Public policy in the UK has struggled to consistently promote evidence based ‘harm reduction’ approaches to managing drug use and its effects. As a result, the criminalising drug users often results in users being imprisoned, rather than accessing the community based services which might be better placed to realise long term and sustainable benefits. The reason for this is a calculation by government ministers about what the public (electorate) will tolerate. This tension is currently being played out in Wales in the dialogue surrounding Medically Supervised Injecting Rooms (MSIR’s).
MSIR’s developed in the Netherlands, Switzerland, Germany, Spain, Canada and Australia over the past 30 years. They are officially provided premises, staffed by health and social welfare staff are in attendance and available to drug users using the premises for the injection of their drug of choice.
Whilst being controversial with the wider public, they are intended to reduce the harm to the individual drug user. They do this by providing access to clean needles, a safe surrounding in which to inject as well as available medical care in respect of common hazards relating to injecting including diagnosis and treatment of localised infections around injecting sites, testing for infection and other necessary interventions. MSIR’s in addition can provide a focus for health promotion and social work aimed at progressing the individual along a recovery pathway through counselling, benefits, rehab, and housing support.
In Wales, Swansea has the highest levels of injecting, accompanied by endemic levels of blood borne viruses especially Hepatitis C amongst injecting drug-users and problems with discarded needles in public spaces including areas used by families and children such as parks. However it is not a problem limited to Swansea. All of the major Welsh towns and cities have a problem and in parts of rural Wales there is also an established culture of injecting drug use.
At a recent conference in Swansea, Ifor Glynn the regional director of Drugaid Cymru called for MSIR facilities to be made available in Wales. He said that there was a growing body of evidence for the effectiveness of MSIR’s in reducing risk to drug users and that consideration should be given to introducing them in Wales.
Following a visit to an MSIR in Sydney, Caroline Phipps, Chief Executive of Drugaid Cymru said “there was an overwhelming feeling that having the consumption rooms in Sydney had helped on several levels, from offering medical support to those in need, as well as leading to improvements in the community with less discarded equipment and anti social behaviour.” In turn the South Wales Police Commissioner, Alun Michael, has given a commitment to be evidence-led in considering the proposal.
International evidence on MSIR’s shows that they are effective in reducing a number of the actual and potential harms associated with injecting drugs, such as;
- Numbers of overdoses (both fatal and non-fatal);
- Public littering of injecting equipment;
- Reaching problematic injecting drug users and providing pathways and opportunities for treatment and support;
- Infection rates of transmissible diseases such as Hepatitis C;
- Harm to people who inject drugs, such skin abscesses and damaged veins;
- Drug-related loitering, drug dealing or petty crime in areas in the area;
- Healthcare costs including ambulance call-outs and hospital admission.
Given the evidence, and the potential benefits to both users and the wider public, it might be time for Welsh policy to follow the evidence on MSIR’s.
