MELBOURNE, April 25 – A study shows that drug consumption rooms (DCR) in France – where people inject drugs under medical supervision in a safe space – improved health and public order.
The research by Marie Jauffret-Roustide, a sociologist and research fellow at the National Institute of Health and Medical Research (Inserm) in Paris, France, was a 12-month longitudinal cohort study enrolling 664 people who inject drugs (PWIDs) in four cities in France: two with a DCR (Paris and Strasbourg) and two without (Bordeaux and Marseille).
It was the first study in Europe and worldwide to evaluate the effectiveness of DCRs using a control group.
According to Jauffret-Roustide’s presentation at the Harm Reduction International Conference (HR23) in Melbourne, Australia, last April 18, the impact of DCRs was among the highest on emergency room (ER) visits, criminal activity, and injection practices in public spaces.
Compared to the control group in the two cities without DCRs, participants in the two cities with DCRs were 24 points lower in the frequency of ER visits in the last six months, 20 points lower in engaging in criminal activity in the last month, and 15 points lower in injection practices in public spaces.
Fewer abscesses in the last six months were also reported among participants living in cities with DCRs (11 points lower), fewer HIV/ Hepatitis C at-risk practices in the last month (10 points lower), and slightly fewer non-fatal overdoses in the last six months (2 points lower).
Jauffret-Roustide told the official scientific press conference at HR23 last April 18 that the number of discarded syringes in public areas surrounding the Parisian DCR was three times fewer than before the DCR came into place.
“We also analysed policing and administrative data, combined with semi-structured interviews with police officers, and data highlighted that the Parisian area where the DCR was implemented was not any more considered as a problematic place with regards to public order, criminality, and safety issues since the drug consumption room has been implemented,” said Jauffret-Roustide.
“We also conducted semi-structured interviews with people who inject drugs who attend drug consumption rooms – they reported that they consider drug consumption rooms as a protective refuge and also as a place where they feel respected as citizens.
“Drug consumption rooms’ implementation is still controversial in France. And since 2016, we have had no new drug consumption rooms that have been able to be implemented, despite the willingness of local actors.”
Surprisingly, the French study showed that the biggest impact of DCRs was on curbing access to a general practitioner (GP), where people who attend DCRs had less access to a GP in the last six months than the control group (38 points lower).
“This can be explained by structural factors: the difficulties of recruiting medical doctors as well as nurses in DCRs in France, but also by the stigma associated to active injecting drug use that makes more difficult for PWIDs to access to care outside harm reduction services and drug treatment centres,” said Jauffret-Roustide’s presentation.
The Cosinus cohort survey showed no significant difference between the two groups in terms of access to opioid agonist therapy (OAT) and Hepatitis C virus testing in the last six months.
“This can be explained by the high coverage of harm reduction facilities, including access to HCV testing and OAT in France beyond DCRs,” said Jauffret-Roustide’s presentation, highlighting 85 per cent OAT coverage of people who attend harm reduction facilities.
“Harm reduction is public funded in France that allows sustainable access for PWIDs, beyond DCRs.”
Jauffret-Roustide suggested that for the future implementation of DCRs in France and abroad, drug policy models must change, besides integrating DCRs with access to stable housing for people who inject drugs, social inclusion, mental and trauma treatment, and empowerment.
“We also need to stop the demonisation of people who inject drugs in prohibitionist regimes, and we need to listen to their voices and experience of drug consumption rooms.”
In the overall study population, 67 per cent injected substances for more than 10 years, among which nearly a quarter (24 per cent) used unprescribed morphine sulfates every day and 22 per cent used cocaine crack daily, followed by cocaine (11 per cent), unprescribed buprenorphine (8 per cent), and heroin (3 per cent).
About 38 per cent of total participants visited the emergency department, 21 per cent had abscesses, and 18 per cent shared syringes and drug paraphernalia. Only 6 per cent suffered from non-fatal drug overdoses.
About 27 per cent of participants were positive for Hepatitis C, while 5 per cent tested positive for HIV.
A whopping 95 per cent of participants were satisfied with DCRs, while 60 per cent were willing to use one.
The majority of participants in the overall study population was male at 80 per cent, with the median age 38 years old.
