Supervised Drug Consumption Facilities

Alison Thewliss Excerpts

1st reading: House of Commons
Wednesday 14th March 2018 Commons Chamber

[Alison Thewliss (Glasgow Central) (SNP)]

I beg to move,

That leave be given to bring in a Bill to make provision about supervised drug consumption facilities; to make it lawful to take controlled substances within such facilities in specified circumstances; and for connected purposes.

On Monday, one of my constituents mentioned to me that Glasgow already has drug consumption facilities: they are behind the bushes near his flat and in his close when it rains. Right now, they are also in bin shelters, on filthy waste ground and in lonely back lanes. They are in public toilets and in stolen spaces where intravenous drug users can grasp the tiniest modicum of dignity and privacy for as long as it takes to prepare and inject their fix. Often they are alone, and, far too regularly, drug users will die as a result. As a society, we can and must do much better than that.

There is a real and persistent issue in Glasgow. In 2016, 2,593 opioid-related deaths were registered in England and Wales. In that same year, 867 were registered in Scotland, and of those, 257 were in the city of Glasgow. We have an ageing population of people with long-term problem drug use. They are increasingly vulnerable and require particular interventions to reduce harm and encourage them to engage, and remain engaged, in health services. The largest cohort of drug users in Scotland are currently aged 35 to 44. This ageing population—people who have survived since starting to take drugs in the 1980s and 1990s—are in deteriorating health. Owing to their sustained opiate use, they are assessed as having a physiological age 15 years greater than their actual age. They have complex co-morbidities, with above population-level instances of conditions including COPD—chronic obstructive pulmonary disease—and asthma, hepatitis C, liver disease, epilepsy, deep vein thrombosis and pulmonary embolism, skin infections and cellulitis, depression and psychosis. This population is vulnerable to overdose and to emergency hospital admission.

The Scottish Drugs Forum has carried out research interviews with a large group of older people with a drug problem. This group feel very strongly that they have been left behind—that they are seen as a waste of space. This House needs to recognise that abstinence-based programmes will not necessarily work for everyone and that harm reduction and support will be better and more worthwhile interventions for a group of people who have not managed to eliminate drug use in the preceding decades. Evidence shows that long-term engagement in treatment is a positive protective factor. The people in Glasgow who would use this facility are not in treatment. The facility would get them through the door and would provide a range of other social and medical support to help them to stabilise their lives.

The report, “Reducing Opioid-Related Deaths in the UK”, published in December 2016 by the Advisory Council on the Misuse of Drugs, recommends that

“consideration be given—by the governments of each UK country and by local commissioners of drug treatment services—to the potential to reduce”

drug-related deaths

“and other harms through the provision of medically-supervised drug consumption clinics in localities with a high concentration of injecting drug use.”

The report cites evidence demonstrating that such facilities reduce injecting risk behaviours and overdose fatalities. Furthermore, it says:

“They have been estimated to save more money than they cost, due to the reductions in deaths and HIV infections that they produce…Such facilities have not been found to increase injecting, drug use or local crime rates. In addition to preventing overdose deaths, they can provide other benefits, such as reductions in blood-borne viruses, improved access to primary care and more intensive forms of drug treatment. No deaths from overdose have ever occurred in such facilities”.

Glasgow has a proposal—a well-worked-through business case produced by Glasgow City Health and Social Care Partnership, which is supported by the Scottish Government. Drugs law remains reserved to Westminster, and Scottish Ministers have requested permission from the Home Office to allow the proposal to go ahead. This has not yet been granted. This proposal has the real potential to reduce drug-related deaths and ongoing harm. It is for an integrated service, as also recommended by the ACMD—not just a “shooting gallery”, as some have suggested. It will allow engagement with a population who at the moment are not being assisted very well at all. There will be medically trained staff who can supervise and administer life-saving naloxone should it be required.

Some may say that this is an unnecessary expense. I say to Ministers on the Front Bench that it will certainly cost them nothing. For Glasgow, there is a significant cost in not doing this. There is a cost in treating the latest HIV outbreak and in treating hep C and other conditions. There is a cost in emergency hospital admissions and ambulance call-outs and in police time dealing with complaints. There is a significant cost in cleaning up discarded needles, with residents being charged by their factor for a problem not of their making and the council picking up the tab for public spaces. A housing association told me how it is regularly paying to clear up areas of hundreds of discarded syringes. A constituent tweeted me today to say that there are syringes on her doorstep. There is an ongoing public health risk to residents, who at any time could be pricked by a contaminated needle, and of course, there is the intangible cost in human lives. We should consider all those costs that we are currently paying in a situation that helps no one.

Heroin-assisted treatment has been mentioned as an alternative to a supervised drug consumption room, and I would like to touch on some of the limitations of that. The Glasgow proposal includes provision for heroin-assisted treatment, but I would like to stress that while it can be a treatment for those for whom many other interventions have failed, it is not suitable for everyone.

There are also capacity and cost issues. Glasgow city centre is thought to have a population in the region of 500 injecting drug users. The Glasgow city health and social care partnership believes that it would only have capacity for 40 to 60 individuals for heroin-assisted treatment, and only when the service was running to full capacity, which will not happen for some time. I understand that the service also requires two separate licences to operate: a premises licence, which is in the gift of the Home Office, and a prescriber’s licence, dependent on the premises licence, for individual doctors directly linked to the site. It is not a simple process, but it has been developed very much alongside the proposal for a supervised drug consumption facility.

To operate a supervised drug consumption facility requires the consent of the Home Office. Those operating, working in and using the facility require protection in law, hence my Bill seeks to exempt staff and those using drugs within the facility from prosecution and remove liability for prosecution from the operators of the facility—in this case, the Glasgow city health and social care partnership.

The supporters of the Bill come from a range of parties: Labour, the Liberal Democrats, Plaid Cymru and even the Conservatives. A letter that I wrote to the Home Secretary earlier this year, ahead of the debate led by my hon. Friend the Member for Inverclyde (Ronnie Cowan), garnered similar cross-party support from MPs right across Scotland. I am particularly grateful to the hon. Member for Stirling (Stephen Kerr), who said in giving his support that

“we should reach out to help those in the grip of drug abuse and do what can be done to help them escape the vile grip of the gangster pushers and dealers.”

This facility is very much a step in that direction.

In my 11 years as an elected member in Glasgow, the issue of drug taking has been a constant. I have seen various police initiatives shunt people around, from bin shelter to close to waste ground. I have seen the council clear up the mess at significant cost and significant risk to its workers. I have seen residents at their wit’s end, worried about what they will open the door to in the morning, with blood, excrement and used syringes on their doorsteps daily. I have seen vulnerable and desperate women and men injecting into their groin in hidden but still public places; they have nowhere else to go. I have listened to the heartbroken families who have lost loved ones. If it was their choice, they would not have their loved one die alone in a filthy back lane. They would want a medically supervised facility where treatment could be given and help could be sought.

The status quo serves none of these people well. I cannot accept that this is the best we can do. It is unacceptable. We must try something different. I accept that it may not work, but we must at least try. Today is International Ask a Question Day, and my question of the UK Government is this: Glasgow has a plan that could reduce drug-related nuisance to residents, reduce harm to drug users and save lives, so will the UK Government let Glasgow get on with the job? I commend the Bill to the House.

Question put and agreed to.

Ordered,

That Crispin Blunt, Mr Alistair Carmichael, Joanna Cherry, Ronnie Cowan, Christine Jardine, Stephen Kerr, Stuart C. McDonald, Ian Murray, Liz Saville Roberts, Mr Paul Sweeney and Dr Philippa Whitford present the Bill.

Alison Thewliss accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 27 April, and to be printed (Bill 184).