This article was originally published in Drugs and Alcohol Today

By Martin Powell, Head of Partnerships
@MartinTransform

I met Peter Krykant exactly one year ago when he visited a Mock-up Safer Drug Consumption Room (DCR) that Transform had brought to the Scottish Government’s Drug Death Summit in Glasgow. He was tired, and exasperated that while there had been yet more talk, there had been no action. The local NHS and others had done great work towards opening a DCR in Glasgow, including winning all-party support on the City Council. However, the proposal was still foundering because Scotland’s chief legal officer - the Lord Advocate - was still failing to provide the prosecution waiver needed to prevent police arresting people using it or working in it. The Scottish Government was blaming the Westminster (i.e. UK) government, saying that the Misuse of Drugs Act needed changing or devolving - something the UK Government refused to do. It had become a game of political football while lives were being lost.

Peter told me he’d had enough. He was going to get a van and start his own Overdose Prevention Service (OPS), as others in Denmark and Canada had done before, to break the impasse. He said he had no faith that the UK Government would deliver anything better at the Drug Death Summit they were planning to hold in the same venue the next day.

He was right. We offered to keep our DCR Mock-up in place for the UK Government Summit so participants could learn about how they work. We were told in no uncertain terms by the Home Office that we had to pack up, and we were not allowed to relocate to anywhere on the conference centre site. Portuguese experts on decriminalisation had been invited to speak at the UK Summit, but astonishingly, all UK Ministers left the room before they presented. But they couldn’t entirely avoid the evidence. Dame Carol Black presented Phase I of her Review - packed with evidence showing the current enforcement led approach has failed, exacerbates many harms, and had not, and in fact, could not eliminate smuggling or illegal drug markets. The Government response… more enforcement.

Roll forward through Covid to August, and Peter was ready to drive his OPS Van out to a busy Glasgow city centre street injecting site, Naloxone, defibs and trained volunteers on hand. We all waited to see what Police Scotland would do about the UK’s first publicly operating safer drug consumption room… And nothing. They pragmatically used discretion to not interfere with a proven life saving intervention at a time when Scotland is the drug death capital of Europe (to date Peter’s team have treated two potentially fatal ODs). Officers even used the sharps bin on the van to dispose of needles found near housing. This was important - it said to other UK police forces that they too could use discretion to not arrest those running or using DCRs.

Until, 23rd October. Suddenly police tried to search the van and people using it, and Peter was charged for allegedly obstructing them by not opening the door fast enough. Note, this was an alleged offence under Section 23 of the Misuse of Drugs Act which is about searching for drugs, not to do with allowing the van to be used to inject drugs. It’s not clear where the order to do this came from, or if it was just one officer’s decision. But by this time Peter’s van had become famous, with international media reporting on it, blanket coverage in Scotland, and vocal support from many politicians. The backlash for his charge was furious, and it further focused attention on the Scottish Government’s failure to deliver its own DCR.

The Lord Advocate offered to drop the charge if Peter accepted a caution. Peter, backed by one of Scotland's leading lawyers, declined. He wanted to make the public interest case in court that his OPS was potentially saving lives. A court finding supporting the position that DCRs were operating in the public interest could have been significant. For example, in Canada the Conservative Government tried to shut down the ‘Insite’ DCR, and so stop others from opening, taking their case through successive courts, up to the Supreme Court. Which determined that: “Insite saves lives. Its benefits have been proven. There has been no discernible negative impact on the public safety and health objectives of Canada during its eight years of operation.” Instead of stopping DCRs, this kicked the door open. There are now around 100 across Canada, roughly half the global total.

Could a court finding in favour of Peter have boosted the case for DCRs in Scotland? We don’t know, because the Lord Advocate dropped the charge, while insisting it was never related to operating DCRs, and that this was not a go-ahead for them.

Since then, Peter has met Nicola Sturgeon, who publicly stated that Scottish drug deaths are an international disgrace. She has since committed to increase funding for drug treatment and harm reduction services by £50m a year for 5 years, roughly doubling the current budget (compare that with the one-off £80m increase in funding the UK Government has announced for England, for ten times the population). In announcing the increased funding, she name-checked Peter twice, and also announced the nationwide roll out of Heroin Assisted Treatment (HAT), increased funding for rehab, and a commitment to explore all legal routes to open a DCR.

In correspondence with Transform and elsewhere, the Lord Advocate has said he would not give the go-ahead to a DCR partly because while he could order police not to arrest clients or staff, this would not deal with civil liability issues that might require legislation (perhaps under the Health Scotland Act), or obviate the need for medical and other regulatory bodies to provide support. This is true - but we would like to see him provide that ‘prosecution waiver’ ready for when these other issues are resolved. With Scotland facing elections in May, it is possible that the Lord Advocate (who sits as part of the Scottish Government’s Cabinet, while politically independent) will step aside anyway, having served 5 years in the role. If that happens, we may have a different scenario, depending on who the new First Minister appoints to the post.

Where does this sit in the wider UK situation? Transform has been working towards the opening of UK DCRs since 2016, supporting Police and Crime Commissioners (PCCs), police, health bodies, service providers, politicians, individuals like Peter, and families, many who have lost loved ones, through our Anyone’s Child Project. There is now a coalition of dedicated and very effective actors pulling together for DCRs in the UK, linked in with counterparts globally.

In that time, the UK Government has been forced to move from saying DCRs don’t work, to admitting they save lives and have health benefits, while still opposing them. We are hoping that Phase II of Dame Carol Black’s Drugs Review on treatment services will back a pilot so that the impact on clients and the local community can be properly assessed.

Legal advice such as that by Release indicates that while it would be easier were the Misuse of Drugs Act to be amended, it is not crucial for pilots. Through using locally determined police discretion over when to arrest, coupled with Memorandums of Understanding with local Public Health and service providers, DCRs could open. This has happened before around Needle and Syringe Programmes, and Drug Safety Checking, where police know people are in possession of illegal drugs but don’t intervene. In both cases, the Home Office eventually moved from opposing to allowing these interventions. This could happen in Scotland - or elsewhere in the UK.

Peter has passed the 6 month mark operating his Overdose Prevention Service, now with the backing of the most powerful voices in Scottish politics, and without police stopping him. This is something other police forces will no doubt be looking at with interest. He recently bought an ambulance to operate out of, and has increased his hours of operation from one day a week, to four. But he is doing so unpaid and relying entirely on voluntary support. With 500 people street injecting in Glasgow alone, much more capacity is needed. That means that official, government-funded Overdose Prevention Services as part of the wider set of recently-announced measures are crucial.

We are confident this will happen. We just hope that it is soon, UK-wide, and that as few people as possible lose their lives unnecessarily in the meantime.

This the latest in a series of blogs commissioned by the editors of Drugs and Alcohol Today journal to explore the causal links between a range of health and public safety problems associated with drugs and addictions.