Addiction, Health, Behaviour Change | CGL

Denmark: leading the way in harm reduction practice

man in yellow coat picking up litter

Denmark: leading the way in harm reduction practice

23 March 2018

Since the publication of the ONS data showing an inexorable rise in drug-related deaths, there has rightly been a focus on how to ensure that treatment systems are effectively balanced. This means any service user can expect to receive the best harm reduction interventions as required, while also having the opportunity to access all other interventions and support to eventually leave services healthy and well.

More recently, CGL has explored some of the ‘new’ innovations such as Drug Consumption Rooms and Heroin-Assisted Treatment/Diamorphine Therapy - services that are not currently available in the UK, for a range of different reasons. As a result of this interest I have been asked to speak on these subjects, but was always acutely aware that I had never even seen a DCR, let alone understanding the complex mechanics of delivering such a service.

My search for more information led me to the HiT conference (which I would recommend to anyone working in the field), where I was fortunate to hear from Stephen Malloy as one of the speakers. He is the Vice Chair of the European Network of People Who Use Drugs (EuroNPUD) and was pivotal in delivering the world’s first national take-home naloxone programme as part of his previous role at the Scottish Drugs Forum. As someone who is incredibly passionate about harm reduction and preventing drug-related deaths, we naturally had a lot to talk about.

Stephen suggested I take a trip to Copenhagen, a city pro-actively tackling the challenge of engaging those outside of treatment services, as well as having a union of people who are active in their drug use.

After some conversation around Drug Consumption Rooms and Heroin Assisted Treatment, Stephen suggested I take a trip to Copenhagen, a city pro-actively tackling the challenge of engaging those outside of treatment services, as well as having a union of people who are active in their drug use.

So at the beginning of March, following an invitation from brugerforeningen, I flew to Copenhagen and not only learnt about Denmark’s sensible and effective approach to harm reduction, but also met some truly inspirational people who challenged many of my preconceptions around drug use and the community that surrounds it.

memorial

My introduction to the Danish Drug Users’ Union (brugerforeningen)

The entire trip, including visits to the commissioned services, was coordinated by the Drug Users’ Union. In Denmark, as well as many other European countries, people who use drugs (PWUD) come together as a community and form an independent self-organised, self-directed entity (a union, a network) in its own right. The Danish Drug Users’ Union is a key stakeholder group – not, by any means, a passive recipient of services.

Getting to know members of the Union made me realise that PWUD are the biggest stakeholders and subject matter experts in our community and we could be learning a lot more from this group if we started to think differently. I began to understand that CGL as an organisation, together with our service users and the wider PWUD group, should be part of one community with a shared interest.

copenhagen needle patrol

Solutions driven by the PWUD community

The Needle Syringe Patrol in Copenhagen is a great example of PWUD leading initiatives and creating new solutions.

The programme has been running since 1997 and is wholly managed by volunteers, including people actively using drugs, from the Drug Users’ Union. It has been led since its inception by Joergen Kjaer, an inspirational man who is passionate about protecting the rights of the drug-using community. The group removes used syringes, needles and other equipment from the streets, with daily patrols in the Vesterbro area, where there have been particular issues with discarded paraphernalia in the past. The initiative has transformed the neighbourhood and is loved by the community.

H17 and Skyen - Copenhagen drug consumption facilities

As part of my trip I visited H17, a purpose-built safer drug consumption facility that cost approximately 18m Euros. The atmosphere, for such a big space, was warm. Leading my tour was Dr Henrik Thiesen a GP who works at H17 and has been involved in the community for many years. His medical team includes another GP and two senior nurses with over 14 years’ experience in frontline street-level health outreach. The ambition of the service was simply articulated by one member of the team: “to bring the street inside”. Once this is achieved there’s an opportunity to provide a safe space, with access to drug-testing for people (not ‘testing people for drugs’), and fundamental physical and mental health care.

The ambition of the service was simply articulated by one member of the team: “to bring the street inside”.

I was impressed and inspired by Henrik’s presentation on the history of drug consumption rooms and the journey of the community. He showed a clear sense of duty, with a fearless approach to getting things done.

I also had the opportunity to visit the Men’s Hostel (Mændenes Hjem) which had the attached Skyen Drug consumption facility and was shown around by the manager Ivan Christensen. I saw the DCR in action and, trying my best not to intrude, had the opportunity to speak with people using the facility to inject heroin, as well as smoke cocaine. The milieu was very lively, and there was no aggression or antisocial behaviour. On the contrary, people waited patiently to use the facility in turn, and listened to staff when asked respectfully to settle down. Carina, the Social Worker managing the active use space at the time I visited, was clearly doing a great job of helping things run smoothly.

drug consumption room

Challenging preconceptions around drug use

Complementing the foundations of treatment such as replacement therapy and psychosocial support, the harm reduction provision in Copenhagen represents a refreshing and innovative approach to the use of illegal substances. If you use heroin or other drugs in Copenhagen you can receive support and access to a state-of-the-art facility. You are not criminalised, you are treated as an equal. This is perhaps best illustrated by the fact that H17 is situated directly opposite a large police station, and the staff there are very experienced and recognise the benefits of H17, Skyen and the managed open-air spaces for people to use drugs.

Denmark appears to have recognised that while ambition must be there, sometimes the best that can be offered is survival, and that is worthwhile in itself.

two men talking

I was truly humbled by my experience in Copenhagen, and I can’t thank the Drug Users’ Union enough for the hospitality they showed me, culminating in us all sharing a meal at the Union Headquarters which also serves as a drop-in for anyone who may need support. 

The visit taught me that dependence on an illegal drug does not always lead to chaos. I realised that the people who use drugs, when we start to think a bit differently, can not only make a hugely valuable contribution to our community, but they can lead.

I would like to say a big thank you to Stephen Malloy and EuroNPUD for facilitating this trip, Joergen and brugerforeningen (BF) for hosting me and organising my itinerary, Heinrik for showing me around Copenhagen’s fantastic drug consumption facility, and Ivan Christensen and the team at Skyen. Last but not least thanks to Karsten of BF who very kindly chauffeured me from place to place during the trip.