Kaleidoscope’s Elwyn ‘Tommy’ Thomas recently spent four days in Copenhagen shadowing the Nurses and staff at a Drug Consumption Room (DCR) and visited a mobile Safe Injecting Facility (SIF) within the Beautiful City of Copenhagen.
“What struck me initially as strange was that I expected these places to be either in some dark back street or the wrong end of Town, how wrong I was. The largest called SKYEN/CLOUD was main street in a fashionable part of Town, next door to a building called Maendenes Hjem. This place gave the homeless somewhere to stay, wash and get fed daily by an array of volunteers. Food is donated by the people of Copenhagen and clients have access to a DR to address issues around homelessness, substance misuse, providing services such as foot clinics, wound/abscess and DVT clinics and the prescribing of anti-biotics.
Firstly, you have register to use the DCR. You don’t need to use your real name, an alias will do. Every time you present to use the facility, after giving your name and initially showing the substance you intend to use, for harm reduction and safety purposes, you are greeted in the reception area by a very friendly member of staff who records data. There are four members of staff on each shift, three eight hour shifts a day, and minimum of one nurse per shift.
All staff I met had a vast experience of IV use and knowledge of individual clients and their problems. A client signs in then awaits his turn to use the facility. There were two rooms adjoining the reception area and you can only access these by swipe card. When a space becomes available a member of staff will swipe you through. In one room you have 9 cubicles for fixing, in the middle of that room there is an area or station for the staff to database and monitor the clients and to give care, and harm min advice if needed. It is a clinical /sterile area, light and airy, stainless steel cubicles all around, boxes of every type of needles and paraphernalia to prevent BBVs, there were groin ,neck, leg ,arm and hand IV users, no different to our own clients in Wales.
What was refreshing was the lack of finger wagging from staff, every cubicle was in use, each client was allowed maximum of 45 minutes stay, if they needed it. There were vein lights attached to some tables, which is a fluorescent light making it easier to find a vein and fix safely. Each client had the responsibility to clean up after themselves. It did get bloody, messy and often stressful to clients and staff alike, with the failure sometimes to achieve their desired goal, (missing veins) as is the nature of the game. It was, however always handled with care and compassion and looked upon as a medical issue to be treated with respect for all those concerned. I watched Naloxone on more than one occasion administered with ease, experience and a professionalism that was absolutely staggering. The Staff Nurse in question really opened my eyes in how you treat those who are truly on the fringes of society, it was heart-warming to see clients having their shoulders rubbed, touched tears wiped and even hugged and treated with respect and compassion. There were clients that were under the influence of alcohol, they were handled differently but always with the upmost respect. There were also people who were on methadone treatment but using IV opiates, the emphasis being pro-choice and a safe environment in which to use. Focusing on harm reduction, more importantly keeping people alive with experienced staff on premises to cope and deal with any and every eventuality.
The adjacent clinical area consisted of a room with eight enclosed cubicles with glass doors that shut. It was a smoking space for smoking opiates /heroin on the foil and smoking Crack cocaine. Staff did not stay in that room and monitor clients as the smoke although extracted would and could be detrimental to their health but the clients would still be monitored through a glass partition and glass door from the fixing room. Staff would frequent the smoking room whenever necessary , the stay in the smoking room is 35 minutes each and again a client has the right to frequent it as many times as they need to through the course of the day. Ammonia dispensers featured on the walls for the washing of cocaine. There is no availability of crack in Copenhagen, only cocaine and so clients have to wash it themselves, bringing with it its own problems in terms of risks to health. Staff have acknowledged this problem and try whenever possible to promote the use of Bicarbonate of soda.
In one 24 hour period on the Saturday I was there the smoking room was used approximately 360 times and the fixing room approx. 270 times with some clients using it more than once. I’ve been told that this was not a particularly busy day. From the Friday – Monday of that particular weekend it was used approx. 2500 times by clients in safety with full knowledge of the local Police force, some of whom I met with their guns, sprays, batons, stab vests and cuffs who experience I’m sure the same difficulties in their working days as our own hard working police force in trying to keep our communities safe in fighting drug relating crime. In talking to the police, it was obvious that they had experience with drug users and street homeless and exerted an amount of tolerance and took the time to get to know all the people that used the facilities by name.
If the police were called to deal with clients who were abusive, dangerous or violent to staff or other clients, they would be escorted off the premises with respect and in some cases banned from using that particular SIF for 24 hours. They could however, use the other facilities which were 200 yards away. There were other police and drug / narc squad officers as drugs were illegal and these guys go in hard to tackle high level drug dealing and crime but they leave the low level drug dealing to the street police who deal with it with a more common sense approach.
The staff rotate from each of the SIFs so everyone knows every one, so communication is key .There are 5000 clients registered to use these facilities in Copenhagen and they have a representative who has been voted democratically to represent the service users and give them a voice in all matters concerning the use of DCRs and their treatment surrounding them. Although a very controversial subject, the police, politicians, small businesses and the people of Copenhagen would never go back to the old days, where needles and the dead littered their streets, a familiar theme to our own UK towns and Cities.
Drugs are illegal in Copenhagen, the SIF were the result of a Copenhagen problem that was dealt with by the people of Copenhagen .First started at a grass route level with an old ambulance that cost 3000 euros, they went out on to the road with it and manned it with a dedicated team of volunteers .The SIFs they have now are funded by the Municipal, the equivalent of our county councils. They are run very low key, they have been running for four years now and not one death has occurred in all that time. There have been approx. 380 over doses in that time, where oxygen Naloxone and ambulance were called, and by experienced staff being there on site, people’s lives were saved.
The smaller of the two DCR is about to close and to replace that the city of Copenhagen has just built the world’s largest DCR. Obviously it will be run differently as its municipally run, but no doubt the philosophy is the same, saving lives and harm reduction and for the people of Copenhagen. It lessens the impact of drug related death on their streets and abandoned needles resulting in sharps injuries to its citizens, there were 5 rules in using the service , there has to be rules but even these were enforced with tolerance and common sense.
The Rules were as follows:-
- Follow Staff Rules
- No Violence
- No Threats
- No Weapons
- No Dealing
More than 3,300 people died from drug poisoning in 2014 in England and Wales, the number of people dying from drug misuse in Wales fell by 20% to 168 last year down from 208 recorded deaths in 2013. Deaths from heroin have increased in England and Wales to 952 in 2014 and in that same year 613 people died as a result of Drugs in Scotland, we don’t have the figures yet for 2016. I’m sure if we had Drug Consumption rooms the number of deaths by drug poisoning would be greatly reduced.”