A table, a chair, and a sharps box
In Episode 19 of the Addictions Edited podcast, Dr Gillian Shorter talks to podcast host Rob Calder about drug consumption rooms and brief interventions, and what lay behind her decision to research two seemingly disparate types of substance use interventions. She explains why she doesn’t see supervised consumption sites as ‘controversial’, and why we probably won’t see a randomised controlled trial of drug consumption rooms any time soon.
Dr Shorter is Senior Lecturer in the School of Psychology at Queen’s University Belfast, and Co-Director of the Drug and Alcohol Research Network (DARN). She evaluated the UK’s first unsanctioned drug consumption room in Glasgow, which you can read more about in a 2022 interview for the SSA website.
“Drug consumption rooms are essentially safe facilities where individuals can use drugs that they’ve obtained elsewhere under supervision from another person. They can be quite simple in design, all the way up to very complex – so you can have people in mobile sites, so they can be in vans, or they can be in fixed sites, such as attached to hospitals or treatment centres or completely independent. The key element is that there’s just somebody keeping an eye on the person who’s taking substances. And that in itself can help reduce overdose or the risk of overdose, and provide a bit of support and community for some of our most vulnerable individuals in society.”
She notes that they are often seen as ‘controversial’ interventions, although she doesn’t personally believe that they should be; if the most controversial part is watching people take drugs, there is already an ‘open drug scene’ in towns and cities around the UK, it’s just that people will be injecting in unsafe, public places:
“[Drug consumption rooms] are very controversial, even though they shouldn’t really be controversial. I’m firmly in the ‘they aren’t controversial’ camp. Sometimes I’m alone in there. Other times I’ve got great company. […] I think sometimes people feel that individuals perhaps should be abstinent from drugs and that that’s the goal. And that may be a goal for some, but some people are just not quite ready for that, and they still deserve our help, support, and more importantly, deserve as much healthcare as anyone else does in our society.”
Gillian says that one of the main aims of drug consumption rooms is to reduce overdose deaths. But she also lists several other important outcomes that could be associated with drug consumption rooms, such as improving access to primary healthcare, reducing use of emergency healthcare, and reducing risky drug use behaviours.
Drug consumption rooms can be really simple…basically just a table, a chair, and a sharps box.
Rob asks about the weight of evidence behind drug consumption rooms to date, particularly given that there are no randomised controlled trials, which are considered the ‘gold standard’ for evaluating whether something works. Addressing this, Gillian says:
“The big thing that always comes up though is ‘why are there no randomised controlled trials?’ It comes up every time and it’s a very simple answer. We know these places save lives. We have an evidence base across multiple countries to show that it does. So, it’s not ethical to randomise one area to have a drug consumption room and one not to.”
Gillian talks about the need for a pilot in the UK and why the job of a researcher is to ‘put evidence before ideology’:
“[A pilot of drug consumption rooms is] really to demonstrate that it does work or doesn’t. And if it doesn’t work, and it’s not the solution that our community needs, then we have to be prepared to say ‘no this is not the right solution’. And that’s just the job of a researcher. We can’t just go into things with ideology. We have to try and back it up with some evidence. And so this is what we want for the UK. We want to try it out, and if it doesn’t work then we have to think of something else, because we have extraordinary drug-related deaths here. It is frightening.”
Rob then asks about Gillian’s experience of researching brief interventions and drug consumption rooms, which seem like two very different interventions on paper:
“I’m really interested in just anyone who maybe is experiencing some harm from alcohol or drugs, or at risk of harm, but doesn’t really feel like treatment is there for them at this point in time. […] I have known a lot of people who, you know, maybe have tried treatments and maybe it hasn’t been the right door for them at that particular time. So I’m a firm believer that we use harm reduction to keep people safe as best we can, and so they’re not that different in my head.”
This article is based on a podcast episode available to download or stream here. Quotes have been condensed and edited for clarity.
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