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A drug user after injecting heroin in his arm at ‘The Cloud’ fixing room facility in Copenhagen, Denmark.
‘Skyen visitors are allowed 35 minutes in the smoking room and 45 minutes in the injecting room.’ Photograph: Ole Jensen/Getty Images for The Guardian
‘Skyen visitors are allowed 35 minutes in the smoking room and 45 minutes in the injecting room.’ Photograph: Ole Jensen/Getty Images for The Guardian

How 'fixing rooms' are saving the lives of drug addicts in Europe

This article is more than 5 years old

Across Europe, facilities that offer medical supervision for addicts are dramatically reducing drug-related deaths

Jørgen sharply inhales as the needle pierces his vein, exhaling when the heroin reaches his bloodstream. His eyes reopen with a glimmer of excitement, tinged by a profound scowl of disapproval.

All over Europe, every day, many thousands of people will perform this same ritual. Hundreds will do so, like Jørgen, in drug consumption rooms. But none of these will be in the UK, where drug addicts are mainly confined to back streets, crack houses and hostel bedrooms.

While European overdose rates are falling, the UK now has the worst drug death rate across the continent: one in three of the approximate 8,000 people who die as a result of drugs in Europe will do so in Britain.

Drug-related deaths graph.

It could all be very different. In Denmark, there has been no shortage of overdoses in the Skyen (Cloud) drug consumption room I visited – more than 800 at the last count. But no one has died. Drug-related deaths in the country have stabilised since 2011.

In fact, there has never been a recorded death in any of the 78 drug consumption rooms in Europe. Why? Because nurses quickly administer antidotes and immediately resuscitate the person before calling an ambulance. Elsewhere, the death rate from opiate overdoses is about 6%.

“These people are really sick, they cannot just suddenly stop taking drugs,” says Anders Larsen, a social worker and chemist at Skyen, as he scrapes a small quantity of powdered heroin from under the microscope and into the bin after testing its purity.

“All we can do is make it as safe as possible, and if they decide that they want to give up, then we will immediately direct them to addiction support services.”

At Skyen, visitors can get clean needles and are allowed 24-hour access. There had been fears the opening of a consumption room would increase the numbers of new drug users, but this has not happened. Rather it has transformed the fabric of Copenhagen’s historic “open drug scene”.

As many as 10,000 syringes were found every week on the streets of Vesterbro, the Danish capital’s former meatpacking district, prior to the consumption room opening in 2012. That figure fell below 1,000 within a year, as drug-taking in the city’s main hotspot – where users would formerly inject behind bins, in stairwells, and on the street – became largely shielded from public view.

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There are now five such medical facilities across the country, where drug addicts take cocaine and heroin as well as methadone, under clinical supervision. At Skyen, staff have overseen more than 7,500 people administer more than 1m fixes in six years.

Their wraparound service delivers harm reduction and social work, in conjunction with the shelter next door, by providing assistance with housing applications and organising hospital appointments. Crucially, most of their visitors are extremely marginalised - “hard-to-reach, hard-to treat” - and may never have any other contact with non-users, or officialdom.

In the UK, pressure is growing on Westminster to allow the Scottish parliament permission to open a drug room in Glasgow, where overdoses are reaching unprecedented levels having quintupled in just 20 years.

‘The legality of injecting rooms does not follow a one-size-fits-all model.’ Photograph: Ole Jensen/Getty Images for The Guardian

The government has repeatedly blocked any attempts to permit a Scottish exception, however, citing fears about the challenges the facility could pose to law enforcement agencies, and of the implied acceptance of wider criminality.

In a statement, the Home Office said there was no legal framework for the provision of drug consumption rooms in the UK and that there were no plans to introduce them. A spokesperson stressed that drug dependency must be prevented through treatment and recovery. Such services, however, are in decline. An addiction service recently blamed the 26% rise in drug-related deaths in England between 2013 and 2016 on the 18% cut to treatment budgets in that time.

“Drug consumption rooms have operated across Europe for the last four decades and they have been proven to be effective at engaging some of those most marginalised in society, providing safe spaces for those who would previously have been injecting in a risky way in public places,” says Niamh Eastwood, executive director of the drug information charity Release. “Drug consumption rooms reduce the risk of fatal overdose, reduce public injecting, and increase access to health and treatment services for those with who have a history of problem drug use.

“The only thing that stands in the way of the UK following the example of other European countries is the British government, who continuously state that they will not support drug consumption rooms despite the evidence and the fact they could save lives. It seems they are happy for the backstreets of our city and town centres to continue to provide such spaces.”

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Although the government has acknowledged the potential public health benefits of consumption rooms, it would rather “see our most vulnerable and desperate fellow citizens suffer and die for ideological reasons, than allow cities like Glasgow to open one”, according to Martin Powell from Transform Drug Policy Foundation. “Europe’s overdose prevention centres have supervised millions of injections, and treated thousands of overdoses without a single death.”

Across Europe the legal status of injecting rooms differs. Germany and Switzerland changed the law to allow for drug consumption rooms. Spain did not need to because it does not criminalise personal possession. In France, the safe spaces (housed in public hospitals in Paris and Strasbourg) are more contentious because the country has some of the strictest narcotics laws in Europe.

In Portugal, which is set to soon introduce consumption rooms, the decriminalisation of drug use caused a steep fall in the drug death rate which now stands at a 10th of that in the UK. Ireland and Belgium are also soon to introduce them too.

In Denmark the provision of the service was sparked by a longstanding campaign led by residents and activists focused on improving public health that eventually gained the support of the majority of the wider population. In an act of civil disobedience on the day of the general election in 2011, a mobile facility in an ambulance run by volunteers in Copenhagen began offering a sterile space for drugs to be taken.

At Skyen, Anders Larsen, a social worker and chemist, tests the quality of heroin for a user to make sure it is safe. Photograph: Ole Jensen/Getty Images for The Guardian

“It was quite controversial at first and there was real tension,” says Ivan Christensen, who now manages the men’s shelter next door to Skyen. The volunteer social workers were waiting to be arrested, but nothing happened.

Weeks later, the second-hand ambulance, known as Fixelance, parked in front of parliament to draw attention to the debate taking place inside: the first reading of a bill to establish consumption rooms. Some months later, the municipal government asked them to establish a fixed drug consumption room – which it has since funded – and a change to the law was passed in the summer of 2012 to allow individuals with severe problems to possess drugs for their own use, thus enabling such facilities to work within the law. A stationary facility was opened shortly after, and since then an even bigger consumption room has opened nearby, along with three others across Denmark.

They are hectic places where minor disputes often erupt, yet workers and visitors snatch sanguine moments together where they bond over stories, meals and shared frustrations. Skyen visitors, who tend to buy their drugs locally, are allowed 35 minutes in the smoking room and 45 minutes in the injecting room.

“I take drugs to numb my pain,” says a Muslim veteran of the Bosnian war, after inhaling heroin fumes in Skyen’s smoking room. “You cannot begin to imagine what I have seen.” Another tells me that he would otherwise be taking drugs on the streets. “It’s more calm here, and I do not have to worry about being attacked,” says an Afghan cocaine addict who fled the country after war began in 2001. “Here I have dignity.”

A longtime heroin addict who was in care growing up in Denmark explains that visitors to Skyen are treated with “empathy, not judgment”, as he recalls his tumultuous life story. “We are not condemned, we are cared for,” he says. “This place gives us greater control over our own destiny.”

Skyen’s employees’ views are shaped by their every day experience, watching people come and go, while committing crimes to fund their addiction which means they are in and out of prison.

“What’s the point of sending people to jail, where there are no harm reduction measures despite drugs being so easy to buy,” says Larsen, sitting next to a man who has just taken a shot of heroin. “People will scratch a needle on the floor to sharpen it so they can get their hit. I wish we could give them free, clean drugs. All this crime is for nothing, the proceeds go back into crime. The war on drugs is lost.”

This article is part of a series on possible solutions to some of the world’s most stubborn problems. What else should we cover? Email us at theupside@theguardian.com

  • Some names have been changed

  • Mattha Busby is a freelance journalist

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