Carolin Hess is a PhD student in the NIHR Policy Research Unit in Health and Social Care Workforce who has been awarded Doctoral funding from the NIHR School for Social Care Research. (701 words)
Over 280 participants joined Ben Scher, a PhD candidate in Social Intervention and Policy Evaluation at the University of Oxford and outreach worker at St. Mungo’s, for the latest webinar of the HSCWRU Homelessness series on how low-barrier drug interventions can reach people experiencing homelessness and drug-related harms. Presenting findings of his doctoral project, which compares the lived experience of street-based drug dependency based on people’s access to low-barrier overdose prevention centres (OPC) across sites in Vancouver (Canada), Birmingham (UK), and Athens (Greece), he provided ethnographic evidence on the effectiveness and feasibility of implementing OPCs.
OPCs are “safer consumption spaces” where drug consumption is monitored by medically-trained professionals. Substantial observational evidence across the 15 countries currently operating OPCs has demonstrated how these centres can be successful in preventing fatal overdoses, reducing risk of blood borne diseases, and increasing safer injecting practices and engagement with substance treatment services.
Investigating the lived experience of people who use drugs, key community stakeholders and service providers, Ben showed that OPCs, when set in an accessible location and operating in a non-judgemental and safe way, can function as a “gateway” to service engagement for people who have negative past experiences with drug services, GPs and health facilities or other services. Communities and local residents proved to be mostly supportive of centres, due to their successes in reducing street-based drug injections and litter locally.
Ben’s insights from Canada, where the first supervised injection centre was opened in 2003 and where growing acceptance has led to the highest numbers of OPCs in a country worldwide, were juxtaposed with a case study of Birmingham where low barrier OPCs are unavailable: drug users often stayed hidden when injecting drugs. With nowhere safe to go, they turn to unsuitable and unsafe places, often littered with debris, faeces and infestations. He found that the criminalisation of drug-injecting behaviour and the lack of harm-reducing consumption sites hinder trust and engagement with services for those using drugs. Moreover, when people are visibly injecting on the streets, public parks, or shop and restaurant toilets, it damages relationships with the local community and increases the risk of stigmatisation.
Despite the growing body of international evidence on the effectiveness of OPCs, UK government policy is one of a ‘punitive’ approach to drug use, rejecting proposals of medical, academic and third sector stakeholders to introduce OPC pilots on legal grounds. While there is growing support for OPCs among the public and service providers in UK cities with pressing problems and record levels of drug-related deaths, the 2021 national 10-year drug strategy does not include plans to open OPCs. The only OPC in the UK which had opened in 2020 in Glasgow, while tolerated by police and legal enforcement, had to close after nine months in operation due to a lack of funding and an unsustainable staffing model.
The subsequent webinar discussion, including policymakers and practitioners from across health, social care, housing and drug services, reflected on their own practice and picked up on themes from previous webinars on how services can support people in their decisions about care and treatment without closing doors behind them. It was mentioned that services sometimes create further barriers to service engagement by having people discard possessions, prohibiting substance use in hostels/shelters, or failing to engage with the trauma and decisions behind someone’s disengaging from services. Such barriers may put people off seeking support, encouraging them to remain in “situations they can’t get out”.
Low barrier intervention and places where people can use drugs in a safe space may thus provide more choice and opportunities to reach people and provide access to services and interventions that prevent drug-related harm, injuries, and deaths. Low threshold services may prove particularly effective for marginalised populations hidden from service support, due to ‘hidden disabilities’, with complex intersectional or multiple disadvantage who are particularly vulnerable to lack of trust in services.
The latter will be further investigated in an upcoming systematic review I’m conducting exploring the help-seeking behaviour for women who are homeless and experience multiple needs and how low-threshold services and health facilities may provide more opportunities to reach out. The project is part of my doctoral studies, which have been awarded Doctoral funding from the NIHR School for Social Care Research.
Carolin Hess is a PhD student at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London.
The Homelessness series at King’s College London is part of the Homelessness Research Programme based at the NIHR Policy Research Unit in Health and Social Care Workforce. Please contact Jess Harris if you are interested in speaking about your research or innovative practice at this series.