OpenLB
Open Library of Bioscience
Advanced Search
Harm reduction journal
Jan 13, 2025;22 (1): 6.

The implementation of safer drug consumption facilities in Scotland: a mixed methods needs assessment and feasibility study for the city of Edinburgh.

James Nicholls, Wendy Masterton, Danilo Falzon, Andrew McAuley, Hannah Carver, Kathryn Skivington, Josh Dumbrell, Andy Perkins, Samantha Steele, Kirsten Trayner, Tessa Parkes
Author Information
  1. James Nicholls: Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland. j.c.nicholls@stir.ac.uk.
  2. Wendy Masterton: Salvation Army Centre for Addiction Services and Research, University of Stirling, Stirling, Scotland.
  3. Danilo Falzon: Salvation Army Centre for Addiction Services and Research, University of Stirling, Stirling, Scotland.
  4. Andrew McAuley: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland.
  5. Hannah Carver: Salvation Army Centre for Addiction Services and Research, University of Stirling, Stirling, Scotland.
  6. Kathryn Skivington: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland.
  7. Josh Dumbrell: Figure 8 Consultancy, Dundee, Scotland.
  8. Andy Perkins: Figure 8 Consultancy, Dundee, Scotland.
  9. Samantha Steele: Figure 8 Consultancy, Dundee, Scotland.
  10. Kirsten Trayner: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland.
  11. Tessa Parkes: Salvation Army Centre for Addiction Services and Research, University of Stirling, Stirling, Scotland.
PMID: 39806415 DOI: 10.1186/s12954-024-01144-1

Abstract

BACKGROUND: Scotland currently has amongst the highest rates of drug-related deaths in Europe, leading to increased advocacy for safer drug consumption facilities (SDCFs) to be piloted in the country. In response to concerns about drug-related harms in Edinburgh, elected officials have considered introducing SDCFs in the city. This paper presents key findings from a feasibility study commissioned by City of Edinburgh Council to support these deliberations.
METHODS: Using a multi-method needs assessment approach, we carried out a spatial and temporal analysis of drug-related data in Edinburgh including health, mortality, consumption, crime and service provision indicators; and 48 interviews including 22 people with lived/living experience (PWLE) of drug use in the city, five family members affected by drug-related harms, and 21 professional stakeholders likely to be involved in commissioning or delivering SDCFs. Data were collected using a convergent parallel design. We carried out a descriptive analysis of quantitative date and a thematic analysis of qualitative data. Quantitative data provides an overview of the local context in terms of recorded harms, service provision and consumption patterns as reported in prior surveys. Qualitative PWLE and families data captures the lived experiences of people who use drugs, and affected loved ones, within that local context, including perceived consumption trends, views on the practicality of SDCF provision, and hopes and anxieties regarding potential service provision. Professional stakeholders data provides insights into how people responsible for strategic planning and service delivery view the potential role of SDCF provision within the context described in the quantitative data.
RESULTS: In Edinburgh, drug-related harms and consumption patterns are dispersed across multiple locations, with some areas of higher concentration. Reported levels of opioid use, illicit benzodiazepine use and cocaine injecting are high. Qualitative interviews revealed strong support for the provision of SDCFs, and a preference for services that include peer delivery. However, PWLE also expressed concerns regarding safety and security, and professional stakeholders remained uncertain as to the prioritisation of facilities and possible opportunity costs in the face of restricted budgets.
CONCLUSION: There is a strong case for the provision of SDCFs in Edinburgh. However, service design needs to reflect spatial distributions of consumption and harm, patterns of consumption by drug type, and expressed preferences for both informality and security among potential service users. Models of SDCF provision used elsewhere in Scotland would therefore need to be adapted to reflect such considerations. These findings may apply more broadly to potential SDCF provision in the UK and internationally, given changing patterns of use and harm.

Keywords

Drug consumption Drug consumption rooms Drug policy Harm reduction Needs assessment Scotland

References

  1. National Records of Scotland. Drug Related Deaths in Scotland in 2023. 2024.
  2. European Monitoring Centre for Drugs and Drug Addiction. Drug-induced deaths���the current situation in Europe. 2023.
  3. Public Health Scotland. Estimated prevalence of opioid dependence in Scotland. 2024.
  4. Markoulidakis A, Hickman M, McAuley A, Barnsdale LR, Welton NJ, Glancy M, Shivaji T, Collins C, Lang J, de Wit F, Hunt G, Wilkinson L, Fraser R, Yeung A, Horsburgh K, Priyadarshi S, Hutchinson SJ, Jones HE. Prevalence of opioid dependence in Scotland 2015���2020: a multi���parameter estimation of prevalence (MPEP) study. Addiction. 2024;119(8):1410���20. https://doi.org/10.1111/add.16500 . [DOI: 10.1111/add.16500]
  5. Scottish Government. Evidence review: current trends in benzodiazepine use in Scotland. Scottish Government. 2022.
  6. Michael Krausz R, Westenberg JN, Meyer M, Choi F. The upcoming synthetic ultrapotent opioid wave as a foreseeable disaster. Lancet Psychiatry. 2022;9(9):699���700. https://doi.org/10.1016/S2215-0366(22)00241-3 . [DOI: 10.1016/S2215-0366(22)00241-3]
  7. Holland A, Copeland CS, Shorter GW, Connolly DJ, Wiseman A, Mooney J, Fenton K, Harris M. Nitazenes���heralding a second wave for the UK drug-related death crisis? Lancet Pub Health. 2024;9(2):e71���2. https://doi.org/10.1016/S2468-2667(24)00001-X . [DOI: 10.1016/S2468-2667(24)00001-X]
  8. Scottish Government. Rights, respect and recovery: Scotland���s strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths. Scottish Government. 2018.
  9. Scottish Drug Deaths Task Force. Changing lives: our final report. 2022.
  10. Scottish Government. National Mission on Drug Deaths: plan 2022���2026 Scottish Government. 2022.
  11. Scottish Government. A caring, compassionate and human rights informed drug policy for Scotland. Scottish Government. 2023.
  12. House of Commons Home Affairs Committee. Drugs: Third report of the session 2022���3. 2023.
  13. Advisory Council on the Misuse of Drugs. Reducing opioid-related deaths in the UK. 2016.
  14. Faculty of Public Health. A call to pilot overdose prevention centres in the UK. 2021.
  15. Health and Social Care Committee. Drugs Policy: First report of session 2019. 2019.
  16. Scottish Affairs Committee. Problem drug use in Scotland inquiry. 2019.
  17. Ivsins A, Warnock A, Small W, Strike C, Kerr T, Bardwell G. A scoping review of qualitative research on barriers and facilitators to the use of supervised consumption services. Int J Drug Policy. 2023;111:103910. https://doi.org/10.1016/j.drugpo.2022.103910 . [DOI: 10.1016/j.drugpo.2022.103910]
  18. European Monitoring Centre for Drugs and Drug Addiction. Perspectives on drugs���Drug consumption rooms: An overview of provision and evidence. 2015.
  19. Scottish Government. Safer drug consumption facilities: evidence paper. Scottish Government. 2021.
  20. Yoon GH, Levengood TW, Davoust MJ, Ogden SN, Kral AH, Cahill SR, Bazzi AR. Implementation and sustainability of safe consumption sites: a qualitative systematic review and thematic synthesis. Harm Reduct J. 2022. https://doi.org/10.1186/s12954-022-00655-z . [DOI: 10.1186/s12954-022-00655-z]
  21. Shorter G, McKenna-Plumley P, Campbell K, Keemink J, Scher B, Cutter S, Khadjesari Z, Stevens A, Artenie A, Vickerman P, Boland P, Miller N, Campbell A. Overdose prevention centres, safe consumption sites, and drug consumption rooms: a rapid evidence review. 2022.
  22. Gledhill R. Public Health England Knowledge and Library Services (KLS) Evidence Briefing: what is the current evidence for the efficacy of drug consumption rooms?. 2019.
  23. Pardo B, Caulkins J, Kilmer B. Assessing the evidence on supervised drug consumption sites. RAND Corporation; 2018. [DOI: 10.7249/WR1261]
  24. Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005;366(9482):316���8. https://doi.org/10.1016/S0140-6736(05)66475-6 . [DOI: 10.1016/S0140-6736(05)66475-6]
  25. Andresen MA, Boyd N. A cost-benefit and cost-effectiveness analysis of Vancouver���s supervised injection facility. Int J Drug Policy. 2010;21(1):70���6. https://doi.org/10.1016/j.drugpo.2009.03.004 . [DOI: 10.1016/j.drugpo.2009.03.004]
  26. Belackova V, Salmon AM, Schatz E, Jauncey M. Drug consumption rooms (DCRs) as a setting to address hepatitis C���findings from an international online survey. Hepatol Med Policy. 2018. https://doi.org/10.1186/s41124-018-0035-6 . [DOI: 10.1186/s41124-018-0035-6]
  27. Schatz EaN M. International Drug Policy Consortium briefing: drug consumption rooms. 2021.
  28. DeBeck K, Kerr T, Bird L, Zhang R, Marsh D, Tyndall M, Montaner J, Wood E. Injection drug use cessation and use of North America���s first medically supervised safer injecting facility. Drug Alcohol Depend. 2011;113(2���3):172���6. https://doi.org/10.1016/j.drugalcdep.2010.07.023 . [DOI: 10.1016/j.drugalcdep.2010.07.023]
  29. Parkes T, Price T, Foster R, Trayner KMA, Sumnall HR, Livingston W, Perkins A, Cairns B, Dumbrell J, Nicholls J. ���Why would we not want to keep everybody safe?��� The views of family members of people who use drugs on the implementation of drug consumption rooms in Scotland. Harm Reduct J. 2022. https://doi.org/10.1186/s12954-022-00679-5 . [DOI: 10.1186/s12954-022-00679-5]
  30. Nicholls J, Livingston W, Perkins A, Cairns B, Foster R, Trayner KMA, Sumnall HR, Price T, Cairney P, Dumbrell J, Parkes T. Drug consumption rooms and public health policy: perspectives of Scottish strategic decision-makers. Int J Environ Res Public Health. 2022;19(11):6575. https://doi.org/10.3390/ijerph19116575 . [DOI: 10.3390/ijerph19116575]
  31. Carmen V, Joan V, Anna G, Albert E, Montserrat B, Yolanda C, Teresa BM. Safe injection rooms and police crackdowns in areas with heavy drug dealing. Evaluation by counting discarded syringes collected from the public space. Adicciones; 25(4). 2013.
  32. Wood E. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Can Med Assoc J. 2004;171(7):731���4. https://doi.org/10.1503/cmaj.1040774 . [DOI: 10.1503/cmaj.1040774]
  33. Salmon AM, Thein H-H, Kimber Jo, Kaldor JM, Maher L. Five years on: what are the community perceptions of drug-related public amenity following the establishment of the Sydney medically supervised injecting centre? Int J Drug Policy. 2007;18(1):46���53. https://doi.org/10.1016/j.drugpo.2006.11.010 . [DOI: 10.1016/j.drugpo.2006.11.010]
  34. Crown Office and Procurator Fiscal Service. Statement on pilot safer drug consumption facility. Crown Office and Procurator Fiscal Service. 2023.
  35. Stevens A, Southwell M, Scher B, Shorter G, Kenth S, Coact, Sandwell. Community Outreach Resource Education and Drugscience Enhanced Harm Reduction Working Group. Reducing drug-related harms in Sandwell: the need and feasibility of an overdose prevention service. 2022.
  36. HSCP GC. Safer Drug Consumption Facility 2024 [Available from: https://glasgowcity.hscp.scot/sdcf .
  37. NHS Lothian. NHS Lothian Director of Public Health annual report. 2022.
  38. Nicholls J, Falzon D, Masterton W, McAuley A, Dumbrell J, Steele S, Perkins A, Carver H, Trayner K, Skivington K, Duan Y, Parkes T. Needs assessment and feasibility study for a safer drug consumption facility in Edinburgh. 2023.
  39. CoECPaS. Minutes of meeting Tuesday 12th March 2024 - Item 13: Responding to the Edinburgh Drug Consumption Room and Edinburgh Drug Checking Service Feasibility Studies. 2024.
  40. Gale NK, Health G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;117:1���8.
  41. Stirling Uo. Ambulance Call-Outs to Drug Overdoses in Scotland: Patterns and Practice (ACODOS). 2020���2023.
  42. McAuley A, Palmateer N, Biggam C, Knox T, Shepherd S, Gunson R, Hutchinson S. Needle Exchange Surveillance Initiative (NESI): Prevalence of blood-borne viruses and injecting risk behaviours among people who inject drugs attending injecting equipment provision services in Scotland, 2008���2020. 2022.
  43. Trayner KMA, Palmateer NE, Hutchinson SJ, Goldberg DJ, Shepherd SJ, Gunson RN, Tweed EJ, Priyadarshi S, Sumnall H, Atkinson A, McAuley A. High willingness to use drug consumption rooms among people who inject drugs in Scotland: findings from a national bio-behavioural survey among people who inject drugs. Int J Drug Policy. 2021;90:102731. https://doi.org/10.1016/j.drugpo.2020.102731 . [DOI: 10.1016/j.drugpo.2020.102731]
  44. Olding M, Boyd J, Kerr T, Fowler Al, McNeil R. (Re)situating expertise in community-based overdose response: Insights from an ethnographic study of overdose prevention sites (OPS) in Vancouver, Canada. Int J Drug Policy. 2023;111:103929. https://doi.org/10.1016/j.drugpo.2022.103929 . [DOI: 10.1016/j.drugpo.2022.103929]
  45. Pauly B, Wallace B, Pagan F, Phillips J, Wilson M, Hobbs H, Connolly J. Impact of overdose prevention sites during a public health emergency in Victoria, Canada. PLoS ONE. 2020;15(5):e0229208. https://doi.org/10.1371/journal.pone.0229208 . [DOI: 10.1371/journal.pone.0229208]
  46. McNeil R, Small W, Lampkin H, Shannon K, Kerr T. ���People knew they could come here to get help���: an ethnographic study of assisted injection practices at a peer-run ���unsanctioned��� supervised drug consumption room in a Canadian setting. AIDS Behav. 2014;18(3):473���85. https://doi.org/10.1007/s10461-013-0540-y . [DOI: 10.1007/s10461-013-0540-y]
  47. European Harm Reduction Network. Drug consumption rooms in Europe: models, best practice and challenges. 2014.
  48. Woods S. Drug consumption Rooms in Europe: Organisational overview. 2014.
  49. Government of Victoria. Review of the Medically Supervised Drug Consumption Room final report: Key findings and recommendations Government of Victoria. 2023.
  50. Mercer F, Miler JA, Pauly B, Carver H, Hn��zdilov�� K, Foster R, Parkes T. Peer support and overdose prevention responses: a systematic ���state-of-the-art��� review. Int J Environ Res Public Health. 2021;18(22):12073. https://doi.org/10.3390/ijerph182212073 . [DOI: 10.3390/ijerph182212073]
  51. Middlesex-London Health Unit. Saving Lives. Changing Lives. Findings from an Evaluation of London���s Temporary Overdose Prevention Site (TOPS). 2019.
  52. Kennedy MC, Kanna Hayashi M-J, Milloy EW, Kerr T. Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: a cohort study. PLoS Med. 2019;16(11):e1002964. https://doi.org/10.1371/journal.pmed.1002964 . [DOI: 10.1371/journal.pmed.1002964]
  53. Betsos A, Valleriani J, Boyd J, McNeil R. Beyond co-production: The construction of drug checking knowledge in a Canadian supervised injection facility. Soc Sci Med. 2022;314:115229. [DOI: 10.1016/j.socscimed.2022.115229]
  54. Tweed EJ, Rodgers M, Priyadarshi S, Crighton E. ���Taking away the chaos���: a health needs assessment for people who inject drugs in public places in Glasgow, Scotland. BMC Public Health. 2018. https://doi.org/10.1186/s12889-018-5718-9 . [DOI: 10.1186/s12889-018-5718-9]
  55. Shorter GW, Harris M, McAuley A, Trayner KMA, Stevens A. The United Kingdom���s first unsanctioned overdose prevention site; a proof-of-concept evaluation. Int J Drug Policy. 2022;104:103670. https://doi.org/10.1016/j.drugpo.2022.103670 . [DOI: 10.1016/j.drugpo.2022.103670]
  56. Transform Drug Policy Foundation. Transform Drug Policy Foundation. 2023. [3rd Feb 2024]. Available from: https://transformdrugs.org/blog/taliban-opium-ban.
  57. Clarke J, Torrance J. Drug consumption room: Could the provision of a drug consumption room bring significant benefit in reducing drug related deaths and other community harms in Bristol. 2018.
  58. Enns EA, Zaric GS, Strike CJ, Jairam JA, Kolla G, Bayoumi AM. Potential cost���effectiveness of supervised injection facilities in Toronto and Ottawa, Canada. Addiction. 2016;111(3):475���89. https://doi.org/10.1111/add.13195 . [DOI: 10.1111/add.13195]
  59. Jozaghi E. A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada. Harm Reduct J. 2014;11(1):30. https://doi.org/10.1186/1477-7517-11-30 . [DOI: 10.1186/1477-7517-11-30]
  60. Jozaghi E. Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection. Health Justice. 2015. https://doi.org/10.1186/s40352-015-0028-0 . [DOI: 10.1186/s40352-015-0028-0]
  61. Jozaghi E, Reid AA, Andresen MA. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Montreal, Canada. Subst Abus Treat Prevent Policy. 2013. https://doi.org/10.1186/1747-597X-8-25 . [DOI: 10.1186/1747-597X-8-25]
  62. Jozaghi E, Reid AA. The potential role for supervised injection facilities in Canada���s largest city, Toronto. Int Crim Justice Rev. 2015;25(3):233���46. https://doi.org/10.1177/1057567715583516 . [DOI: 10.1177/1057567715583516]
  63. Andresen MA, Jozaghi E. The point of diminishing returns: an examination of expanding Vancouver���s insite. Urb Stud. 2012;49(16):3531���44. https://doi.org/10.1177/0042098012443865 . [DOI: 10.1177/0042098012443865]
  64. Collins A, Marshall B, Flam-Ross J, Casey S, Thompson T, Kelley S, Hurd C, Gaur D, Shihipar A. Somerville supervised consumption site: needs assessment and feasibility report. 2021.
  65. Dietze P, Winter R, Pedrana A, Leicht A, Brugal MT. Mobile safe injecting facilities in Barcelona and Berlin. Int J Drug Policy. 2012;23(4):257���60. [DOI: 10.1016/j.drugpo.2012.02.006]
  66. Holland A, Harris M, Hickman M, Lewer D, Shorter GW, Horsley J, Powell M, Rae M. Overdose prevention centres in the UK. Lancet Public Health. 2022;7(3):e196���7. https://doi.org/10.1016/S2468-2667(22)00038-X . [DOI: 10.1016/S2468-2667(22)00038-X]

Grants

  1. CT2922/City of Edinburgh Council

MeSH Term

Humans
Scotland
Feasibility Studies
Harm Reduction
Substance-Related Disorders
Needs Assessment
Female
Male
Adult
Journal Article
Article has an altmetric score of 20

Word Cloud

Created with Highcharts 10.0.0consumptionprovisionEdinburghdataservicedrug-relatedSDCFsusedrugharmspatternsSDCFpotentialScotlandfacilitiescityneedsassessmentanalysisincludingpeoplePWLEstakeholderscontextDrugsaferconcernsfindingsfeasibilitystudysupportcarriedspatialinterviewsaffectedprofessionaldesignquantitativeprovideslocalQualitativewithinregardingdeliverystrongHoweverexpressedsecurityreflectharmBACKGROUND:currentlyamongsthighestratesdeathsEuropeleadingincreasedadvocacypilotedcountryresponseelectedofficialsconsideredintroducingpaperpresentskeycommissionedCityCouncildeliberationsMETHODS:Usingmulti-methodapproachtemporalhealthmortalitycrimeindicators4822lived/livingexperiencefivefamilymembers21likelyinvolvedcommissioningdeliveringDatacollectedusingconvergentparalleldescriptivedatethematicqualitativeQuantitativeoverviewtermsrecordedreportedpriorsurveysfamiliescaptureslivedexperiencesdrugslovedonesperceivedtrendsviewspracticalityhopesanxietiesProfessionalinsightsresponsiblestrategicplanningviewroledescribedRESULTS:dispersedacrossmultiplelocationsareashigherconcentrationReportedlevelsopioidillicitbenzodiazepinecocaineinjectinghighrevealedpreferenceservicesincludepeeralsosafetyremaineduncertainprioritisationpossibleopportunitycostsfacerestrictedbudgetsCONCLUSION:casedistributionstypepreferencesinformalityamongusersModelsusedelsewherethereforeneedadaptedconsiderationsmayapplybroadlyUKinternationallygivenchangingimplementationScotland:mixedmethodsroomspolicyHarmreductionNeeds

Similar Articles

Cited By (1)