They can take it out of your body but they can’t take it out of your brain.
– Charlie Parker
Supervised injection sites sometimes known as fixing rooms or drug consumption facilities are legal, medically supervised spaces designed to offer a hygienic space in which to consume illicit recreational drugs intravenously.
Fixing rooms are part of a broader therapeutic approach in relation to the addicted population, known as harm reduction . When there, addicts will have access to support, sterile injecting equipment, information about drugs and health care, access to medical staff and importantly, treatment referrals. They provide supervision by a staff that is equipped and trained to administer Oxygen or >Naloxone in the case of overdose.
Facilities do differ somewhat in terms of services offered and protocol, many require identification cards and prohibit the sale and purchase of recreational drugs. Whilst the facilities are primarily for intravenous drug users, people who consume drugs in other ways are not usually excluded.
Public Injecting – A Danger for the Community
Public injecting refers to the injection of intravenous recreational drugs, like heroin, in places potentially accessed by the general public, like public toilets, alleyways, car parks, parks, and doorways. This definition does not encompass people gathering to inject drugs on private property, rooms sometimes referred to as ‘shooting galleries’.
It is important to note that people choose the environment in which they take drugs due to powerful factors such as severity of dependence, housing/homelessness status, and societal attitudes to drug use/stigma, rather than it being because of some kind of lifestyle choice or disregard for the community.
As stated by the using addicts in the documentary A Place Called Safe, there is a great sense of shame and isolation experienced by addicts when using in public spaces where they may be seen by children for example.
The History of Fixing Rooms
Heroin addiction is like driving a car with the steering going out. You eventually resign yourself to the inevitability of what’s going to happen.
– David Bowie
The first professionally staffed facility in which drug injection was accepted was pioneered in the Netherlands in the 1970s as an element of the youth service provided by the St Paul’s Church in Rotterdam. It had two centers that allowed for some social interaction as well as basic health care, a laundry and food.
As well as this they were one of the first services to provide the invaluable needle-exchange. These services aimed to improve the psycho-social repertoire and health of its clients, though they were supported by the local community they were not officially sanctioned until 1996.
In 1986 a café was set up in Berne in Germany as part of a project combatting HIV. It was intended to be a place where food was served and information about safe sex and safe using could be given as well as condoms and clean injecting equipment.
It was not originally meant to be a safe injecting site but when drug users started using the café for this use, following discussions with relevant organizations, the café was turned into the first legally sanctioned drug consumption facility, under the proviso that it was an over 18 site .
These facilities often evolved from other services, through recognizing the dire need for some humanity and dignity toward addicts and also for the community in which the addicts live. In the UK, Glasgow is set to become the site of the UK’s first legal fixing room.
This comes after a sharp rise in HIV cases amid the intravenous drug using community in Glasgow. There have been 90 cases of HIV diagnosed in Glasgow since 2015, 12 of which have come this year. This significant increase in HIV infections and drug-related deaths among addicts and the sheer number of using addicts in the city center of Glasgow have made the drug consumption rooms considered a viable option for the UK. Several other recent outbreaks of serious infectious disease among people who inject drugs – such as botulism (2014-2015) and anthrax (2009-2010) – have further highlighted the vulnerability of this group to significant harm.
Reducing the transmission of blood-borne virus infections, and inequalities in their impact, are key outcomes for the National Sexual Health and Blood Borne Virus Framework, published in 2011 and updated in 201511,12.
Will Fixing Rooms Stop People Dying?
Drugs policy expert Professor Neil McKeganey has expressed concerns about the proposed sites, doubting that they would reduce rates of heroin use and heroin-related deaths. The lack of an evidence base has been the reason that these rooms have not been introduced sooner, successive UK governments have rejected the idea, most recently in 2006. But that evidence base is now in existence and the experience of countries where such facilities have been provided has shown that fixing rooms are instrumental in reducing HIV infections, drug overdoses and issues surrounding public injecting and discarded needles.
Initial public resistance towards them was found to fall once they had opened, as they are able to reach the most vulnerable of users and reduce the public inconvenience caused by them.
Demonisation or Dignity?
Drug users are not using public spaces to cause a nuisance, instead their behavior is born of necessity and desperation. Using in public toilets, under bridges and in doorways is dangerous and degrading, fixing rooms will provide a sort of dignity as well as safety for the addict and the public.
The environment in which people consume drugs is a key determinant of the harms of injecting drug use, for both the individual and the wider community. Both the causes and consequences of public injecting highlight it as a marker of heightened vulnerability to poor health. This is illustrated by personal stories from people currently involved in public injecting, as told to outreach staff from Turning Point Scotland.
The tragedy and violence suffered by the addicted and often homeless population make it even more unconscionable that we should deny them a sanitary environment, understanding and help. Ultimately the fixing rooms will help to curb the spread of disease. There is even the possibility that service users will engage with recovery services and heal from their addiction.
In some cases, where current treatments were unsuccessful, users may be offered medical-grade heroin, diamorphine – the debate about leaving heroin distribution in the hands of criminals or whether legalization is acceptable is ongoing. Prince William, the Duke of Cambridge, has entered the debate about the pros and cons of legalizing drugs in the UK, bringing the issue into the media spotlight again.
What about the Cost?
The funding for this project will cost the health service 2.36m, paid for by the city council and NHS Greater Glasgow and Clyde, an amount that pales in comparison with the potential cost of could cost the NHS more than £29m over the lifetime of those suffering from HIV on top of the annual cost of an addict to society.
The IJB said: “In terms of social costs incurred as a result of problem drug use, namely the cost to victims of crime, the cost of pain and suffering for the individuals themselves and their families caused by drug-related death, it is estimated that the annual cost of each problem drug user is £31,438.”
Disregarding these facts seems counterintuitive and lacking in foresight, research has shown that for every £1 invested in the treatment of alcohol addiction £5 is saved on health, welfare and crime costs.
Health Budget Cuts
The recent health budget cuts will have consequences for Britain’s using population. The King’s Fund think tank calculated that in 2017 £85m is set to be cut from public health funding. From this, local authority funding for addressing drug misuse is facing cuts amounting to more than £22m.
‘Taking away the chaos’, the wonderfully rigorous report whose recommendations form the foundation of these proposals, stated that the drug using population experiences extremely poor health and has been significantly affected by the recent HIV outbreak in Glasgow;
“As well as HIV, Glasgow has been the center of a number of infectious disease outbreaks among people who inject drugs in recent years, and also experiences a high burden of acute drug-related deaths. Indeed, 2015 saw a 15 per cent increase in drug-related deaths in Glasgow, with the city accounting for almost a quarter of the total Scottish figure.”
A Way Out or Just Enabling?
Every worthy act is difficult. Ascent is always difficult. Descent is easy and often slippery.
– Mahatma Gandhi
The proposed new services offer an evidence-based approach to addressing these risks, supported by experience from a number of other countries over the last three decades.
The argument against such provision is that whilst it might decrease some of the harm addiction causes it does not offer a way out of addiction, addicts ultimately need help to become drug free. There needs to be a commitment to provide funding for services which help addicts to actually get and stay clean, not an either or situation. Safe Drug Consumption Rooms have been running in Europe successfully for a long time, Holland for example has 31 drug consumption rooms and Germany 24, as part of the whole welfare provision for addicts.
The History of the Welfare State
We can’t solve problems by using the same kind of thinking we used when we created them.
– Albert Einstein
On the 5th July 1948 a system of universal healthcare was introduced in Britain based neither on ability to pay nor on previous national insurance contributions but free for all at the point of delivery. Since then the National Health Service has dramatically changed the lives of millions of working class people for the better. Under Clement Attlee post war Labour introduced The NHS amid a number of reforms which became known as the “welfare state”.
Along with the NHS, two other acts were passed which also improved the lives of working class people, The National Insurance Act introduced a state-run insurance system which, made possible a range of new or better benefits -unemployment and sickness benefits, maternity allowances, retirement pensions and a grant which made possible a basic funeral. This National Assistance Act was “to terminate the existing Poor Law” by nationalizing responsibility for cash payments to those in need.
The Attlee government included the building of a million new homes and an act sanctioning the creation of 25 new towns, including Basildon in Essex and East Kilbride in Scotland, housing around two million people in total including those that had been bombed out during the war. The 1944 Education Act provided free secondary education for all and raised the school leaving age to 15.
NHS under Attack
Though the way in which of these new services were implemented were far from perfect these reforms were real, they changed lives for the better for millions of people. In today’s climate where public services are being cut, sold off and privatized, we can see a tragic move away from the spirit of these reforms and dark times ahead. Every aspect of that welfare state is under attack. Huge swathes of provision are now being run by Virgin Care .
As funding is cut for services and eligibility criteria become stricter and stricter, inadequate personal budgets will leave many people unable to access support. The social security system has been attacked through the implementations of sanctions, bedroom m tax etc.…the shortfall being picked up by grass roots organizations like food banks and churches as best they can.
Of course all this has been eased through with a constant ideological assault against the welfare state in the press which has given rise to more hate crime, a rise in suicide in those on benefits not to mention Brexit and the current Tory/DUP horror story.
Can We Do Without a Welfare State?
Karl Marx’s phrase, “accumulation for accumulation sake” encapsulates purpose of capitalism quite well. It is important to remember the past in which capitalism was not tamed by Labour’s welfare state and ask if capitalists provided any money for the welfare of the workers. The answer is they did not. People/workers are part of a wealth producing machine and so not have human rights, as we understand them, as such. Where there is no shortage of workers there is no motivator to preserve the health and wellbeing of the workers.
We often hear of the outsourcing of work to countries which do not have workers’ rights with often tragic consequences, such as the deaths of more than 1,100 garment workers in a factory building collapse in Dhaka, Bangladesh, in April 2013. Capitalism does not care about the wellbeing of society – our happiness, families or wellbeing where those things don’t impact production – a harsh reality.
What Will Happen When You Visit a Safe Injecting Site?
In the recently opened Paris safe injecting site near the Gare du Nord railway station where the Eurostar arrives from London, clients are given a numbered ticket on arrival in the adjoined waiting room. As each number appears on the screen drug users can enter the injecting room with the sterile needles and paraphernalia needed, provided by staff members who are on hand to supervise and to offer support.
In the room there are a number of clean bays in which individual users can sit, use their drugs safely and dispose of any rubbish in medical bins provided.
There is a resting area’ in which addicts can stay, chat to staff and each other in a relaxing, nonjudgmental environment – very different from the desperation of using in public toilets or huddled in doorways. There are housing officers and social workers who are able to engage clients and point them in the direction of appropriate help when it is available.
Moral Panic or Community and Compassion
We feel free when we escape, even if it be from the frying pan into the fire.
– Eric Hoffer
We need to get over this kind of moral panic about providing addicts with a safe place to use as part of an overall treatment plan, to not provide sanitary conditions and a bare minimum of dignity to people caught in the grip of the terrible illness of addiction is cruel. Despite the fact that drugs are illegal, addiction is a medical problem rather than a criminal justice one really.
As we have seen during the war on drugs eras, the criminal justice system is just not equipped to offer solutions to addicts, nor to curb the flow of drugs or stop people from using. Enforcement efforts have met no success, tending instead to exacerbate the harmful impacts of street drug use through criminalizing drug use and marginalizing addicts.
In contrast, there is an accumulating body of evidence to support those interventions that address underlying social vulnerabilities and provide safer environments in which addicts can do what they need to do, which is use. People who are committing crimes because they are addicted need help, community and compassion rather than to be shamed, incarcerated and denied housing, safety and treatment.
Vox Populi Vox Dei
There is also an important ideological challenge made against mainstream/right wing media which depicts the working class, immigrants, single mothers and addicts in a demeaning way – as it always has done.
Today we are facing the most comprehensive attack on the welfare state since its foundation, the ruling class are prepared to gamble the NHS, secure in their political security – this is the nature of contemporary British Tory capitalism – waiting for a change of heart on their part isn’t likely to bear any fruit, it is all of our job to look out for the weak in society, to stand up for the rights and humanity of all.
The addicted population is one of the most voiceless in our society, the disparity between felt need and expressed need is so high due to stigma and shame; difficulties accessing services; limited opportunities or skills for advocacy; and low priority accorded to health, because the addict is powerless over their disease and is just doing what they need to do to feel ‘ok’ as in not withdrawing from the drug. Their silence is not indicative of their desire to continue living the way they do, it is symptomatic of the illness.
Whilst the idea of fixing rooms is a controversial one, because it seems that addiction and drug use itself is becoming state sanctioned, these places will provide safety for someones child, someone’s sister, mother, or son. It will put users in touch with services that could help.
An estimated 149,807 people are addicted to opiates, most report multiple social vulnerabilities, including unemployment, homelessness, and offending. The combination of these factors is often referred to as severe and multiple disadvantage and is increasingly recognized as a powerful marker for poor health and social exclusion. Anything that can add some stability and reduce the chaos of a person’s using will help them to see things more clearly and make it easier for them to address their using.
The aim is to save the lives of addicts, to reduce the impact of addiction in the community, and give as many people access to help as possible.
It won’t change the world
It won’t improve relations among men
It will not shorten the age of exploitation
But a few men have a bed for the night
For a night the wind is kept from them
The snow meant for them falls on the roadway.
– Bertolt Brecht