the costs that come with the safe injecting sites – costs that really need addressing and analysing.

Firstly, there will inevitably be a cost in community relations. Nothing exists in a vacuum – especially not property prices which, given the amount of stigma around IV drug use, will inevitably drop at the first mention of a safe injecting site in the neighbourhood. While it’s tempting to mock this sort of ignorance-based nimbyism, it would be wiser to realise that anything that further erodes the troubled relationship between drug users and wider society should be treated carefully.

Then there’s the inevitable political cost. By this I mean that admitting an area needs a safe injecting site is equivalent to admitting that a laundry list of policies – including housing, mental health, welfare and addiction polices – have all failed miserably, and politicians don’t like admitting and taking ownership of that kind of collection of failures. Persuading them otherwise takes a concerted effort – effort that could have been used to persuade them to adopt other, less glamorous, but more productive policies. Far too often substance misuse is an afterthought for politicians. Can the bandwidth they do devote to the subject be better used?

Then there’s the bottom-line cost. Money is an ugly subject, but sadly it’s always relevant – especially in an age of austerity and government indifference.

Before we go any further I keep hearing comments like ‘safe injecting sites can be cheap – you just need a tent and some works’. Guys, that’s not a safe injecting site. That’s a shooting gallery in a tent! Unfortunately the things that differentiate between a shooting gallery and a safe injecting site tend to be expensive and range from the cost of premises to the most important of all – the cost of suitable staff. Done right, a safe injecting site is not a cheap option.

In Germany consumption rooms provide information about therapy, clean syringes and cheap meals.

Importantly, it also needs pointing out that while offering a valuable service to the drug users who use them, the majority of drug users won’t use a safe injecting site. Not even a majority of IV drug users will use them – including me. I won’t use a safe injecting site because I’m fortunate enough to have a home. Even if I were homeless I wouldn’t travel far, pay for public transport, or spend time travelling to use a safe injecting site, and I’m far from alone in this. In fact while preparing to write this article I asked several current and past IV drug users what they thought of safe injecting sites. To a man/woman they replied they were a wonderful idea, but when asked if they’d use them personally they universally replied ‘NO’.  

Safe injecting sites’ clientele will tend to be chaotic, homeless users with complex problems, and that’s a small subset of not just drug users, but also a small subset of IV drug users – a very vulnerable, very visible subset, yet still a subset. So, the question is, is it acceptable to furnish the signifi­cant cost of a site that will only be used by a small percentage of drug users from a budget aimed at a much wider community of drug users?

I must admit that one of my pet peeves is that drug treatment is rarely designed for the primary purpose of helping drug users. Instead it tends to be designed to protect wider society from drug users by reducing crime, reducing the spread of BBVs in society and even by attempting to make drug users more economically productive. Safe injecting sites fit firmly into this peeve because it’s easy to see the benefit for local merchants and residents, but it’s a lot harder to discern much of a benefit to the majority of IV drug users.

At my most cynical I feel there’s something disturbing about an approach that can easily be seen as saying ‘come in for half an hour, have a shot so you don’t scare the public and then fuck off back to your cardboard box’. I’m sorry, but there are far more effective ways of helping a larger percentage of IV users – like the far more prosaic re-evaluation and design of housing, welfare, mental health and drug treatment services in the area for a start.

In October 2018 a safe injecting site shouldn’t be a priority in England. However, in other parts of the world they’re a viable policy option. In America the opioid epidemic and open air drug markets (which cause users to congregate in one place) make safe injecting sites viable. In Europe and Australia they’re the fruit of better funding and treatment philosophy, but in England the situation is different. This is not to say things won’t change – it would take a brave person to bet that the gradual arrival of fentanyl and other research chemical opioids won’t completely change the equation and push safe injecting sites up the agenda, but in the here and now we have other more pressing needs.

If, or rather when, the situation in England changes, then safe injecting sites may well become a viable treatment option, and when that time comes there’s much that can be done to mitigate the costs involved. We can accept that the sites should be temporary and serve as an emergency measure while the fundamental issues underlying their need are fixed. Temporary sites would also do much to allay local community concerns regarding their impact. A temporary safe injecting site also opens the door to using pre-fabricated buildings or converted buses, which would help to reduce the financial cost. So, there are options that can be taken to help make safe injecting sites viable in the future – IF they become needed.  

As it is today, safe injecting sites aren’t an exciting panacea to all drug users’ problems. They are in fact a luxury in an age of austerity and all the virtue signalling and group-think in the world won’t change that.

Nick Goldstein is a service user

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