Drug consumption rooms – from a conceptual framework to a basic institutionalised service. The experience of Germany

Background

Infectious diseases, (e.g., hepatitis B and C) among injecting drug users is alarming. In an increasing number of the prevalence of HIV infections is decreasing due to the implementation of effective harm reduction measures, such as syringe exchange and opiate substitution treatment (OST) and low-threshold services, including drug consumption rooms (safer injecting facilities).

Heroin entered the German illicit market around 1970 followed by a rapid increase in the number of heroin/opioid users and addicts. It is estimated that currently there are about 150,000 opioid users in Germany. Up to the mid 1980ies, Germany’s national drug policy was solely abstinence-based. But due to the rise of HIV-infections among injecting drug users (IDUs), the developments in legal, medical and political areas then changed toward a more pragmatic and harm-reduction oriented strategy. A variety of needle and syringe exchange models exist in Germany providing a range of equipment, contact, information, and knowledge. These relate to an ongoing difficulty in obtaining sterile equipment at the moment when it is needed (late at night, on weekends, when injecting drugs immediately after buying, or of fear of detection, when injecting drugs because of craving, in prisons).

Results

After working in a juridical gray field for nearly a decade, Drug Consumption Rooms (DCRs) were legalized by the German government in February 2000. The introduction of DCRs in Germany cannot be understood without realizing the win-win-situation for several key players involved and concerned since the late 1980s: municipal authorities, police, administration of justice, drug user’s self-help organization, and of the organizations of drug-addict care services. Open drug scenes in several big cities (such as Hamburg, Hanover, Frankfurt, and several cities in North-Rhine-Westfalia) led to public nuisance, which could not be reduced with police means only. Thus, supervised injecting rooms were an early option, promoted by the involved institutions. Hamburg and Frankfurt started first to introduce supervised injecting facilities. At present, 25 such facilities are being operated in six federal states (“Länder”) with varying concepts: different target groups (e.g., for women only, Hamburg), different modes of application allowed (injecting and smoking, Hamburg and Frankfurt), with or without attached higher threshold services (e.g., Frankfurt and Bochum), with or without explicit exclusion of OST patients. DCRs have been chosen as a means to: Initiate contact with otherwise hidden intravenous drug users and offer them counselling, involvement in peer projects, and safer use messages; Contribute to harm minimization by providing a hygienic setting, needle exchange, additional paraphernalia to reduce the risk of blood-borne virus transmission, food, and medical counselling; reduce the level of public nuisance by offering a place where annoying substance use can occur outside of public spaces; and improve access to and the arrangement of health and other welfare services.

Conclusions

These facilities are running in Germany now for more than 25 years successfully and accepted by policy ad communities involved. What had been the conditions, what had been obstacles and failures, what had been successes? The history of these experiences will be presented.