Drug consumption rooms: evidence-based but controversial

Drug consumption rooms are an evidence based intervention which can help people who use drugs do so in a safer environment. However, they remain controversial in many countries. In this blog, authors,Pierre SmithPablo Nicaisefrom theInstitute of Health and Society在UCLOUVAIN,强调比利时列格市的经历。

“Prove that they are cost-effective, and your policy makers will open them!”said the head of the Drug Consumption Room (DCR) we were visiting in Amsterdam during our feasibility study. However, not all politicians, at least in Belgium, are so pragmatic. DCRs are legally sanctioned public health facilities that offer a hygienic and supervised environment where people who use drugs (PWUD) can do so safely.

三十多年来,一百个DCR遍布西方国家,主要是在欧洲。在此期间,大量证据积累了其公共安全和公共卫生效力。但是,在许多国家,他们的实施仍然存在争议。在比利时,这种情况是这种情况,DCR可能与1921年的一项法律相抵触,该法律明确惩罚了供应房间以促进吸毒的供应。当时,立法者害怕鸦片巢穴,例如Tintin的蓝莲花. Despite the evidence, amending the law has never reached political consensus.

然而,尽管困难重重,DCR打开的Liège in 2018. We recently published a案例报告评估LiègeDCR的开放过程中如何克服政治和法律障碍。也许这将是其他地方不利环境的灵感来源?

More than three decades of scientific evidence…

A recentsystematic reviewshowed the effectiveness of DCRs on public health and safety outcomes. DCRs contribute to decreasing unsafe and unhygienic consumption behaviors (syringe sharing and reuse) and drug-related harm (overdose, HIV and hepatitis C virus contamination). They help reduce drug consumption in public spaces, the number of discarded syringes, and other public nuisances.

此外,DCR可有效地达到和维持与难以及的社会边缘化群体的接触。它们有助于获得健康和社会服务,包括成瘾治疗计划。担心DCR的负面后果并没有得到经验的影响:DCR并没有增加附近的药物使用,也没有鼓励吸毒开始。随着时间的流逝,DCR被认为是国际立法的有效公共卫生干预措施(例如欧盟毒品行动计划2017-2020,International Narcotics Control Board 2016 report).

…仍然意识形态争议

但是,由于道德和意识形态问题以及对公众反对,负面的媒体反应和相关政治后果的恐惧,DCR仍然引起极大争议。因此,有关实施DCR的辩论在包括英国和美国在内的许多国家 /地区的政治议程上仍然很高。

比利时的情况

International legislation mentioned previously recommend that DCRs be part of a national public health and harm-reduction strategy. Several countries adapted their legislation accordingly (i.e. Canada, France, and Luxembourg). In Belgium, the Federal authorities commissioned a feasibility study of DCR implementation in 2016 to address the debate. The publication of the study report coincided with local elections. This initiated an institutional debate about the political responsibility of DCRs as a public health intervention, with healthcare being mainly a matter of regional policy while the penal law was a federal responsibility.

联邦联合政府内部缺乏共识导致政治僵局的局势。这种情况为列格当局提供了重新启动有关DCR的当地辩论的机会。当地执法,护理专业人员,居民,用户和新闻界都参与了辩论。利用先前的实验,形成了局部共识。

Despite the absence of any legal change, the DCR opened one month before the local elections, and the mayor of Liège was re-elected. The DCR has been working without major medical or legal incident since then. Other Belgian cities are now considering their own DCR in the near future.

What can we learn from this experience?

The strategy employed in Liège proved to be successful in overcoming negative public opinion. In this case, the local political support for DCR implementation was a factor of popularity in the electoral context. The local stakeholders reached a consensus with the support of a significant increase in public safety issues related to drug use over the past decade in the city and experiences of harm-reduction interventions. In addition, the communication strategy lead to the involvement of all stakeholders throughout the implementation process.

可行性研究的出版物回顾了有关DCR的证据,以及当地的选举背景,有助于创造动力。国家一级缺乏政治共识为地方领导和倡议的自治提供了空间。有趣的是,重点是政策问题的公共烦恼,有助于接受当地利益相关者和居民的认可,而强调DCR作为公共卫生工具的政策制定是针对联邦当局引发的僵局。

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