Glasgow Alcohol & Drugs Partnership Looking at the health needs of people who inject in public places

Published: 30 June 2016

The Glasgow City Alcohol and Drug Partnership (ADP) is setting up a working group to research the potential of piloting a drug injecting facility and heroin-assisted treatment within the city centre.

Current estimates suggest there is a group of approximately 500 very vulnerable people who inject drugs in public places in Glasgow city centre. The majority are individuals experiencing homelessness, mental health issues, recent imprisonment and poverty.

These individuals are substantially responsible for the majority of discarded needles in public areas such as alleyways, car parks, parks, public toilets, and closes, putting the general public at risk and contributing to other related public order problems.

In 2015 Glasgow City Council, Police Scotland and Community Safety Glasgow dealt with hundreds of instances of discarded needles and drug misuse in the city centre.

Habitual public injectors' own health needs include the heightened risk of blood-borne viruses, overdose and drug-related death, and other injecting-related complications such as serious bacterial infections.

Last year saw an HIV outbreak in the city with 47 new infections compared to the previously consistent annual average of 10. There have also been several other outbreaks of serious infectious diseases such as botulism and anthrax.

To address this group's health needs and to minimise risk to the public, a business case will be compiled for consideration by the ADP in early autumn. If approved, the ADP will make recommendations to Glasgow City Integrated Joint Board (IJB) - the decision-making body of the Glasgow Health & Social Care Partnership. The business case will consider:

• The introduction of a pilot medically supervised injecting facility
• The extension of existing opioid substitution therapy services to include heroin-assisted treatment
• The development of a peer support network for harm reduction

The business case will need to set out the various negotiations that would need to take place to allow a pilot to be developed. The ability of Glasgow to pilot this approach will need to be founded on partnership working with a range of agencies. Engagement with the Scottish Government is also required to ensure the legal framework is in place to allow any facility to be developed.

None of these measures on their own will solve the problems associated with public injecting in the city centre. Instead, they will be part of a wider response to addressing the needs of vulnerable people and supporting their recovery.

This would involve working with those groups of people for whom our current services, including recovery based services, community addiction teams and homeslessness teams have not been successful to date.

Medically supervised drug injecting facilities have been running since the mid-1980s with 90 facilities across 61 cities currently running. The majority are in Europe, there is one in Vancouver, one in Sydney and approval has been granted for facilities in Dublin and across France.

The facilities seek to contribute to a reduction in drug use in public places and the presence of discarded needles and other related public order problems linked with public injecting.

They are clean, hygienic environments where people can inject drugs under clinical supervision. The facilities provide sterile needles to reduce the risk of infections like HIV, assistance in the event of an overdose and provide linked up health services.

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) research shows such facilities do not increase drug use, frequency of injecting or higher rates of local drug-related crime.                                                                                                                 

Heroin assisted treatment is the next progression for people for whom current treatments have been ineffective, and who continue to use street drugs, with all the risks that entails - injecting-related infections and overdose.

It uses pharmaceutical grade heroin administered under strict controls. This method of treatment is legal in the UK, having been trialled in London, Darlington and Brighton and is already widely used in Germany, Belgium and Switzerland.

Research trials have shown that it substantially reduces people's need for street drugs, reduces crime and leads to more engagement with healthcare and addictions services.

Susanne Millar, chief officer of Planning, Strategy and Commissioning for the Glasgow City HSCP, and chair of the ADP, said: "There are approximately 5,500 drug injectors in Glasgow with around 500 of these injecting in public in the city centre. While this is a tiny percentage of the city's population, it has a huge level of need and consists of a huge cost to the public purse.

"People injecting drugs in public spaces are experiencing high levels of harm and are impacting on the wider community. We need to make our communities safer for all people living in and visiting the city, including those who publicly inject.

"Last year, the Assertive Outreach Team dealing with homeless injectors distributed almost 13,000 sterile needles. Of that number, only 16 or 0.1% of the used needles were returned to an injecting equipment centre for safe disposal."

Dr Emilia Crighton, director of Public Health at NHSGGC, and vice chair of the ADP, said: "We are decades behind other countries in the way we tackle this problem. In line with our

current research, it's clear we need to move beyond the current model in order to meet the needs of our communities and this very vulnerable group.

"In recent years Glasgow has been at the centre of outbreaks of anthrax, botulism and most recently HIV infection in people who inject drugs.

"This public injecting group has high rates of hospital admissions, incarceration and homelessness. Conventional treatment and services have not been as effective as we would want in reducing health risks and the resulting costs.

"Our ultimate goal is for drug users to recover from their addiction and remain drug free.

"However, until someone is ready to seek and receive help to stop using drugs it is important to keep them as safe as possible while do they continue to use drugs."

The first supervised drug consumption room was opened in Berne, Switzerland in June 1986. Further facilities operate in Germany, the Netherlands, Spain, Norway, Luxembourg, Denmark, Canada and Australia.

Figures from the National Records of Scotland show that 114 people in Glasgow lost their lives to accidental and preventable overdoses in 2014.

Although there is no cure for HIV, there are now treatments which reduce the virus to undetectable levels. New guidelines highlight the importance of starting HIV treatment early. This is beneficial for the individual, but is also important in preventing the spread of HIV.

Glasgow City Alcohol and Drug Partnership (ADP) is a multi-agency group tasked by the Scottish Government with tackling alcohol and drug issues through partnership working.  Organisational membership includes Glasgow City Council, NHSGGC, Police Scotland, Scottish Fire & Rescue, Community Safety Glasgow, voluntary sector alcohol and drug agencies and others.

The ADP Strategic Group is chaired by the Chief Planning Officer of the Health and Social Care Partnership. Its membership includes three people with 'lived experience' and two family/carer representatives.