The Faculty of Public Health has coordinated an urgent call for overdose prevention centres (also known as drug consumption rooms and safer injecting facilities) to be piloted in the UK. Signatories include the Royal College of Emergency Medicine, All-Party Parliamentary Group for Drug Policy Reform, and London Network of Nurses and Midwives Homelessness Group.
Over 70 public health and healthcare organisations and 100 individual professionals have signed a letter asking the UK Government to pilot drug consumption rooms, which are hygienic and supervised spaces in which people can inject illicit drugs. They say:
“As public health and healthcare professionals, we the signatories can no longer accept the UK’s record number of drug-related deaths without implementing all available evidence-based interventions to save lives and protect health.”
The letter states that the scale of the overdose crisis is unacceptable, that drug-related deaths are avoidable, and that the UK is currently constrained from using the full range of evidence-based interventions in order to save lives.
“We welcome Dame Carol Black’s recent independent report on drug treatment, recovery, and prevention, which concluded that despite the best efforts of health and care professionals, current services are unable to deliver results to match the scale of the challenge we face.”
The new 10-year drug strategy, published last week (6 December 2021), pledged to ensure that “a full range of treatment and harm reduction interventions are available”; however, as the Faculty of Public Health and colleagues noted, the government’s plans “do not include setting up overdose prevention centres”.
“Whilst the Government has recently issued a new 10-year strategy to tackle harms from drug use in England, these plans fail to go far enough in implementing a full public health approach as they do not include setting up overdose prevention centres.”
Political opposition
In August 2021, Prime Minister Boris Johnson rejected drug consumption rooms as a potential solution to the record number of drug-related deaths in Scotland, saying that he was “instinctively” opposed to drug consumption rooms and “not in favour of encouraging people to take more drugs”.
A year earlier, in March 2020, Kit Malthouse (Minister of State for Crime and Policing) dismissed the possibility of the government shifting its policy on drug consumption rooms, adopting a skeptical view of the evidence-base:
“One of the issues in politics is people do reach for a simple solution, and, while drug consumption rooms have been used around the world, to a variable degree, and the research is mixed, even if we were to start it would take some time to get them in place. They’re quite small-scale and the scale of the problem certainly in Scotland demands a much more assertive approach.
“I think it is a distraction. We’re not convinced yet that the evidence is there.”
The evidence
‘Improving survival’ and ‘increasing social integration’ are the overarching aims of drug consumption rooms, according to the European Monitoring Centre for Drugs and Drug Addiction. Indicators that these aims are being achieved include:
- establishing contact with hard-to-reach populations
- identifying and referring clients needing medical care
- reducing immediate risks related to drug consumption
- reducing morbidity and mortality
- stabilising and promoting clients’ health
- reducing public disorder
- increasing client awareness of treatment options and promoting clients’ service access
- increasing chances that client will accept a referral to treatment
The Home Affairs Select Committee on drugs policy (2002), the Independent Working Group on Drug Consumption Rooms (2006), and the Advisory Council on the Misuse of Drugs (2016) have all previously concluded that the evidentiary threshold has been passed for trialling drug consumption rooms in the UK. And doing so would give an opportunity to determine the acceptability, feasibility, and effectiveness of the intervention in the British context.
Drug consumption rooms have tended to emerge from local initiatives aimed at reducing the harms and risks associated with public injecting. Under these circumstances, it has proven difficult (and ethically complicated) to evaluate drug consumption rooms via randomised controlled trials – the scientific ‘gold standard’ for determining a causal effect. Despite these limitations, a paper published in Addiction found that there has been consistent and “almost unanimous” evidential support for drug consumption rooms.
The letter to government organised by the Faculty of Public Health cited a number of pieces of evidence supporting the effectiveness of drug consumption rooms. This included:
- evidence demonstrating that drug consumption rooms are effective in preventing drug deaths (1 2 3)
- evidence highlighting the benefits of drug consumption rooms in facilitating patient referrals to treatment services and the adoption of safer injecting practices to reduce blood-borne virus transmission (1 2)
- review highlighting that there has never been a fatal overdose reported in the over 130 sites available globally
- no evidence linking drug consumption rooms to increased drug use, criminal activity, or associated policing problems
Ending their December 2021 letter, the Faculty of Public Health and co-signatories said, “it is clear that current strategies to tackle this [drug deaths] crisis are failing to deliver for populations across the UK”, and “we call on Government to take steps towards funding pilots on their implementation to save lives and reduce harm”.
Recommended reading
Click on the image (above) to read a new resource on the SSA website summarising what drug consumption rooms are, how they are delivered, and whether they are effective
From the SSA website:
- a new resource summarising what drug consumption rooms are, how they are delivered, and whether they are effective
- a blog on whether drug consumption rooms are testing the limits of our acceptance of harm reduction, and whether a change in language can reframe the debate from being about the problems of implementing drug consumption rooms, to drug consumption rooms being a potential solution to the problem of public injecting
- two discussions from the Qualitative Methods Journal Club – the first from December 2019 on the significance of pleasure within the drug consumption room as a way of engaging service users, and the second from October 2021 on a women-only supervised consumption service in Canada, which permitted smoking of illicit substances
From the Drug and Alcohol Findings archive:
- Summary and analysis of the 2018 overview of provision and evidence from the European Monitoring Centre for Drugs and Drug Addiction
- Summary and analysis of a review of evidence published in Addiction in 2019
- Summary and analysis of a study set inside North America’s first women-only safer injecting facility, which emerged in response to an epidemic of fatal drug overdoses and an epidemic of violence against women
- In-depth essay exploring whether it is time for safer injecting spaces in the UK
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