Morbidity and mortality associated with drug dependence affect a sizeable number of European citizens and constitute major problems for public health in Europe. According to current estimates, the prevalence of problem drug use (1) in the European Union (EU) Member States and Norway varies between two and nine cases per 1 000 of the population aged 15–64, indicating a large population at risk for serious health consequences. Most of the more than 8 000 acute drug-related deaths reported annually in the EU and Norway are due to injecting heroin use, and the numbers are rising (EMCDDA, 2003). Risks related to injecting drug use are the transmission of blood-borne infections, in particular human immunodeficiency virus (HIV) and hepatitis B and C, fatal and non-fatal overdoses and other morbidity, i.e. bacterial infections.
Drug users who congregate in public areas or open drug scenes are often homeless and marginalised, and lack access to social and health care services. Studies suggest that severe health risks are linked to street-based injecting (Klee, 1995; Best et al., 2000). Owing to their visibility, this group is subject to continuous police attention and public hostility, which, as users try to avoid detection, increases their vulnerability to injection-related complications, blood- borne infections and their risk to die from a drug overdose. Drug dealing and drug use in public affect cities with some neighbourhoods experiencing considerable nuisance, and create a feeling of lack of public order and safety (Renn and Lange, 1996).
The serious health and public order problems associated with drug use, especially drug injecting in public places, have led in recent years to the establishment of drug consumption rooms in several countries. Here confirmed drug users are allowed to consume drugs in hygienic conditions and without fear of arrest. The establishment of drug consumption rooms is controversial and has led to disagreement between the International Narcotics Control Board (INCB) and some UN Member States on the one hand and other UN Member States on the other hand, about the interpretation of the international drug conventions (2), in particular in relation to the basic provision of the conventions, obliging States to limit the use of narcotic drugs strictly to medical and scientific purposes.
1This report does not address this debate; nor does it offer comment on the position of consumption rooms in respect of international drug control treaties. It aims to provide a descriptive analysis of historical background, operational frameworks and outcomes of such services that can serve as a basis for a more informed discussion. The report is part of the remit of the EMCDDA to monitor drug use-related health consequences and efforts to reduce these, guided by the second target of the European Union Drugs Strategy 2000–04, which is the substantial reduction over five years of the incidence of infectious diseases and the number of drug-related deaths.
Chapter 1 gives an overview of objectives, target groups and functioning of consumption rooms. Chapter 2 describes the historical background and the driving forces that contributed to the setting up of such services, and outlines expected benefits and risks. Chapters 3 to 5 describe who uses these facilities and what outcomes have been documented with regard to individual and public health as well as public order and safety. The final chapter summarises the findings and conclusions of the report.
What are consumption rooms?
Consumption rooms are protected places for the hygienic consumption of preobtained drugs in a non-judgemental environment and under the supervision of trained staff (Akzept, 2000). They constitute a highly specialised drugs service within a wider network of services for drug users, embedded in comprehensive local strategies to reach and fulfil a diverse range of individual and community needs that arise from