Kaleidoscope wants to provide Drug Consumption Rooms because they save lives, in the same way that substitute prescribing and needle syringe exchange do. We want to provide such services because they benefit communities by reducing drug related litter, but they also reach out to some of the neediest in the community who do not find traditional treatment works for them.
The need for such approaches has never been greater, with an increase in drug related deaths in England and Wales. You could argue that some of the increase in deaths can be put down to an ageing community of drug users, but it is also because treatment has failed so many.
Kaleidoscope has always been committed to the principles of Harm Reduction, be it in setting up the first needle syringe exchange in the UK or providing innovative contraception services in a Friday Club. Our priority has been to work with the most needy and we fundamentally believe that quick, accessible, non-judgemental treatment services are key. This is why in Kingston we had the first computerised dispensing services for methadone, so we could accept everyone who needed help rather than putting hurdles in the way of people.
In the last few years the UK drug policy agenda has all been about Recovery. This is a wonderful concept for those who can make changes to their lives and often works for people without complex needs. Sadly, there are people whose lives are blighted by poor mental health, terrible housing and no exit routes out of their predicament. Their situation is like many people I met in India, whose life opportunities are earning a living from the rubbish tips of Delhi. If your life has little hope, why would you not escape with drugs? I am not sure if I would not go down that path for temporary relief.
Too often the most vulnerable people end up injecting drugs on the street because they have no place that feels like home. They live a sad existence made worse by a drug policy that means most will experience prison, again an environment that their fragile mental state will struggle to deal with.
So why do I believe in Drug Consumption rooms? I do so because we need to show we care about people, and by engaging them even at this basic level, we can offer hope. Of course such a facility can only be a very small part of the problem, but if you look at a person in a hostel, if they take drugs in their rooms they are evicted, but if they take it in a safe environment they may preserve their tenancy. If they can come somewhere safe, they do not use public toilets or play parks as somewhere to inject drugs. The simple truth is a drug consumption room is better for the drug user and is also safer for the community.
The issue of drug related deaths is likely to get worse. Austerity is hitting drug services in England and Wales. Sadly we are seeing a reduction in the services being offered. Of course you could argue a new type of service will cost more, but it does not have to be that way. A simple area where it is safe to take your own drugs is not expensive, particularly if it is integrated into existing services. The other reason we need to do this now is the serious concern that drug related deaths will significantly increase because of pharmaceutical drugs such as Fentanyl, which are much more powerful than the street drugs. We need to ensure we are there if people inject more powerful drugs than they are expecting, as treatment agencies we need to be vigilant about new drugs coming on the scene that will be more damaging than those currently around.
So the issue for me is, in an ideal world I would like to provide those coming to us with a job, a new home, a family and a safe community network where people gain acceptance. I would like to erase the traumas people have, such as being abused as a child, so the damage it still causes them is removed. I would like to find cures for personality dis-orders and schizophrenia. It would be wonderful, but we do not live in such times and so we have to try to reduce the harm people can do to themselves and try and support people to make the changes they can in their lives.
The service would be targeted at the most dis-advantaged, because their outcomes from their addiction are much worse. If we look at alcohol for example, its consumption per population may be higher in Monmouthshire than Blaenau Gwent, but alcohol related death is a serious problem in Blaenau rather than Monmouthshire. In essence, drug consumption rooms are not necessarily vital for people with their own homes, and who have some finances to purchase drugs, but for those living on the street or hostels where they face eviction for their drug use. These people are also more visible and therefore likely to face arrest for taking illegal drugs. At present it would seem that agencies’ toilets are the injecting rooms or a nearby alley way is the drug consumption space, which cannot be good. Drug services have created a situation where people who use drugs try and cheat the testing regimes where they need to provide a negative test. We do not listen to the reality of a person’s life and create mis-trust, which is not the basis for a strong therapeutic relationship.
The model we would follow is similar to Insite in Vancouver, Canada, which is a supervised drug injection service accessible to street drug users. Insite has injection booths where clients inject pre-obtained illicit drugs under the supervision of nurses and health care staff. Clean injection equipment such as syringes, cookers, filters, water and tourniquets are supplied. If an overdose occurs, the team, led by a nurse, are available to intervene immediately. Nurses also provide other health care services, like wound care and immunizations.
Statistics from the centre running from 2003:
- More than 3.6 million clients have injected illicit drugs under supervision by nurses at Insite since 2003.
- There have been 48,798 clinical treatment visits and 6,440 overdose interventions without any deaths.
One of the key reasons for drug consumption rooms was safety through a questionnaire of IDU users in Canadas ST Peters Centre AIDS Care.
The paper titled ‘An integrated supervised injecting program within a care facility for HIV-positive individuals: a qualitative evaluation’.
The most common motivations for injecting in the DCRs were hygiene, safety from the risks associated with overdoses, and physical safety. While both male and female participants named physical safety as a benefit of injecting in the HRR, this theme was particularly common in female participants’ accounts: “I got a safe place to use, and all my new syringes are there. It’s safe in case I overdose, or someone is going to rob me or anything like that. I’d feel safer in the room there … I’ve been robbed like three times on East Hastings.”
Participants described the DCR as a unique setting for accessing safer injection education and pointed out that the guidance received in the HRR impacted their injection practice and reduced the occurrence of injection-related infections:
“They offer cleanliness and hygiene, it’s real good. Now I use an alcohol swab more, I didn’t use them before … That’s why a lot of people get abscesses, because of the hygiene. And, plus after 27 years of using, I wasn’t doing it right.” (Male participant #6).
The staff running the service noted, “We used to have a lot more injecting-related abscesses … I’ve seen a reduction, possibly teaching, through vein maintenance and rotating sites. If there are abscesses we just intervene sooner. They’re willing to tell us about it so we can help.”
The work in Canada is accepted by the local community and businesses. It is an approach where people are given a chance to be honest and address the real health issues their drug use is causing them. It means that police are not called for what ultimately is a health and social care issue.