A safe fix for Bristol’s drug users and the city

Saving lives and clearing needles off the streets: Bristol has the power to become the first UK city to set up a safe consumption room.

Addicted Bristol: Life and Death 25th January, 2019

Matty Edwards

Saving lives and clearing needles off the streets: Bristol has the power to become the first UK city to set up a safe consumption room.

Illustration: Rosie Carmichael

Tegan Smith stops off at Greggs on her way to work in the city centre. Inside, she notices a middle-aged woman with her belongings at her feet. After fiddling with something for a few minutes, she puts a needle in the bin, pats her arm and paces around, eyes rolled back.

Tegan assumes she has just injected herself with drugs. Her reaction is shock, but also sadness for the woman, who needs support for her habit. She is just one of the many people who inject in public places because they have an addiction and nowhere safe to go, and Tegan is just one of a number of Bristolians I’ve spoken to who regularly witness the effects.

Unlike in Bristol, in 66 cities around the world, drug users don’t have to take their drugs in public or down an alleyway. Instead they do it in a clean, safe environment. Safe consumption rooms (SCRs) are legal medical facilities where drug users safely take their illegal substances – particularly heroin and crack – with staff on hand if they overdose. They have been found to reduce deaths, make drug use safer, and clean up the streets of public injecting and used needles.

When I tell Tegan, 24, about the idea, she replies: “I completely agree with that. I think it’s a really positive solution.” She sometimes sees people sat on benches by the Harbourside injecting during her lunch break. “It’s really eye-opening. Half the reason people are homeless is they have this addiction and have nowhere else to go, so I think there needs to be a legal safe place.”

There aren’t any SCRs in the UK, but support for them is growing, including from police and crime commissioners in North Wales, Durham and the West Midlands and MPs who have written to the home secretary, as well as the government’s official advisors, the Advisory Council on the Misuse of Drugs (ACMD), and Glasgow council, which has been pushing for one since 2016.

The government now accepts the public health arguments but remains opposed, saying the Misuse of Drugs Act needs to be changed. However, Cable research has found it would be legal to set up a SCR in Bristol if there was agreement between local stakeholders, including the council and police – in a similar way that allowed Bristol to become the first city to pilot drug safety testing outside a music festival.

The council has done a feasibility study into whether Bristol could also become the first UK city to set up a SCR, but has delayed its review. The city’s main treatment provider, Bristol Drugs Project (BDP), has indicated to me that a SCR would reduce harm and they would support a pilot if it were funded by the city’s different stakeholders, instead of drug treatment budgets.

Making drugs safer

Martin Powell is head of campaigns at Transform, the Bristol-based drug policy think tank. “Across the UK there are thousands of people injecting in the street – hundreds of them in Bristol,” he tells me. “Most are homeless or live alone, lead chaotic lives, and we have not been able to get them into treatment because they are too hard to reach. They are at great risk of dying from overdoses or catching infections like HIV and hepatitis C, or getting wounds from rushed injections in dirty environments.

“Street injecting also creates problems for local communities – it is unpleasant to see, bad for businesses, can be off-putting to tourists, and leaves discarded needles with the risk of injuries for children,” he adds. “Safe consumption rooms are proven to help with all these issues.”

A central aim of SCRs is to prevent drug-related deaths, which have been at worryingly high levels in the UK for the last five years. In Bristol, there were 113 between 2015 and 2017.

One of many cities to have a SCR is Copenhagen, which opened a facility called Skyen in 2012. It has almost 6,000 registered users and offers eight seats for injecting drug users and six seats for smokers of hard drugs such as crack cocaine. 400 users come every day and are allowed 30-45 minutes.

At Skyen, there have been 800 overdoses but not a single death. In fact, despite millions of injections taking place in SCRs around the world, no-one has died from a heroin overdose. In Denmark, where there are five facilities in total, drug deaths fell by a third between 2011 and 2015.

Apart from overdose, another major health risk of injecting drugs is sharing needles and getting blood-borne viruses such as hepatitis C and HIV. There are an estimated 2,650 injecting drug users in Bristol, Gloucestershire and Somerset with hep C.

BDP already offers various harm reduction initiatives, including a needle exchange, which handed out 635,000 clean syringes in 2018, so users can inject safely and not have to share. The main treatment for heroin users is opiate substitution therapy (OST), where users are prescribed medical heroin alternatives instead of facing the dangers of injecting. This option reaches around 2,000 people a year, but BDP estimates up to 4,000 injecting drug users need their services, meaning there are lots of vulnerable people not getting help.

SCRs can tackle this by improving access to treatment, particularly for homeless people, who are less likely to be registered with a GP. SCRs are widely accessible so that people who aren’t able to engage with the current system can be connected with treatment.

After years of cuts to drug budgets, extra money is scarce. A SCR requires set up and running costs but research shows they save money in the long run by easing the burden on the criminal justice system and health services who have to treat overdoses, blood-borne viruses, and injection-related harms.

For example, Skyen in Copenhagen costs about £1 million a year to run, but this is roughly how much it cost to treat drug users at the Bristol Royal Infirmary (BRI) in 2015, according to council estimates.

Glasgow’s business case for a SCR found that a small group of 350 injecting drug users cost local hospitals and emergency services £1.7 million pounds over a two-year period. This is before you consider costs for the criminal justice system, other health services and social care.

Powell thinks the feasibility study done by Bristol council would show similar cost effectiveness, which is why any pilot should not be funded from existing drug treatment budgets, but by the different services set to save money from the SCR.

Maggie Telfer, BDP’s chief executive, tells me: “A safe consumption room would provide an alternative which would undoubtedly reduce harm to individuals and communities.”

“With 25% funding reductions for drug and alcohol treatment services in the last three years, funding would need to come from a wide range of sources – health, police, business, all affected by people injecting in public settings – and BDP would be keen to work with all others on a business case for a pilot project,” she says.

Another concern is that a SCR would bring drug use and dealing to the area. Powell says: “To be effective, SCRs have to be located where there’s an existing street injecting problem, and the street dealing that goes with it – so they do not create a problem, they reduce an existing one.”

In Bristol, this could be in Stokes Croft or St Pauls, where drug treatment services are already located and hard drug use is common. But it’s sometimes not easy to get everyone on-side. In the Republic of Ireland, SCRs were legalised in 2017 and a location has been found in Dublin, but the pilot has been delayed due to concerns from local businesses about anti-social behaviour and policing.

However, Powell says that SCRs are supported by the communities they are in once people see the benefits. This means it is crucial to consult with the public – especially the Bristolians, like Tegan, who see the effects of drug use on a regular basis. Even those who might not have a liberal view towards drugs may prefer it didn’t happen near where they live or work.

Cleaning up our streets

In December, a sign appeared outside a block of flats on Dove Street near Stokes Croft, where needles are sometimes found. It read: “Don’t do drugs, it’s disgusting. By a child who lives here.”

A resident of one of these blocks is Mike Stuart, 53, who has lived on the estate for 10 years. Last winter, he stumbled upon a man lying on the floor at the top entrance to the estate. “This guy was not moving, and mumbling. I tried talking to him,” he tells me.

“It was bitterly cold and it wasn’t good to see someone lying on the floor. He wasn’t properly dressed. I tried to hold his hand, but it was like a block of ice. The ambulance people said it was happening all the time and it was taking up their time.”

In the past, Mike has heard of people shooting up in the stairs of another block, Armada House, and selling crack out of flats. Now things are a bit quieter but people still congregate down by the garages. “You get people drinking and taking stuff. There’s a lot of homeless hostels around here, so people try and find a quiet spot.”

He supports current harm reduction initiatives, such as giving out clean needles, and thinks a SCR would be a helpful solution. “That’s a good idea, rather than treating people like they’re less than human and trying to make their life bearable. The argument against is that you’re facilitating drug use, but it doesn’t go away, just like with criminalising it.

The day before meeting Mike, I had been walking through Montpellier when I stumbled across a used needle in an alleyway. Reports of discarded needles are common in Bristol, and have been found in McDonalds toilets, children’s playgrounds and by Bristol Bridge.

Local poet Lawrence Hoo made national news in 2017 after taking it upon himself to pick up needles in St Agnes Park. In the same year, four-year-old Tamara Lee-Smith pricked herself with a discarded needle on the Bristol to Bath cycle path and her mum Caroline had to wait for months checking for symptoms of HIV or hepatitis C. Last summer, volunteers had to sweep away needles from St Pauls Adventure Playground.

A few months ago, meanwhile, the People’s Republic of Stokes Croft installed a sharps bin for needles outside its building on Jamaica Street – also home to the Cable – because they were so often finding discarded needles.

According to data acquired through a Freedom of Information request by the Cable, there were 4,200 reports of sex and drugs litter – which includes needles, other drug refuse such as nitrous oxide canisters and condoms – reported to Bristol Waste between April 2015 and 2018. That’s an average of four every day.

SCRs have proven to tackle this problem. For example, in Barcelona, a fourfold reduction was reported in the number of disposed syringes being collected from a monthly average of over 13,000 in 2004 to around 3,000 in 2012.

The power to save lives

Bristol council has produced a feasibility study into whether a SCR would benefit Bristol, but the study is yet to be reviewed, even though Marvin Rees said this would happen in September 2018.

I’ve been trying to find out for months about when the study will be published, but have got no concrete answers. A council spokesperson said: “Further investigation is taking place into the use of safe consumption rooms, to see if they could support the partnership’s wider substance misuse strategy.”

Bristol West MP Thangam Debbonaire has long been a supporter of SCRs, which she says would reduce the harm of injecting drugs and save money for the council, police and local NHS.

“Bristol’s drug treatment room already exists – it is currently people’s stairwells, doorways and parks. Constituents often complain to me about this situation, especially when people leave needles and other litter where people may be harmed. A drug treatment room would change this.”

“A SCR will have to have support from the council and police. I know there are people in both who see the flaws in the current legal system. They have been willing to go out on a limb when it comes to drug safety testing at music festivals, which may well have saved lives in Bristol.”

Niamh Eastwood, from drug information charity Release, tells me a SCR could operate following an agreement between local police and other stakeholders expressed by a ‘comfort letter’ – assurance that service users and staff will not be arrested or prosecuted.

However, Sue Mountstevens, Avon and Somerset police and crime commissioner told me: “I believe that the use of safe consumption rooms is part of a wider national debate on the legalisation of drugs and I have always been clear it is up to the government to change the law regarding drugs and drugs policy.”

Powell says: “Some of the most marginalised, and voiceless people in Bristol are desperately in need of local political leadership on this issue.” He urged Marvin Rees and deputy mayor Asher Craig to join others in calling on the government to devolve powers to open a SCR to local areas, and to bring together all the stakeholders needed to deliver and fund a SCR pilot. This would ”save Bristol as a whole money, and people’s lives”.

With early signs of support in the city, it’s now up to the council to publish its feasibility study and take the lead.

Matty Edwards