In a lime-green room behind Geneva’s main train station, a man is slumped over a chair, the heroin he has just injected taking effect. Around him, a handful of others are in the process of reaching that same state of bliss: administering bands to their arms to produce a vein, unpeeling plastic-clad syringes, exhaling as the needle goes in. Some will return later today – maybe a handful of times – to get their hit at one of the oldest supervised drug consumption rooms in the world, where users can take their own illicit substances without fear of prosecution.
A state-provided supply of safe injecting equipment, along with tea, croissants and hot showers, may seem an unusual way to handle a citywide drug epidemic, but Geneva’s Quai 9 facility – which turned 20 this year – may well provide a blueprint for Britain. In September, it was announced that the UK’s first legal consumption room is to open in Glasgow, a city in a country with higher fatal overdose rates than anywhere in Europe; deaths caused by drug poisoning in Scotland are 2.7 times higher than the UK average. First proposed seven years ago, the site – five minutes from the city centre’s main drag, by a Morrison’s and a pram shop – will cost £7m to build.
Kirsten Horsburgh, chief executive of the Scottish Drugs Forum, says she is “delighted” by this “massive, massive achievement over many years” for health leaders and city officials in Glasgow, “who should be applauded for their tenacity and resilience in trying to push this forward”.
Studies of the approximately 120 facilities worldwide appear positive: Vancouver’s has been “associated with improved health outcomes” such as reducing HIV and hepatitis C transmission by providing clean needles; Sydney’s, which opened in 2001, noted a reduction in ambulance callouts. A 2011 paper found that consumption rooms reduced fatal overdose rates by a third, while a paper published by French researchers last year showed that emergency department visits and crime dropped once they had been introduced, too.
Its proponents argue that consumption rooms not only provide better outcomes for users’ health, but for the public – and the public purse. Reduced illnesses and overdoses means fewer people needing medical care; a 2021 government review found that the societal cost of drug misuse in England and Wales is £20bn annually, yet that for every £1 spent on harm reduction and treatment, there is a fourfold return on investment via alleviated pressure on health and justice services.
“It’s really hard to find people who are against drug consumption rooms,” Horsburgh says, adding that if one were to open close to her home, she would “welcome it”.
Of course, not everyone is on side. The idea seems mind-boggling to many, even if consumption rooms have been around for close to four decades (the first opened in Bern, Switzerland, in 1986). After a five-year trial, a small group of vocal protesters expressed their fury at the recent opening of the medically supervised injecting room (MSIR) in Melbourne, sharing photos of addicts lying in the street outside in a chemically induced stupor. (Its location, next to a primary school, has been a key source of ire.)
Horsburgh appreciates that “there’s always the mystique around these types of services. If you’ve never been familiar with them before, if you’ve never visited a facility like this, it’s really difficult to understand how it operates, what it does, what outcomes can be for people.” As such, she thinks the most important next step for Glasgow – along with ensuring the facility doesn’t enter a protracted consultation period that derails it from its opening, projected to be within a matter of months – is a “really good consultation with the neighbours, because while a lot of people may be supportive of services for people who use drugs, quite often it’s then the ‘well, not in my back yard’ stuff.”
Quai 9 appeared to have cracked that. Run by Première Ligne (a nonprofit focusing on drug harm reduction), with 4m Swiss francs (about £3.6m) in funding from the Canton of Geneva over the past year, it has become a fundamental part of the city’s makeup. Its central location (considered a necessity for consumption rooms, so they are based where excessive drug use is) and lurid lime-green exterior are not intended to hide its identity, but signpost it to those in need – something that requires close cooperation between local businesses and residents, police, healthcare and housing facilities. It is seen as mutually beneficial: reducing the number of addicts who would otherwise have been consuming drugs on the street or on doorsteps, potentially in large groups, and leaving drug paraphernalia on the floor.
The relationship between the centre and locals, and the fact that, to date, there has not been a lethal overdose at Quai 9, are “a matter of pride … It’s nice to think that good decisions were taken in Geneva”, says Ruth Dreifuss, a former Swiss president and ex-chair of the Global Commission on Drug Policy (which includes a handful of world leaders, Richard Branson and Nick Clegg).
Dreifuss, who was elected to the Swiss cabinet in the early 1990s – when the country was in the grip of the HIV crisis – is adamant that “drug use is a health problem”, and that the “illusion” that it is a social ill that can be dealt with by “repressive” criminal laws alone “really has to stop, and to be replaced by pragmatic answers to the needs of the people who use drugs”. She believes that penalising users of illicit substances serves only to potentially worsen their health and social footing when they are forced through the justice system for something that could be overseen safely.
Yet in recent months, Quai 9 has been hit hard by new challenges. Geneva, along with other cities in Switzerland, is facing a crack cocaine epidemic, with cheap “rocks” available for as little as £9. Its presence on the streets has become so strong that Quai 9 has introduced a smoking room in its facility, with plastic dividers to help contain the fumes. “You cannot predict what’s going to be the next step,” says Thomas Herquel, Première Ligne’s director. “The only thing I know is that I don’t know.”
Around the world, shifting drug use habits have unseated what appeared to be permissive drug law success stories. Portugal decriminalised consumption of all drugs for personal use in 2001; it technically remains against the law, but instead of prison, users are registered by police and referred for help (attendance is voluntary). In the early days, it appeared to be an unequivocal success: HIV transmission rates via syringes dropped, as did the number of overdoses, and prison populations were down 16.5% by 2008. But a recent national survey shows illicit drug use up from 7.8% to 12.8% between 2001 and 2022; overdose rates are at a 12-year high, having nearly doubled in Lisbon between 2019 and 2023 (this is still below the European average). In Porto, there has been a 24% jump in drug paraphernalia being collected from city streets in the year to 2022, with this year set to outpace that. Crimes such as robbery in public spaces rose 14% from 2021 to 2022, which police have in part blamed on the rise in drug use.
Drug reforms in Oregon and Canada have also failed to live up to their promises. Measure 110, introduced in the US state three years ago to limit the role of law enforcement in drug use, has resulted in rising overdoses and delays in funding for treatment; a statewide nonpartisan poll in May found that more than 60% of residents believe the policy has worsened levels of addiction, crime and homelessness. In British Columbia, decriminalisation efforts amid an opioid crisis have been called a “failed experiment” by the Conservative party leader, Pierre Poilievre.
Dr Nico Clark led the establishment of the MSIR in Melbourne, worked on drug treatment efforts at the World Health Organization and is now head of addiction medicine at Royal Melbourne hospital. He remains optimistic that “if you redesign [drug] services in a way that works for [drug users], then you have this combined benefit of helping people stay alive, but also helping them change their lives and improve their lives”. He points to figures showing a drop in ambulance callouts in the area around the centre once it opened, and data modelling that estimates more than 6,000 overdoses have since been successfully managed, and 63 lives saved.
Its location next to a community health centre has, he says, made it possible to give further treatment quickly, including dental services for those whose drug use had severely damaged their teeth, as “not only does it cause chronic pain, but it severely limits their opportunity to re-engage with society … We had so many examples of people who transformed their lives before our eyes.” Opposition, he adds, is based less on centres’ efficacy, more on the “huge stigma” that drug-taking retains. “It’s confronting for us as a society… we think sometimes the only path is to kind of have some kind of authoritarian response or take [drug users] away.”
For Keith Humphreys, a professor of psychiatry and behavioural sciences at Stanford University, it is hard to conclude whether consumption rooms – which “have become a battleground in the culture wars” – are really the answer to rising global drug use rates. Evidence to date is “methodologically weak”, Humphreys says. “Supervised drug consumption sites may make a small difference or they may not, especially when compared with better evidenced services [such as treatment with medications and counselling, or provision of naloxone, used to reverse the effects of an opioid overdose] that could be supported with the same money.”
Increasingly, how well consumption rooms work comes down to what “working” looks like. Do reduced ambulance callouts and less antisocial behaviour constitute success? Or does that only come with a drop in drug use and crime rates? Is the main goal simply keeping people who would be injecting anyway off the streets?
Vincent*, who has been visiting Quai 9 for six years, is that dichotomy made flesh. “At the beginning I was only smoking heroin. After four or five months, I started injecting, and started mixing medication [taking other substances], which made things feel much stronger,” he tells me. “It makes me calm, but at the same time, it’s a false calm, because I’m very nervous, stressed and anxious.” Inside his mind is a prison, he says, from which he is unable to escape.
He is grateful for the centre, to “have a safe place to smoke and inject, we don’t have to use drugs outside people’s houses, [or] on the streets”. But he also attends five times a day, his addiction showing no signs of slowing. Vincent aspires to have “a beautiful family”, he says, smiling; “to be given a chance”. Quai 9 may be the safest place he can achieve that. But there is no guarantee.
*Name has been changed
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