If you have a family member who suffers with addiction, how would you choose to help them?
There’s been a great deal of talk around what the press sometimes calls ‘shooting galleries’, but the preferred term is Safe Injection Facilities (SIF), or even Drug Consumption Room (DCR). In practice, these emplacements are life-saving sites, which are doing more than just helping those who may suffer from dependency to opioids such as heroin.
The UK has never been in a worse place when it comes to drugs. This year it was reported that there’s an all-time high with drug related deaths, beating road deaths for the first time ever. There’s also an ever-increasing and record level of hospital admissions for drugs, and according to the government’s own experts, the Advisory Council on the Misuse of Drugs (ACMD), we have never seen such levels of opioid-related deaths with 2,677 registered in 2015.
It’s no wonder that many parts of the UK are looking for pragmatic alternatives to our current drug policy. Under the leadership of Police and Crime Commissioner (PCC) Ron Hogg and Chief Constable Mike Barton, police forces are taking steps to save lives as well as have a positive impact on their communities. North Wales is also looking for progress in the way they handle drugs; PCC Arfon Jones has made a public assessment of how UK drug laws compare to other countries such as Portugal who decriminalised all drugs in 2001.
Initially, it may seem counterintuitive – should we allow those with drug dependency to have safe rooms where they can inject and potentially receive pharmaceutical-grade heroin?
In Durham alone there’s an estimated 43 organised crime groups. These coordinated factions are the apex of criminality with much of their funding streams coming from the illicit drugs trade. They rely on the culture of fear; drugs and existing policies inherently place the most vulnerable in society in the clutches of organised crime. Those who are dependent on drugs tend to be owing to deep levels of trauma, often childhood sexual and physical abuse. Drugs can become a raft of emotional survival. Safe Injection Sites are more than just a place to consume drugs safely; they are a place of amnesty, enabling those who suffer with dependency to escape the often calamitous realms in which they can find themselves in. We can ask a simple question at this point: is it better for healthcare professionals to work with those who suffer with addiction, or should we allow organised crime groups take charge?
Taking a look at existing sites, SIFs have been operating since Switzerland took the initiative in 1986, this proved so successful that they now have over a dozen operating in the country with Heroin Assisted Treatment (HAT) also used in collaboration. Over 70 per cent of Switzerland voted to keep HAT permanently in 2008, proving that it is indeed a popular public health model.
There are now SIFs in a number of countries across the globe, around 90 in total including facilities in Canada, Germany, Luxembourg, Denmark, France, Norway, and Australia. Some of these facilities also have a mobile van service ensuring that outreach efforts can get to the most embedded members of our society who are homeless. Not only are these services benefiting the consumers of drugs, but they lessen of the prevalence of discarded needles on the streets and in public toilets; this is a big driving forces in enabling the public to understand how public health solutions benefit the wider community where crime and punishment fatally fail. Dublin, Glasgow and Brighton are all looking to follow with plans to use the SIF model to make necessary changes to their streets. It’s testament to the success of these reforms in noticing that once SIF and Heroin Assisted Treatment come into effect, they are developed further and are requested in more and more regions. Collective public health also benefits as rates of HIV and hepatitis are reduced dramatically.
Contrary to what we may think, drug use figures can actually decline under these reforms. The UK Home Office acknowledges that the harshness of drug laws does not impact on drug use, but the risk of criminal charges can act as a barrier to seeking help. Those with dependency are granted care, understanding and help, empowering them to take charge of their own life and circumstances. The criminal justice system has been used as a very blunt and uncaring tool in trying to police culture, but the allowance of autonomy in the sufferer’s life will often see the patient choose to direct themselves in dovetailing programmes which have more effective recovery rates.
The cost benefit analysis for society speaks for itself, but what about the actual fiscal costs? Heroin Assisted Treatment is estimated to cost around £15,000 per patient; this is typically about a third of what it costs to keep someone in prison for a year, and treating someone with HIV typically costs around £38,000 a year. The saving to the public purse is self-evident. England and Wales now houses over 85,000 prisoners and the service is at crisis point; drug offences account for the second highest rate of imprisonment, but it doesn’t start or stop there. Drug abuse and prison life of course go hand in hand with many people exiting prison with a drug habit that they didn’t have before they went in. This is why so many are choosing to relocate drug services over towards health and evidence-based alternatives to the criminal justice system.
There remains one last fact that makes all others redundant. The cost effectiveness of HAT and SIF is more than apparent – it works and saves money. We do, however, need to place human life above all other costs. Despite the unconscionable fact that we’re facing a global rise drug related deaths - and this is especially true in the UK – no one has ever died in a Safe Injection Facility. Not a single person.
So if it’s your loved one who needed help… how would you prefer they received it?
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