Let’s Safe Lives

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Damien was a smart kid, a good friend and successful sportsman. He grew up in a good family and no one would have guessed that his path would have led him to drugs. And yet, at only 22 of age, Damien passed away from a heroin overdose. It happened in February 1997, in Australia, and now, two decades later, his father Tony, a psychotherapist is also a well-known spokesperson for harm reduction and drug consumption rooms. I heard him speaking at a conference two years ago, “It was, of course, a shock even though we knew that death was a possibility with heroin use,” he said. At the time of his death, Damien was trying to stay clean. His father said, “That’s one of the ironies of heroin use, that the people who die are often the ones trying to give it up. I was to find out later that no one has ever died in an injection centre anywhere around the world, even though there are many overdoses.”

That’s when Tony engaged with the idea of drug consumption rooms. Although they are still illegal in the USA, there are more than 100 of them throughout the world, in countries like Canada, Spain, Germany, Holland and Norway.

The idea is that drug consumption rooms provide a safer environment for injection drug users. Staff is available to teach safe injection practices and clean syringes are free for the taking. Crucially, there’s also naloxone available to treat overdoses immediately, without any fatalities.

Predictably, these rooms tend to face some initial resistance, but in Australia, Tony was instrumental in turning the tide of public opinion.

The year that Damien died, the Australian government proposed a heroin prescription program, but ultimately the prime minister vetoed it. But the time seemed ripe for harm reduction and so Tony took action. He wrote a letter to the local paper, describing his son’s death and explaining how unnecessary it was. The paper published his piece on the front page, sparking a fierce debate.

After four years of lobbying and advocating, the first drug consumption room in Australia was opened in 1999. On that occasion, Tony stated, “We got our injection facility, thank goodness.” He added, “It was a hard road because there were opponents.”

Overall, the main obstacle seemed not to be opposing viewpoints but rather apathy. “Most of the general public don’t really care,” he said. “They’re not pro, they’re not against. It doesn’t affect them.”

Like Australia, Germany opened its drug consumption rooms in 1994, and another of the panellists—former Frankfurt drug czar Werner Schneider—documented the history of his city’s harm reduction efforts. Frankfurt began exploring harm reduction in earnest in the 1990s in response to a significant rise in heroin use. That exploratory work quickly led to the creation of drug consumption rooms.

Schneider said, “The most important result of this program was a tremendous reduction in the drug-use related death cases.”

Simultaneously, the city witnessed a decrease in criminality and also a decrease in public concern about drug use as a major citywide problem.

Like Frankfurt, Vancouver experienced a ballooning heroin problem in the 1990s. Canadian Senator Larry Campbell—a former law enforcement officer who was also the mayor of Vancouver—told the crowd that as overdose deaths skyrocketed, so did HIV and incarceration rates.

After a decade as a cop and twenty as an inspector, Senator Campbell got tired of watching the bodies pile up, and so in2002He did that, but keeping open North America’s only drug consumption facility, Insite for

“I ran on the platform that I would open a supervised injection site in Vancouver,” he said.

he ran for mayor.community safety,  was a struggle. Although the federal government initially offered the program a three-year legal exemption, once that initial approval expired, Insite had to sue to keep its doors open.

Campbell said that drug consumption facilities are a crucial part of the shift from punishing addicts to treating addiction as a medical problem.

“Addiction is a medical disease. Addiction is not a criminal offence. No one starts out life saying, ‘You know what, I think I’ll be an addict,’” he said.

“You can address this as a humanitarian gesture, a humanitarian idea, that we’re all people … but I recognize that there are those who don’t move from a humanitarian end but from an economic end.” That works, too, though, because Campbell explained that drug consumption rooms can save on welfare, police and prison costs.
“So whether you believe in humanitarianism or economy,” he concluded, “this is an idea that works. It’s good, and it’s time.”

Liz Evans, a nurse who works with Insite, concurred. She said that Insite is estimated to have saved $14 million in 10 years. “Over 2 million injections have taken place and not one has resulted in death,” she said.

Over time, the community has come to accept the program. Evans said that the last poll taken showed that 76% of Vancouver residents supported the drug consumption site.

By bringing users off the streets, it has created a better environment with less public injection around the facility but also, she said, the presence of a safe injection facility seems to encourage people to get help. “If you’ve just come to Insite once, you’re 33% more likely to come to detoxification or treatment,” she said.

It should be quite clear by now what drug consumption rooms are. It is a type of program allowing people who use drugs to do so safely, hygienically and under medical supervision. The main purpose is to reduce the number of overdose death cases. Drug users are provided with additional guidance on harm reduction, are educated and offered information related to their health. In 2007, 32 drug consumption rooms were operating in Holland and by 2010 other 37 programs were opened in 25 cities.

In August 2010, I had the opportunity to visit such a program in Switzerland. I was staying in Geneva for a different reason, however, as long as I was there, I decided to personally witness how such a program functions. I dialled the contact number from the organization’s website and showed up the next day in front of the site. The first surprise – the site was renting a space in a residential building, along with the offices of other companies, lawyers etc. I was welcomed on the second floor by the program coordinator. They welcomed me in the centre with a coffee and offered basic information about the program. The number of people visiting shocked me, quite a high frequency of people and yet everything functioned flawlessly. People who come to use drugs receive a number and wait for their turn to inject their drug of choice, that they carry with them, in one of the three rooms available. If necessary, a nurse would assist, however, the act of injecting is performed by the users themselves. Prior to this, they are given the opportunity to talk to a social worker, a psychologist or a doctor, depending on the needs or problems they are facing. Albert from Tetovo was the only Macedonian visiting the programme and he spoke highly of it.

“It saved my life,” he said, “I overdosed twice, and if I had been at home or on the street instead of here, I probably wouldn’t have been alive now.” “In cases of overdose the team intervenes and administers naloxone to block the effects of heroin,” joined in Brigitte, a nurse at the centre. It is precisely why this program is so important in reducing the death rate, and consequently improving the state of people who use drugs. Only a user who is alive can consider treatment and integration in society. In fact, this is the main goal of the programme, to save lives and reduce the risk of blood-borne infections.

In October 2014, I had the opportunity to visit a similar program intended exclusively for emigrants in Amsterdam. An important feature is that the program was opened within the other programs this organization has to offer. Consequently, a person who uses drugs, apart from an injection room, can receive the services of a social worker, food, clothing, treatment motivation, employment etc. in the same facility. It only goes to show how complementary the Dutch approach is, based on the harm reduction principles and offering a broad spectre of social services to people who use drugs. Such an approach acknowledges the understanding that drug use is not simply a health issue but rather a social and cultural one.

According to the Drug Consumption Rooms in Europe: Client Experience Survey in Amsterdam and Rotterdam, all drug consumption rooms in these two cities offer the services of a social worker, with 65 % of the clients using these services mostly for housing and certain financial or other benefits, such as assistance in personal identification documents application. A notable information is that as many as 53% of the clients upon joining the program also joined a substitution treatment programme, mostly methadone, 25.2% started detoxification and 11.3% joined rehabilitation programs.

All of this information reveals that drug consumption rooms, in addition to saving lives, motivate people who use drugs, mostly those dependent on drugs, to make the decision to seek treatment and lead a better quality life.

Vlatko Dekov

The author is currently pursuing his Master’s degree in social politics. He has been engaged with addiction-related issues for fourteen years and has developed most of the harm reduction programs in Macedonia. At present he is working as a manager of CEDR – the Centre for Education, Documentation and Research within HOPS. He is the author of numerous papers, publications and research. He is also an activist for human rights of marginalized communities and a member of several national and international committees, bodies and forums, such as the European Commission’s Forum on Drugs in Brussels. Since 2014 he has been a member of the Board of the Eurasian Harm Reduction Network.

The online version you can find it HERE.

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