European literature

[Update] Perspectives on drugs. Drug consumption rooms: an overview of provision and evidence, EMCCDA, June 2016.

Supervised drug consumption facilities, where illicit drugs can be used under the supervision of trained staff, have been operating in Europe for the last three decades. These facilities primarily aim to reduce the acute risks of disease transmission through unhygienic injecting, prevent drug-related overdose deaths and connect high-risk drug users with addiction treatment and other health and social services.

Perspectives on drugs. Drug consumption rooms: an overview of provision and evidence, EMCCDA, June 2015.

Supervised drug consumption facilities, where illicit drugs can be used under the supervision of trained staff, have been operating in Europe for the last three decades. These facilities primarily aim to reduce the acute risks of disease transmission through unhygienic injecting, prevent drug-related overdose deaths and connect high-risk drug users with addiction treatment and other health and social services. They also seek to contribute to a reduction in drug use in public places and the presence of discarded needles and other related public order problems linked with open drug scenes.

Dirk Schäffer, Heino Stöver, Leon Weichert, Drug Consumption Rooms in Europe, Models, best practice and challenges, European Harm Reduction Network, 2014.

Jennifer Peace, Drug Consumption Rooms in Europe, Client experience survey in Amsterdam and Rotterdam, European Harm Reduction Network, 2014.

A summary report on the results of a 101-question survey designed for clients of drug consumption rooms (DCRs). The survey focusses on client health and wellbeing attributes, along with experiences at four integrated DCRs in the Netherlands.

Sara Woods, Drug Consumption Rooms in Europe, Organisational overview, European Harm Reduction Network, 2014.

This report provides an overview of the organisation and working methods of drug consumption rooms (DCRs) in Europe It offers information about the functioning of DCRs as well as on the organisation and structure of such facilities and aims to benefit various groups of stakeholders.

Perspectives on drugs. Preventing overdose deaths in Europe, EMCCDA, May 2013.

The heroin epidemics that spread across Europe in the 1980s resulted in increasing numbers of overdose deaths among opioid users. Although the annual number of reported deaths peaked around the turn of the millennium, drug overdose still claimed more than 70 000 in Europe in the subsequent decade. Despite the fact that recent data show some promising signs, with the number of reported overdose deaths falling from around 7 700 to 6 500 between 2009 and 2011, stable or increasing death tolls continue to be reported, for example in Estonia, Sweden and the United Kingdom (Scotland).

Martin Busc, Alexander Grabenhofer-Eggerth, Marion Weigl and Charlotte Wirl, Report on the current state of play of the 2003 Council Recommendation on the prevention and reduction of health-related harm, associated with drug dependence, in the EU and candidate countries, Sogeti and Gesundheit Österreich Forschungs- und Planungs, Vienna, April 2013.

On 18th June 2003, the European Commission adopted a Council Recommendation on the prevention and reduction of health-related harm, associated with drug dependence, in the EU and candidate countries. The second progress report monitoring the implementation of the Council Recommendation has just been released and it is important reading for those advocating for harm reduction approaches within the European region. It presents country-by-country information on harm reduction policies, services and facilities, as well as an analyses of epidemiological trends. Based on the answers to a policy survey and a survey among field organisations, the authors have assessed the availability, access to and coverage of harm reduction measures in each country. The authors go on to present a set of thirteen conclusions regarding the follow-up of the Council Recommendation with three priority areas of action: the reduction of drug-induced deaths, the improvement of harm reduction in prison and the reduction of harm caused by drug-related infections. Also of particular interest are the four useful systematic literature reviews annexed to the report. These cover peer naloxone programmes, prison release management, needle exchange in prison and measures to change the route of drug administration.

European Centre for Disease Prevention and Control and European Monitoring Centre for Drugs and Drug Addiction. Prevention and control of infectious diseases among people who inject drugs. Stockholm: ECDC; Oct. 2011.

"Des possibilités supplémentaires pour réduire la probabilité de dommages liés à une surdose de médicaments sont à encourager les personnes qui s'injectent des drogues à utiliser des salles d'injection supervisée, si ces services sont disponibles. Grâce à la supervision directe par le personnel, une aide immédiate est disponible en cas de surdosage. Une étude récente a documenté une association entre l'existence de ces installations et la réduction des décès par surdose au niveau de la population." (p. 25).

Dagmar Hedrich, Thomas Kerr and Françoise Dubois-Arber, Drug consumption facilities in Europe and beyond in EMCDDA, Harm reduction: evidence, impacts and challenges, April 2010, Chapter 11, p.305.

Drug consumption rooms (DCRs) are professionally supervised healthcare facilities where drug users can use drugs in safer and more hygienic conditions. Since 1986, more than 90 DCRs have been set up in Switzerland, the Netherlands, Germany, Spain, Luxembourg, Norway, Canada and Australia. Consumption rooms aim to establish contact with difficult-to-reach populations of drug users, provide an environment for more hygienic drug use, reduce morbidity and mortality risks associated with drug use — in particular street-based drug injecting — and promote drug users' access to other social, health and drug treatment services. They also aim to reduce public drug use and improve public amenity near urban drug markets. At times, their establishment has been controversial due to concerns that they may encourage drug use, delay treatment entry or aggravate problems of local drug markets. As with evaluations of other public health interventions, research on DCRs faces methodological challenges in taking account of the effects of broader local policy or ecological changes. Despite these limitations, research shows that the facilities reach their target population and provide immediate improvements through better hygiene and safety conditions for injectors. At the same time, the availability of safer injecting facilities does not increase levels of drug use or risky patterns of consumption, nor does it result in higher rates of local drug acquisition crime. There is consistent evidence that DCR use is associated with self-reported reductions in injecting risk behaviour such as syringe sharing, and in public drug use. Due to a lack of studies, as well as methodological problems such as isolating the effect from other interventions or low coverage of the risk population, evidence regarding DCRs — while encouraging — is insufficient for drawing conclusions with regard to their effectiveness in reducing HIV or hepatitis C virus (HCV) incidence. However, use of the facilities is associated with increased uptake of detoxification and treatment services. While there is suggestive evidence from modelling studies that they may contribute to reducing drug-related deaths at a city level where coverage is adequate, the review-level evidence of this effect is still insufficient. Taken in sum, the available evidence does not support the main concerns raised about this kind of intervention and points to generally positive impacts in terms of increasing drug users' access to health and social care, and reducing public drug use and associated nuisance.

Dagmar Hedrich, European report on drug consumption rooms, OEDT, 2004.

Ecrit par Dagmar Hedrich et publié en langue anglaise par le EMCDDA, ce rapport offre une description de l'histoire et de la situation actuelle des différents locaux de consommation en Suisse, Allemagne, Pays-bas, Espagne, Australie et Canada. Un résumé de ce rapport (7 pages, format Word) peut être téléchargé sur le site web de l'EMCDDA.

Kate Dolan et al., Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia, Drug and Alcohol Review n°19, 2000, p.337-346.

In Europe, there are over 45 drug consumption rooms. While these facilities differ in their models of service delivery, there are some basic common elements. These include: being officially sanctioned; regulated entry; supervised injecting; provision of sterile injection equipment; immediate resuscitation after overdose; primary health care and referral to drug treatment. On-site drug dealing is prohibited and ancillary services such as meals, showers and laundry facilities are available. The European facilities in general operate successfully in consultation with the local community, police and local government. Outcome research into these facilities is limited and very little has been published in English. Findings, however, have been encouraging. In some areas public nuisance has been minimized, the number of overdose deaths and complications from non-fatal overdoses have decreased, BBV risk behaviour has decreased and health and social functioning of clients have improved.

Pr. Brice DE RUYVER, Les conditions juridiques (préalables) et les mécanismes de contrôle en matière de réduction des risques, Groupe Pompidou, Conseil de l'Europe, 28 septembre 2000, p.26.

Aucun élément n'indique clairement si les salles d'injection sont conformes au droit international. D'une part, ces services enfreignent certaines dispositions des conventions internationales concernant l'usage et la détention de drogues, mais d'autre part, le droit international n'impose pas d'ériger en infraction pénale la détention de drogues pour usage personnel. Il exige seulement sa désapprobation. Par ailleurs, les pays prévoyant le principe d'opportunité peuvent choisir de s'appuyer sur ce principe pour autoriser la détention de drogues pour usage personnel. Néanmoins, il convient de rappeler que les gouvernements n'ont pas le droit d'invoquer ce principe chaque fois que cela les arrange de s'écarter des dispositions internationales. En outre, étant donné que les salles d'injection représentent des formes extrêmes de réduction des risques, certains doutes peuvent être émis quant à leur conformité avec les obligations imposées par les conventions. Par ailleurs, le Plan d'action de l'Union européenne en matière de lutte contre la drogue fait référence à l'article 152 du Traité d'Amsterdam (1997) pour mettre en évidence un nouvel objectif de la coopération entre les Etats membres, à savoir la réduction des dommages pour la santé liés à la toxicomanie, parallèlement à la coopération traditionnelle dans le domaine de la prévention. Par conséquent, les stratégies de réduction des risques, y compris sous la forme de salles d'injection, sont de mieux en mieux acceptées. Mais là encore, des conditions préalables spéciales détermineront si ces stratégies peuvent être qualifiées comme stratégies de réduction des risques.