Drug consumption rooms can save lives in the UK, says Niamh Eastwood

The most recent statistics on drug related deaths from across the UK make for grim reading. Once again the UK has recorded the highest rate of drug related deaths—this is the seventh annual increase we have witnessed. In Scotland and parts of England and Wales, the number of people dying is at unprecedented levels, which has led to some, including myself, to demand that this is treated as a public health emergency. 

There were nearly 3000 drug misuse deaths in England and Wales in 2018, with nearly three in four of these deaths involving opioids—the situation is worse in Scotland. These are not just statistics, these are human beings who were someone’s mum, dad, daughter, son, sibling—these tragic deaths, many of which are avoidable, are felt deeply by those left behind. 

Drug consumption rooms (DCR) also known as Safer Injecting Facilities or Overdose Prevention Sites are one way to reduce the scale of drug related deaths. These facilities vary in what they offer, but at the core of this service is the provision of a sterile space where people inject or smoke their illegally bought substances under medical supervision, and where they are given hygienic equipment to do so. This may sound controversial but there are over 100 such facilities operating in 11 countries across the world. Drug consumption rooms support, in the main, populations that are incredibly marginalised and that would otherwise be using public spaces—you can’t use drugs in the privacy of your own home if you don’t have access to one.

The first DCR was opened in Switzerland in 1986 and we have decades of evidence demonstrating their effectiveness not only for people using these facilities but also for the wider community. This non-judgmental approach to, in particular, problematic use of drugs has been shown to significantly reduce overdoses incidents and fatalities, provide routes into treatment, reduce discarded syringes in public spaces, and reduces the burden on emergency services including the need for ambulance call outs. But despite overwhelming evidence that DCRs save lives, the UK government has blocked the implementation of DCRs in the UK.

The Home Office repeatedly states that they are unwilling to support the establishment of a DCR because, they say, it would break the law, namely provisions in the Misuse of Drugs Act 1971 and in particular the offence of possession of a controlled substance. This position seems particularly disingenuous considering that they have the power to change the law in order to save the lives of some of the most vulnerable in society. The Home Office is also unwilling to support implementation at a local level, a strategy that could act as an interim solution on the road to legislative change, instead reiterating that police officers must enforce the law. 

But police and prosecutors already manage potential criminal offences under the 1971 Act in relation to other drug treatment interventions. Take, for example, needle exchanges where people can access sterile injecting equipment. The view of the Crown Prosecution Service is that those accessing such services and those who work in them will “necessarily commit offences under the Act [1971 Act].” It is clear that many people accessing needle exchange programmes will be in possession of controlled drugs, but the CPS clearly state that the “need to prevent the spread of serious infections outweighs the normal requirement for prosecution.” It is the public interest arguments based on public health needs which override the need for a prosecution. 

Beyond CPS guidance, local agreements between police, local authorities, health providers, and drug treatment providers could be established in order to facilitate a DCR. Such an agreement would essentially nullify the risk of prosecution and would have clear agreements on how difficult aspects of the service are managed, for example, the disposal of controlled drugs. Such agreements, often known as “comfort letters,” have been used to extend the type of equipment that can be dispensed by needle exchanges but that were technically against the law. 

More recently, we have seen local agreements between police and other local agencies to allow The Loop to carry out front of house drug checking. This brilliant initiative reduces the risks faced by people who use drugs, joining DCRs as a legitimate response to drug use that seeks to reduce the harms of drug consumption rather than punish any and all associated activities. The government has given tacit support to local agreements that allow for drug checking, even though similar offences are engaged to that of a DCR. The only reason they would not extend the same thinking to DCRs is likely because of the profile of those who would use this facility—namely poor, marginalised groups who have little access to support from anywhere else.

The law is not an insurmountable barrier to establishing a DCR, although it would appear the ideological position of the Home Office is. As already discussed, drug related deaths are at an all time high. In Glasgow the drug related deaths are now outstripping the rates in the US and Canada. The city and the Scottish parliament have endorsed the need for a DCR to counter this crisis, the business case has been made, and the funding has been secured. But the Lord Advocate in Scotland will not provide legal protection, instead referring as a reserved matter to Westminster who vetoed the planned DCR in Glasgow. Unfortunately, it appears those with the power to save lives—the UK government—would rather play politics while people continue to die.

Niamh Eastwood is executive director at Release. Release is the national centre of expertise on drugs and drugs law, providing free and confidential specialist advice and advocates for evidence-based drug policies.

Twitter: @niamhrelease

Competing interests: None declared