Transcript drug consuption rooms

DRUG CONSUPTION ROOMS / DCR,
OR SAFE INJECTING FACILITY / SIF, IN
COPENHAGAN
Elwyn Thomas, Gwent Drug and
Alcohol Service
I recently spent four days in Copenhagen shadowing the Nurses and staff at a DCR /Drug
consumption room. I also visited another DCR and a mobile SIF/Safe Injecting Facility within
the Beautiful City of Copenhagen.
What struck me initially as strange was that I expected these places to be either in some dark
back street or the wrong end of Town, how wrong I was. The largest called SKYEN/CLOUD was
main street in a fashionable part of Town, next door to a building called Maendenes Hjem.
This place gave the homeless somewhere to stay, wash and get fed daily by an array of
volunteers.
Food is donated by the people of Copenhagen and clients have access to a DR to address
issues around homelessness, substance misuse, providing services such as foot clinics,
wound/abscess and DVT clinics and the prescribing of anti-biotics.
Firstly, you have register to use the DCR. You don’t need to use your real name, an alias will
do. Every time you present to use the facility, after giving your name and initially showing the
substance you intend to use, for harm reduction and safety purposes, you are greeted in the
reception area by a very friendly member of staff who records data.
There are four members of staff on each shift, three eight hour shifts a day, and minimum of
one nurse per shift.
All staff I met had a vast experience of IV use and knowledge of individual clients and their
problems. A client signs in then awaits his turn to use the facility. There were two rooms
adjoining the reception area and you can only access these by swipe card. When a space
becomes available a member of staff will swipe you through. In one room you have 9 cubicles for
fixing, in the middle of that room there is an area or station for the staff to database and monitor
the clients and to give care, and harm min advice if needed. It is a clinical /sterile area, light and
airy, stainless steel cubicles all around, boxes of every type of needles and paraphernalia to
prevent BBVs, there were groin ,neck, leg ,arm and hand IV users, no different to our own
clients in Wales.
What was refreshing was the lack of finger wagging from staff, every cubicle was in use, each
client was allowed maximum of 45 minutes stay, if they needed it. There were vein lights
attached to some tables, which is a fluorescent light making it easier to find a vein and fix safely.
Each client had the responsibility to clean up after themselves. It did get bloody, messy and often
stressful to clients and staff alike, with the failure sometimes to achieve their desired goal,
(missing veins) as is the nature of the game. It was, however always handled with care and
compassion and looked upon as a medical issue to be treated with respect for all those
concerned. I watched Naloxone on more than one occasion administered with ease, experience
and a professionalism that was absolutely staggering. The Staff Nurse in question really opened
my eyes in how you treat those who are truly on the fringes of society, it was heart-warming to
see clients having their shoulders rubbed, touched tears wiped and even hugged and treated
with respect and compassion. There were clients that were under the influence of alcohol, they
were handled differently but always with the upmost respect. There were also people who were
on methadone treatment but using IV opiates, the emphasis being pro-choice and a safe
environment in which to use. Focusing on harm reduction, more importantly keeping people
alive with experienced staff on premises to cope and deal with any and every eventuality.
The adjacent clinical area consisted of a room with eight enclosed cubicles with glass doors that
shut. It was a smoking space for smoking opiates /heroin on the foil and smoking Crack cocaine.
Staff did not stay in that room and monitor clients as the smoke although extracted would and
could be detrimental to their health but the clients would still be monitored through a glass
partition and glass door from the fixing room. Staff would frequent the smoking room whenever
necessary , the stay in the smoking room is 35 minutes each and again a client has the right to
frequent it as many times as they need to through the course of the day. Ammonia dispensers
featured on the walls for the washing of cocaine. There is no availability of crack in Copenhagen,
only cocaine and so clients have to wash it themselves, bringing with it its own problems in terms
of risks to health. Staff have acknowledged this problem and try whenever possible to promote
the use of Bicarbonate of soda.
In one 24 hour period on the Saturday I was there the smoking room was used approximately 360
times and the fixing room approx. 270 times with some clients using it more than once. I’ve been
told that this was not a particularly busy day. From the Friday - Monday of that particular
weekend it was used approx. 2500 times by clients in safety with full knowledge of the local Police
force, some of whom I met with their guns, sprays, batons, stab vests and cuffs who experience
I’m sure the same difficulties in their working days as our own hard working police force in trying
to keep our communities safe in fighting drug relating crime. In talking to the police, it was
obvious that they had experience with drug users and street homeless and exerted an amount of
tolerance and took the time to get to know all the people that used the facilities by name.
If the police were called to deal with clients who were abusive, dangerous or violent to staff or
other clients, they would be escorted off the premises with respect and in some cases banned
from using that particular SIF for 24 hours. They could however, use the other facilities which
were 200 yards away. There were other police and drug / narc squad officers as drugs were
illegal and these guys go in hard to tackle high level drug dealing and crime but they leave the
low level drug dealing to the street police who deal with it with a more common sense
approach.
The staff rotate from each of the SIFs so everyone knows every one, so communication is key
.There are 5000 clients registered to use these facilities in Copenhagen and they have a
representative who has been voted democratically to represent the service users and give them
a voice in all matters concerning the use of DCRs and their treatment surrounding them.
Although a very controversial subject, the police, politicians, small businesses and the people of
Copenhagen would never go back to the old days, where needles and the dead littered their
streets, a familiar theme to our own UK towns and Cities.
Drugs are illegal in Copenhagen, the SIF were the result of a Copenhagen problem that was
dealt with by the people of Copenhagen .First started at a grass route level with an old
ambulance that cost 3000 euros, they went out on to the road with it and manned it with a
dedicated team of volunteers .The SIFs they have now are funded by the Municipal, the
equivalent of our county councils. They are run very low key, they have been running for four
years now and not one death has occurred in all that time. There have been approx. 380 over
doses in that time, where oxygen Naloxone and ambulance were called, and by experienced
staff being there on site, people’s lives were saved.
The smaller of the two DCR is about to close and to replace that the city of
Copenhagen has just built the world’s largest DCR. Obviously it will be run
differently as its municipally run, but no doubt the philosophy is the same, saving
lives and harm reduction and for the people of Copenhagen.
It lessens the impact of drug related death on their streets and abandoned
needles resulting in sharps injuries to its citizens, there were 5 rules in using the
service , there has to be rules but even these were enforced with tolerance and
common sense.
The Rules were as follows:• Follow Staff Rules
• No Violence
• No Threats
• No Weapons
• No Dealing
More than 3,300 people died from drug poisoning in 2014 in England and Wales, the
number of people dying from drug misuse in Wales fell by 20% to 168 last year down
from 208 recorded deaths in 2013. Deaths from heroin have increased in England and
Wales to 952 in 2014 and in that same year 613 people died as a result of Drugs in
Scotland, we don’t have the figures yet for 2016. I’m sure if we had Drug Consumption
rooms the number of deaths by drug poisoning would be greatly reduced.
Tommy – in the
smoking cubicle
Tommy – cubicle room
DCR Worker
Vein machine in fixing cubicle
Front entrance to DCR
Fixing Room
Mobile SIF / Safer injecting
facility
Tommy in mobile SIF
Tommy using the vein
machine
Vein reader
Tommy’s veins
Copenhagen's first ever
sharps box
Tommy playing
Smoking cubicles
Selection of clean needles
Mobile SIF Nurses
Nurse station in fixing
room
Reception waiting area
Front of house and to the
left is the homeless shelter
Staff nurse Emilie