Inside the UK’s first drug consumption room

The doctor in charge of the Glasgow facility writes about its first two weeks of operation

Inside the UK’s first drug consumption room

The doctor in charge of the Glasgow facility writes about its first two weeks of operation
By Dr Saket Priyadarshi

It has been almost a decade in the making, but the UK’s first Safer Drug Consumption Facility finally opened its doors to service users in January.

The centre in Glasgow’s east end was delayed several times and had a number of hurdles to overcome.

Seeing the service become operational has been a huge relief and source of pride for me and my colleagues, who’ve all worked tirelessly to make it a reality.

As someone with a keen interest in approaching the country’s drug harms crisis at a societal level, it has felt like a hugely significant moment.

Scotland’s place as the European capital of drug-related deaths is no secret, and we believe the Safer Drug Consumption Facility (SDCF) – known as The Thistle – is an important step in tackling the harms associated with injecting drugs.

It is no silver bullet, but could help support the hundreds of people who we know regularly inject drugs in public places around Glasgow city centre and the east end.

I have been working with people who inject drugs for over 20 years and have seen the problem worsen and the need for services like this get more urgent.

“Most injecting is now of cocaine rather than heroin, which is very different from when the service was first proposed.”

However, this service is only one in a system of care that includes residential rehabilitation, medication assisted treatment, and other essential services.

With national funding, there has been no diversion from these other services. In fact, we have been working to simultaneously improve and increase access to these and as such, users of The Thistle will have access to a diverse range of support.

Our early experience in The Thistle, which at the time of writing has been open for little more than three weeks, has been very promising.

We were delighted to welcome our first service users into the facility on the morning of January 13.

Since then, we have had hundreds of visits and have been increasing registration numbers on a daily basis. In its first fortnight, the centre welcomed 60 individuals who accessed it 239 times.

Feedback from the service users has been very positive, particularly around the look and feel of the building, and on the welcoming and positive attitudes of staff.

When they arrive, service users are greeted by our reception staff and taken to one of our ‘chat rooms’ to discuss what drugs they plan to take, and any support they may require.

They’re then taken through to the ‘using room’ and given clean equipment and safer injection techniques.

Close by, we have two rooms where people can receive care for injection wounds, and more extensive treatment should they fall ill suddenly or overdose.

Service users are already utilising a range of support services on the site in our lounge area – from the shower and clothes room to referrals for housing and treatment.

The staff have managed well with the core business of onsite injecting, harm reduction advice and wound management.

What has become apparent from these very early days is the rapidly shifting pattern of drug use in the population the service is reaching.

Most injecting is now of cocaine rather than heroin, which is very different from when the service was first proposed.

Currently there is a smoking area outside for tobacco only, but we know that many people would use an inhalation space for other types of drugs if we had one. This is something we would like to progress in due course.

Our experience confirms that the people we are seeing are some of the most marginalised in our society, and feel extremely stigmatised.

They live socially precarious lives, and other than their drug-using peers, they often have little in the way of meaningful positive relationships, including with health and care services.

It will take time to build relationships, trust and confidence, and it is therefore crucial for them to feel ‘safe’ in The Thistle.

Professor David Wilson with Bob Alexander

A robust and fully independent evaluation of the SDCF is in place, and formal reports will be submitted to the Glasgow City Integrated Joint Board in the months to come.

This will allow us to understand the impact the service is having on those who use it, and on the local community. It will look at various aspects including litter levels, discarded needles, anti-social behaviour, and crime.

The unique legal framework for the service has meant that we have been in close contact with our colleagues in Police Scotland in the build up to the service opening and since then.

Glasgow has a public health-based policing strategy for problem drug use and we welcome this approach.

When people arrive for their first registration, we explain the rules of the service, which includes not dealing or sharing drugs on the site.

It is explained to them that there is no ‘exclusion zone’ around the facility where the police won’t be able to go about their normal duties if they need to.

But we let them know that if they don’t give the police cause to intervene then they should be able to attend the service without problems.

We have a number of services available on this site and entering the gates does not identify anyone as a user of The Thistle. All of this is reinforced during any subsequent visits.

We have strong evidence from other cities with similar problems that shows the SCDF in Glasgow could help prevent drug deaths, help stem the spread of HIV infection, reduce drug-related litter, and significantly reduce costs in other health and social care services.

It also provides a severely marginalised group access to the treatment and support they have been lacking for years.

It is very early days, but we will learn a lot in the first three to six months, and plan to keep developing our services in response to the needs of individuals.

 

Dr Saket Priyadarshi is an associate medical director for alcohol and drug services at NHS Greater Glasgow and Clyde

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