Gregory Scott inside a Safe Shape mock safer consumption site. Photo by Nigel Brunsdon
Call it what you will—chemsex, parTying, *cloud emojis*—but the gay meth crisis never went away. In fact, it may be getting worse.Last year, a CDC study found that after plummeting throughout the aughts, meth use more than doubled among gay men in New York City between 2011 and 2014. (The same study found a modest bump in use in San Francisco, and a slight decline in Los Angeles.) That meth use may be growing among certain gay enclaves echoes the concerns of public health workers, who caution that the epidemic is far from over—it's just expanding into new communities.As activists look for novel solutions to address an evolving epidemic, it's worth asking: Can supervised use and safer drug consumption sites help curb meth's impact on the gay community?In cities like Copenhagen and Vancouver, safer consumption sites (SCS) have been shown to help reduce overdose fatalities and diminish the spread of HIV and other infectious diseases. And while none yet exist in the US, our unceasing opioid epidemic has spurred efforts to open the first, in communities from Seattle to San Francisco to Massachusetts.Gregory Scott, a sociologist and professor at DePaul University, has been working to spread awareness of how safer consumption sites work; touring the country with Safe Shape, a traveling pop-up demonstration of an SCS, Scott provides skeptics and activists an inside view of how these centers can help compassionately mitigate the drug crisis. With an inside look at how these sites may factor into the future of American drug policy, Scott has ample authority to comment on how they could impact gay meth users. He spoke with VICE about that impact, and why the greatest hurdle to saving lives isn't political or financial, but the stigma of pleasure itself.VICE: The war on drugs has largely been a failure. We need to start thinking creatively about harm reduction. Are safer consumption spaces a way for drug users to consume with less risk?
Gregory Scott: There's no absolutely safe drug use. That doesn't exist. There are just degrees of risk and safety, and I think we can do a much better job with this idea of safer consumption spaces to address those needs in particular. We know from hundreds of scientific and academic studies that these spaces make communities healthier and safer for everyone. Their effects are salubrious. They're not detrimental. They generally produce decreases in overdose, drug injection, and drug smoking. Infection goes down, and often drug use itself goes down, which is interesting, because people are getting access to a form of health services they trust.What does a safer consumption site look like? Are they permanent spaces?
Safer consumption spaces vary greatly in what they look like. Some of them are pretty large brick and mortar enterprises, like InSite in Vancouver and H17 in Copenhagen. They can accommodate between 10 and 20 people at a time and have staff on board. Other facilities can be much more sparse, resembling a cluster of kiosks. Then we have mobile services. In Denmark they're almost like airport shuttle vans that hotels use.So the sites can look different and be customized based on local need. Are there characteristics that all SCSs have in common?
They all share three key elements. First, each has an area at which participants can access sterile supplies for the use of pre-obtained drugs. Another is consumption—there's going to be a place where substances can be consumed in a maximally hygienic way. What's really important about a consumption station is that you have a sterile and a repeatedly sterilizable surface. This is really critical. The great proportion of Hepatitis C, Hepatitis B and HIV transmission cases aren't really coming from contaminated syringes, but rather from environmental contaminants that often live on surfaces and come into contact with sterile gear.Finally, nearly all of these spaces have what we can think of as a post-consumption space. Many call it a "chill room." This is a space where participants can experience the effects of the substance they've consumed, and they can also be monitored for potential adverse outcomes like overdose. In the event that someone overdoses, staff or peer workers can respond with Naloxone or with other services in the case of "tweaking," where people are amped up and require assistance to get through that high-anxiety period.I know many SCSs only allow injections, but some are more flexible. Could safe consumption sites be used to reduce the meth crisis in the LGBT community?
Drug prohibition policies exacerbate vulnerability among the vulnerable. One of the really big issues particularly is LGBT youth of color who are so precariously housed. Where meth use is happening, we're seeing it happen in really unsafe situations. We need to do a better job of helping that particular sub-population within the LGBT community access resources that will help them build an infrastructure of safety in their lives. We can do that with SCSs and we will do that, but it might not be with brick and mortar facilities.If not a traditional facility, how can SCSs be incorporated into queer spaces? Would they be inside parties? Would they be mobile?
We can think about this kind of how we started syringe access services in the late 80s and early 90s. It wasn't about, "Okay, we're gonna have this one place and everyone has to come to us." We were like, "We need to be decentralized. We need to think creatively about how we're going to go out into the community and meet people where they're at." Particularly in the LGBT community, we need to be thinking flexibly and creatively about meeting people where they're at physically and geographically. Whether that's a party or club or on the streets.What are the hurdles we're really facing right now with incorporating safer consumption spaces? What do we need to overcome to make these spaces a reality?
There's a lot of legal interpretation out there which leads us to believe that these sites would violate federal crack house statutes, and that is a huge, huge concern for the organizations that are in the best position to actually start these kinds of spaces. There is this overriding fear that if an SCS would open publicly it would be shut down by the authorities. And if this were to happen, that would produce a chilling effect which might delay this whole thing by another 10 or 20 years.But the main hurdle is stigma. We have no idea in this country how to talk about drug use in a way that's sane and rational and that acknowledges the fact that humans have always consumed psychoactive substances for the purposes of altering consciousness. How many young people encounter adults in their lives who will talk to them about drug-induced pleasure, and how to maximize pleasure and minimize risk? Not many. I teach at a university, and every single time I teach a class I ask students that question. In 17 years, I've had probably three students raise their hands to say somebody in their life—some authority, some elder—actually talked to them about pleasure and risk in a really tangible, helpful, experiential way.You have two choices here. You either let this continue, and people will continue dying and getting sick, or you want to somehow change or improve that. You either want to perpetuate harm or you want to do something to reduce harm. That's a big picture, a kind of cultural shift that many of us are working to establish.Interview has been condensed and edited. Follow Chase Burns on Twitter.
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Gregory Scott: There's no absolutely safe drug use. That doesn't exist. There are just degrees of risk and safety, and I think we can do a much better job with this idea of safer consumption spaces to address those needs in particular. We know from hundreds of scientific and academic studies that these spaces make communities healthier and safer for everyone. Their effects are salubrious. They're not detrimental. They generally produce decreases in overdose, drug injection, and drug smoking. Infection goes down, and often drug use itself goes down, which is interesting, because people are getting access to a form of health services they trust.
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Safer consumption spaces vary greatly in what they look like. Some of them are pretty large brick and mortar enterprises, like InSite in Vancouver and H17 in Copenhagen. They can accommodate between 10 and 20 people at a time and have staff on board. Other facilities can be much more sparse, resembling a cluster of kiosks. Then we have mobile services. In Denmark they're almost like airport shuttle vans that hotels use.So the sites can look different and be customized based on local need. Are there characteristics that all SCSs have in common?
They all share three key elements. First, each has an area at which participants can access sterile supplies for the use of pre-obtained drugs. Another is consumption—there's going to be a place where substances can be consumed in a maximally hygienic way. What's really important about a consumption station is that you have a sterile and a repeatedly sterilizable surface. This is really critical. The great proportion of Hepatitis C, Hepatitis B and HIV transmission cases aren't really coming from contaminated syringes, but rather from environmental contaminants that often live on surfaces and come into contact with sterile gear.Finally, nearly all of these spaces have what we can think of as a post-consumption space. Many call it a "chill room." This is a space where participants can experience the effects of the substance they've consumed, and they can also be monitored for potential adverse outcomes like overdose. In the event that someone overdoses, staff or peer workers can respond with Naloxone or with other services in the case of "tweaking," where people are amped up and require assistance to get through that high-anxiety period.
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Drug prohibition policies exacerbate vulnerability among the vulnerable. One of the really big issues particularly is LGBT youth of color who are so precariously housed. Where meth use is happening, we're seeing it happen in really unsafe situations. We need to do a better job of helping that particular sub-population within the LGBT community access resources that will help them build an infrastructure of safety in their lives. We can do that with SCSs and we will do that, but it might not be with brick and mortar facilities.If not a traditional facility, how can SCSs be incorporated into queer spaces? Would they be inside parties? Would they be mobile?
We can think about this kind of how we started syringe access services in the late 80s and early 90s. It wasn't about, "Okay, we're gonna have this one place and everyone has to come to us." We were like, "We need to be decentralized. We need to think creatively about how we're going to go out into the community and meet people where they're at." Particularly in the LGBT community, we need to be thinking flexibly and creatively about meeting people where they're at physically and geographically. Whether that's a party or club or on the streets.What are the hurdles we're really facing right now with incorporating safer consumption spaces? What do we need to overcome to make these spaces a reality?
There's a lot of legal interpretation out there which leads us to believe that these sites would violate federal crack house statutes, and that is a huge, huge concern for the organizations that are in the best position to actually start these kinds of spaces. There is this overriding fear that if an SCS would open publicly it would be shut down by the authorities. And if this were to happen, that would produce a chilling effect which might delay this whole thing by another 10 or 20 years.But the main hurdle is stigma. We have no idea in this country how to talk about drug use in a way that's sane and rational and that acknowledges the fact that humans have always consumed psychoactive substances for the purposes of altering consciousness. How many young people encounter adults in their lives who will talk to them about drug-induced pleasure, and how to maximize pleasure and minimize risk? Not many. I teach at a university, and every single time I teach a class I ask students that question. In 17 years, I've had probably three students raise their hands to say somebody in their life—some authority, some elder—actually talked to them about pleasure and risk in a really tangible, helpful, experiential way.You have two choices here. You either let this continue, and people will continue dying and getting sick, or you want to somehow change or improve that. You either want to perpetuate harm or you want to do something to reduce harm. That's a big picture, a kind of cultural shift that many of us are working to establish.Interview has been condensed and edited. Follow Chase Burns on Twitter.