Drug consumption rooms, a service to curb the HIV epidemic in Romania!

In this moment, Romania is facing a new epidemiological wave of HIV infections.   If in 2008 there were just three confirmed cases with HIV infection, in 2012 there were 237 new, confirmed cases (Ref:  National Institute of Infectious Diseases, “Prof.Dr.M.Bals”).

In September 2012, the Romanian Angel Appeal Foundation, in collaboration with the National Antidrug Agency and the Carusel Association performed a Behaviour Surveillance Study among injecting drug users in Bucharest and Ilfov, Romania. Out of 417 participants tested with rapid test in this study 52,5% were positive  to HIV, 85% with Hepatitis C virus, and 20 % with Hepatitis B virus  (National Anti-Drug Agency, Report for 2013).

Injecting drugs in public areas increases the risk of infections with different bacterias. Another major risk that drug users have when they are using drug in public places is the lack of sterile injecting equipment, therefore they have a big risk of getting infected with HIV, HVC and HVB. Drug consumption rooms could play an important role in preventing the risks associated with the use of drugs.

Definition of DCRs:

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”. (EMCDDA: Azkept, 2000, p.8).

In Romania there are „illegal drug consumption rooms” (such as an apartment) where drug users gather to inject themselves.  These „drug-user houses” are not sanitary enough for drug-using.  The walls are dirty, blackened with smoke, spray-painted, the floors filthy and bug-ridden. Some rooms don't have windows, and due to the common conflicts that arise in these places, a good part of the apartment, furniture and goods (such as electrical items and appliances and household furnishings) are damaged or destroyed.

In general, drug-users who inject themselves in public spaces don't have access to social services or medical treatment and are marginalized. Following an analysis of the daily files of Caracuda Ferentari center of the Carusel Association, a part of the drug users have double or triple risk exposure:

Ex 1:	IDU + H
Ex 2:	IDU + roma
Ex 3:	IDU +SW
Ex4:	IDU + roma + SW
Ex 5:	IDU + H +SW
Ex.6:	IDU + H + roma

 IDU – injecting drug user; H – homeless;  SW – sex worker

Drug users injecting in non-sanitary mediums are more exposed to risks such as blood clots, pulmonary embolism and bacterial endocarditis. Also the risk of infection with HIV or HVC or HVB is higher due to the lack of sterile injecting equipment.  Injections in public spaces such as parks, trains, parking garages, waste management areas, stairways, etc. is a problem of public health: used syringes thrown away on the street

An effective method to prevent all the risk mentioned above , „drug consumption rooms” could be an efficient method to lower the risks associated with injecting drug use among  young drug users. For the problems which drug users face: discrimination, lack of treatment, police harassment, the risks associated with drug use ( overdose, infections with HIV, HVC, HVB,  blood clots, pulmonary embolism, bacterial endocarditis, etc.), drug consumption rooms could be the solution to reduce these risks. A bridge could be created between the drug-users and other medical/social services; beneficiaries of these services would have a lot to gain.

Unhygienic public space where drug users are injecting - Ferentari neighborhood, Bucharest, Romania, Photo source: C.T. Din

« According to the report launched on World Antidrug Day (June 23), the cost for HIV treatment for one person is about 500 euros per month, while the cost for distributing disposable syringes  is about 450 per year. (Report: „Estimating the costs for the anti-drug policies in Romania”)  From the drug consumption rooms would benefit not only the drug users, but also the local community, this being a win-win situation.  Furthermore, the authorities would win, since it is cheaper to invest in a medical service for prevention than one for treatment afterwards.

Recommendations

Drug consumption rooms at this time  is not sufficiently documented in Romania but in order to establish this service to reduce the HIV epidemic among young drug users, the first step would be to modify law 143/2000.

 Article 5 „Putting in function, with foreknowledge, under any name, of any place, abode or any other furnished place, to which the public has access, for the use of illicit drugs or allowing the illicit use in such a place is punishable with imprisonment for three to ten years and restricting certain rights,” must be modified, so a place like a drug consumption room can function legally.

    

In article 4, “1) The growth, production, fabrication, experimentation, purchase or possession of drugs labelled risky, for personal use, without right, is punishable by imprisonment for six months to two years or a fine.

                (2) If the facts pertaining to (1) regard drugs labelled of great risk, the punishment is imprisonment for two to five years. “  adjustments to the articles can be made, such as to allow the possession of a certain quantity of drugs (similar to countries such as  Czech Republic, Portugal, Holland, etc. ). If this article would be modified, there wouldn't be any more abuses from the police amongst drug users.

Furthermore, at this time this law has severe consequences upon users of illegal substances, for example the police record will prevent the subject from being able to find a job after serving the incarceration, thus he/she will be forced to look for work outside the legal boundaries, which puts him/her in a vicious circle.

In order to have interventions and services for injecting drug users to face the new situation (a new epidemiological wave of HIV infections among injecting drug users), which would contribute to the reduction of the risks associated with the use of drugs, I consider it is necessary to start discussions for the modification of law 143/2000, with soliciting and  information campaigns on this subject, such that in the future the establishment and functioning of drug consumption rooms may be possible in Romania, as soon as possible.

More on: 

Crina Teodora Din, The Role of Drug Consumption Rooms in HIV Prevention, Revista de Asistenţă Socială, Numar: 1, 2014.