Safer Injection Rooms

This summary of preliminary research examines results of SIRs in Germany, Switzerland and the Netherlands.

By 1998, legal SIRs had been established in three European countries.

• Five SIRs operate in Frankfurt, Germany, the first of which opened in 1994; others can be found in Hamburg, Hannover, Bremen and Bonn.
• Thirteen SIRs operate in the Swiss cities of Zurich, Bern, and Basel, where the first one opened in 1986.
• SIRs operate in the Dutch cities of Rotterdam, Arnhem, and Maastricht; Amsterdam, which closed down poorly managed SIRs in the 1970s, is currently considering their development.

SIRs help providers contact a hard-to-reach population.

• Ninety-five percent of SIR clients in Frankfurt carry hepatitis C, and 25 percent carry HIV.(2)
• Seventy-six percent of clients at Paulus Kerk, a church-based SIR in Rotterdam, use both heroin and cocaine; nearly 50 percent are immigrants and 40 percent are homeless.(2)
• SIRs in all three countries attract clients above the average age of local drug injectors.(2)

SIRs can alleviate health problems related to injecting drugs.

• A 1996 evaluation of three SIRs in Basel reported that SIRs provided hygienic and controlled atmospheres and access to primary and emergency medical care.(3) (4) Staff believed SIRs had reduced the number of overdoses, although no data were available. In 1995, Bern SIR staff helped drug injectors switch from 2-milliliter to 1-milliliter syringes, possibly decreasing risks of disease transmission and vein damage.(5) Clients in Swiss SIRs report injecting drugs more safely and engaging in unsafe sex less often.(6) There have been no deaths in Swiss SIRs to date. (5)
• Since SIRs were established in Arnhem, SIR clients take fewer health risks. (7)
• Overdoses are very rare in Frankfurt SIRs compared to on the streets. Those that do occur are 10 times less likely to require a hospital stay than overdoses occurring on the street.(8) No overdoses in German SIRs have been fatal to date.
• Fatal overdoses in Frankfurt have declined from 147 in 1991 to 26 in 1997,(9) and according to autopsy results, HIV among drug users declined from 63-65 percent in 1985 to 12-15 percent in 1994.(10) These results are attributed to Frankfurt's integrated harm reduction strategy, which includes SIRs and a variety of other low-threshold drug services.

• Since SIRs were established in Arnhem, public drug use has declined. (7)
• Fewer discarded syringes are found on streets in Swiss cities with SIRs. (6)
• Public drug use in Frankfurt shrunk from 800 individuals in 1991-1992 to 150 in 1993(11) and neighborhood complaints about drug use dropped significantly.(11) Drug-related criminality in Frankfurt also declined: cases of street robbery declined from 1,800 in 1991 to 1,300-1,400 in 1994; cases of car break-ins declined from 40,000 in 1987 to 23,000 in 1994; cases of house break-ins declined from 5,000-6,000 in 1990 to 4,000-5,000 in 1994.(12) Likewise, cases of heroin trafficking in Frankfurt declined from 1,400 in 1992 to 500 in 1994,(10) and legal proceedings involving drug users dropped 20 percent from 1995 to 1996.(10) These results are attributed to Frankfurt's integrated harm reduction strategy.

Data on the effects of SIRs are scarce. Nonetheless, researchers have found SIRs to be an effective component of municipal drug strategies that include other low-threshold services, such as needle exchange and various forms of maintenance and treatment for drug abuse. In certain locations and under certain circumstances, SIRs may be an effective way to contact some of the most marginalized drug users and reduce the harm of their drug use on individual and community health and public order.

* Most of the research cited is available in: Jong WM de, Weber U. The professional acceptance of drug use. International Journal of Drug Policy. February 1999 (Forthcoming); and Joint Select Committee Into Safe Injecting Rooms. Report on the Establishment or Trial of Safe Injecting Rooms. Parliament of New South Wales, Australia. February 1998.

Notes:

1. Körner, Harald Hans. Gutachten zur Zulässigkeit von Gesundheitsräumen für den hygienischen und streßfreien Konsum von Opiatabhängigen: Az. 406/20-9 [Testimony for the establishment of health rooms for hygenic and stress-free consumption by opiate-addicted individuals]. Frankfurt, Germany: Headquarters of the Campaign against Drug Abuse (ZfB). 1993. 21 p.
2. Joint Select Committee into Safe Injection Rooms, Parliament of New South Wales. Report on the establishment or trial of safe injection rooms. Australia: Parliament of New South Wales. 1998. 284p.
3. Trägerverein AAJ, Arbeitsgemeinschaft für aktuelle Jugendfragen. Halbjahresauswertung: Gassenzimmer 1, Gassenzimmer 2, 01.07. bis 31.12. 1995 [Biannual evaluation: Alley-room 1, Alley-room 2]. Basel, Switzerland: Trägerverein AAJ. 1995. 15 p.
4. Trägerverein AAJ, Arbeitsgemeinschaft für aktuelle Jugendfragen. Halbjahresbericht: Gassenzimmer BL, Januar bis Juni 1996 [Biannual evaluation: Alleyroom BL, January to June 1996]. Basel, Switzerland: Trägerverein AAJ. 1996. 11 p.
5. Dolan, Kate; Wodak, Alex. Final report on injecting rooms in Switzerland. Unpublished. 1996. 7 p.
6. Haemmig Robert B. Speech on Swiss experiences with heroin dispension, fixer rooms and hard reduction in prison. Conference 'Overlastenverlichting,' Trimbos Institute, 21 November 1996.
7. Warner, M. N. Over de Drempel: Onderzoek naar de mogelijkheid om harddruggebruik binnen een opvangvoorziening in Arnhem te reguleren. Arnhem, Netherlands: Gelders Centrum voor Verslavingszorg. 1997.
8. Integrative Drogenhilfe. Annual report 1997. Frankfurt, Germany: Integrative Drogenhilfe an der Fachhochschule Frankfurt am Main e.V. 1998.
9. Böllinger, Lorenz; Stöver, Heino; Fietzek, Lothar. "Druckräume: Angebote, in denen der intravenöse Drogenkonsum toleriert wird [Injection rooms: Places where intravenous drug use is tolerated]." In: Böllinger, Lorenz; Stöver, Heino; Fietzek, Lothar, Drogenpraxis, Drogenrecht, Drogenpolitik. Frankfurt, Germany: Fachhochschulverlag. 1995. 142-145.
10. Nickolai, Marion. "Evolution of Frankfurt's approach to the drug problem." EuroMethwork. 1997. No. 12: 3-4.
11. Kemmesies, Uwe E. "Szenebefragung, Frankfurt/Main 1995: Die 'offene drogenszene' und das Gesundheitsraumangebot in Ffm [Drug scene survey, Frankfurt am Main 1995: The 'open drug scene' and the availability of health rooms in Franfurt am Main]." Frankfurt, Germany: Stadt Frankfurt/Dezernat Frauen und Gesundheit, Drogenreferat. 1995. 58 p.
12. Polizeiprasidium Frankfurt. Bericht zur Rauschgiftkriminalitat (Report on drug-related criminality). Frankfurt 1994Nickolai M. Evolution of Frankfurt's approach to the drug problem. Euro-Meth Newsletter No.12, August 1997.