British literature

Fiona Mitchell, Glasgow, Scotland: tackling injection of drugs in public spaces through introduction of safer facilities, The Lancet Psychiatry, Volume 4, No. 4, p.280, April 2017.

In October, 2016, approval was granted by the Glasgow City Council Integration Joint Board to proceed with a business case for a co-located safer drug consumption facility and heroin-assisted treatment service in the city centre of Glasgow, Scotland. According to Saket Priyadarshi, lead clinician on this project, “the main aim is to engage and build trust and relationships with a high-risk population on their terms”.

Frequently asked questions: Safer drug consumption facilities and heroin-assisted treatment, Glasgow City Health and Social Care Partnership, 2017.

Susanne Millar, Safer consumption facility and Heroin Assisted Treatment Service, Project Initiation Document and Business Case, Glasgow City Integration Joint Board, February 2017.

The purpose of this report is to Update the Integration Joint Board on progress towards development of a safer drug consumption facility and heroin assisted treatment service; and, Seek approval of the draft Business Case.

Georgia Butler, Attitudes of intravenous drug users in London towards the provision of drug consumption rooms, Drugs: Education, Prevention and Policy, Nov 2016.

Aim: The study investigated the attitudes of intravenous drug users (IDUs) towards the provision of drug consumption rooms (DCRs) in the UK and their willingness to use DCRs. Methods: Participants were 90 methadone-maintained outpatients recruited from a London clinic. A questionnaire asked about their willingness to use a DCR, their views on various rules commonly-implemented by DCRs, and how they believed DCRs might impact on the drug-taking behaviours of drug users and their peers. Findings: A large majority (89%) expressed willingness to use a DCR and accepted the need for rules such as no drug sharing (84.3%), no assistance with injecting (81.8%), compulsory supervision (76.7%) and compulsory hand washing (92.1%). However, the IDUs were split over whether injection in the neck or groin should be disallowed and whether certain categories of IDUs (e.g. juveniles, pregnant women) should be excluded from DCRs. Majorities thought it unlikely that DCRs would encourage users to try risker drug preparations (76.6%), or encourage non-injectors to inject for the first time (74.5%). Conclusions: In a country where DCRs are not available, the study highlights the willingness of IDUs to use a DCR and accept its rules, even for a sample most of whom were not homeless.

Time for safer injecting spaces in Britain?, Drug and Alcohol Findings magazine, Nov 2016.

Drug consumption rooms provide a hygienic and supervised space for users to inject or otherwise consume illicitly-obtained drugs, the overarching aim being to reduce or eliminate public injecting and its adverse effects on the environment, public order, and the health of drug users. Evidence does not support concerns that drug consumption rooms might encourage drug use, delay treatment entry, or aggravate problems arising from local drug markets, suggesting instead that they facilitate safer drug use, increase access to health and social services, and reduce public drug use and associated nuisance. However, cutting across the grain of prohibitionist policies, they remain highly controversial. There are an estimated 90 facilities across Europe, Canada and Australia, with intermittent calls to see them extended to the UK. In areas blighted by a ‘perfect storm’ of visible injecting scenes, discarded paraphernalia, and injecting-related overdose and deaths, could drug consumption rooms which provide an alternative to public injecting be part of the solution?

Kirsten Horsburg, Reducing preventable deaths among people who use drugs, Winston Churchill Memorial Trust, Travel Fellowship 2015, 2016.

Dr Emily Tweed and Mark Rodgers, “Taking away the chaos”. The health needs of people who inject drugs in public places in Glasgow city centre, NHSGGC, June 2016.

Recommendations for the introduction and evaluation of new services: 5. Introduce and evaluate a pilot safer injecting facility in the city centre, to address the unacceptable burden of health and social harms caused by public injecting. Safer injecting facilities are low-threshold harm reduction services which aim to minimise the risks of public injecting and help engage people with health and social care, including addictions treatment.  A substantial body of international research evidence has accumulated over the past three decades to support their effectiveness in reducing the health and social harms associated with injecting drug use, and public injecting in particular. In our consultation, this proposal enjoyed widespread support by stakeholders from the target population, health services, and organisations representing drug users and their families. In contrast to other UK cities which have previously considered such a measure, the evidence presented here indicates that the scale of public injecting – and its associated health harms – in Glasgow city centre justifies the introduction of a pilot safer injecting facility. However, any such initiative would require a robust, prospective evaluation – including an economic component – to confirm whether the benefits observed in other cities are transferable to the local context. The facility should be established through co-operation between key local agencies and the wider community, and carefully integrated with existing services. Addressing the concerns expressed in our stakeholder consultation by colleagues from Community Safety and Police Scotland is an important challenge in this respect.

Dr Julia Lewis, Drug Consumption Rooms, Pulse Addiction, April 2016.

Drug Consumption Rooms in Drugs: International Comparator, Home Office, October 2014, p.13.

International comparators study launched by of the Coalition Government’s, which considers a range of policy and operational responses to drugs in other countries and reviews the evidence of their impacts.

Peter James and Mike Trace, Independent Drugs Commission for Brighton & Hove, Final analysis and conclusions, May 2014.

Commission vice-chair Mike Trace: "Although, after careful consideration, the response by the working group was that the time is not right to pilot a drug consumption room in the city, we believe the detailed feasibility study undertaken will ensure a strong evidence-base to inform decision-making on whether a local DCR should be deployed in the future."

Dr. Roy Robertson and Dr. Saket Priyadarsh, National Forum on Drug-related Deaths in Scotland, Annual report 2013, March 2014.

Giulia Federica Zampin, Governance versus Government: Drug Consumption Rooms in Australia and the UK, International Journal of Drug Policy, 28 March 2014.

Both governance and government are useful frameworks in conceptualising the policy process. The governance narrative risks overlooking the importance of traditional government structures. In the case of drug consumption rooms in the UK and Australia, a focus on government is shown to have been crucial in determining whether the intervention was implemented.

Philippe Bonnet, Street injecting & the case for a DCR in Birmingham, ICDCR, NNEF Meeting, September 2013.

Charlie Lloyd, Heino Stöver, Heike Zurhold and Neil Hunt, Similar Problems, Divergent Responses: A Comparative Analysis of Drug Consumption Room Policies in the UK and Germany, Seventh Annual Conference of the International Society for the Study of Drug Policy, Universidad de los Andes, Bogotá, Colombia, May 2013.

Peter James and Mike Trace, Independent Drugs Commission for Brighton & Hove, January 2013.

In the spring of 2012, the Safe In The City Partnership responded to a proposal from Caroline Lucas MP to set up an Independent Drugs Commission to look at the current state of drug problems in the city, and the various efforts to address them. The aim was to take a fresh look at the city's response to the problems associated with drug markets and drug use, and to suggest ways in which the local agencies could be more successful in reducing the drug related problems that mattered to the citizens of Brighton & Hove.

Stephen Parkin PhD and Dr. Ross Coomber, Informal ‘Sorter' Houses: A qualitative insight of the ‘shooting gallery' phenomenon in a UK setting. Health & Place, University of Huddersfield, 2009, 15 (4). pp. 981-98, ISSN 1353-8292.

This paper considers the ‘shooting gallery' phenomenon and presents findings from a sample of injecting drug users with experience of attending such premises in the South-West of England (UK). Due to the reciprocal relationship within these settings, involving the provision of drugs for place, the term Informal Sorter House has been coined by the authors. The social organisation and associative health risks within Informal Sorter Houses were found to have resounding similarities with those previously identified within American settings. However, several differences were also noted. Namely, Informal Sorter Houses appear to be located within a continuum of control that contains regulated, unregulated, and restored injecting environments and accordingly, it is suggested that such environments are in constant flux. A further difference relates to drug-user activism identified within such settings. This involves the establishment of an informal, street-based harm reduction practice that provides potential for future service development.

Charlie Lloyd and Neil Hunt, Drug consumption rooms: An overdue extension to harm reduction policy in the UK? International Journal of Drug Policy 18 (2007) 5–9.

This commentary examines the drug policy context of drug consumption rooms (DCRs) in the UK and describe the conclusions of an Independent Working Group (IWG) that was set up to evaluate the evidence of need in the UK, the international evaluation literature and legal, political and ethical concerns. Having considered this evidence, the IWG produced its report in May 2006, recommending a trial of DCRs in the UK, on the basis that DCRs offer a unique and promising way to work with problematic drug users in order to reduce the risk of overdose, improve their health and lessen the damage and costs to society. However, despite support for the idea from a number of quarters, the UK Government has rejected this recommendation, citing previously deployed arguments that do not appear to be carry much weight in 2007.

Neil Hunt, Charlie Lloyd, Jo Kimber, Charlotte Tompkins, Public injecting and willingness to use a drug consumption room among needle exchange programme attendees in the UK, International Journal of Drug Policy 18 (2007) 62–65.

This study examines the prevalence of public injecting and willingness to use drug consumption rooms (DCRs) among UK needle exchange programme (NEP) attendees. Three hundred and one injecting drug users (IDUs) were surveyed using a brief questionnaire across five NEPs in London and Leeds between April and June 2005. Injection in a public place in the past week was reported by 55% of the sample and 84% reported willingness to use a DCR if it was available. Public injecting was positively associated with insecure housing (AOR= 2.1, CI 1.2–3.5, p = 0.009), unsafe needle and syringe disposal in the past month (AOR= 3.6, CI 1.9–6.9, p < 0.001) and willingness to use DCR (AOR= 2.7, CI 1.3–5.4, p = 0.006). Public injecting was negatively associated with being aged more than 30 years (AOR= 0.4, CI 0.3–0.7, p = 0.003) and living in close proximity (within 0.5 miles/0.8 km) of the usual place of drug purchase (AOR= 0.6, CI 0.3–0.9, p = 0.02). Our findings suggest that recent public injecting is prevalent among UK NEP attendees and the majority would be willing to use DCRs if available. It is also probable that if such services were located close to key drug markets they would engage vulnerable IDU sub-populations such as young people and the insecurely housed and reduce their levels of public injecting and unsafe needle/syringe disposal. Targeted pilot implementation of DCRs in the UK is recommended.

Joseph Rowntree Foundation, SUMMARY : The Report of the Independent Working Group on Drug Consumtion Rooms, 2006.

Joseph Rowntree Foundation, The Report of the Independent Working Group on Drug Consumtion Rooms, 2006.

Neil Hunt, Indicators of the need for drug consumption rooms in the UK, Paper A, Joseph Rowntree Foundation, 2006.

Neil Hunt, The evaluation literature on drug consumption rooms, Paper B, Joseph Rowntree Foundation, 2006.

Neil Hunt, An overview of models of delivery of drug consumption rooms, Paper C, Joseph Rowntree Foundation, 2006.

Avril Taylor, The social impact of public injecting, Paper D, Joseph Rowntree Foundation, 2006.

Rudi Fortson, Harm reduction and the law of the United Kingdom, Paper E, Joseph Rowntree Foundation, 2006.

Rudi Fortson, Setting up a drug consumption room Legal issues, Paper F, Joseph Rowntree Foundation, 2006.