Drug consumption rooms have been established in several countries, where confirmed drug users are allowed to consume their drugs in hygienic conditions and without fear of arrest. These facilities, which mostly operate in big cities, emerged because of serious health and public order problems associated with drug use, especially drug injecting in public places. In 2004, there were about 60 consumption rooms in 36 European cities and two pilot projects of medically supervised injecting centres in Australia and Canada.
Besides the classic approaches (drug counselling centres, therapy for substance abuse) there exist reform and pilot projects to develop alternative ways of helping. These are intended for longtime drug users who have undergone several therapies unsuccessfully or could not be reached by existing resources. Amongst those alternative services is the treatment with substitution therapy as well as the establishment of drug consumption rooms.
State-controlled public injection rooms are not expressly referred to in any of the relevant international conventions. It is thus necessary to determine, by way of a preliminary factual enquiry, the exact characteristics of such institutions that fall within the ambit of one or more of the conventions. The rather superficial provisions concerning drug addicts stand in stark contrast to the stated primary aims of the conventions, which are formulated in the preambles as preventing and combatting abuse of narcotic drugs and psychotropic substances and the public health and social problems which such abuse engenders.
In a confidential and authoritative memorandum to the INCB, UNODC legal experts argue that most harm reduction measures are in fact acceptable under the conventions. According to the Legal Affairs Section "it could easily be argued that the Guiding Principles of Drug Demand Reduction provide a clear mandate for the institution of harm reduction policies that, respecting cultural and gender differences, provide for a more supportive environment for drug users."
In 2008, Harm Reduction International released the Global State of Harm Reduction, a report that mapped responses to drug-related HIV and hepatitis C epidemics around the world for the first time.(1) The data gathered for the report provided a critical baseline against which progress could be measured in terms of the international, regional and national recognition of harm reduction in policy and practice. Since then, the biennial report has become a key publication for researchers, policymakers, civil society organisations and advocates, mapping harm reduction policy adoption and programme implementation globally.
The government’s indecision over plans to set up a permanent injection room for drug addicts may cost the lives of over 100 users, according to Michael Lodberg Olsen, the organiser of a mobile injection room. Astrid Krag, the health minister, last week scaled back the government’s election promise to have a permanent room set up by the end of the year.
The first drug consumption room for opiate-dependent persons in Germany was opened in Frankfort on the Main in December 1994. In March 2003 there were 19 drug consumption rooms in the Federal Republic of Germany: These institutions provide several hundred drug injecting places; they are used every day by several thousand addicts several times a day.
Two out-of-service ambulances have been put back into service as mobile injection rooms for drug addicts in Copenhagen (Denmark). The vehicles will be used to transport a team of volunteer doctors and nurses and a stock of clean needles in the Vesterbro district.
For the past 10 to 20 years, drug consumption rooms (DCRs) have become an integrated part of the drug treatment and harm reduction strategy in a variety of countries in Western Europe, North America and Australia. However, they have not yet been established in the majority of countries worldwide.
Ignoring all the scientific evidence, Canada Health Minister Tony Clement will move to close Canada's only sanctioned safe-injection site, announcing it will appeal a British Colombia court ruling that Vancouver's Insite should stay open because reducing the risk of drug overdoses is a vital health service.
Lynne Leonard, Emily DeRubeis, Linda Pelude, Emily Medd, Nick Birkett, Joyce Seto
30 April 2007
Among injection drug users (IDUs) in Ottawa, the capital of Canada, prevalence rates of HIV (20.6 percent) and hepatitis C HCV (75.8 percent) are among the highest in Canada. Recent research evidence suggests the potential for HCV and HIV transmission through the multi-person use of crack-smoking implements. On the basis of this scientific evidence, in April 2005, Ottawa's needle exchange programme (NEP) commenced distributing glass stems, rubber mouthpieces, brass screens, chopsticks, lip balm and chewing gum to reduce the harms associated with smoking crack.
When the Supreme Court of Canada convenes to consider Vancouver’s supervised injection site, it will hear detailed arguments that hinge on the fine print of the Canadian Constitution. But besides being a landmark showdown between federal and provincial powers, the hearing also sets the stage for a ruling expected to affect not only the daily lives of injection drug users on Vancouver’s Downtown Eastside but drug policy across the country and potentially farther afield.
Divided by politics but united by drug policy, five former Vancouver mayors have issued a last-minute plea to Ottawa to drop its appeal of earlier court decisions approving Insite, the city’s supervised drug injection site. “Since opening in 2003, Insite has proven – beyond a doubt – its worth to our community,” the five ex-mayors say in an open letter issued to the federal Conservative government. Open letter supporting Insite from Vancouver mayors.
Under tough judicial grilling, the Harper government conceded it had no evidence to counter scientific research showing supervised drug injections save lives and reduce harm to addicts. Federal lawyers said a final decision had not been made whether to extend or end a legal exemption for Vancouver’s Insite injection clinic before local health authorities launched a lawsuit in 2008 to save it. But they were at a loss to explain the basis for the Conservative government’s stated reluctance to allow it to continue.
Mobile injection rooms have been operated for the past year out of two former ambulances. Run by the private organisation Foreningen Fixerum and staffed by volunteer healthcare workers, the rooms-on-wheels offered a safe and hygienic place, off the streets, for drug users to inject. The City Council took over the project earlier this year when the long legal battle to establish stationary injection rooms was finally won.
The number of drug-overdose deaths on Vancouver’s notorious downtown Eastside fell sharply after the opening of a safe injection site, new research shows. The study, published online Monday in the medical journal The Lancet, shows that fatal overdoses dropped 35 per cent in the vicinity of Insite in the two years after it opened. By comparison, OD deaths dropped only 9 per cent in the rest of Vancouver in that same period.
InSite does not operate under the assumption that addiction is incurable. We believe in recovery; in fact, the biggest difference between our approach to recovery and the opinion expressed by Barbara Kay in her recent column (Rehab still the best solution for addiction) is that we believe it should be possible even for addicts who are not ready to get clean. InSite’s purpose is to help prevent addicts from dying, either from an overdose or from a disease, before they get a chance to recover.
The drug injection rooms ('fixerum') that opened for customers some two and a half years ago in Denmark have been hailed as a resounding success. Out of the 355,255 injections that have taken place in the rooms in Copenhagen, Odense and Aarhus since they opened in 2012, some 301 people have overdosed but not one single death has been reported. "It must be assumed that the hygienic surroundings and the qualified personnel have had a great impact in the injection rooms," the Ministry of Health found in an evaluation (here in Danish).
This paper examined whether use of crack cocaine has become a risk factor for HIV infection. Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine. Innovative interventions that have the potential to reduce HIV transmission in this population, including the distribution of safer crack kits and medically supervised inhalation rooms, need to be evaluated.
Vancouver’s supervised drug-injection clinic, Insite, saves lives and prevents human misery. Providing addicts with a safe, sterile place to inject heroin and other drugs is a pragmatic and effective way to curb the spread of infectious disease, including HIV/AIDs and hepatitis B and C, and to reduce substance abuse and overdoses. Yet the federal government persists in opposing it, viewing Insite not as a critical component of British Columbia’s health-based approach to treating addiction, but as a stark violation of criminal law.