Drug consumption rooms (DCRs) are a touchy subject in the UK. They're designed to prevent death – users can inject their drugs in a safe, clean environment, surrounded by medical professionals there to prevent overdoses – and evidence from Europe, where almost 80 of the rooms exist, shows overwhelmingly that they work. Yet, over the last few years, the British government has blocked potential DCRs from opening and consistently decreased funding for drug and alcohol services.
There are other factors at play – better reporting, an increased suicide rate – but it's likely these cuts contributed to the 3,756 drug-related deaths recorded in England and Wales in 2017, the highest number since records began in 1993.
These statistics are harrowing, but a report released this morning by the National AIDS Trust (NAT) indicates there's work being done to tackle the issue at local authority level. Of the 40 authorities with particularly high drug-related death rates they contacted, 35 responded to outline the work they were doing to tackle the problem – which included seriously considering the positive impact that DCRs could have.
There's currently no legislation to state that DCRs in and of themselves are illegal, but anything that happened inside them would be. Still, there are ways around this. Police officers currently turn a blind eye to the needle exchanges which offer safe injection equipment, while the government announced last year that it "wouldn't stand in the way" of festival drug testing rooms, one of which was shown to reduce hospital admission rates by 95 percent.
The festival testing rooms initially seemed a sign of more progressive things to come, but so far this change hasn't manifested on a wider scale, meaning while you can bump a few lines of tested coke at Bestival, users on the street are being denied vital services that could save their lives.
Not even an unprecedented spike in HIV transmission rates among drug users in Glasgow was enough to convince the Home Office that consumption rooms are a safer bet than just ignoring the problem. "It is enormously frustrating that this same approach [to festival drug testing] is not applied to DCRs," adds Deborah Gold, Chief Executive of the NAT. "There is a wealth of evidence that shows [they] can substantially reduce drug-related deaths and other harm such as HIV, yet the government is standing in the way."
The report also shows that Naloxone – a cheap drug that reverses the effect of opioid overdose to prevent death – isn't being used widely enough. Of the 151 local authorities nationwide, 138 were providing Naloxone. Despite this, only 12 percent of opiate users nationally are being given it. Why?
The first reason is that it seems to be provided only when patients are in treatment. Although police officers can carry Naloxone kits with them, Southampton's local authority explained that national guidance currently makes this unclear. In some cases, officers were told it was unsafe for them to carry the life-saving drug. More training might be needed, but studies show that Naloxone has no potential for misuse. Local authorities are paying for Naloxone that's often not being used, and the reasons for this reluctance are unclear.
Confusingly, the report also revealed inconsistency across the country, meaning that your chances of being saved from an overdose by an officer are currently dependent on a kind of national postcode lottery. "This inconsistency is deeply worrying," adds Gold. "We recommend the National Police Chiefs' Council address this urgently and issue guidance to police forces that it is safe for officers to carry Naloxone."
Then there's the treatment of prisoners. Although some authorities provide prisons with Naloxone throughout their stay and upon release, plenty of others don't. One authority blamed this on NHS England, which is responsible for commissioning the prison health pathway. Naloxone aside, drug-dependent prisoners are being released without being given treatment that could save their lives; as a result, the report states, there's a particularly high death rate among users in the immediate post-release period. Even Opioid Substitution Therapy (OST) is often ended too quickly, and it's largely because treatment tends to work on a reward-based system. Research shows that some users will need to be on OST for the rest of their lives, yet this often isn't an option.
Despite these issues, the report at least shows that some progress is being made. "Overall, we were encouraged by the responses from local authorities," says Gold optimistically. "[They] all seem to have considered the high rate of drug-related deaths in their area, with many implementing concrete actions and developing innovative ideas in an attempt to reduce the rate of deaths." These ideas include issuing warnings around the purity of drugs (the high purity of heroin is said to be one of the reasons behind increased death rates), appointing drug-related death coordinators and treating each death as a case study for future improvement.
It's also promising to see that government can make exceptions to legislation. The blind eye that's been turned to festival drug testing and needle exchanges represents a glimmer of hope for local authorities, which increasingly seem to be taking note of other countries' success stories. There has never been a recorded death in a European DCR, and Denmark in particularly is often cited as a shining example of their benefit: drug-related death rates fell after DCRs were introduced, as did HIV rates.
But there's still stigma to contend with, and it's written across the various DCR nicknames – "fix rooms", "shooting galleries" – which indicate their sole purpose is to enable "junkies". Needle exchanges have been shuttered due to drug-related litter, and the general consensus is that any positive stance the government could make would be too "politically risky". In other words, plenty of MPs would rather ignore the problem than take a controversial stance and risk losing support from those who believe all drug policies should be firmly rooted in abstinence.
Austerity measures are crippling the public health budgets of local authorities, and more cuts are predicted over the next few years. "Central government decisions are contributing to the humanitarian crisis of drug-related deaths," says Gold, who sees only one solution: "the cuts must be reversed".
In the meantime, there are other tactics: equip police officers with Naloxone and train them properly; consider the overwhelming evidence in favour of DCRs and eliminate the legal barriers blocking them; ensure that people aren't being kicked out of substitution therapy before they're ready. If MPs can turn a blind eye to festival-goers, they can certainly allow the country's most marginalised drug users to use without seriously risking their lives.