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June 2014 |
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Harm reduction |
Overseas initiatives
smoking, used as an argument against allowing those on medically prescribed
heroin programmes to smoke rather than inject. Health service guidance also
refers to the health risks of using foil in smoking heroin, obstinately failing to
distinguish between plain foil and foil coated or treated for the catering trade,
the coatings and their carcinogenic fumes representing the risks. The 2010
ACMD report on foil is being used in this campaign.
*****
The opening of consumption rooms has the ‘best’ lesson for the UK. As part of
their aim to reduce drug-related deaths, Danish campaigners had long argued for
drug consumption rooms. Part of their case was the evidence of lives saved,
emerging from studies where DCRs operate. While still in opposition, the parties
now in government (since September 2011) undertook to introduce legislation
enabling DCRs to be established. The new government introduced its bill to
permit DCRs, enable local authorities to commission and operate them, and
provide for their funding. The law came into force on 1 July 2012 after gaining
parliamentary approval.
Two building-based drug consumption rooms have since opened in Vesterbro,
one in the premises of Mændenes Hjem (The Men’s Home), a project for
homeless people which, despite its name, works with all who are homeless and
responds to their needs. This room (Skyen: The Cloud) has two sections, for
injecting and for smoking, separated by a transparent, air-tight partition. When I
visited in October 2013, all 14 places were occupied, mostly by men, some
Swedish. Users check in with the medical staff present. Pseudonyms may be
used, if constant, and the drug/s used noted – on my visit, cocaine was the
principal drug used.
In January 2014 the Home Office stated that drug consumption rooms were
not in prospect for the UK, being in breach of domestic legislation and
international conventions. Lesson from Denmark: always seek a second legal
opinion when governments say ‘it breaches national law and international
conventions’ – national governments have the power to change domestic law if
the political will exists.
The provision of sterile and safe injecting facilities was catalysed by the
establishment of a mobile DCR by a citizens’ initiative in Vesterbro. This
converted ambulance, Fixelance (Fixerum (consumption room) + ambulance), took
to the streets on 11 September 2011 – before the election and the subsequent
change in the law. Staffed by volunteers, including medical professionals and
social workers, and funded by individual and small-business donations, Fixelance
initially operated on tenterhooks, with legal teams from Gadejuristen on call in
case of challenge or interventions by the authorities. There were none. Shortly
after Fixelance 1 started operating, a second was donated by the national
emergency service, Falck. Once the legislation was passed, Copenhagen City
Council took over the running and funding of the two Fixelance. The citizens’
initiative was dissolved. Its originator, Michael Lodberg Olsen, now campaigns, as
Antidote, with BrugerForening for improved access to naloxone. Fixelance 1 has
since been replaced by a purpose-built vehicle.
The Fixelance initiative was started by local residents in Vesterbro, where many
injecting drug users and other marginalised social groups congregate. They were
concerned at the poor health, living and social conditions of those groups, and
rather than trying to exclude or displace them, developed positive responses, an
ongoing, decades-long task. The focus has been to restore a sense of dignity and
worth to the lives of injecting drug users at the same time as reducing the impact
their lifestyles have on local residents. (Moves to set up a DCR in Birmingham are
based on similar principles.) The results have included less discarded injecting
equipment; increasing use of the mobile and building-based consumption rooms,
rather than playgrounds, backyards and stairwells, to inject; an absence of DRDs in
the consumption rooms, and significant changes in public opinion. Here is a further
potential lesson for the UK – process, public support, pragmatism.
Campaigners expect the consumption rooms to contribute to a further
reduction in drug-related deaths (DRDs). While the significant 2012 fall in DRDs,
recorded in the 2013 EMCDDA
Focal point report
, is welcomed, all involved
express caution in attributing the fall to the DCRs and Fixelance. The statistics
covered the whole of 2012: the building-based DCRs had only been operating for
two months – and there was an increase (from 32 to 37) in Copenhagen DRDs.
The 2013 statistics are awaited with great anticipation.
The Danish National Museum, curators of the Viking exhibition currently at the
British Museum, has added Fixelance 1 to its collection, using it to illustrate
themes in contemporary Danish history. It was formally ‘unveiled’ at the museum
in April, in a courtyard next to one of the museum’s ancient runic stones, with the
spire of Christiansborg, the parliament building, in the background. Maybe there
is a further lesson here about acknowledging social issues and challenges and
the individuals affected rather than denying, dismissing or demonising them. They
exist and are part of contemporary society, and are better responded to when
understood, not subjected to scorn, misrepresentation and stigma.
Blaine Stothard is an independent consultant in health education,
www.healthed.org.uk
As part of their aim to reduce
drug-related deaths, Danish
campaigners had long argued for
drug consumption rooms. Part of
their case was the evidence of
lives saved, emerging from
studies where DCRs operate.