Overdose prevention sites: a missing part of caring compassionately for people who use drugs

There are few towns and city centres anywhere in the country that are not touched by drug use. Stray off the high street, and it doesn’t take long to find dark alleys filled with evidence of troubled lives being played out on them.

Abandoned sleeping bags, discarded injecting equipment, and human excrement left as evidence of deeply personal acts being played out among industrial waste bins and rodents.

Local residents share their disgust and frustration on community forums, in local newspapers and to the police.

Despite protestations, little appears to change, beyond the problem being shifted to a street elsewhere in response to increased police patrols.

Background

The weight of the problem is played out in annual figures published by the Office for National Statistics (2021). In 2020, a total of 4,561 people in England and Wales died due to drug poisoning; this is the highest number since records began in 1993, increasing by 60% in a single decade.

Opiates, which are often injected, account for around half of all recorded deaths. It is speculated in the same report that at least part of the upsurge in deaths can be linked to an increased use of gabapentinoids alongside opiates and the associated risk of respiratory depression.

As these are increasingly difficult to obtain from legitimate sources, they are often sourced from the ‘dark web’. As a result, it is impossible for those who use them to predict their potency or to indeed know if they contain an altogether different, riskier substance.

A new strategy

This month (December) sees the launch of the government’s new 10-year drugs strategy (Home Office, 2021a).

Set against a backdrop of a decade of significant cuts to funding, the news of an injection of cash for treatment services has been well received by the substance use healthcare community.

It remains clear that the government’s position with regards to the purpose of that funding is a total emphasis on achieving and maintaining complete abstinence from all substance use, also known as the ‘recovery agenda’.

It is widely accepted in the field that while people can and do recover, this position is harmful, because it excludes and perpetuates stigma against people who for a variety of reasons, including complex mental health and social factors, are unable to engage with a goal of abstinence.