France Is Testing Safe Drug Consumption Rooms for Opioid Addicts

(Bloomberg Businessweek) -- Before October 2016, Marie used crack and opioids in public bathrooms around Paris. Waiting to get into the stalls, which were frequently littered with syringes, the 27-year-old student feared being arrested or attacked by fellow users. Inside, she witnessed thefts, rapes, and prostitution. Now she injects skénan, a morphine painkiller that she buys on the black market, in a regulated clinic under the supervision of medical staff.

Today, Marie, who requested a pseudonym to protect her anonymity, is among the 160 or so daily visitors at Paris’s supervised consumption room, close to the Gare du Nord train station in the north of the city. Most inject illegal opioid medicines and inhale crack; others take cocaine or heroin. Users bring their own drugs (police won’t charge them with personal possession in the surrounding streets), while staff members issue clean needles, send drug samples to labs to check purity, and intervene in emergencies. The facility also has a lounge, library, and arts space. “This is a place of real social reintegration and warmth,” Marie says. “We are a strong marginal community.”

Paris’s consumption room is one of two such drug centers in France authorized under a six-year national trial that began in 2016. More than 100 such sites already exist in 10 European countries, Canada, and Australia. Proponents around the world, including in Britain and the U.S., are pushing to open more safe consumption rooms, also known as supervised injection sites. They’re part of a global movement to divert drug users from criminal penalties that, critics argue, are ineffective, costly to governments, and may unfairly punish those who often pose little danger to society.

Staff and users say the Paris center is already preventing potential fatalities and delivering much-needed health care. In the first year, the team provided more than 800 treatments, including dressing wounds and directing users to opioid substitutes such as methadone, and screened more than 100 people for infectious diseases. Visitors were rushed to an adjacent hospital or given emergency medical care on-site on average once every three weeks. An academic study of the French sites’ effectiveness is under way, but other data, including research cited by the American Medical Association, suggest the facilities can prevent overdose deaths by issuing instant-acting opioid antidotes such as naloxone, as well as promote safe injecting and reduce syringe-transmitted diseases such as HIV and hepatitis. After Canada’s first center opened in Vancouver in 2003, one study found that fatal overdoses in the surrounding area dropped 35% in the following two years.

Some Paris users say they’ve reduced their intake or stopped using hard drugs like heroin altogether after visiting the consumption room, but drug diversion isn’t in the center’s mission. While staff put users in touch with withdrawal services if requested, their focus is on making consumption safer rather than trying to eradicate it. Ruth Gozlan, a health adviser in the French prime minister’s office, says that “we can’t expect the rooms to solve everything,” and that they must be part of a broader set of responses.

Besides medical support, the Paris site’s staff helps people apply for emergency accommodation and social welfare services. More than half of the users there are homeless and formerly injected openly on the streets, in bathrooms, and in parking lots. Six months after the city’s consumption room opened, there were 60% fewer syringes left around the neighborhood, although drug use in public places remains a problem. France’s second center, 300 miles east of Paris in Strasbourg, will soon create a 24-hour housing unit as part of an effort to address more of the risk factors for drug abuse.

Alexandra Cordebard, a Paris district mayor and a proponent of supervised consumption, whose constituency encompasses the Paris site, says she’s confident that a string of new centers will be approved around France following municipal elections in March. Two other cities, Bordeaux and Marseille, have indicated they could authorize sites this year, but the mayor of Marseille backpedaled last month after encountering opposition from local residents, French media reported.

“There are political obstacles,” Cordebard says. A group called Residents of the Lariboisière Gare du Nord Neighborhood has lobbied for the site to be moved to a nonresidential district, saying it attracts a “tide of drug addicts and dealers” that ruins their businesses and community. Staff say that local opposition to the room is fading as people learn of its benefits, but even supporters remain unhappy with the nuisance in nearby streets, which can include screaming, fighting, and public nudity.

Since France authorized its pilot program, several other countries, including Ireland and Iceland, have announced plans to implement the supervised injection model. As the U.S. confronts its own epidemic of drug-related deaths and incarceration, officials in several cities, including New York, San Francisco, and Seattle, have explored creating injection sites, despite federal opposition. After the Philadelphia nonprofit Safehouse stepped up plans to open the country’s first such site in January, the Department of Justice filed a lawsuit seeking to block it. U.S. Attorney William McSwain said the plans violated federal law and risked “normalizing the use of deadly drugs.” Safehouse is fighting the suit in federal court and still hopes to open later this year, pending the judge’s decision and a planning battle with neighbors.

The Paris facility, which can serve as many as 16 people at a time, can’t fully satisfy the demand in a city of more than 2 million. “There is far too much need, and we can’t accept everybody,” says Céline Debaulieu, who manages the room for French charity Gaïa with the help of state and city funding. The center will extend opening hours in the fall, and Paris officials have said they want to see as many as four similar centers around the city, something that will require local politicians’ approval.

The results of the ongoing academic study will help to decide the consumption sites’ future once the trial authorization expires in 2022. France’s Parliament may then vote on whether to approve the sites permanently. Debaulieu is optimistic that politicians and citizens can be won over. “For decades we have led a crackdown with the war against drugs and drug users,” she says. “It doesn’t work, and people go on using in ever worse conditions. There are other responses.”

Romain, a communications consultant in his 30s, had taken heroin for more than a decade before he first learned how to limit needle injuries at the Paris center. He previously injected cocktails of heroin and cocaine, called speedballs, in the consumption room, but has since transitioned to a safer opioid substitute alongside occasional crack. More than once before he started regularly visiting the consumption room, he came close to a fatal overdose.

Romain recognizes that it remains difficult for some people to accept state-authorized drug use, but he believes Paris’s site plays an important role. “Many here feel like they are the trash of society,” he says. “But since the room, there is a place they can come, people say hello to them, and nobody treats them like they are monsters.”

To contact the editor responsible for this story: Jillian Goodman at jgoodman74@bloomberg.net

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