Giving addicts the tools to save themselves

Since opening in 2012, legal injection rooms have yet to register a fatality despite one facility having overseen half a million of injections. The reality is very different on the streets and in the homes of addicts where increasing numbers are losing their lives from overdosing. The answer could be to equip drug users with the antidote

Nana walks towards the doorway of her living room as she feels the heroin surge through her veins. She squats by the door and looks back towards her boyfriend who is being shot up by a friend. She can sense something is wrong with the drug, she is going under. In a daze she tries to call out to warn the men that they are in danger too. But she cannot speak and no words exit her mouth before she loses consciousness from an overdose.

Nana recalled her overdose experience in a video for ILLEGAL Magazine. While she was saved by an injection of an antidote, Nana’s boyfriend, who also overdosed that day, died. His life might have been saved had he also been administered the antidote in time, but addicts who take drugs at home have to wait for paramedics to arrive, and often that is too late.

Legal injection facilities were established to make it safer to inject and smoke drugs such as heroin and cocaine – the drugs responsible for most overdose deaths. The first legal injection facilitie in Denmark was opened in October 2012 in Copenhagen’s Vesterbro district. It was a landmark moment in Danish drug policy, representing a move away from the criminalisation of addiction.

Saving lives
Besides providing a safe location and clean needles for taking drugs, addicts can also feel safe in the knowledge that should they overdose, staff are on hand to administer an antidote. Skyen (The Cloud) injection room on Istedgade opened three years ago and has overseen over half a million fixes of, primarily, cocaine and heroin that is either smoked or injected. 370 potentially-deadly overdoses have been successfully treated in Skyen, which has not reported a single fatality since it opened.

The introduction of injection facilities in Copenhagen and Aarhus could be responsible for the drop in overdose deaths between 2011 and 2012, from 285 to 210, according to the Danish health authority.

The number deaths from overdoses shot back up to 263 in  2014, though there was no registered increase in cities such as Copenhagen and Aarhus, which have legal injection facilities. Rasmus Koberg Christiansen, daily manager of Skyen, says the injection facility is doing its job.

“There has been a significant rise in overdose deaths in Southern Denmark and in other areas where there are no injection facilities. If you look at the treatment systems in the areas where deaths are rising, I believe there is enormous potential to improve their preventative strategies,” he explains, before urging caution about how to interpret the statistics.

“There are so many potential reasons for the increase and I would be very careful about drawing final conclusions based on these numbers, as it is really hard to measure deaths caused by overdoses precisely. The reported rise could also be the result of the authorities doing more autopsies and therefore finding more cases of fatal overdoses, a stronger drug coming into circulation, or a number of different factors – it is really hard to say.”

Injection facilities questioned
Associate professor Esben Houborg from the Centre for Alcohol and Drug Research at Aarhus University says there is a link between the introduction of injection rooms and the drop in drug-related deaths.

“It is likely that the injection facilities have had a part to play in the drop in deaths in 2011 and 2012 – why the number has now risen I could not possibly guess without further studies,” he says.

Despite their potential, health minister Sophie Løhde is unwilling to support the creation of more injection facilities, arguing that roughly 80 percent of all overdoses take place in private homes.

“If the fatalities are going to drop, it is necessary to employ several tools and create equal focus on preventative efforts, addiction treatments and harm reduction,” the minister told Ritzau.

Michael Lodberg Olsen established the first injection room in a renovated ambulance in 2011. The success of his project lead to the creation of the first non-mobile injection room. He points out that the mortality rate is highest outside so-called ‘open’ drug scenes, where drug addicts meet up in large groups in public spaces.

“With eight out of ten overdoses taking place in private homes, we absolutely have to change our way of tackling the issue. Injection rooms are only effective in cities where drug users gather in public places,” explains Olsen.

Antidote Danmark
Olsen adds that while it is important to carry on the work of the injection facilities and set up more of these facilities across the country, it is essential to take a different approach in places without these open scenes.

“It is hard to be sure, but it is almost certain that the injection facilities are keeping fatalities low in Copenhagen and Aarhus. For this reason we should definitely be setting up more facilities around Denmark. But we also need to start educating users and providing them with the right tools so they can help each other when they overdose outside the facilities.”

Overdosing is always a risk when injecting opiates such as heroin or methadone into the bloodstream. While in some cases it can cause cardiac arrest, non-fatal overdoses can leave the user with organ damage. According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) there are up to 25 non-fatal overdoses for every fatal overdose.

Thankfully, overdoses are easy to treat with the non-toxic drug naloxone, though it is normally only available in injection facilities or hospitals. To increase its availability, Olsen has co-founded the volunteer organisation Antidote Danmark to provide drug users with naloxone so they can treat each other.

“When users are fixing in small groups in the living facilities of private homes in smaller towns without an open drug scene, they are very likely to have either drugs or stolen goods lying around. When someone overdoses, they do not call for an ambulance as a police car will almost always accompany the ambulance to the site of the overdose. Instead, users have been known to drag their overdosed friends onto the street and call for help – and by then it is often too late,” Olsen explains.

Antidote projects carried out in the United States have had enormous success rates. A study conducted by the Clinical Addiction Research Education Unit at Boston University showed a 50 percent drop in fatalities among addicts in some communities. One set of naloxone antidote costs roughly 250 kroner and training takes around 20 minutes.

“The only way to tackle the issue is to educate the users and their loved ones and teach them how to save each other. We cannot do this fast enough – it is essential if we want the mortality rate among users to drop.” M

News, Urban

By Joshua Hollingdale

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