The United Kingdom’s first unsanctioned safe injecting facility; a proof-of-concept evaluation

Background: There is a public health crisis of drug-related deaths in the United Kingdom (UK); although safe injecting facilities (SIF) may help, the government have rejected recommendations to open them. Aim: Report on the use of an unsanctioned SIF in Glasgow (operational between September 2020 and May 2021).

Methods: Descriptive analyses of injecting events including drugs injected, polydrug use, gender differences, mental health and physical health concerns, and the intersection of other substances injected with substitution treatment.

Results: In the nine months of operation, there were well over 1000 injections, of which 894 were recorded by facility staff. There were nine successful overdose interventions (seven opiate/two cocaine). Powder cocaine injection predominated either alone (60.6%) or with heroin (22.1%). Injection was mostly in the groin (68.0%). More injecting events were by males (70.1%). Around 65% of injecting events featured an individual on a buprenorphine/methadone prescription. Predominant health concerns included abscesses and other infections, mental health including trauma, and blood borne viruses.

Conclusions: A safe injecting facility is a feasible option to address increasing drug-related deaths in the UK, and can operate without being shut down by police or with negative consequences for the community. Data collected was limited to what could be collected by volunteer staff in a high-pressure environment. Future UK sites must tailor to substances used by potential clients, and there is a notable divergence from international trends (e.g. no fentanyl use). There is an urgent need for services in the UK to reduce harm in highly marginalised populations. The service was also more than overdose prevention and numbers of injections. It provided a listening ear, needle exchange and health support, simple services like clothing, and valued human connection to help build capability, opportunity, and motivation to empower clients to engage in enhanced harm reduction practices.