Safe Spaces for Users

(Photo by Aleksandra Baranova/iStock) 

Smoke clouded the tiny room where three heroin users were puffing on clear pipes, blowing fumes from the corners of their mouths. Smiles spread across their faces as they watched a nurse buzz two new users inside. More people with heroin addictions waited their turn to use brand-new syringes at the injection room inside of CAS Baluard, a drug-consumption facility in the heart of downtown Barcelona’s hip Raval neighborhood.

With about 700 visits daily, the center is the busiest of Barcelona’s nine drug consumption sites, which aim to bring drug users in off the streets, reduce crime, and prevent overdoses. Clients bring their own drugs and are given clean needles and a safe place to use and access services. Social service organizations run the sites with funding from Barcelona’s public health agency. Staff monitor medications for addicts, test their drugs for substances such as fentanyl, introduce them to alternative treatment plans such as methadone, or help them access social services.

“If I couldn’t come here, I would be dead on the street or robbed,” says Juan Carlos Gómez, 47, as he scratches his scarred arm. His social worker, Noelia Girona Marlos, says Gómez has not been arrested by the police, overdosed, or committed other crimes since coming to CAS Baluard.

In an effort to propagate the success of such centers, and forewarned by the American opioid epidemic, the European Forum for Urban Security (EFUS), a Paris-based NGO, started Project Solidify. Launched in January 2018, the two-year, $62.7 million (€55.1 million) effort aims to create a network among municipalities with existing drug-consumption rooms and others that are interested in opening them. Partners exchange information, research, and provide technical assistance to each other.

“Cities are looking for new ways of handling these drug epidemics,” says Solidify program manager Moritz Konradi. “They needed to find out what works in some places and what doesn’t in others.”

Ten cities—including Lisbon, Brussels, and Paris—and numerous organizations are participating.

While Barcelona’s first drug-consumption rooms opened in 2004, other cities across Europe have long faced resistance to bring the idea to neighborhoods dealing with addiction. Residents don’t want people facing drug addiction coming into their area, and police and politicians don’t want to legitimize illegal drug use.

There are currently about 90 drug-consumption rooms across Europe, according to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), an EU agency that monitors drug use in 30 member countries. Each city manages its own services. Some facilities also offer hot showers, housing, or psychiatric support. There has yet to be a fatal overdose in a European drug-consumption room, says researcher Dagmar Hedrich, EMCDDA’s lead harm-reduction scientist.

“Public health officials need to realize consumption is part of drug users’ lives,” Hedrich says. “Before the rooms we didn’t know about the injection mistakes addicts were making, nor were we able to warn them. Now we can save lives.”

Studies of safe injection sites in Australia and Canada found that they significantly reduced risky behaviors such as injecting with dirty syringes and that users who visited were more likely to accept addiction treatment. Additional data collected by consumption room staff is essential to understanding drug use trends, Hedrich says.

The United States has yet to open a drug room, due to federal law that prohibits maintaining a location for the purpose of facilitating illicit drug use, although cities including Denver and Philadelphia are in the planning stages regardless.

It took time for Barcelona’s sites to gain traction, says Oleguer Pares-Badell, a doctor with Barcelona’s Public Health Agency. After a major uptick in drug-related deaths, crime, and general nuisance in open-air drug markets, police, residents, and politicians finally had enough.

“There was enough political will to do something,” says Badell, who oversees the city’s drug-consumption rooms. Now he hopes to pass on their success to Solidify participants. “Now many cities in Europe are coming around to these types of interventions after watching the epidemic in the United States. Solidify helps us achieve what we already know: We need to be prepared.”

This article appeared in the Spring 2019 issue of the magazine with the headline: "Safe Spaces for Users."

Read more stories by Cara Tabachnick.