Module 2

After studying this module you will:

• Comprehend the practical aspects of delivering care within DCRs, including site selection, facility layout, and service provision.
• Understand the legal and policy frameworks that govern the establishment and operation of DCRs in different countries.
• Appreciate the importance of partnerships and collaboration with various stakeholders, including municipal authorities, health services, law enforcement, and local communities.

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Location and venue
Facilities for supervised drug consumption tend to be located in areas that are experiencing problems in terms of public use, including communities with open drug scenes, and are targeted at people who use drugs with limited opportunities for hygienic injection. Ideally, the location should be easy to access by public transport or walking distance from the areas with drug use. The venue should be also barrier-free. Experience from some drug consumption rooms has shown that it makes sense to choose a location where there is a lot of activity so that individual people visiting the facility are not noticed in the overall picture.

Typically the DCR venue consists of the following elements:

• Waiting room (as the points for injection or smoking drugs might be busy)
• Toilets, showers
• Injection and smoking room
• Rooms for consulting

Drug Consumption Room in Muhlenstube

Number of points to inject and smoke drugs
Most DCRs offer places for intravenous drug use as well as for smoking/inhaling substances. The number of seats differs - for example, the drug consumption room Skyen on Istedgade in the Copenhagen district Vesterbro has 20 spaces for smoking and eight spaces for injecting drugs. On average, DCRs offer between 7 and 8 (7.41) intravenous drug-use places and between 6 and 7 (6.73) drug-smoking places (Woods, 2014, p. 17). This very much depends on the prevalence of used drugs - for example, compared to other European countries, the prevalence of injecting drug use in the Netherlands is among the lowest in Europe. Some individuals need help because they lack experience injecting or have physical or psychological limitations. However, staff is usually not allowed to assist clients in administering their drugs.

Consumed drugs

Injecting drugs

Equipment

Inhaling drugs
Some DCRs allow one to inhale drugs as for some people this is the main route of drug consumption. The review by Speed et al. identified 48 sites worldwide that permitted non-injection routes of consumption, with the majority located in Europe (18).

The proportion of smokers has risen significantly in recent years. The risk of an unintentional overdose is significantly reduced when smoking heroin - in contrast to injecting. In addition, the risk of becoming infected with HIV, hepatitis B or C through blood contact is considerably lower with foil smoking than with intravenous consumption.

Safer Crack Kits

The number of users
The number of users also varies, depending on the number of places to use drugs. In her report (2014) Woods indicated that the number of visitors per day ranges from a minimum of 20 to a maximum of 400, with great differences within and between countries.

Opening time
There is also no one model in here. Some of the facilities are opened 7 days a week, some are closed on weekends, or operating on a shorter time. Also the opening time varies - with some facilities being open only for 3 hours per day, with some open 15 hours a day.

Using time
This also depends on the facility but on average it’s around 30 minutes (for both smoking or injecting). Usually, there are queues or people so the time limit has to be set.

People who use services
The primary target group for DCR services is people who engage in risky drug use. The dominating group is men. The demographics of people who use Drug Consumption Rooms (DCRs) in Europe reflect a diverse and often marginalized population. With growing migratory patterns, many migrants who use drugs are increasingly accessing these facilities. Additionally, individuals experiencing or at risk of homelessness and living in poverty are disproportionately represented among DCR users. These groups often face concurrent substance use issues, highlighting the critical need for DCRs to provide tailored support and services to address their complex needs.

Admission criteria
The admission criteria also vary between the places, however, one of the most common is age-related with a minimum age of 18 years (if underaged you need to have permission from legal guardians), not being in substitution treatment or a first-time user, ‘being in possession of drugs before entering (as you can’t buy drugs or share them in the facility) and ‘signing a contract (Woods, 2014).

House rules and contract
People are asked to sign a contract before using the DCR, this is required by the law, but also help to collect some information for monitoring. The basic contract consists of information about gender, age, consumed drug, insurance status, and agreement to follow the rules of the place.

For example Skyen on Istedgade in the Copenhagen district Vesterbro (https://maendeneshjem.dk/en/hvad-er-maendenes-hjem/stofindtagelsesrum/)

DCRs have a few and simple rules:

• You must be over 18 years of age.
• Violence and threats are not permitted.
• Drug trafficking is not permitted.
• You must follow the staff's instructions.
• You must adhere to the time that is made available to you for your drug intake.

House rules

Contract

Staff
Across DCRs in Europe, there are no standard minimal levels or set skills, competencies or training requirements for the professionals working there (Fuertes & Perez Gayo, 2022, p.24).

Depending on the DCR, there are different people working there - nurses, social workers, medical doctors, health educators (often peers), and guards, there is a trend to provide a multidisciplinary team.

Typically, nurses and other staff are not permitted to administer injections but provide education on safer injecting that includes in situ demonstrations of safer injecting techniques.

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

Naloxone, overdose and emergencies

Key issues