Empowering communities in harm reduction: insights from a community-led drug consumption room in Lisbon

Abstract submitted by an ENDCR Member, thematically linked to other Members submissions.

Background 

The challenge of implementing a drug consumption room in central Lisbon led GAT to take the initiative to install this facility at its harm reduction centre in Mouraria. The organization opted for a community-led peer-driven model, differentiating it from the programmes that already existing in the city. The ongoing work in harm reduction, coupled with acceptance from the local community and previous experience in supervising injected consumption and educating for safer use, initiated through the European Eurosider project, provided support for this initiative. 

Methods 

This study starts by reflecting on a model under construction that places the community of people who use drugs at the centre of the process of implementing a response that is not always easily accepted. We aim to discuss the advantages and disadvantages of this approach, giving voice to those on the frontline, particularly peers. Data reflecting the evolution of service utilization and user profiles will also be presented. 

Results 

The GAT IN-Mouraria drug consumption room, currently in the process of authorization by competent authorities, informally began in 2022. The community-driven model originates from the mission and principles of the organization. Peer workers are responsible for the day-to-day management of the room, supervision of the consumption, and connection with other organization services. The response to overdoses follows a medical protocol, with the presence of a nurse on-site in case of emergency. The advantages of a less medicalized model include promoting an environment favourable to intervention, greater openness to socialization, creating a sense of belonging to the community, and a greater possibility of implementing peer-assisted strategies, such as assisted injection. However, the limitation of space to meet the growing demand is acknowledged, as well as the increased emotional strain on peers in this close proximity to situations of great vulnerability. 

In 2023, the consumption room was used by more than 400 users engaging in a total of 13454 consumptions. Most of the episodes were of smoking (78%). There was an increase in the number of migrant users, especially from South Asia, reflecting the migration pattern in this area of the city. The proportion of women frequenting the drug consumption room remained stable throughout the year, hovering around 20% in smoking episodes. 

Conclusions 

It is important to emphasize the diversity of models that can be adopted in drug consumption rooms, with advantages and disadvantages in each option. The community-led model, although supported by medical protocols for overdose response, is increasingly a viable option when expanding this type of response. One potential solution is to incorporate it as a component within existing harm reduction responses.