There’s been a lot of discussion lately, in the harm reduction movement and the media, about something with a lot of different names. The Collins dictionary, for example, lists only “shooting gallery,” as “[slang] a house where heroin addicts inject themselves.” Harm reductionists variously prefer “safer injection facilities” (SIFs); “safer consumption sites” (SCS), “overdose prevention sites;” or the one I choose to use for this article: “drug users’ safe spaces” (DUSS).

“There’s no heaven on earth but it’s got to be better than the hell we’ve all been through the last few years.”

Their public-health benefits have been proven, and activists in a several US cities are fighting to establish the first legal one in the country. “There’s no heaven on earth,” says Jackson. “But it’s got to be better than the hell we’ve all been through the last few years.”

But the semantic differences I mentioned make clear that we’re going to have to come up with our own definitions for what we mean when we talk about safer places for people to use drugs. What are they exactly, and how should they work in practice?

The Urban Survivors Union (USU)—a national network of drug users, with chapters and partner organizations dedicated to drug users’ safety and well-being—is one organization taking on this work. As Louise Vincent, the USU’s executive director, has said, “a safe place for drug users can mean the difference between life and death.”

Reggie Thomas, USU’s Seattle chapter president, says, “A safe place for drug users means an area with cultural competency run by and for drug users to look after their brothers and sisters.”

And Mona Bennett, an outreach worker at Atlanta Harm Reduction Coalition, says that such a place should be “under the police radar, staffed by culturally competent [people], and connected to the community, with an ample amount of supplies for injection and smoking [and] with an incredible amount of love that is both peaceful and lively.”

Based on these ideas, and on many discussions with my fellow drug users, I suggest the following reasonable expectations for DUSS:

First and foremost, they must have naloxone/Narcan on site, and people who know how to administer it.

Second, it is also reasonable to expect that this place would have someone staffing it, making sure that everyone is safe, and assisting anyone who needs help.

Third, it’s reasonable to expect a clean and safe space, supplied with all of the injection and smoking equipment you will need to use best practices to stay safer and stop the spread of diseases.

Fourth, it is also reasonable to expect that the space has hours that accommodate drug users’ needs, including a minimum of at least eight hours per day.

With those guidelines established, let’s start defining where and what DUSS are.

Can they be your friend’s house, where everyone goes to party or to get high? If we stick to the reasonable expectations above, it is possible to define those as DUSS. If we define a DUSS in this way, there could already be hundreds if not thousands of DUSS operating (though not legally) across the United States.

But some might argue that you need to meet more than just those reasonable expectations to call yourself a DUSS. For example, you might need much more infrastructure, like scheduling people for shifts, and connecting people to other services. And some groups are doing just that.

For instance, in Toronto, organizers created a massive pop-up tent in a park, assigned people for shifts, and educated drug users on how to safely use.

In Seattle, where I live, there are three underground groups that have each set up safe spaces for people to use drugs. They are vastly different from each other and have completely different policies; they therefore illustrate a diverse range of possibilities for what a DUSS can be.

I’ll call them “Group A,” “Group B,” and “Group C.”

Group A

Group A—made up of 20 to 30 volunteers—has rented a house, and turned it into a place where people can safely use. When I toured their facility six months ago, the space was organized around a stainless steel table in the shape of a crescent moon. This table is a one-of-a-kind design, specifically for this location: A person can stand in the middle of the table and assist people as they use. This table was located in the living room where people could safely inject, along with multiple sharps containers for people to dispose of their syringes.

The bedrooms had been turned into smoking facilities, where people could smoke drugs safely. Volunteer staff members made sure everyone was OK, and helped teach people how to use safely.

The location of this space is not advertised, and they have asked me to keep it anonymous. Their typical clientele seemed to be a middle-class, stable drug users, with lots of people coming on their lunch break and after work.

Group A does not allow drug dealing to happen on the premises, so the clientele must bring their own drugs.

Group B

Group B—a small group of five or six people—has rented a three-bedroom apartment. It contains a long wooden table, on which they’ve placed a piece of stainless steel to create a clean surface. There are couches all around the table for people to be comfortable after they inject. This group also allows people to help each other inject if they’re having trouble.

This group seems to serve much more of a low-income, street-based population of drug users; they do not allow smoking at the apartment, as they feel like that will be an easy way for them to be caught.

To enter, you must know the password; it’s a little like an old speakeasy—only the nature of the “moonshine” is different.

Group C

Group C is run by just one person, with a handful of helpers. It has a small storefront, through which you can go down into a basement and safely inject and smoke drugs. Group C’s space is another kind of membership-only space. It’s physically a much darker area. There are mirrors along the wall, and tables right in front of them, with chairs against the tables, facing the wall. There’s also an old La-Z-Boy chair from which one person can monitor everyone else.

The atmosphere here includes lots of jokes, and everybody’s teasing each other constantly—it reminds me of a barbershop feel. It seems like some people there are just hanging out for hours, chatting and laughing with each other.

Group C seems to be serving approximately 50 people in a week, with at least 20 people per day. It is the most welcoming space I have ever seen. They have a large Bob Marley flag on the ceiling, with music playing at all times. This group is also doing a small needle exchange program for the folks they serve.

“They talk, we die.”

These three examples are underground places; you need to know about them to be able to access them. Should we consider them DUSS? They are following all of the guidelines described above. Along with written policies and procedures about what happens at their space, they also have oxygen tanks to prevent overdoses, epinephrine for allergic reactions, and much more.

It would still be preferable if the legalization of such spaces meant they could be openly available to all who need them. But we can’t just wait for that to happen.

As cities and states debate the merits of DUSS, people are already creating them for themselves—making policies and creating their own best practices without the input of health departments and governments. Their staff members are risking their safety and their freedom to provide a safer space for fellow drug users.

At the International Harm Reduction Conference in Montreal last year, Zoë Dodd of Toronto Harm Reduction Alliance said: “They talk, we die.” She was protesting the fact that Canada has not gone far enough in giving services to drug users. Her words are exactly applicable to DUSS in the United States.

There were an estimated 72,000 overdose fatalities in the US  last year. There was a combined total of zero deaths in all consumption rooms throughout the world.

“I never thought we would ever again allow fellow citizens to die in hundreds of thousands like what happened with AIDS,” says Isaac Jackson. “But here we are. So in that sense these safe-using spaces will be a game-changer.”

Cities, counties, and states will eventually have to engage these programs and services and find ways to work with them. For now, brave drug users are looking after their communities in the only way they can—by giving unconditional love, support and safety.

Photo by Belinda Fewings on Unsplash

The post Safer Consumption Spaces: Three Underground Models appeared first on Filter.

But in the rush to bring attention to stimulants, it’s crucial that we don’t simply jump to decrying a new “epidemic.” Instead, let’s make our strategies more inclusive of the reality that most people are polydrug users.

I’ve seen that first hand as Executive Director of the People’s Harm Reduction Alliance (PHRA), the largest needle exchange in the US. The vast majority of people who use our services use more than one drug. Two-thirds use cocaine or methamphetamine (or both). PHRA is a peer-run organization in the Pacific Northwest established in 2007 in response to the government removing all funding for syringe exchanges (they have since resumed funding). We give out about 7.5 million syringes a year. I’m also the founder of the Seattle chapter of the Urban Survivors’ Union (now the National Drug Users Union).

My own drug use, plus over two decades of working with people who use drugs, leads me to believe it’s crucial that we incorporate services for people who use stimulants into our existing infrastructure for opioids. Here are some do’s and don’ts for doing so.

1. Don’t lean on stereotypes.

A common misconception is that all meth users are white men from sparsely populated rural areas, and that all crack users are black men who live in cities. These myths can have dangerous consequences. For example, when the University District needle exchange program, where I worked, started handing out safer crack kits in 2010, the University Chamber of Commerce contacted me and asked why we were giving out crack pipes when so few black people live in the U District. In fact, the vast majority of people who have accessed our safer crack kits have been younger white men who typically go to the University of Washington. If the University District needle exchange had relied on stereotypes, there wouldn’t be a comprehensive pipe program, and we would have neglected a population of people who needed services.

2. Don’t assume method of use.

Another common mistake is to assume that all drug users are injecting, and forget how many people — especially those who use stimulants — smoke or snort their drugs. Smoking and snorting carry their own unique set of benefits and risks, and these type of drug users can’t be left out of programs, whether syringe exchanges or future Safe Consumption Spaces.

3. Don’t pigeonhole people by their drug use.

Remember that there are very few drug users who use only one particular drug; the vast majority of drug users are polydrug users, and they have been throughout the past decade, in spite of the focus on opioids. In addition to those who intentionally use multiple drugs, many people who use illegal drugs may be unintentional polydrug users. Illegal drugs, including stimulants, are often quite adulterated with other substances, including bath salts, PCP, Epson salts, and fentanyl. When a substances is illegal, the FDA has no authority nor ability to regulate the drug supply. By criminalizing drugs, we have chosen cartels not the FDA to look out for the quality and safety of our drug users. In addition to the potentially fatal consequences of using adulterated drugs, we have noticed more and more mental health crises among those who use adulterated stimulants. Regg Thomas, the chapter president of the Seattle chapter of the Urban Survivors Union says, “ I’m seeing more methamphetamine users struggling with psychotic breaks in a way we have never seen before. This has to be the cut of the drugs. This is why I advocate people test their drugs before taking them. You just want to know what you’re taking.”

In addition to drug testing, there are several other concrete strategies we can implement to engage stimulant users in harm reduction services. Some programs do one or two of these services, but it is very rare to find all of them combined.

1. Do offer people food.

This is one of the simplest, yet most helpful things you can do.  Miso soup or chicken broth seem to be a favorite of many programs, as they are cheap to make and give the person the opportunity to ingest some nutrients. Stimulate users can be up for days without eating or drinking, and so getting their metabolism working again can be really helpful. Plus, the simple process of sitting down to eat provides them with a break or a breather. This can give them the opportunity to make choices from a calmer, less urgent state.

2. Do provide snorting kits and pipes of various types, in addition to syringes, in order to engage stimulant users.

Providing snorting kits and pipes has several benefits. Using damaged pipes increases the likelihood of cuts to the hands and lips, increasing risk of infection. And sharing pipes has the potential to transmit HIV, Hep C and other illnesses. Providing easily accessible, new pipes reduces those risks. Also, whether we’re talking about opioids or stimulants, you get less of the drug by smoking than injecting, and so transitioning to smoking can be a great way to help reduce use for those who have previously injected. Many active injectors switch to smoking when programs provide pipes. In the eight years that we’ve been providing pipes at PHRA, we’ve been able to give out over 80,000.

3. Do incorporate stimulant users into plans for Safe Consumption Spaces.

As we talk about the possibility of the United States developing safe consumption spaces (SCS), most programs are focused on opioid users. Almost all existing consumption rooms have created “chill out zones,” which are designed to monitor users to prevent overdoses. But stimulant users who have just received a large rush likely have no intention of sitting down and being quiet. We can’t push stimulant users into these rooms among opioid users who likely want to relax. However, if you have thoughtful policies that keep stimulant users in mind, safe consumption rooms can be great at connecting people to comprehensive services like health-care and housing. One idea is for SCS to include smoking rooms. PHPA has designed plexiglass stalls with filters that you can smoke in, while someone on the other side of the door can help you with anything you need to know, as well as monitor you in case of an overdose. SCS can also provide a space where people can move around, even dance if they want to dance. Not a quiet room; more like a “busy” room. Some harm reduction programs already provide spaces like that, and it’s very valuable for their folks — people have a place to be where they don’t get arrested, they don’t get targeted.

4. Do provide safe spaces for stimulant users even while we wait for SCS.  

When someone is coming down from a stimulant, they will likely be exhausted after being kept awake for so long by the drugs. The come-down can occur at any hour of the day, and often lead the person to sleep for 12 to 20 hours. They need a safe space to do that. For folks who live on the streets, sleeping is one of the most dangerous acts you can do, as it is time when you’re not alert and not able to defend yourself. Provide space where someone can just sleep, uninterrupted, when they have no place else to go.

5. Do treat people like full human beings.

Rather than thinking about specific “drug treatments,” treating the full person, and their range of physical and mental needs, is the most effective way to prevent needless harms and keep people alive. In my 22 years of working among people who use drugs, I have rarely seen someone change their life in response to being told they’re a bad person. For someone who is in a state of chaotic drug use, it has probably been a long time since they were told they were loved. Providing welcoming services that are inclusive to stimulant users is an important part of combatting the overdose crisis and keeping people alive.

Photo: Safer Snorting Kit via People’s Harm Reduction Alliance

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