Drug consumption facilities

What are drug consumption facilities?

Drug consumption facilities, sometimes known as supervised injecting facilities or drug consumption rooms, are places in which drug users can use illicit drugs under the supervision of medically trained staff. They exist in several European countries and are usually located in areas where there is an open drug scene and injecting in public places is common. Their primary goal is to reduce morbidity and mortality by providing a safer environment for drug use and training clients in safer forms of drug use.

What problems do they address?

Drug consumption facilities were originally developed as a public health response to the rapid spread of HIV/AIDS among injecting drug users in the 1980s. Their aims were to reduce the risks of unhygienic injecting, prevent fatal overdoses and link drug users with treatment, health and social services. Their establishment was often opposed because of community fears that they would encourage drug use, delay treatment and aggravate open drug scenes. However, there is increasing awareness of their potential to reduce harms to communities associated with public drug injecting, such as drug litter.

What is known about their effectiveness?

There is growing moderate quality evidence that drug consumption rooms are able to attract hard-to-reach drug users, especially marginalised ones who inject drugs on the streets, under risky and unhygienic conditions. There is also moderate quality evidence that drug consumption facilities increase safer injecting and may reduce the transmission of blood-borne infections and the occurrence of overdoses near services. There is similar evidence that they reduce the public visibility of illicit drug use and drug litter, thereby improving public amenity around urban drug markets.

Drug consumption facilities in Europe

There have been drug consumption facilities operating in Europe since 1986, when the first one was established in Berne, Switzerland. As of 2016, 90 of these facilities were operating in six EU countries, Norway and Switzerland. In 2016, two opened in France, new facilities were established in Denmark and Norway, and other countries are in the process of passing legislation to permit drug consumption facilities to operate.

Looking to the future

Drug consumption facilities were originally established to reduce the harms associated with public injecting of opioids, but in some cases they are also used by people injecting other substances. As rates of injecting in some countries decrease, consideration has been given to using drug consumption facilities to reduce harms associated with other routes of administration (e.g. smoking) or other substances (e.g. cocaine and methamphetamine). This implies some changes in the aims of this response, and research and evaluation will be necessary to assess the effectiveness of this approach with non-injecting populations. More generally as the number of drug consumption facilities expands, it is important

that they are evaluated to improve the evidence on the extent to which they reduce individual harms and harms to the community.