Europe: Drug consumption rooms

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.