Synthetic Opioid key responses
- Mapping evidence-based key responses to synthetic opioids and their implementation strategies
- Field-tested Toolkit with seven implementation guides
Thematic information: Drug consumption rooms - Global State of Harm Reduction 2018 briefing
Find out about which countries have drug consumption rooms, the different types of services available and the benefits they bring to public health.
Une dépolitisation hygiénique : les lieux d'injection de drogues illicites comme stratégie de réduction des méfaits
Au Canada, depuis la fin des années 1990, la mise en place de lieux où il serait possible de s'injecter des drogues interdites sans craindre d'autre intervention étatique que le contrôle médical est revendiquée par plusieurs acteurs sociaux. Le fait qu'il n'aura fallu que quelques années pour que cette stratégie de « réduction des méfaits» soit envisagée politiquement dans un Canada pourtant toujours attaché à son régime prohibitif appelle une interprétation sociologique. Examinant les motifs utilisés pour justifier la mise en place éventuelle de tels lieux par les acteurs des champs universitaire, journalistique et politique, on constate que ces motifs prennent pour axe majeur la dimension socio-sanitaire de l'usage. Une dépolitisation hygiénique: la tension prohibition-légalisation a disparue.
What is the current evidence for the efficacy of drug consumption rooms?
This briefing summarises the evidence on the efficacy of drug consumption rooms from 1st January 2003 to 11th March 2019.
Attitudes towards safe consumption sites among police and people with lived experience in Tijuana, Mexico: initial report from the field
INTRODUCTION: Mexico northern border has high levels of heroin use. For more than 10 years, the country has implemented several harm reduction interventions to reduce the risks associated with drug use. New strategies such as Safe Consumption Sites (SCS) must be considered as a next step to service vulnerable populations and increase their health outcomes.
OBJECTIVE: This report seeks to measure and compare attitudes on a potential SCS intervention in Tijuana among police and people with lived experience (PLE) in heroin use in the city.
METHOD: Two parallel studies on police practices and everyday experiences of heroin users in Tijuana were able to ask similar questions about attitudes toward SCS and its implementation in the city. They conducted quantitative interviews with 771 active police officers and 200 PLE while in rehabilitation services.
RESULTS: Both groups showed a high personal support for SCS of nearly 82% and a perceived implementation success around 80%. Officers reported 58.9% peer support for SCS while PLE 79%. Around 76% of both groups agreed that a SCS would help to improve their personal health. Finally, 86.2% of the officers would refer people to a SCS while 62.5% of PLE would use the service.
DISCUSSION AND CONCLUSIONS: The strong positive attitudes from police officers and PLE towards SCS in the city of Tijuana reported in both studies indicate the possibility of a successful implementation of a SCS. This intervention would represent an innovative way to protect PLE from police harassment and victimization, helping reduce HIV and HCV risk behaviors while improving community health.
Correlates of Seeking Injection Assistance among Injection Drug Users in Tijuana, Mexico: Correlates of Seeking Help Injecting in Tijuana, Mexico
Assisted injection among injection drug users (IDUs) remains understudied. We recruited 1056 injecting drug users (IDUs) using respondent driven sampling in Tijuana, Mexico. Participants underwent HIV and syphilis testing and structured interviews. One quarter (25%) sought injection assistance in the past 6 months. Seeking injection assistance was independently associated with being female [Adjusted Odds Ratio (AOR)=2.59; 95% Confidence Interval (CI)=1.73–3.90], being born outside Baja California (AOR=1.75; CI=1.26–2.42), having recent abscesses (AOR=2.59; CI=1.93–3.47), using syringes previously used by others in the past six months (AOR=1.99; CI=1.45–2.71), and ever being arrested for carrying sterile syringes (AOR=1.55; CI=1.15–2.09).
Shooting Gallery Attendance among IDUs in Tijuana and Ciudad Juarez, Mexico: Correlates, Prevention Opportunities, and the Role of the Environment
We identified factors associated with shooting gallery attendance among injection drug users (IDUs) in two Mexico-US border cities. IDUs in Tijuana (n=222) and Ciudad Juarez (n=205), Mexico, who were >or=18 years and injected illicit drugs in the last month were recruited using respondent-driven sampling (RDS). An interviewer-administered survey collected sociodemographic and behavioral data. Logistic regression was used to examine correlates of shooting gallery attendance in each of the two cities. Homelessness and being arrested for syringe possession--both structural level factors--were associated with shooting gallery use in both cities. In Ciudad Juarez, younger age and having overdosed were also associated with shooting gallery use. Our study highlights the need for structural interventions that mitigate homelessness among IDUs and facilitate changes in law enforcement practices associated with shooting gallery use. Harm reduction interventions based within shooting galleries should also be considered to prevent transmission of blood-borne pathogens among IDUs.
Ethical reflections emerging during the activity of a low threshold facility with supervised drug consumption room in Geneva, Switzerland
A drug consumption room (DCR), ‘Quai 9’, opened in Geneva, Switzerland in 2001. As part of its evaluation, a study of situations which presented staff with ethical conflicts in their day to day work was undertaken in 2003. Problem situations were identified via an open ended questionnaire and non-participatory observations. The nature of the ethical conflicts encountered in the identified situations was discussed in a staff focus group and analysed using an ethical framework based on three levels of norms (personal, professional, institutional) adapted from a clinical setting. In a second focus group, an applied analysis, using the same level of norms from the first focus group, was presented to the staff to assist them dealing with ethical conflicts. Situations associated with ethical conflicts for staff were assisting clients to inject, client refusal to seek treatment in spite of poor health, new injectors, prohibition of access to minors, pregnant clients, client self mutilation, and non-participation in proposed activities. The study showed that despite Quai 9's clear objectives, expressed philosophy, and operational rules, the staff were frequently exposed to ethically conflicting situations. However, open and structured discussion of these situations using an ethical framework which allowed the identification of different norms and discussion of their respective importance in order to reach a common decision was feasible and useful in a DCR setting.
Monitorage de la consommation de substances dans les centres d’accueil bas seuil. Rapport annuel 2017
Le but de ce projet est d’obtenir un premier aperçu au niveau suisse de la consommation de substances dans les centres d’accueil disposant de locaux pour la consommation de substances psychoactives illégales. On récolte en particulier des données sur les substances consommées dans les centres d’accueil, les formes de consommation (injection, inhalation, sniff) et sur les formes de polyconsommation les plus répandues.
An investigation into the feasibility of establishing Drug Consumption Rooms
The time is right to look at new ways of reducing mortality among people who use illicit drugs. Across the UK, we are seeing record levels of drug-related deaths. These deaths often occur among people who use heroin, as well as alcohol and tobacco. The appearance of synthetic opioids like fentanyl and carfentanil in the UK drug markets threatens to cause even more harm.Many of the most vulnerable people are not well served by existing models of treatment. So we need new ways of engaging these people in services that can save their lives. The need for drug consumption rooms is urgent.
As this report shows, providing facilities where people can use illicitly purchased heroin under the supervision of trained staff has saved many lives in the countries where they already exist. There has never been a death from overdose in a drug consumption room. Although many overdose events have occurred, the presence of trained staff and swift delivery of oxygen and naloxone prevents death. Such facilities do not increase drug use or crime in their neighbourhoods. Rather, they reduce risks related to public injecting and discarded needles. They form a valuable part of the mix of interventions that are required to reduce deaths. This also includes opioid substitution therapy of optimal dosage and duration, wider provision of naloxone, heroin-assisted treatment and investment in welfare, social and mental health services.
The legal barriers to the establishment of drug consumption rooms have been reduced by acknowledgement at UN and UK government level that they can form a legitimate part of local responses to drug-related harms. But the Scottish Lord Advocate’s recent advice shows that a clearer legal framework will need to be provided. In the meanwhile, as this report explains, it is still possible for local areas to develop a discretionary model that enables the establishment of drug consumption rooms in places which have a high concentration of injecting drug use. The longer we wait to set them up, the more people will die preventable deaths.
Drug Consumption Rooms: A Welsh Response
Drug Consumption Rooms (DCRs) can go by multiple names including: Medically Supervised Injecting Centres (MSIC); Supervised Injecting Facilities; Supervised Injecting Services; Community Health Engagement Locations (CHELs); and what they intend to be called in Wales, Enhanced Harm Reduction Centres (EHRCs). For the simplicity of this report, I will only use the DCR terminology, that will encapsulate all the other names. DCRs have been a part of the harm reduction movement within the substance use field since the mid 1980’s with the first such facility opening in Bern, Switzerland in 1986. Of the 123 DCRs that are currently operational worldwide, the majority are based within Europe. Australia and Canada are the hosts to DCRs outside of Europe. Closer to home, discussions regarding establishing a DCR in both Dublin and Glasgow are ongoing.
Within a DCR, people can use illicit drugs under the supervision of trained staff. The way these drugs can be administered depends on the model of the DCR; some facilities only allow injecting whereas others also provide areas for inhalation of substances. Different services may be available at other DCRs, with further explanation in section 7.1 but all DCRs provide clean equipment for people to administer their substances (e.g. needles, syringes, cookers etc). Most DCRs also provide naloxone on site (legislation permitting).
