Transcript drug consumption rooms in the uk - National Treatment Agency for

DRUG CONSUMPTION
ROOMS IN THE UK:
The evidence base and policy backdrop
Charlie Lloyd
Department of Health Sciences
University of York
Neil Hunt
Honorary Research Fellow,
The Centre for Research on Drugs and Health Behaviour
London School of Hygiene and Tropical Medicine
Overview
• Introduction
• Evidence of effectiveness
• Evidence of need
• The story of non-implementation
Introduction
• Place where problem drug users are allowed to
bring their illegally-obtained drugs and take them
in a supervised, hygienic environment. Sterile
injecting equipment. Closely observed, in order to
give medical assistance should they overdose.
• c. 90 DCRs operating in 10 countries:
Switzerland, Germany, the Netherlands, Spain,
Norway, Luxembourg, Australia, Canada,
Denmark and Greece. Advanced plans in France
Vancouver
Zurich
Evidence of effectiveness 1
• DCRs can prevent drug-related deaths:
• millions of injections in DCRs, only one death.
• Vancouver Insite implementation – 35% drop in
lethal overdoses in vicinity of project.
• Reduction in ambulance callouts to overdose
incidents (Sydney)
• If coverage, capacity and opening hours
appropriate, likely to contribute to reducing DRDs at
city level.
Evidence of effectiveness 2
• Improve the health of users, reduce risky injecting and
prevent self-reported needle-sharing. No direct evidence
of viral transmission prevention.
• Reduce public injecting, discarded needles and litter. 50%
reductions – Vancouver.
• Increase in referral to treatment services. 30% increase in
DCR-users entering detox – Vancouver.
• Studies have found DCRs to be cost-effective
Evidence of effectiveness 3
• Most of those using DCRs are local drug users.
• No increase in crime or drug dealing in area
around DCR (Vancouver and Sydney).
• In Europe, public disorder and drug-dealing
around DCRs have occurred but have been
successfully addressed through interagency
working.
Evidence of need
• Prevalence of problematic drug use and drug-related
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death rate comparatively high in the UK
Non-fatal overdose much more common.
HIV and Hep C prevalence among injectors appear to be
stable but Hep C high (c. 50%)
Abscesses, cellulitis and damaged veins common
Substantial population of homeless users
Injecting in public places common (42% NSP users
injected in pp at least once/last week – Hunt et al. 2007).
Problems coalesce in particular areas in particular cities
Conclusions on evidence of effectiveness
and evidence of need
• Increasingly strong evidence base showing DCRs
to be a cost-effective way to reduce overdose
deaths, ambulance call-outs to overdose events,
needle-sharing and public injecting. They are also
associated with increases in PWID entering
treatment.
• Levels of relevant needs and concentration in
particular cities suggest that DCRs may have an
impact in the UK.
So why no DCRs in the UK? The story of
non-implementation
• 2002 Home Affairs Select Committee recommended:
‘…an evaluated pilot programme of safe injecting houses for [illicit]
heroin users is established without delay and that if, as we expect,
this is successful, the programme is extended across the country.’
• Reasons for Home Office rejection included:
• International legal position means that the rooms could be (but
have not been) open to legal challenge.
• The Government could be accused by the media and others of
opening "drug dens".
• There may be problems in some areas on occasion with drug
dealers congregating near to venues, leading to reduced local
tolerance for the presence of injecting rooms in their
neighbourhood.
• No evaluations of DCRs developed in other European countries.
Blunkett and heroin prescription
• In a 2003 interview with Druglink, Blunkett (then Home
Sec) ruled out ‘shooting galleries’ on the basis of need for
stronger evidence of effectiveness but also the fear that
they might create ‘a backlash and undermine our
progressive step-by-step policy in terms of prescribing’
• The following year (2004), in the HO response to proposal
for mobile DCR in Cardiff, central focus was legal status:
• The UK will not contravene or undermine UN conventions or the
Misuse of Drugs Act. We believe facilities for supervising the
consumption of illegal drugs would fall foul of these. Therefore, no
authority could be given to the piloting of initiatives to supervise the
consumption of illegal drugs.
Increasing evidence of effectiveness
• Important review of the evidence undertaken in 2004 for
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the EMCDDA (Dagmar Hedrich)
Increasingly sophisticated evaluations undertaken of the
new facilities in Sydney and Vancouver
JRF set up Independent Working Group on DCRs in
2005, reported May 2006
Concluded that sufficient positive evidence to warrant
trialling DCRs in the UK
Widespread coverage and debate
Responses to the IWG
• David Cameron, leader of the opposition:
• ‘I certainly wouldn’t rule them out because anything that helps us
get users off the streets and in touch with agencies that provide
treatment is worth looking at.’
• Mixed coverage across the newspapers, TV and radio but
clear support from The Independent and The Mirror
• Lancet editorial: ‘After 4 years, and thousands of needless
drug-related deaths, a thorough trial of DCRs is a
requirement the Government cannot afford to refuse a
second time.’
• But…no change in Government position
• Published amid prisoner deportation crisis, poor local
election results and departure of Charles Clarke.
Since 2006
• Relatively quiet
• Some local areas have got close to establishing pilot
projects but fallen through due to range of circumstances
• Most recent: Brighton. Independent Drugs Commission
recommended that local authorities examine the feasibility
of opening a DCR. Not considered a priority due to
unlikely impact on deaths in Brighton, cost and legal
advice from the HO.
• Meanwhile DCRs have spread to many more countries
So why not in the UK?
• Not the sort of policy to put on the front of your manifesto
• Govt’s response to 2002 HASC rec candid – media could
accuse them of opening ‘drug dens’. Perhaps a harder
sell in the UK than elsewhere due to British press
• Lack of local autonomy: local response to local problems
• No ‘open drug scenes’ akin to those seen in Germany,
Austria and Vancouver
• Chance. UK came close in 2006 but winds of political
fortune changed and Govt in turmoil
Conclusions
• Good evidence for the effectiveness of DCRs (as good as
can be expected in absence of RCTs)
• However, not a ‘universal service’ for PWID: local
response to high rates of public injecting and overdose
incidents
• Likely to have a significant impact in some areas of some
cities in the UK
• Political barriers considerable