Feasibility study for a safer drug consumption facility in Edinburgh

Background

This presentation reports on a feasibility study for a safer drug consumption facility (SDCF) commissioned for Edinburgh City Council. In 2020, the Lord Advocate of Scotland produced guidance enabling the UK’s first SDCF to open in Glasgow. Other cities have shown an interest in developing similar facilities. In 2023, a team led by the first author were commissioned by the City of Edinburgh Alcohol and Drug Partnership to provide a feasibility study for an SDCF in the city. The report contains 12 recommendations and is, at the time of abstract submission, under consideration by the local authority. 

Methods

1: Narrative review of global evidence on SDCF provision
2: Quantitative analysis of administrative data, including drug-related deaths, non-fatal ambulance callouts, injecting equipment provision and police records, analysed by small geographies and mapped to identify key hotspots and spatial patterns
3: Semi-structured interviews with 22 people with living experience of injecting drug use (PWLE) and five affected family members
4: Semi-structured interviews with 21 professional stakeholders working across key sectors.

Results
The evidence review identified core and ancillary services to provide a framework for SDCF service design. The administrative data analysis found hotspots in two areas of the city, but also demonstrated many harms are dispersed, with a skew towards areas of higher deprivation. Interviews with PWLE provided key insights into anxieties, aspirations and expectations. There was strong support for peer delivery and a belief that SDCFs could help develop supportive communities. There was also support for strict regulations and safeguarding procedures to protect clients and staff. PWLE highlighted high levels of cocaine injecting in the city, with many suggesting this was more widespread than heroin. There was clear support for SDCFs to act as a gateway to wider services including treatment and recovery. Interviews with professional stakeholders revealed widespread support for SDCFs, and a belief they could tackle stigma and marginalisation as well as acute risks. However, there were concerns about opportunity costs and a view that potential benefits should not be overstated, or viewed in isolation from wider harm reduction systems. 

Conclusions
The review concluded that Edinburgh could benefit from the introduction of an SDCF. It recommended this should be developed through close engagement with PWLE and local communities, with an emphasis on peer provision and service integration. The need for clear safeguarding was noted. It was noted that high levels of cocaine injecting present novel problems regarding service design, potential patterns of use, and training for expected behavioural responses post-consumption. Extensive public and stakeholder engagement was also recommended to raise awareness, address concerns regarding opportunity costs and to challenge perceptions that SDCF provision may be seen as a 'silver bullet'.