Reframing the debate about drug consumption rooms
To continue May’s harm reduction theme, Natalie Davies writes about an intervention yet to be implemented in the UK. She asks whether drug consumption rooms are testing the limits of our acceptance of harm reduction, and whether a change in language can reframe the debate from being about the problems of implementing drug consumption rooms, to drug consumption rooms being a potential solution to the problem of public injecting.
An article published in Addiction noted that the literature is “large and almost unanimous in its support” for drug consumption rooms, and there is little to no basis for concern about drug consumption rooms producing adverse effects. Reviewing the evidence base in 2016 and again in 2019, Drug and Alcohol Findings came to the conclusion that drug consumption rooms more likely than not made drug use safer in that they increased access to health and social services and helped people to identify and respond to emergencies, and also that concerns about encouraging drug use, delaying treatment entry or aggravating problems arising from local drug markets were unfounded.
As early as 2002, the Home Affairs Select Committee on drugs policy recommended that the UK should introduce pilot drug consumption rooms to determine their acceptability, feasibility, and effectiveness. This was followed by similar recommendations in 2006 by the Independent Working Group on Drug Consumption Rooms and in 2016 by the Advisory Council on the Misuse of Drugs. Successive governments have, however, remained unconvinced.
Public and policy debates in the UK have continued to focus on the problem of implementing drug consumption rooms, rather than on drug consumption rooms being a potential solution to the problem of public injecting.
A ‘normalised harm reduction approach across Europe’
A study from 2019 reported that drug consumption rooms have become a “normalised harm reduction approach across Europe and other countries”, and tend to emerge from local initiatives aimed at reducing the harms of public drug consumption. This mirrors the emergence of needle exchange programmes several decades ago in response to avoidable injecting-related harms including the spread of HIV.
“What makes drug consumption rooms distinct from and more disruptive than other harm reduction approaches such as needle exchanges, is that they employ staff who witness illicit drug use, as opposed to staff who advise and provide resources but who are ultimately absent for the act of drugtaking.”
Drug consumption rooms are first and foremost a form of harm reduction. They provide hygienic and supervised spaces for people to inject or otherwise consume illicit drugs. What makes drug consumption rooms distinct from and more disruptive than other harm reduction approaches such as needle exchanges, is that they employ staff who witness illicit drug use, as opposed to staff who advise and provide resources but who are ultimately absent for the act of drugtaking.
This unique context enables staff to respond to emergencies. It enables them to provide specific (rather than generic) harm reduction advice based on direct observation of “consumption patterns, risky dosages and improper handling of equipment”. It also enables people who inject drugs to be fully seen and accepted – even and especially while engaging in behaviour that is typically stigmatised and shamed. It is worth noting that these features are not universally viewed as strengths; critics have persistently positioned drug consumption rooms as places that legitimise drug use, and that therefore cause, rather than alleviate, harm.
Drug consumption rooms portrayed as controversial
In reaction to these perceived ‘wrongs’ of drug consumption rooms, the intervention is routinely depicted as a something controversial in the media and in academia (even among sympathetic authors). Sometimes, this occurs through authors listing concerns about drug consumption rooms, even when such concerns are unfounded or largely debunked by the evidence base. Sometimes, it is through authors associating drug consumption rooms with ‘shooting galleries’, which are illegal venues run for profit by drug dealers and by no means comparable to the over 100 sanctioned drug consumption rooms in 11 countries around the world.
In the UK, where there are no drug consumption rooms, and central government has no plans to change this, the tendency to frame drug consumption rooms as a controversial intervention can have the effect of cementing their political reality as ‘extreme’ and ‘unrealistic’ – perpetuating the thinking that current drug policy and practice is the neutral position to take. Furthermore, such framing is often a distraction from talking about an evidence base, which, although not perfect, is consistent in its support for drug consumption rooms.
- Blog to mark International Harm Reduction Day 2021
- Coverage of drug consumption rooms in the news ahead of a UK-wide summit on drug-related deaths held in Glasgow
- Qualitative Methods Journal Club discusses paper, “Enjoying the Kick: Locating pleasure within the drug consumption room”
- Discussion of the need for a ‘women-only’ drug consumption room to mark International Women’s Day 2021
- In-depth essay from Drug and Alcohol Findings on the strengths and pitfalls of the literature on drug consumption rooms, and how values can influence the way people engage with the evidence base
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