Supervised Injection Facilities save lives


(Pictured) The H17 Supervised drug consumption venue in Copenhagen, Denmark

As UK overdose deaths continue to rise alarmingly, by more than 100% in just three years, the introduction of supervised drug consumption venues becomes ever more urgent. Amongst their many proven benefits we know that they save lives. But whilst a cowardly government continues to drag its heels, entirely avoidable deaths will continue – so leadership from local authorities, such as that now being shown in Glasgow, is critical.   

 

Supervised drug consumption venues, also called supervised injection facilities (SIFs) or sometimes, less helpfully, referred to in the media as ‘fix rooms’ or ‘shooting galleries’, are legally sanctioned facilities where people who inject drugs can use pre-obtained drugs under medical supervision. They are designed to reduce the health risks and social costs of drug injection by reducing overdose deaths and transmission of diseases through needle sharing, by connecting hard to reach vulnerable populations with service providers, and reducing public injecting and drug litter.

Whilst the nature of the services varies, SIFs typically provide people who use drug users with: sterile injecting equipment and hygienic space in which to inject; emergency care in the event of overdose; counselling services; and primary medical care and referral to appropriate social healthcare and treatment services. Many also allow or have a dedicated space for smoking of drugs (including heroin and crack cocaine). 

There are now more than 100 SIFs operating in at least 66 cities around the world, in 10 countries (Switzerland, Germany, the Netherlands, Norway, France, Luxembourg, Spain, Denmark, Australia and Canada). There are official funded plans to open a SIF in Dublin, Ireland in the New Year, and today the welcome news that similar plans are in train in Glasgow Scotland – likely to be the first such facility in the UK.


Mobile supervised injection facility in Copenhagen, Denmark

 

SIFs have been extensively researched and evaluated for years. Indeed because they have been so politically controversial, they are some of the best evaluated of all drug harm reduction interventions. The evidence is conclusive and powerful; they reduce transmission of HIV and hepatitis transmission risks, prevent overdose deaths, reduce public drug use and injecting, reduce discarded syringes and drug litter, and increase the number of people who access and enter drug treatment. As overdose deaths hit record levels in the UK – one fact stands out above all others – No one has EVER died in a SIF, despite the 1000s of overdoses that have occurred. Opiate overdose is, in reality, easily reversed and rarely fatal if attended to quickly – only when people are using alone or without rapid access to emergency care does it become deadly.  A review by the European Monitoring Centre for Drugs & Drug Addiction (EMCDDA) also concluded that:

“There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”

SIFs have, unsurprisingly, often been controversial. But interestingly, where they have established they have soon won over support of the public and authorities – for the simple reason that they work, where other attempts have consistently failed. Forcing people into treatment when they are unready or unwilling to engage has always proved futile. Enforcement responses tend to simply displace the problems of public drug use elsewhere, increase vulnerability of target populations and make drug use even more risky.

Given the evidence of previous failings, and overwhelming evidence that SIFs can deliver - it seems a mystery why the UK government has so utterly failed to engage with the idea. The driving fear of a tabloid backlash, and the fear of NIMBYism also takes place in the context of a policy shift away from a pragmatic harm reduction approaches, towards a more ideological driven emphasis on abstinence. This ideological anti-science mindset permeates throughout UK drug policy. 
Disappointingly, key voices we might hope to speak out have also remained silent on SIFs – apparently cowered by the government in period when drug service funding is under serious threat. In an otherwise sensible report on addressing rising drug deaths by Public Health England, SIFs did not warrant a single mention. A group representing the interests of the UKs major drug service providers, Collective voice, has also been silent or dismissive of the idea.
So, as seems to be happening more and more in the UK in the absence of leadership from central government – local government are taking matters into their own hands. They want to save lives, they know how to do it and they are getting on with it. Congratulations to Glasgow. The hope is now that other local government will follow their example. And eventually The Government, who evidently couldn’t care less about the UKs disgraceful drug death stats, will get on board when they calculate that it works for them politically.

 

 

Author: Steve Rolles, Senior Policy Analyst for Transform Drug Policy Foundation

@SteveTransform