Drug Consumption Rooms and Public Health Policy
Drug Consumption Rooms (DCRs) are settings for the supervised consumption of pre-obtained drugs, where there is clean injecting equipment, and trained staff who can signpost to health and social care services but also support in cases of overdose. DCRs, therefore, intend to mediate the impact of using drugs, preventing drug-related deaths and transmission of viruses, with the ultimate aim of supporting the user to seek help for their situation.
Scotland currently has three times the number of drug-related deaths compared to the UK as a whole, but the UK does not currently have DCRs. Government legislation is a barrier, however, stakeholders knowledgeable in the area of drug use have called for DCRs to be introduced, but the Government rejects these proposals suggesting that providing these rooms would encourage drug use and detract from other services. Consequently, the issue is politically and socially complex, and the introduction of DCRs would require special legal exemptions under the Misuse of Drugs Act 1971.
This research sought the views of strategic stakeholders who would likely be involved in implementing and managing DCRs were they to be introduced in Scotland. A cross-sectional, qualitative interview study was carried out with a sample of key decision makers from the Scottish Government, local Alcohol and Drug Partnerships, local Health and Social Care partnerships, third sector organisations, and national advocacy groups.
There was a consensus amongst participants that drug-related deaths were a national crisis demanding action. There was universal support for piloting DCRs. Four key themes were identified:
1. DCRs and decision making in a complex political system
The interviewees talked of tensions between devolved powers and national legislation. Because the decision making venue was unclear, people could support the adoption of DCRs whilst claiming the responsibility for deciding to implement them lay elsewhere. It was suggested that political indecisiveness was preventing evidence-based action. Inaction was also assigned to legislative uncertainties. Overall, interviewees suggested that no single stakeholder had the power to break this political deadlock.
2. The role and positions of DCRs in the wider treatment system
Interviewees viewed DCRs as part of a wider system of public health provisions, acknowledging their impacts should complement existing interventions. Therefore, there was opposition to the UK Government’s claim that DCR supporters saw them as an independent solution. The discussion remained more on where the DCR provision could fit into the existing system, rather than whether it should be introduced. Points were also raised about the limitations of fixed DCRs being geographically limiting because some users could not travel to them. Most interviewees also felt the scope of DCRs reached further than reducing viral transmission, indicating that service users deserve respect and dignity, rather than reducing drug harm to purely a public health concern.
3. Approaches to evidence
Interviewees suggested that strong evidence was required to convince the political entities with the power to make a change. Decision makers adopted an ‘improvement science’ approach, saying that evidence gathering needs to be local and co-produced, whilst also accepting that international evidence sufficiently justified implementing a DCR pilot.
4. The role of language in framing DCRs
It was identified that harm reduction principles needed to be understood and adopted before DCRs were to be viewed in a positive light. For example, the phrase ‘drug consumption rooms’ might be interpreted differently from ‘overdose prevention centre’, so the importance of language and framing was acknowledged. Perceptions of the outcomes were also vital. Language mattered in regards to establishing wider community support, as communities affected by drug problems have shown some opposition.
Overall, the data show that political considerations often overshadowed change. Levels of support for DCRs were also determined by personal values and existing data on DCR effectiveness. There was an awareness that DCRs would need to form part of a wider treatment structure and uncertainty about how they could fit into this.
