Swansea pitch perfect for Drug Consumption Rooms by Rob Barker (Wales Ambassador)

Swansea has been awarded the unwanted prize of being the location for the highest death rate from opioids in England and Wales, with 16 people per 100,000 suffering a fatality associated to pain killers. Despite the hard work that has been done over the years in the South Wales city, it shows there is still plenty to be done within the health and social care settings to help reduce this figure. It is difficult to ascertain as to whether such individuals would have benefited from enhanced harm reduction services in the area such as drug testing or drug consumption rooms, but if both were readily accessible, it could well have prevented such tragic eventualities.

It is pleasing to hear that enhanced harm reduction services are being given the go ahead, such as licensed drug testing facilities backed by the Home office. Drug testing services have been in operation via The Loop at various music festivals over the last couple of years, resulting in positive outcomes in relation to reducing harm. Heroin assisted treatment, where some of the most vulnerable individuals will be prescribed heroin rather than the more traditional Opioid Substitution Treatment (OST) such as methadone, are also being established. Many would agree that it is also refreshing to hear that multiple locations throughout the UK have either piloted, or are in the process of establishing, diversion schemes, whereby those that are caught in possession of illegal substances are diverted to drug awareness workshops and sessions, rather than be prosecuted. Such schemes not only reduce the financial impact upon the criminal justice system, as it costs the tax payer upwards of £37,000 per inmate per year in UK prisons, but also diminishes the burden on already overcrowded prisons. It is aimed that such processes also allow for a more informed and conscientious drug using population, that aims to reduce the risk to all, in relation to drug use. However, there is one enhanced harm reduction service that splits opinion, and that is Drug Consumption Rooms (DCRs), or what we term in Wales, Enhanced Harm Reduction Centres. Swansea therefore poses as the pitch perfect city for multiple aforementioned services to be implemented.

DCRs are facilities where people can use illegal drugs in a clean, hygienic and supervised environment. They are not a new phenomenon. The first such facility was established in Berne, Switzerland in 1986, and over 100 more have been established worldwide since. They are not uncommon in many European countries. Walk along the streets of Vesterbro, an affluent and tourist attractive district of Copenhagen, and you are likely to walk past two of the most well-known DCRs in Europe, without even knowing it. DCRs aim to reduce street-based drug use and improve public amenity; reduce the amount of drug litter on the streets; reduce acute risks of disease transmission through unhygienic injecting; and reduce morbidity and mortality within the population of people who use drugs. Yet there is much more to DCRs than just providing a space for people to consume drugs. Many DCRs provide an abundant of services under one roof. Take Ragazza e.V. in Hamburg. This is a service specific to females who both sex work and use illegal drugs. Not only is there a consumption room where females can inject or smoke illegal drugs, but they can also get access to a wide array of services, from medical treatment; a bed for the night; and psychosocial interventions, to name just a few.

However, many may disagree with such facilities being established in Swansea, and the rest of the UK, and that is only normal. Those who argue against DCRs being established in the UK have a right to voice their opinions, and many viewpoints are relatable within a wider social context. Anecdotally, many residents and business owners in Swansea are for such facilities yet wouldn’t like one to be established on their street. A point many would agree with. However, DCRs in Wales would only be established where there is a significant need and where there is a significant amount of public drug use already taking place. It is also worthy to note, that many of the drug-related-deaths we see in South Wales are as a result of people passing away within private residence, such as within their own homes. Therefore, it is hard to determine whether such facilities would have prevented these fatalities. Having spoken to many people who use drugs over the years, there are plenty that prefer to use in their own home, in privacy, out of view of anyone else, despite the opposing harm reduction advice regarding such risky behaviour frequently disseminated. Yet it shouldn’t come as a shock that many take such risks, given how this cohort of individuals are shamefully portrayed and marginalised by today’s society. Yet, if DCRs were already established, it would have at least given those who have since passed away, the option of using there rather than at home, and consequently reduced the chances of experiencing a fatal overdose. Maybe more emphasis on peer to peer support needs to be focused upon to curb the growing number of people using drugs on their own, in private. As DCRs are targeted more towards those that are most vulnerable, it is possible that these individuals would have been known to a DCR service and therefore increase the opportunity for engagement. While public opinion on this matter is crucial to any further developments in terms of establishing DCRs in Wales, it is vital that there is also a cross-party consensus that the use of drugs should change to being a health and social issue, rather than the draconian criminal justice view point which has had a helping hand in the UK experiencing record-levels of drug-related-deaths over the last few years.

The recent support offered by Carolyn Harris, MP for Swansea East and Deputy Leader for Welsh Labour, in relation to DCRs, is poignant and yet comes at a crucial time.  With the world evolving its drug policies, from Canada legalising cannabis to Portugal decriminalising possession of all drugs, the U.K. continues to fall behind in relation to pragmatic responses to health and social-based initiatives relating to drug use. However, Wales can be seen as setting the standards within the UK, such as the establishment of WEDINOS, to implementing a highly successful national naloxone program, the drug that can act as an opioid overdose antidote. Outreach provision in Wales continues to improve and is being viewed upon as an important part of treatment provision especially in relation to working with those that are deemed most vulnerable or change-resistant. OST continues to be provided, but many will argue that there are significant improvements still to be made, including the basics of compassion in the delivery of such interventions. Such services, as well as the establishment of DCRs, could help ‘the many and not just the few’ in relation to the impact of drug use within communities and society in Wales. As Carolyn Harris states, “DCRs can act as a way to protect us ALL from harm from public drug use”. That is why such social movements, like that of the Labour Campaign for Drug Policy Reform (LCDPR) is so vital. From improving drug treatment provision to changing legislation, it is a political issue and one that must be led by those at the top of government, whether it be in the Senedd or Westminster. If LCDPR only highlights these issues to AMs and MPs, then that is a start. However, despite decisions being made by government officials, change is only likely to come via social movements such as LCDPR which allows for sensible, humanitarian debates to take place. Subsequently this can hopefully start to put things in motion, from gathering cross-party support to eventually changing drug policy within the U.K. that moves away from the failed war on drugs.  DCRs alone are not the answer, but they could well be the missing piece of a very complex jigsaw.

Anthony Lehane