Six reasons why drug consumption rooms work

A booth in a drug consumption room © Frontline AIDS
A booth at Insite, a drug consumption room in Vancouver, Canada.

With zero deaths from overdose since 2003, the Insite drug consumption site in Vancouver, Canada, has been on the frontline of reducing the harm caused by injecting drugs for 16 years.

Open from 9am until 3am the following day, Insite is nestled in the heart of Downtown Eastside. Behind Insite’s green front door, a group of friendly faces greets people at reception before showing them to the consumption room and, eventually, the chill out room.

It’s a place of safety and sterility for the 10,000 people in the neighbourhood who use drugs. The site sees up to 800 visits a day, with some people coming six times. In total, 8,000 visitors enter its doors a year.

Men aged between 25 and 49 are disproportionately affected by the opioid crisis in Vancouver, but 30% of Insite’s visitors are female. This is considerably higher than the percentage of clients who are female using drug consumption sites in India and Portugal. In addition, Sister Space – a women-only drug consumption room – opened nearby in Vancouver in 2018.

Insite operates alongside eight other drug consumption sites in Vancouver, plus a number of pop-us; the need is colossal. It’s funded by Vancouver Coastal Health, and is operated by them in partnership with the Portland Hotel Society, a local housing non-profit.

Since the contamination of the local drug supply with fentanyl, the number of deaths from overdose in Vancouver have shot up. Fentanyl’s synthetic make up is 100 times stronger than heroin and is a major factor in the 1,400 overdose deaths a year in the area. Over 60% of those who die due to an overdose are not regular opioid users, hence the critical need for harm reduction services like drug consumption rooms, needle and syringe programmes and opioid substitution therapy.

So, what makes these sites successful in providing the harm reduction services needed by people who use drugs?

1. Public health over abstinence

Insite’s goal is not drug abstinence. Drug consumption sites exist to reduce the harm caused when injecting drugs, not to encourage people to stop taking drugs. Sites operate on the grounds that a public health approach to drug use is a lot more successful than a punitive approach requiring abstinence.

However, the journey to recovery is available via referral. On the 2nd floor at Insite clients can stay for anywhere from seven days to two weeks in withdrawal management. In addition, 90 day transition accommodation is available. Considering the homelessness of many of Insite’s clients, this goes some way towards meeting an additional need of the local community.

2. Anonymity

Insite runs its services anonymously. Clients need only provide a first name and date of birth; they can even choose their own name handle or nickname.

This promise of anonymity creates a more welcoming and non-judgemental environment than a traditional healthcare facility. The service is set up to support, not punish its users. The aim is to encourage people in, not dissuade them with the threat of repercussions.

Rather than complete anonymity, the use of a handle allows the facility to monitor when and how often clients access the site, as well as recording other health needs. It enables the medical staff to provide a person-centred service.

3. Drug checking

Clients can take in drugs they have bought on the street and check what’s really in them. By providing access to the equipment needed to check the substances in any drug packet, the likelihood of overdose or harm is reduced. This service is not limited to clients of the facility; by opening it up to those who supply the drugs, the goal is a cleaner local drug supply.

The demand for drug checking has increased since fentanyl polluted the local drug supply. Alongside fentanyl and all sorts of common household substances, they also commonly find benzodiazepine. When taken with heroin, this sedative substance increases the likelihood of overdose due to the way it restricts breathing.

4. Safe injecting support

Medical staff can support in all aspects of the injection process bar plunging the syringe. When a person enters the consumption room, staff are on hand to provide clean needles and syringes, antibacterial swabs, and other equipment. They’ll then show you to your booth, assist with dose measurements and drawing up the syringe, and help you safely find a vein.

The open plan consumption room and presence of mirrors at first feels like a hair salon. However, this gives staff visibility of all clients at all times. When they are not assisting with injecting preparation, they are keeping an eye on those who remain in their booth after injecting. Those who appear asleep will have their breathing monitored in order to see if they are overdosing before it’s too late.

5. Overdose prevention

Insite prevents 30 deaths from drug overdose a day. This statistic alone demonstrates the acute need for the service.

In a suspected overdose, the medical staff have two options: oxygen or naloxone. Naloxone counters the effects of an overdose from opioids and brings a client round within a couple of minutes. However, after about 40 minutes, people experience deep withdrawal symptoms and may want to use heroin again, which puts them at risk of another overdose.

As a result, the preferred anti-overdose treatment is administering pure oxygen. Although more gradual, its effects are more sustaining.

6. Wound treatment and HIV testing

A treatment room is available for urgent wound care, and testing for HIV and sexually transmitted infections (STIs).

Medical staff are on hand to deal with any injuries caused by the injection process, and clear up any infections. With regular injecting, wounds frequently develop.

Onsite HIV testing and other blood work for STIs and Hepatitis C are also available at Insite. The sharing of used needles drives HIV transmission in the area, so access to clean needles allows this service to play a role in curbing the local epidemic.

Canada is one of just 11 countries worldwide that operates drug consumption rooms. Totalling 117 sites, they vary from static locations such as Insite, to pop-up sites in alleys and mobile vans. There is no doubt that Insite has been built with the needs of its 10,000 strong community in mind. But there are many more communities about the world where the foundations of a similar service have not yet even been laid.


Harm reductionPeople who use drugs