DOORSTEP CHALL
HARM REDUCTION
Strong partnerships could overturn nimbyism and make
supervised injecting facilities a reality, DDN reports
A
supervised injecting
facility (SIF, also
referred to as a
drug consumption
room or DCR) is not
the only answer to
reducing drug-related deaths, but
could fit into ‘a multi-component
strategy’ to reduce vulnerability,
overdose risk and fatal outcomes
from overdose. Introducing an
online session, Professor Alex
Stevens of the University of Kent
wanted to discuss the evidence, the
obstacles and a way forward for
making SIFs a reality.
‘Not only do they save lives,
they help people to improve
their injecting technique, access
treatment and harm reduction
services, and address other
vulnerabilities in their lives,’ he said.
Release’s executive director
Niamh Eastwood looked at
whether a SIF could be legal.
With the government ignoring
the ACMD’s recommendations
and continuing to oppose such a
facility, three offences relevant to
a DCR/SIF stood out in particular
– possession, encouraging or
assisting a person to commit an
offence, and contravening the Anti-
Social Behaviour Act.
With legislation unlikely
to change anytime soon, she
suggested that a way forward
would be through multi-agency
agreements between the police,
local authorities, PHE, health
providers and prosecution services.
‘Letters of comfort’ could be
provided by police to allow local
services to provide harm reduction
equipment such as citric acid and
foil. ‘The impetus comes from local
activity,’ she said.
DCI Jason Kew gave thoughts
on working with the police to open
a SIF. His strong view was that it
was a health matter – ‘a medical
facility, a harm reduction facility’
– and it wasn’t the police’s place
to lead on this work. The data on
drug misuse deaths showed ‘a clear
picture of where we need to act
sooner,’ he said. With 78 legalised
DCRs operating in Europe without
a single drug-related death, we
needed to ‘humanise the statistics’.
‘Is there really the public interest in
prosecuting a healthcare professional
trying to safe somebody’s life?
Absolutely not,’ he added.
‘DCRs attract a great deal of
emotion for or against them,’
said Rudi Fortson QC. A local
memorandum of understanding
was the best way forward, he
suggested. ‘One has to look
at the reality of the situation,
which is that despite 14 years of
campaigning to even pilot a DCR
within the United Kingdom, we
haven’t got one. Why not? It comes
back to those fundamental issues
of public acceptability of a DCR on
their doorstep.’
Saket Priyadarshi, medical
lead at Glasgow Alcohol and Drug
Recovery Service, had been closely
involved in making the case for a
DCR in the city – a move provoked
by an outbreak of HIV in people
who injected drugs. A formal
health needs assessment by public
health colleagues had resulted in
recommendations for a heroinassisted
treatment service (HAT)
and a SIF. Glasgow’s health and
social care partnership – which
included police and people with
lived experience of using drugs in
public places – had accepted the
recommendations and asked for a
business plan for a SIF in the city.
SafePoint, a
supervised
injection facility
in Surrey, part
of the larger
Vancouver area,
Canada. Credit:
Xinhua/Alamy
‘Is there really a
public interest
in prosecuting
a healthcare
professional
trying to safe
somebody’s life?’
DCI JASON KEW
The model they proposed
was co-located with HAT and a
very low threshold service ‘to
capture as many of our target
population as possible’, including
pregnant drug users. The large
fixed-site model ‘would manage
the clinical governance concerns
being expressed’ and it included an
aftercare area.
The project is currently
snagged by ‘a constitutional
stand-off between Edinburgh and
Westminster’ but they have made
plans around public engagement
to manage local concerns and ‘have
an evaluation and research agenda
in place’. A HAT service has already
been implemented in the interim,
and they anticipate that the SIF will
be a ‘scaled-up version’.
The West Midlands had also
been developing a model, as Megan
Jones, head of policy for the Office
18 • DRINK AND DRUGS NEWS • JULY/AUGUST 2020
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