Module 2

Upon completion of this module you will be able to:

• Understand the practical aspects of delivering care within DCRs, including site selection, facility design, and service provision.
• Understand the legal and policy frameworks governing the establishment and operation of DCRs across various countries.
• Recognise the significance of partnerships and collaboration with various stakeholders, including municipal authorities, health services, law enforcement agencies, and local communities.

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Location and venue

Facilities for supervised drug consumption are typically located in areas experiencing challenges related to public drug use, such as communities with open drug scenes. These facilities primarily serve people who use drugs and lack access for hygienic injection practices. Ideally, the location should be easily accessible by public transportation or within walking distance of areas where drug use occurs. The venue should be also barrier-free. Experience from some drug consumption rooms has shown that it is reasonable to choose a location withhigh activity levels, ensuring that individual visitors blend into the environment.

Typical elements of a DCR venue comprise:

• Waiting room (to accommodate potential wait times for injection or smoking).
• Toilets and showers.
• Injection and smoking rooms.
• Consultation rooms.

Drug Consumption Room in Muhlenstube

Number of points to inject and smoke drugs

Most DCRs provide designated areas for both intravenous drug use and smoking/inhalation. The number of spaces varies; for example, the Skyen drug consumption room on Istedgade in Copenhagen district of Vesterbro offers 20 smoking spaces and eight injection spaces. On average, DCRs offer between seven and eight (7.41) spaces for intravenous drug-use and between six and seven (6.73) spaces for smoking drugs (Woods, 2014, p. 17). This is highly dependent on local drug use patterns - for instance, compared to other European countries, the Netherlands has a lower prevalence of injecting drug use. While some individuals may require assistance due to inexperience or physical or psychological limitations, staff are generally prohibited from directly administering drugs to clients.

Consumed drugs

Injecting drugs

Equipment

Inhaling drugs

Some DCRs accommodate inhalation drug use as it represents a primary method of drug consumption for certain individuals. A review by Speed et al. identified 48 global sites that permit non-injection method of drugconsumption, with the majority located in Europe (18).

The proportion of individuals using smoking methods has increased considerably in recent years. Smoking heroin presents a significantly reduced risk of unintentional overdose compared to injection. Moreover,, the risk of contractingHIV, hepatitis B or C through blood contact is substantially lower with foil smoking than with intravenous drug consumption.

Safer Crack Kits

The number of users

The number of visitors also varies, depending on the number of spaces offered for drug consumption. Woods (2014) reported daily visitor numbers ranging from a minimum of 20 to a maximum of 400, with significant differences observed within and between countries.

Opening time

There is no unified model applied for all DCRs.. Some facilities are open seven days a week, while others close on weekends, or operate with reduced hours. Also, opening times vary, with some facilities being open only for three hours per day, and others for 15 hours.

Using time

Usage time averages approximately 30 minutes (for both smoking or injecting). Time limits are often imposed due to queues or high user volume.

People who use services

DCRs primarily serve individuals engaged in risky drug use. The majority of DCR users are men. Europe’s DCR demographics reflect a diverse and often marginalised population. With growing migratory patterns, an increasing number of migrants who use drugs are accessing these facilities. Furthermore, individuals experiencing or at risk of homelessness and poverty are disproportionately represented among DCR users. These groups frequently face concurrent substance use issues, underscoring the critical need for DCRs to provide tailored support and services addressing their complex needs.

Admission criteria

Admission criteria also vary between facilities; however, one of the most common requirements is a minimum age of 18 years (parental consent is required for individuals under 18)). Other criteria often includenot being in substitution treatment or a first-time user, being in possession of drugs prior to entering (as purchasing or sharing drugswithin the facility is prohibited) and signing a contract (Woods, 2014).

House rules and contract

Prior to using the DCR, individuals are required to sign a contract mandatedby law. The basic contract helps to collect some information for monitoring purposes. The basic contract includes information such as gender, age, consumed drug, insurance status, and agreement to abide by the rules of the facility.

For example, DCRs, such as Skyen on Istedgade in Copenhagen’s Vesterbro district

(https://maendeneshjem.dk/en/hvad-er-maendenes-hjem/stofindtagelsesrum/)

operate under a few simple rules:

• Users must be 18 years of age or older.
• Violence and threats are strictly prohibited.
• Drug trafficking is not permitted on the premises.
• Visitors are expected to follow staff instructions.
• Time limits for drug consumption must be adhered to.

House rules

Contract

Staff

European DCRs lack standardised staffing requirements, with no minimum levels or set skills, competencies, or training mandated for professionals working in the facility [^1].

Staffing varies across DCR facilities, often comprising nurses, social workers, medical doctors, health educators (frequently peers), and security personnel. There is a growing trend towards multidisciplinary teams.

While nurses and other staff typically refrain from administering injections, they provide education on safer injecting practices, including in situ demonstrations of these techniques.

Staff are trained to administer naloxone (in response to an opioid overdose) and are directed to contact emergency services if a service user experiences an overdose.

Naloxone, overdose and emergencies

Key issues