Scotland Opens Drug Facility: Do They Work?

It has taken more than ten years of wrangling , but the UK's first legal drug-consumption facility has finally opened in Glasgow.

These facilities offer a safe, clean place for people to use illicit drugs, usually by injection, in the presence of health professionals. It is hoped that the facility in Glasgow, called The Thistle, will reduce drug-related overdoses (Scotland has the highest rate of drug-related deaths in Europe) and reduce the transmission of blood-borne viruses, such as HIV.

Informal drug consumption spaces have existed for a while. An unsanctioned facility , delivered from an old ambulance was briefly operational in Glasgow city centre in 2020-21. However, a wide range of legal barriers can prevent formal implementation, so organisations, such as local councils and the NHS, are often reluctant to get involved.

Previous attempts to introduce these types of facilities in other cities across the UK were unable to resolve these barriers. In Scotland, however, a strong and sustained partnership between the city council and Glasgow City Health, led to the country's most senior legal authority, the lord advocate, announcing people would not be prosecuted for possessing illegal drugs while using the facility.

Importantly, the Westminster government, which controls drug laws across the UK, announced that it would not interfere.

A global phenomenon

Although this is a new service in the UK, several other countries have had drug consumption facilities for some time. The first of these was opened in 1986 in Bern, Switzerland. Since then, facilities have opened across Europe, North America and Australia, where they form one part of the overall response to drug harm.

Globally, there are over 100 drug consumption facilities in 66 cities. Although they can be subject to political interference , once established, they become a routine and mostly uncontroversial service.

But do they work? Reviews of studies suggest that the facilities have several benefits for people who use drugs, and for the local communities where they are sited. However, there are considerable gaps in knowledge about the effectiveness of these spaces. A large research programme will evaluate the impact of the new Glasgow facility to help address some of these gaps.

The Glasgow facility has been subject to much political and media discussion, with the public tending to support the approach. Our research found that public support was higher when the facilities were framed as reducing drug deaths of family members rather than focusing on scientific evidence of benefits.

Local concerns

As with other types of drug service, there are fears voiced by local communities and businesses when a facility is planned in their area, even among family members of those that use drugs.

Some fear that there will be an increase in drug use or dealing. The evidence so far is that there is a reduction in public use of drugs, which results in fewer discarded needles and syringes in the area.

There are other concerns over the cost of the Glasgow facility ( £2.3 million a year ), especially when other types of service face funding restrictions. Although these costs may seem high at first glance, the financial costs of responding to a drug-related death or overdose, providing treatment for an HIV infection, or missing opportunities to provide other types of long-term health and social care in a vulnerable population are even higher.

Drug-related deaths are not spread equally in the population. As with other aspects of health, social and economic factors influence the risk of a fatal overdose. Those living in deprived communities are over-represented in drug-related deaths. It would cost more not to do anything .

Some opponents of the Glasgow facilities argue that they have been presented as a "silver bullet" to Scotland's - and the UK's - drug-death crisis. The Scottish government and developers of the Glasgow facility don't make this claim, but it is still important to be clear about the aims of safer consumption facilities.

They are intended to respond to some of the most severe and complex drug-related harms in high-risk local populations and help link them to a range of support services. The facilities may therefore not be suitable for other towns and cities, or other groups of people who use drugs. As such, the facilities are unlikely to have a major impact on national rates of drug-related deaths, which require a holistic long-term response.

Besides helping to reduce the direct risks of injecting drug use, drug consumption facilities are an effective way of engaging a group of people who rarely use other services. Because of the stigma associated with drug use, and injecting drug use in particular, some services may not welcome these people.

The evidence suggests there are several benefits that people gain when using drug consumption rooms. These include safer ways of using drugs. It may seem counterintuitive, but there is also a reduction in drug use as people are offered support and treatment to address their problems with addiction.

Despite this evidence, the UK government has been reluctant to permit the opening of drug consumption rooms across the country, which would probably require major legislative change.

In recent years, governments have avoided any action that might give the impression to the public that they are encouraging or facilitating drug use. However, the government's independent scientific advisers on drugs, the Advisory Council on the Misuse of Drugs, has long recommended introducing drug consumption facilities.

With the emergence of potent new synthetic opioids in the UK drugs market, there are concerns that the UK's record high drug death rates might increase further. Coupled with emerging evidence from the new Glasgow facility, this new drug threat may persuade legislators to look again at the place of safer drug consumption facilities in the overall response to drug harm.

Harry Sumnall receives funding from public grant awarding bodies for alcohol and other drugs research, and fees from (international) not-for-profit organisations and government departments for consultation work. He is an unpaid member of the UK Government Advisory Council on the Misuse of Drugs (ACMD), the Scientific Advisory Board of the Mind Foundation, the Scientific Advisory Board of the International Society of Substance Use Professionals, an unpaid advisor to the UK Drug Education Forum, and an unpaid steering group member of the Anti Stigma Network. The views expressed in this article represent Harry's personal views only, and not those of any of these organisations.

Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.