FAQs – Overdose Prevention Centres are also known as Safer Drug Consumption Rooms; Enhanced Harm Reduction Centres; Supervised Injection Sites; Supervised Injecting Facility; Safe Drug Consumption Facility and a number of other terms.
- What is an Overdose Prevention Centre (OPC)?
A hygienic, safe, space where people are allowed to inject illegal drugs under the supervision of trained staff who supply sterile needles, and can respond immediately to any overdoses – no one has ever died from an overdose in an OPC. It is also a place to access drug treatment, mental health services, wound care, blood testing and other support.
Some also allow snorting or smoking of drugs (including heroin and crack cocaine).
- What does an OPC look like?
The most important thing about an OPC is that it provides a clinically clean, safe environment. They can be housed in a building, ambulance or temporary structure. When in a building, they usually have a reception area, room for injecting, toilets, a recovery area, and space for private meetings. Some have showers and other facilities.
Many also have staff spaces, and separate rooms for wound care etc. If smoking is allowed, it will be in sealed ventilated booths, with a glass door to allow observation.
Most DCRs are in permanent buildings – whether stand-alone, or as part of a treatment service or homeless hostel. Ambulance-style vehicles can move from location to location, or be parked in one space all day. In Canada, some have opened in tents in parks, usually when lack of formal permission, or resources prevents using a physical structure.
- Who can use an OPC?
OPCs are only open to people with a long history of injecting drug use, and are over 18 (or occasionally 16). Normally only people living locally, often on the streets, use them because people leading chaotic lives with drug dependency issues do not travel far.
- How does an OPC work?
On arrival, new clients’ health status, needs, risk of overdose and drug use are briefly assessed. In a separate room, they wash hands, receive sterile equipment, and inject (or smoke) at a sterile desk or booth, under the care of a nurse or other professional. Each desk normally has a mirror and bright light, sharps bin for safe disposal of needles, and disinfectant products to clean up with.
Staff provide safer injecting advice, injection-related first aid, and overdose reversal treatment (e.g. with oxygen or Naloxone) if needed. Clients then move to a recovery area for observation until safe to leave. At this point they can talk to staff, whether just chatting, or to discuss advice, treatment options and other services.
- Why are OPCs needed?
People injecting in the street are more likely to die from overdoses, catch diseases from sharing needles, and end up hospitalised. Discarded needles also affect the local community, tourism and businesses. OPCs provide a way of addressing these problems – by creating safer spaces for people to use drugs, and preventing needles from being left in public places.
For 6 years in a row, the UK has had record drug-related deaths, very high levels of hepatitis among people who inject drugs, and now a COVID-19 epidemic. There is also an HIV crisis among people who inject drugs in Glasgow, and Scotland has the highest drug-related death rates in the developed world. We have failed to get many of the people who inject in the street into treatment. OPCs can prevent these outcomes, while helping to engage otherwise hard-to-reach communities in harm reduction, treatment and other services.
For example, no one has ever died from an overdose in an OPC because staff are on hand to help with oxygen, or the overdose reversal drug Naloxone. Barcelona saw a fourfold reduction in discarded syringes collected after it opened an OPC. In Copenhagen, there was 75-80% reduction in drug-related litter in the vicinity of new OPC facilities. Research predicts that the Insite facility (the first sanctioned supervised injection service in Canada) will prevent between 1191-1517 HIV infections over a 10 year period Evaluation shows an overall positive impact on the communities where these facilities are located.
- Who Supports OPCs?
A wide range of health, treatment and law enforcement bodies back OPCs nationally and internationally. In the UK, they have received public support from a wide range of groups, including for example the Advisory Council on the Misuse of Drugs (ACMD), Royal Society for Public Health, British Medical Journal, a number of Police and Crime Commissioners, and the Scottish Government. The Westminster Government opposes OPCs claiming (against the available evidence) that they might encourage use and facilitate drug markets; however, they also acknowledge the public health and community benefits.
- Are OPCs legal in the UK?
The UK Government claims OPCs are illegal based on contested readings of the Misuse of Drugs Act (MDA) that haven’t been tested in court. Principly whether dissolving heroin ready for injecting constitutes ‘the production of a drug’, and certain aspects of the Serious Crime Act 2007 (which would not apply in Scotland). For a detailed look at this see Rudi Fortson QC’s paper. For a case to get to court would also require the CPS to decide that prosecuting staff trying to save lives would meet the threshold of being in the public interest.
In any case, legal barriers could be overcome, without explicit government backing, if the local stakeholders (police, treatment, local authority and health) signed a lawful agreement with the managers of the OPC. This happens regularly to allow drug safety testing at festivals and city centre, and similarly, in the past police wrote ‘Letters of Comfort’ promising not to arrest people providing foil from needle exchanges, until the MDA was amended to allow this harm reduction measure.
A number of areas are looking at this local route, and seem likely to proceed. However it would be made easier if the UK Government confirmed that whether to allow OPS was an operational matter for police (as they have done for drug safety testing, and other issues), or amended the Misuse of Drugs Act.
There is currently a stalemate between the Scottish and UK Governments on this issue. Scotland’s senior legal officer has said he won’t grant the NHS in Glasgow permission to open one without a move from the UK Government, because the drug laws are not devolved to Scotland, and refuses to sign a Letter of Comfort. More widely, some statutory bodies like the NHS are not likely to participate without absolute legal certainty – even if they are keen to do so.
- Where are OPCs in operation?
The first OPC opened in the Netherlands in the 1970s. There are now OPCs in Switzerland, Germany, the Netherlands, Norway, France, Luxembourg, Spain, Denmark, Australia, Portugal, the Ukraine, and over 50 in Canada, with more opening all the time. There are government plans to open one in Dublin, and Glasgow is ready when permission is granted by the UK government, with several US cities exploring this option.
- Do they deliver value for money?
By reducing the costs of medical interventions down the line, OPCs represent good value for money. Glasgow NHS and numerous other studies found they make savings in reduced emergency call-outs, hospital admissions, wound and infection treatments, policing costs, and drug litter clearance. In addition, the value of the human lives saved should be acknowledged.
For example, given the high life-time cost of treating diseases like HIV (about £380,000 per person) and hepatitis C, avoiding even a small number of infections from needle sharing can mean an OPC pays for itself rapidly. They can also make significant savings in reduced emergency call-outs and hospital admissions, wound treatments, policing costs, and drug litter clearance. Street injecting can also negatively impact businesses, tourism and quality of life for residents in the area. An assessment for a proposed OPC in San Francisco suggested savings of $2.33 for every $1 spent.
- Do OPCs encourage drug use or have a ‘honey-pot’ effect?
OPS only open where there is already a concentration of street injecting and an existing drug market. It is very unlikely that people will travel long distances to use them, so they impact primarily on use that is already happening in a given area. By engaging people in treatment they have the potential to reduce drug use in the long term.
A review by the European Monitoring Centre for Drugs & Drug Addiction (EMCDDA) concluded: “There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”
- Is an Overdose Prevention Centre the same as a Heroin Prescribing Clinic?
No. Both OPCs and Heroin Assisted Treatment (HAT) clinics involve people injecting themselves with sterile needles, in a hygienic supervised space. But while in an OPS people bring their own illegal drugs, in a HAT clinic the drugs used are prescribed by a doctor, and legally produced by a pharmaceutical company. The UK Government supports heroin prescribing clinics, which are legal in the UK with a special licence. There are currently HAT clinics in Middlesbrough and Glasgow.
- Why is the government blocking OPCs?
Continuing UK Government opposition is political. The Government used to say OPCs didn’t work – but now accepts they bring health and community benefits, and several Police and Crime Commissioners say they could police them.
So now the Government says it opposes them because by allowing illegal drug use, OPCs support the illegal drug market. But the reverse is true. Firstly, in the short term people will buy and take these drugs anyway – in the street. But OPCs help get people into treatment, and off illegal drugs, so in the long term OPCs can actually reduce the size of the illegal drugs market.
- How much do they cost?
Cost varies with size, opening hours, whether in a building or vehicle, and if piggybacking on existing services. But as noted above, all models have been shown to provide good value for money.
A 2-booth service in Wrexham in an existing treatment facility was costed at £40k a year. A 13 booth unit, in a building adapted for the purpose, with dedicated staffing at the high levels used in Sydney’s OPC, plus longer opening hours, would be about £900k pa. While this may look expensive at first, what matters is the costs they save in regard to other services. As noted previously, those costs are usually far higher than the cost of running the facility itself. Mobile ambulance style OPCs in Denmark cost around £220k a year to run.