Safe space for injecting drugs is approved in Scotland
BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p2238 (Published 27 September 2023) Cite this as: BMJ 2023;382:p2238
After a five year political fight, approval has been given for the first drug consumption facility in Scotland that allows users to inject illegal drugs under supervision.
The breakthrough came earlier this month when Scotland’s chief law officer, Dorothy Bain, decided that it would not be in the public interest to prosecute anyone using such a facility. This removed a legal obstacle to the proposal and was soon followed by a statement from the UK government, which has control over drug policy, that it would not block the plan. This is despite its continued opposition based on the argument that there is no safe way to inject drugs.
The Scottish government has been trying since 2018 to pilot safe injecting spaces as part of its response to the country having the worst drug overdose death rate in Europe: 1051 such deaths were recorded in 2022. Although this was down on previous years and the first reduction since 2017, it still left Scotland with a death rate of 24.8 per 100 000 population, which compared with a rate of 8.8 in Great Britain as a whole and 1.8 in the EU.1
A Scottish government report in 2021 provided evidence for the effectiveness of drug consumption rooms and found that more than 100 such facilities existed around the world in Australia, Canada, and several countries in Europe.2
The new facility will be based in Glasgow. A report to the city’s Integration Joint Board, which approved the proposal, said, “There is overwhelming international evidence which demonstrates that safer drug consumption facilities can improve the health, wellbeing, and recovery of people who use the facility and reduce the negative impact that public injecting has on local communities and businesses.” It said that currently around 400 to 500 people were regularly injecting drugs in public places in Glasgow. The Scottish government is funding the pilot scheme, which runs until 2027.
The first supervised drug consumption room opened in Bern, Switzerland, in 1986, and a review by the European Monitoring Centre for Drugs and Drug Addiction in 2018 found evidence of its effectiveness. The report said that the benefits can include “improvements in safe, hygienic drug use, especially among regular clients, increased access to health and social services, and reduced public drug use and associated nuisance.” It added, “There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry and do not result in higher rates of local drug related crime.”3
Decriminalisation
Meanwhile, a study in the United States has found no evidence that legal changes to decriminalise possession of drugs have had any effect in reducing drug overdose deaths.4 Early in 2021 the states of Oregon and Washington removed or substantially reduced criminal penalties for possession of drugs and increased their spending on support services in an attempt to treat the problem as a public health issue rather than a criminal one.
The study in JAMA Psychiatry analysed data on drug overdose deaths before and in the year after the change and found no improvement. However, the researchers said that one year could be too short a period and that it was important to evaluate the medium and long term consequences of the new laws when more data became available.