Drug consumption rooms (DCRs) are fixed or mobile spaces in which people who use drugs are provided with sterile drug use equipment and can use illicit drugs under the supervision of trained staff.

They exist in several European countries, Australia, Canada, Mexico and the USA, and are usually located in areas where there is an open drug scene and injecting in public places is common. Their primary goal is to reduce morbidity and mortality by providing a safer environment for drug use and training clients in safer forms of drug use. Other explicit objectives may be providing a conduit to other care services and reducing public nuisance.

A main aim of this report is to inform discussions on DCRs by examining the available evidence, as well as reviewing the various models being adopted and their characteristics.

Two operational models are typically used in Europe:

(1) integrated DCRs, operating within low-threshold facilities, where the supervision of drug use is just one of several services offered; and

(2) specialised DCRs, which provide a narrower range of services directly related to supervised consumption.

Services typically available within DCRs include: provision of a supervised environment for drug use; clean drug use equipment, including sterile syringes; and rapid interventions if overdose occurs. In addition, DCRs may offer counselling services; primary medical care; training for clients in safer forms of drug use, overdose awareness and the use of naloxone; and referral to social, healthcare and treatment services.

Access to consumption facilities may be restricted to registered service users, and often certain conditions have to be met, for example minimum age and local residency. Typically, drugs used in these facilities must be obtained prior to entry. Drug dealing and drug sharing are not allowed within the facilities (staff may be required to call in the police if necessary), and staff can advise but do not directly assist clients in administering their drugs.

As frontline, low-threshold services, drug consumption rooms are often among the first places where insights can be gained into new drug use patterns, and, thus, they also can have a role to play in the early identification of new and emerging trends among high-risk populations using their services. The operation and functioning of DCRs has adapted to changes in the profiles and needs of their target groups, and to new patterns of use, as well as to new types of drugs emerging on the market. DCRs may also therefore be well placed to identify and inform strategies to mitigate harms related to developments in the illicit drug market that present new health challenges.

In Europe as a whole, the injection of heroin has been on the decline for a number of years and in some countries has been superseded by the misuse of synthetic opioids and/or stimulants. Within this dynamic context, many drug services, including DCRs, have had to adapt their services to the needs of local populations and the marketplace, often this implies addressing a broad range of practices and harms. This has included, in some countries, providing spaces for non-injecting routes of administration, most commonly smoking, and allowing the consumption of a wider range of substances within the facility.

As services, DCRs are particularly challenging to evaluate due in part to the considerable differences in the operational models that exist. This is further exacerbated by the differences in definitions used in by reviews of the topic and the heterogeneity of outcomes measures adopted by different research studies. This means generalising from the research evidence that exist in this area is challenging.

Currently available evidence does suggest that DCRs may have a beneficial impact on the level of access to healthcare and harm reduction services among hard-to-reach target groups; do not increase crime in the surrounding area; and may contribute to decreasing drug use in public spaces as well as reducing overall public nuisance. There is also some evidence indicating that drug consumption rooms can reduce drug-related deaths (1). In addition, an expert panel concluded that DCRs may contribute to reducing injecting-related risk behaviour and therefore potentially contribute to efforts to reduce the transmission of viral infections among people who inject drugs (ECDC and EMCDDA, 2023).

Despite the difficulties of conducting research in this setting, more studies are needed to improve the evidence on the extent to which DCRs may contribute to reducing both individual and community harms, in terms of outcomes associated with both drug injecting and non-injecting routes of administration.

Europe: Drug consumption rooms

There is an increasing tendency to get service users, such as Drug Users (DU’s) involved in health services and health policies. Participation is seen as an indispensible ingredient for good and effective policymaking and there exist numerous best practice examples of peer involvement in the field of health promotion and prevention. Health policies and health interventions are considered to be more effective and supported, when all relevant parties and communities (including civil society and the final target group) are being involved equally. In addition, policy makers and professionals realise that it is no longer appropriate to talk about and not with the final target group. All kind of communities and also DU’s demand their rights: they want to be heard and they want to be taken serious.

There are numerous ways and forms of participation and also the purpose varies from case to case. One could think of information sharing and consultation or focus on empowerment and joint decision-making. Saying this, it can be assumed, that participation is not only a tool and a method, but also a process and a principle. Yet there are numerous drawbacks which jeopardize the process and make it difficult to respond appropriately. DU’s are often poorly represented in service provision and decision making, although there is evidence that their knowledge and expertise is important and most useful for the development of tailored responses and policies.

‘Nothing about us, without us’ - Participation and involvement of drug users in health services and policy making 

Harm Reduction in Europe is confronted with new developments and challenges. The provision of HR services is inadequate in many countries, especially in the eastern part and the situation is deteriorating in countries with traditionally good coverage. Combatting viral hepatitis remains to be one of the health priorities for PWIDs, requiring the involvement of HR services in the cascade of care. The number of overdose deaths continues to grow. Drug use and drug use patterns have changed: the use of cocaine, stimulants and synthetic drugs is increasing and HR services need to extend the focus on different groups: marginalised and recreational drug users, aging drug users, homeless people and adapt services accordingly.

This session will launch a thematic series in the Harm Reduction Journal , which seeks to examine where harm reduction is as philosophy, policy and practice in 2020 in the broader European regions. The collected articles cover a variety of topics, including the funding crisis for harm reduction in Central and Eastern Europe, the specific needs of women, Hepatitis C, prison-related needs and challenges, innovations in treatment, the role of civil society in policy development and monitoring, New Psychoactive Substance and the impact of Covid-19 on harm reduction services.


Katrin Schiffer, Correlation- European Harm Reduction Network
Eberhard Schatz, Correlation – European Harm Reduction Network
Ghanna Dovbakh, European Harm Reduction Association


Welcome and Introduction
Prof. Nick Crofts


Katrin Schiffer , C-EHRN
Ghanna Dovbakh, EHRA

Launch of the special edition of the Harm Reduction Journal

This paper, written in collaboration with the Correlation Network, briefly describes the history and the basic elements of the Dutch drug dependence treatment policy, including recent trends in drug use and the current drug treatment system implemented in the four largest cities in the Netherlands. Building on more than 30 years’ experience, the Dutch approach focuses on an integrated treatment system, which provides comprehensive support and services to the most vulnerable groups, including homeless people, problematic drug users and chronic psychiatric patients. At the same time, a strong emphasis is given to public order and crime reduction.

The paper describes the law enforcement and community involvement elements of the strategy, and provides available data on the results achieved so far. Although the current policy has shown positive results for individuals and society as a whole, the system is at risk of losing its balanced approach. The approach of public health-based regulation may have reached its limits and is lose focus in over-medicalization and over-regulation.

The policy may have been under pressure from surrounding countries in the 1980s and 1990s, but nowadays, the biggest threat for turning back the clock is coming from inside the country. There is a growing concern among service providers and drug using communities that the new government will be redrafting the policy agenda away from the primary interest of drug policy: increasing the quality of life of people who use drugs.

IDPC Briefing Paper - The Dutch treatment and social support system for drug users: Recent developments and the example of Amsterdam

This article describes approaches to improve the situation regarding particular target groups, such as drug users, sex workers, (undocumented) migrants and youth at risk. The experiences of the activities of Correlation - The European Network on Social Inclusion & Heath - illustrate concrete examples of interventions and skills building, taking into account elements as empowerment and the impact on policy debate.

Correlation Report - Marginalisation, Social Inclusion and Health

Katrin studied social work in Germany and moved to the Netherlands in 1994 . Since then, she has worked in several organisations and projects targeting drug users and sex workers. Since 1996, Katrin works for The Rainbow Group – a low-threshold organisation targeting drug users, homeless people and people with mental health problems. In the beginning, she worked as an outreach and social worker for male sex workers and drug users. From 1997 to 2003, Katrin coordinated a European Network focusing on male sex work, financed by the European Commission. Since 2005, Katrin is one of the coordinators of Correlation – European Harm Reduction Network, with more than 250 members in all European countries. The network organises different European projects, activities, seminars, conferences and training events in the area of harm reduction, social inclusion, peer involvement and Hepatitis C among drug users. In 2011, Katrin graduated graduated at the Netherlands School for Public and Occupational Health as a Master of Public Health (MPH).

Katrin estudió trabajo social en Alemania y se trasladó a los Países Bajos en 1994. Desde entonces, ha trabajado en varias organizaciones y proyectos dirigidos a consumidores de drogas y trabajadores del sexo. Desde 1996, Katrin trabaja para el Grupo Arco Iris, una organización de bajo umbral dirigida a personas usuarias de drogas, personas sin hogar y personas con problemas de salud mental. Al principio, trabajaba como trabajadora social y de proximidad para los trabajadores del sexo y personas usuarias de drogas. De 1997 a 2003, Katrin coordinó una red europea centrada en el trabajo sexual masculino, financiada por la Comisión Europea. Desde 2005, Katrin es una de las coordinadoras de Correlation - Red Europea de Reducción de Daños, con más de 250 miembros en todos los países europeos. La red organiza diferentes proyectos europeos, actividades, seminarios, conferencias y eventos de formación en el ámbito de la reducción de daños, la inclusión social, la participación de los pares y la hepatitis C entre los usuarios de drogas. En 2011, Katrin se graduó en la Escuela de Salud Pública y Ocupacional de los Países Bajos como Máster en Salud Pública (MPH).

Katrin a étudié le travail social en Allemagne et s'est installée aux Pays-Bas en 1994. Depuis lors, elle a travaillé dans plusieurs organisations et projets ciblant les toxicomanes et les travailleurs du sexe. Depuis 1996, Katrin travaille pour le Rainbow Group - une organisation à bas seuil qui s'adresse aux toxicomanes, aux sans-abri et aux personnes souffrant de problèmes de santé mentale. Au début, elle a travaillé en tant que travailleuse sociale et de proximité pour les travailleurs du sexe masculins et les personnes usagères des drogues. De 1997 à 2003, Katrin a coordonné un réseau européen axé sur le travail sexuel masculin, financé par la Commission européenne. Depuis 2005, Katrin est l'une des coordinatrices de Correlation - Réseau européen de réduction des risques, qui compte plus de 250 membres dans tous les pays européens. Le réseau organise différents projets européens, des activités, des séminaires, des conférences et des formations dans le domaine de la réduction des risques, de l'inclusion sociale, de la participation des pairs et de l'hépatite C chez les consommateurs de drogues. En 2011, Katrin a obtenu un Master en santé publique (MPH) à la Netherlands School for Public and Occupational Health.

Katrin Schiffer

Western & South East Europe (Correlation - European Harm Reduction Network)

Translations

Related Content

Europe: Drug consumption rooms

‘Nothing about us, without us’ - Participation and involvement of drug users in health services and policy making

Launch of the special edition of the Harm Reduction Journal

IDPC Briefing Paper - The Dutch treatment and social support system for drug users: Recent developments and the example of Amsterdam

Correlation Report - Marginalisation, Social Inclusion and Health