The time is right to look at new ways of reducing mortality among people who use illicit drugs. Across the UK, we are seeing record levels of drug-related deaths. These deaths often occur among people who use heroin, as well as alcohol and tobacco. The appearance of synthetic opioids like fentanyl and carfentanil in the UK drug markets threatens to cause even more harm.Many of the most vulnerable people are not well served by existing models of treatment. So we need new ways of engaging these people in services that can save their lives. The need for drug consumption rooms is urgent.

As this report shows, providing facilities where people can use illicitly purchased heroin under the supervision of trained staff has saved many lives in the countries where they already exist. There has never been a death from overdose in a drug consumption room. Although many overdose events have occurred, the presence of trained staff and swift delivery of oxygen and naloxone prevents death. Such facilities do not increase drug use or crime in their neighbourhoods. Rather, they reduce risks related to public injecting and discarded needles. They form a valuable part of the mix of interventions that are required to reduce deaths. This also includes opioid substitution therapy of optimal dosage and duration, wider provision of naloxone, heroin-assisted treatment and investment in welfare, social and mental health services.

The legal barriers to the establishment of drug consumption rooms have been reduced by acknowledgement at UN and UK government level that they can form a legitimate part of local responses to drug-related harms. But the Scottish Lord Advocate’s recent advice shows that a clearer legal framework will need to be provided. In the meanwhile, as this report explains, it is still possible for local areas to develop a discretionary model that enables the establishment of drug consumption rooms in places which have a high concentration of injecting drug use. The longer we wait to set them up, the more people will die preventable deaths.

Professor Alex Stevens

University of Kent

Executive Summary

The ACMD and other bodies have recommended that the UK introduces drug consumption rooms (DCRs) to reduce drug-related deaths and other drug-related harms. Drug consumption rooms are professionally supervised healthcare facilities where people can consume drugs in safer conditions. Robust evidence demonstrates that DCRs are effective in reducing self-reported risk behaviors associated with injection, such as syringe sharing, reaching and staying in contact with highly marginalised target populations, reducing drug-related deaths, increasing uptake of detoxification and drug dependence treatment, decreasing public injecting and reducing the number of syringes discarded in a vicinity.

The evidence does not suggest that a DCR increases drug use, frequency of injecting, drug dealing, drug trafficking or drug-related crime in the surrounding environment. A DCR offers numerous benefits to the community and to people who use drugs.

The UK is currently experiencing record numbers of drug-related deaths, particularly among people who use opioids and who are not in drug treatment. These deaths could escalate even further following the emergence of fentanyl, a highly potent opioid which has been linked to at least 60 deaths since December 2016. Call- outs for the removal of drug-related litter are also rising with Leeds, Cardiff, Doncaster, Belfast, Liverpool and Sheffield seeing an increase in the last five years.

Existing policies are failing to meet the needs of the UK’s communities and society’s most vulnerable people. The evidence indicates that DCRs could address this gap in provision, but that there are a number of issues affecting feasibility. This report examines these issues.

The answers lie with the innovations occurring in Glasgow and Dublin. The Glasgow Health and Social Care Partnership is currently identifying a site for a DCR, and the Irish Health Service Executive is undergoing a tendering process for a service in Dublin city centre.

The first hurdle would be making the case that the facility would have sufficient impact. People will not travel to use a DCR and thus qualitative and quantitative data collection should be used to identify a location for the service where there is a concentrated drug-using population. A business case should also be guided by other needs than just the presence of an open drug scene, which the UK may not see to the same extent as international comparators.

Funding is a core concern and financial provision should not come solely from treatment budgets, which are already under significant strain. Alternative funding streams may include: central budgets, contingency funding, diversion from services targeted towards the population who are likely to use the DCR such as homeless addiction services, or diversion from services which would see savings as a consequence of the DCR being established. It is appropriate that funding is allocated to a DCR as existing services are failing to engage marginalised groups and failing to address drug-related litter and public injecting, which is a significant burden in some communities.

Residents may have concerns that a DCR will create more drug-related disorder, though evidence points to the contrary. The community should be continually engaged in the proposal and clear communication channels provided with the local authority. As evidenced elsewhere, levels of community support are likely to increase after the facility is established. To avoid media coverage derailing attempts to establish a DCR, stakeholders are advised to seek out media opportunities to promote the proposal, though the expression of formal interest by the locality should be accompanied by a bedrock of local stakeholder support.

To encourage support from politicians, the proposal should be championed by their peers and framed as a humanitarian, evidence-based intervention, rather than as a wider call for drug reform. It is also advantageous for structures to be in place that ensure politicians are involved and consulted throughout the planning and development process and prior to key political decisions. DCR acceptability also depends on how consistent it is with the recovery agenda. Although the primary remit is to reduce harm, DCRs are a recovery-orientated service as they improve engagement with treatments for addiction, offer care and support, and address adverse life circumstances.

The legality of DCRs was cited as one of the most significant feasibility hurdles, as there are persisting legal barriers that would challenge its operation. A DCR could operate through a discretionary model, pursuant to guidance given by the police and prosecution service. Alternatively, a discretionary model could operate without legal guidance from the prosecution service and instead rely solely on multi-agency support, with local stakeholders signing a document regarding the establishment and running of the DCR. A legislative route is a longer process but offers a more stable and permanent legal solution. DCR pilots operating on a discretionary legal basis could be used to build the case for legislative change. The international community does also play a role in determining the legality of DCRs. The UN no longer cites concerns, and now just asks that DCRs should reduce the negative consequences of drug abuse and lead to treatment and rehabilitation, without condoning or encouraging drug abuse and drug trafficking. The international community can also be a highly useful source of expertise.

New policing practices would be required, but they are unlikely to be a significant departure from existing procedure for policing drug services. Forces would benefit from receiving clear guidance and legislation and observing models of practice in countries with DCRs. There may be apprehension over the risks involved for DCR operators, but providers can turn to existing protocol as most of the risks are similar to those they already manage.

It is likely that drug consumption will continue outside of service hours, however, to minimise the extent to which this occurs, opening hours should be balanced against community need and local capabilities.

Stakeholders can learn from innovation in Glasgow and Dublin, but can also turn to existing practice, realising that the way forward may not be a significant departure from well trodden paths. By following in the footsteps of Glasgow and Dublin, but also turning to what is already known, localities will be best placed to replicate their progress and success.

DCRs are now a viable policy option and serious consideration should be given to their introduction.