Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers
Abstract
:1. Introduction
Drug Consumption Rooms in the Scottish Political Context
- (1)
- Why, given widespread support for DCRs, do strategic decision-makers feel adoption is proving so difficult?
- (2)
- How do strategic decision-makers view DCRs as fitting into the wider policy and treatment systems?
2. Materials and Methods
3. Results
- interviewee perceptions of where decision-making power lay within the wider political system;
- how interviewees saw the role of DCRs in relation to the wider treatment system;
- approaches towards different roles, and types, of evidence in the debate;
- use of language in framing the purpose of, and principles behind, DCRs.
3.1. DCRs and Decision-Making in a Complex Political System
It definitely shows the limitations of devolution, that we have something that is very clearly a public health issue, very clearly an area where it is the Scottish Government’s remit to try and fix this issue if it can be fixed. But there is that barrier there, which is a Westminster barrier—and not just with drug consumption rooms, just in terms of the Misuse of Drugs Act in its broadest sense and what it prevents you from doing.(DM12)
It’s obviously Westminster. I’d like to think Scottish Government is actually genuine in its request for this rather than simply playing a card which they knew was going to get thrown out.(DM1)
I would acknowledge it has at times been kicked around like a political football and when newspapers are looking for a news line, I can see why DCRs become the story. I think we have been caught between two Governments in this.(DM16)
So perhaps the Government in Scotland need to be bold because this isn’t an argument about whether or not we devolve… I don’t know agriculture […] this is an argument about saving lives, and I think there is so much evidence out there that drug consumption rooms save lives.(DM14)
I think the Lord Advocate could be accused of bottling it by some […] as far as I can see needle exchange[s] are tolerated and I can’t see the difference.(DM1)
[The Lord Advocate] will do exactly what the Government instruct him to do. So, if the Government really want a DCR, they would instruct him to issue a letter of comfort […] the Scottish Government could instruct him to do that tomorrow and he would find a way of doing that within the law.(DM5)
[The Lord Advocate] doesn’t have the power to override UK law unless it’s in the public interest, and that’s only for prosecution, not for policing policy. So, there is a whole, it’s just another characteristic of the UK Government.(DM19)
We are working within the law; we don’t have any say really in what the law is. So, we are working within the law and within public expectation. And we don’t have the discretion to just generally ignore a crime if it’s reported to us or happening in front of us.(DM7)
We do need to have local community councils involved, as well as the elected members […] and the local authority actually needs to be involved […] I think we need to have as many local bodies as possible involved in that opening gambit, now that could make it an absolute quagmire and we might never get out of it. But we do need to bring together as many people as possible to start to move this forward.(DM4)
3.2. The Role and Position of DCRs in the Wider Treatment System
And, of course, people who are not keen on DCRs will say “Well, it’s not the silver bullet!”. Well, no one is claiming that any one measure is the magic cure here. There is no magic cure.(DM16)
It’s not one silver bullet because we are talking about quite a diverse group of drug users. They are not all the same […] They are not all affected in the same way and they don’t all have the same needs.(DM5)
We are aware that it’s one of the things that is being promoted as the golden bullet to solve Scotland’s appalling drugs death problems. Personally, I’m not convinced. There is never a golden bullet on these issues. It’s a lot more complicated than one intervention, I think.(DM15)
[W]e need a safe drug consumption facility … as part of the kind of range of services and interventions that we have in place for people with multiple and complex needs. So, I am absolutely clear on that.(DM10)
So is there any reason, and I’m just thinking this off the top of my head, why we couldn’t integrate a kind of drug consumption space, or whatever way you want to phrase it, alongside our integrated homelessness services? Could we not do it, you know, alongside an integrated criminal justice service?(DM11)
Our crisis centre in [city name removed] is a great example of this, where people come in for one thing and end up walking out with a lot more. So, they come in for a bit of advice or to get their gear, and while they are there they get blood spot tested and they get an HIV test, and they get whatever else and they get whatever else and a few leaflets to take away to say ‘Look if you are in crisis, for Pete’s sake, phone us’.(DM6)
When people are really in a bad place and they want to use, they are not going to go and buy their drugs, keep in in their pocket, then get on a bus […]. People that I know, who have taken drugs for a long time, want to do that in the comfort of their own home.(DM2)
If the only investment, the only conversation we are having, is about drug consumption rooms then that is the wrong conversation. And we need to know what it costs, what is the financial envelope in relation to this?(DM1)
So, I think the risk with something like drug consumption rooms is that government will give money expecting us to spend it on that, because that’s their preferred solution to the problem. And that might not be the best use.(DM15)
The evidence suggests that, yes, there is a need for it. However, that should not be to the detriment of other parts of the system.(DM2)
3.3. Approaches to Evidence
Politically the evidence would need to be incredibly strong […] if […] there had to be a political and [Integrated Joint Board] decision.(DM3)
There needs to be a fairly robust sort of evidence base around the use of drug consumption rooms. So, whether that’s through pilots or through studies from other countries or, but also include people with living or lived experience of drug use. I think as well around public perceptions.(DM17)
3.4. The Role of Language in Framing DCRs
‘Consumption’ I think is okay, ‘injecting’ is probably not because we would want to have a service […] which would not just be about injecting because lots of people use drugs in other ways. They may for example smoke heroin instead of injecting […] so I feel [safer injecting facilities] is a bit too narrow a term, plus it’s a bit in your face really as well.(DM14)
The language does matter I think, so that people who might benefit from the service understand what it is and that it’s there. So, if you dress it up in opaque language then the people you are trying to reach won’t think this is for them. So, I think you know ‘drug consumption’ makes it obvious what it is. But I think that the language of safer injecting probably does take some of the fear factor away from you know, from residents, from other people who might feel a bit unsure.(DM16)
The Herald and the Scotsman had editorials to support us, so eventually it only became the Daily Mail. Even the Evening Times changed their […] mind, which was fascinating. And colleagues in England were asking us about that because that was one of the things that they really struggled with and we had, we had national newspapers who had a different headline up here.(DM10)
I still remember it was a comment, and I shouldn’t have read it, it was a comment to one of the earlier Evening Times articles and it was about yeah something, shooting galleries, except you should shut the door and shoot them all. I mean, I still remember that.(DM10)
We talk about being inclusive and, you know, taking a health approach. Actually, for people living in a tenement where there is a drug user that has a dealer and their mates traipsing up and down the tenements, they just want rid of it.(DM15)
In a place where you are trying to get people to address the stigma, even the words drug consumption rooms don’t sit particularly well with communities, with the cutting of council services all over the place, because the councils don’t have enough money for services(DM1)
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Nicholls, J.; Livingston, W.; Perkins, A.; Cairns, B.; Foster, R.; Trayner, K.M.A.; Sumnall, H.R.; Price, T.; Cairney, P.; Dumbrell, J.; et al. Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers. Int. J. Environ. Res. Public Health 2022, 19, 6575. https://doi.org/10.3390/ijerph19116575
Nicholls J, Livingston W, Perkins A, Cairns B, Foster R, Trayner KMA, Sumnall HR, Price T, Cairney P, Dumbrell J, et al. Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers. International Journal of Environmental Research and Public Health. 2022; 19(11):6575. https://doi.org/10.3390/ijerph19116575
Chicago/Turabian StyleNicholls, James, Wulf Livingston, Andy Perkins, Beth Cairns, Rebecca Foster, Kirsten M. A. Trayner, Harry R. Sumnall, Tracey Price, Paul Cairney, Josh Dumbrell, and et al. 2022. "Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers" International Journal of Environmental Research and Public Health 19, no. 11: 6575. https://doi.org/10.3390/ijerph19116575