Drug consumption rooms - an important role in HIV prevention?

Definition

Drug consumption rooms (DCRs) have been defined as: ..."protected places for the hygienic consumption of preobtained drugs in a non-judgemental environment and under the supervision of trained staff". (Akzept , 2000)

HIV epidemic

In 2008 there were only three confirmed cases of HIV infection and in  2012 there are 237 cases of confirmed. (Source: Department for Monitoring and Evaluation HIV / AIDS in Romania - INBI "Prof.Dr.M.Bals")


In 2010, according to the behavioral surveillance study on the prevalence of infectious diseases among injecting drug users (IDUs), 15.7% IDUs said that at last injection the syringes were used previously by another person. The lack of hygienic spaces and sterile materials for each drug user increases the number of infections associated with injecting drug use. (Source: National Report on drugs in 2011, National Antidrug Agency)

In September 2012, the study was repeated by Romanian Angel Appeal, National Antidrug Agency and Carusel Association among IDUs in Bucharest and Ilfov, Romania. From the total of 417 respondents surveyed, the preliminary data shows that about 50% of IDUs are infected with HIV, about 80% with HVC and about 20% with hepatitis B.

Injecting drugs in public spaces

Due to unhealthy environments, drug users are exposed to infections such as abscesses, gangrene, due to injection of psychoactive substances.

I conducted a study among IDUs about their consumption in public spaces and I collected data about the manner in which people inject drugs in Bucharest (especially unhygienic conditions) and locations where this phenomenon occurs (apartment building hallways, next to garbage bins, parkings, streets and so on.) Almost all of respondents from this study don’t have hygienic spaces for injecting. They shoot often in public spaces. They don’t have sterile equipment for injecting as syringes, distilled water or alcohol wipes.

Drug user injecting in a building hallway Photo: Diana Markosian//Reuters

 Decriminalizing drug possession

From my point of view, decriminalizing drug possession would be the most effective policy for Romania. Many benefits, as helping more people get substitutive treatment, reduce HIV, HVC, and HVB epidemic, reduce overdoses, Informed youth, fewer people arrested, reduce the criminal justice costs are effective ways to reduce drug related harms in Romania.

Also, the abuses on injecting drug users from police officers would be stopped. From my experience,  a big part of them are scared or traumatized about their experiences with the police.

One article from the  romanian law  which says that “providing any local, house or other place where the public has access to illicit drugs consumption or illicit tolerance in such places is punished with imprisonment from 3 to 10 years and interdiction of certain rights” should be modified. If Romania’s law would decriminalize drug possession and modify the article mentioned above, then would be easier to develop DCRs.

Effectiveness of drug consumption rooms

DCRs already exist in countries like Canada, Holland, Switzerland, Germany, Spain, Norway, Spain, France, Australia, unfortunately in Romania we do not have such places, but in exchange we have drug  users that are injecting in the streets and unsanitary places. In Romania are only some illegal spaces for shooting but without hygienic conditions (ex: with no water or electricity).

The effectiveness of DCRs is priceless among drug users. They provide a safe environment that reduces risks related to drug use, a hygienic area, reduce mortality, facilitate drug access to other services, reduce public drug use associated with inappropriate behavior, reduce infections and so on.

Who should support the costs?

Below are opinions of three specialists on this question. They are part of a series of interviews with experts  that I’ve done it  in March.

 “DCRs are in my view an essential health service and healthcare should be free at the point of delivery. I believe DCRs should be funded as part of national health systems, and would be happy to see my own taxes helping to achieve this. “ (Damon Barrett, Harm Reduction International)

“The local government should invest in DCRs as well as drug treatment programs and medical centre’s.  All are important parts of a comprehensive network for providing services for drug users.  The DCR is an entry point connecting drug users to such services. “ (Jason Farrell, International Consultant)

DCRs are proposed in the draft on National Antidrug Agency’s strategy for 2015 – 2020. This service should be funded by local public authorities, but managed by NGOs.” (Ionut Alexandrescu, Drop-in Center Coordinator)

 Conclusion/Personal experience
The most important benefits of DCRs are to reduce the risks of infections  among drug users, access to sterile injection equipment, first aid in case of overdose, drug removal from public spaces, attract consumers to a specialized treatment and social reintegration.
Working at the Drop-in center, Caracuda Ferentari,  developed by Carusel Association, and interacting with IDUs, I have seen places in the neighborhood where they use drugs. These spaces do not have a minimum of hygiene, they often are injecting near the garbage bins or on the street, so the risk for transmission of infections and overdose is very high. Injecting in public spaces represents a big public health issue and DCRs would be the only viable option.

Ferentari neighborhood – Bucharest; Photo: www.a1.ro