The SSA’s Natalie Davies talks to Dr Gillian Shorter about an evaluation of a mobile overdose prevention site in Glasgow in 2020, referred to in the media as the ‘drug consumption van’. Read about its harm reduction outcomes, how volunteers responded to overdose events, and the surprising prevalence of cocaine use.

Natalie: You recently had an article published in the International Journal of Drug Policy, which sought to evaluate an unsanctioned overdose prevention site in Glasgow between September 2020 and May 2021. For people who aren’t aware of the story or the context, can you define what you mean by an ‘overdose prevention site’ and what you mean by ‘unsanctioned’?

Gillian: “In response to the public health crisis of drug-related deaths in Glasgow, Peter Krykant made the decision to purchase his own minibus from savings/donations, and began to operate the UK’s first overdose prevention site on 11 September 2020.”

As time progressed the van began to co-exist easily in the environment

“An ‘overdose prevention site’ is a place providing a safe, supportive, and hygienic environment where controlled drugs, obtained elsewhere, are consumed under observation from staff who can advise, intervene in overdose events, and provide sterile injecting equipment or other basic supplies (clothing, food, water etc.). In this case it was a van parked in a single place. However, both mobile sites and fixed buildings can successfully host overdose prevention services – it really depends on the needs of the community they serve and the resources available.”

“The term ‘unsanctioned’ refers to not having official permission. Plans had been afoot for a sanctioned, healthcare-led site in Glasgow, but were halted due to legal concerns, and the lack of a letter of comfort from the Lord Advocate at the time.”

In nine months of operation, 894 ‘injection events’ took place onsite. What did you learn about the types of people coming to use the overdose prevention site? And, what did you learn about the type of harm reduction or broader health and social needs they had?

“Our paper provides a research breakdown of those who participated in injecting events, including that most were men, most were mid-thirties, and most rated their health as good/okay. From the field notes we know that these were good, generous, and kind people who made a community around the van, and were sad when it closed. Many had extensive trauma histories, and some took a while to feel comfortable attending the van given the stigma they have experienced elsewhere.”

“In terms of their health, the predominant concerns were around abscesses and infections, mental health, HIV and antiretroviral matters, mobility, and treatment needs (but we only collected this later in the data collection phases).”

One of the unique aspects of overdose prevention sites, compared with other harm reduction services such as needle exchanges, is that staff are there to witness people taking drugs and are able to intervene in order to reduce the risks associated with that drug-taking. Can you talk about how staff in the Glasgow drug consumption room responded to overdoses in particular, and what the outcomes were?

“There were only four simple rules at the van, and one was to agree to intervention following an overdose. There were nine overdose events involving eight individuals; all made a full recovery, and only one required an ambulance response. All volunteers at the van were trained to respond in the event of an overdose. However, many more overdoses were prevented with simple conversations during the time people were at the van. This shows how conversations and community-building with service users are central to the success of overdose prevention centres.”

“A very low-threshold approach, which is non-judgmental and accepting of individuals’ lived realities, is really important in facilitating healthful conversations. Fortunately, Peter and the volunteers who helped embodied this ethos.”

Your paper reported that most people who used the service injected powder cocaine alone (61% of recorded supervised injections) or with opioids (17%). Did it come as a surprise that cocaine was such a strong feature?

“Not to Peter who knew the context well, but when I originally got involved, I think I asked if the data was correct more than once! However, it does show that whenever the next overdose prevention site opens, it will be vital to have meaningful community engagement with potential service users to find out what their needs might be (including the substances they use). This will make the service a success.”

This was a very low-threshold service, the work was hard, and the service was busy, but volunteers were skilled in communication and support

“You must tailor service provision to the needs of the community. This is everything from advice to equipment, the nature of the staff running it, and staff/volunteer training. For example, for heroin or other opioid overdoses, being able to use naloxone is key; for cocaine, you have to take a different approach as naloxone would have no effect.”

The overdose prevention site was staffed by volunteers, who weren’t paid. Did this make it difficult to sustain, and did it ultimately limit what conclusions you could draw about the feasibility of running a drug consumption room?

“Absolutely, this was a very low-threshold service, the work was hard, and the service was busy, but volunteers were skilled in communication and support. Being unsanctioned limited the ability to link to formal or other healthcare supports, or provide a safety net or paid positions to provide this support. It is a lot of pressure psychologically, financially, and physically to always be there. Not being paid for the work is an issue as volunteers still had bills of their own to pay.”

“We tried to be conscious of the pressure that volunteers were under when reforming the data-collection instrument, and there were times that no data was collected or only partial data was collected as the priority was always to provide the service. We know there were well over 100 injections missed from the record, and from a research standpoint this was regrettable, but the priority is always to save lives and protect health.”

Can you talk about the nature of any criminal justice involvement both before the drug consumption room opened and while it was in operation (e.g. was there any informal local agreement with police, was anyone arrested, were service users surveilled or searched)?

“There was no formal agreement with the police at the time it opened, and there was one incident involving the police where the van and its inhabitants were searched for the presence of drugs. Peter was ultimately charged with an offence under section 23 of the Misuse of Drugs Act 1971, but charges were later dropped.”

“On occasion, the police would visit the area or the van following comments from the public; the police have a duty to respond. But no arrest or charge was brought against service users, Mr Krykant, or any other volunteer of the overdose prevention site for any of the offences that the UK Government and previous Lord Advocate warned would be committed if an overdose prevention site was in operation.”

Was there any impression from your research about whether a ‘positive precedent’ was set for operating a drug consumption room in the UK?

“Very much so. The van was novel and surprising in the early days of operation garnering attention from the public, businesses and locals, police, and the media. As time progressed the van began to co-exist easily in the environment, providing a focal point for individuals, and removing much street drug use and discarded equipment, and co-existing alongside businesses, public, and community members.”

People who use drugs are members of our communities too

“It was well-regarded amongst people who used the service, and for many clients, it was the first time that they had found someone who cared about them for a long time. Many used this as a springboard to seek treatment, or otherwise take steps to improve their health and wellbeing. Peter still receives messages from former users of the van, some of whom have made big changes in their lives, and are now thriving.”

And finally, what’s next for this research and/or for drug consumption rooms in the UK?

“For this research, there are some interesting threads we would like to pull – for example, looking at the model of operation, and how it intersects with opiate substitution treatment and other substance use. We have collected a lot of field notes, clippings, and messages about how it all worked over the time of operation, and are developing evaluation models and trying to identify areas where a pilot could be completed.”

“For drug consumption rooms, we are strongly calling for an amendment to Misuse of Drugs regulations to make it easier to pilot facilities with the Faculty of Public Health/Drug Science. People can read more about this and sign the public letter. It is rare that doing the right thing has this much potential to save money and lives, but every moment we delay in setting up and running a pilot costs lives. People who use drugs are members of our communities too.”

Dr Gillian Shorter is Co-Director of the Drug and Alcohol Research Network at Queen’s University Belfast.

edited by Natalie Davies

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