Mon December 16, 2013
Denmark's 'Fix Rooms' Give Drug Users A Safe Haven
Originally published on Mon December 16, 2013 6:06 pm
Martin Jensen smokes heroin.
In the past, when this gaunt-faced Dane had to hide in elevators and stairwells to feed his addiction, he probably wouldn't have been so willing to advertise that fact. Back then, his days were spent scouring Copenhagen — mostly the notorious Vesterbro neighborhood — for places to smoke, out of sight of the police and children. He says he never felt safe, understandably, given what happened to one of his friends.
"My friend, he [was trying to] get some sleep, when he had smoked," Jensen recalls.
That's when an arsonist stopped by.
"They put gasoline here, on top of his head. And put on fire and just let him ..." Jensen trails off, though he notes the friend survived.
All this is by way of explaining why, for Jensen, this year has meant the difference between "hell" and "heaven." It's not that he's quit — though he is taking methadone, which has helped him cut back. It's that now he has a place to come and take his drugs in peace.
In June 2012, the Danish Parliament passed legislation making it possible for municipalities to open so-called drug consumption rooms (known in Denmark as "fix rooms" and elsewhere, more specifically, as supervised injection sites) — facilities where adults with serious addictions can bring their illegal drugs and take them, legally, under the watchful eye of a nurse. Within four months, Copenhagen had opened the first. Two other cities have since followed suit.
Denmark is not the first country to try out the DCR concept — though it is the first in almost a decade and the Danish launch rate has been exceptional. The initial wave of DCRs opened in the 1990s in Switzerland, Germany and the Netherlands. In 2003, Vancouver became the first (and still only) North American city to have one, and a handful of other countries came onboard around the same time. Since then, there has been a bit of a lull.
But a growing body of evidence suggests that DCRs can save lives and reduce the public nuisance of open drug use without increasing crime. The DCR strategy seems to be, once again, getting attention — even in the U.S., where places like Seattle, San Francisco and New Mexico are starting to consider the idea more seriously.
"It's very similar to the early days of needle exchange in the U.S., where there was a lot of opposition," explains Laura Thomas with the New York-based Drug Policy Alliance. "Pretty much all of that opposition has now faded away and a lot of people acknowledge they were wrong to oppose it: that it didn't increase drug use, that it didn't do a lot of things that people feared. But at the same time, there's a very human cost to a slow learning curve."
So far, Copenhagen's two DCRs (a second one opened in August) have hosted 1,800 unique users, including people who smoke and inject heroin and cocaine.
Rasmus Christansen, manager at one of the Copenhagen DCRs, explains how the process works. On their first visit, drug users register anonymously, using a nickname and the year of birth.
"But it's not like East German border control to get in," he says. "We want people to get [into the rooms] pretty fast ... so we can get drug consumption out of the streets."
Inside, to the left, behind a huge window, is cluster of smokers with improvised pipes, enveloped in haze. To the right is a long, stainless steel table where several people sit, injecting themselves with heroin, cocaine or both. Some finish and leave quietly. A few slump over the table, asleep. One man gets up and paces frantically back and forth, swearing and shouting. In the middle of it all, sits a nurse in street clothes, calmly taking in the scene.
Every day, these nurses witness up to 800 injections. During this first year, 135 people have overdosed; none of them have died.
That is probably the largest measure of success, Christansen says, given Denmark's record-high 285 drug-related deaths just two years ago (part of a larger global trend).
Christansen cites another achievement: In one year, the DCR has helped these hard-to-reach users make more than 1,000 contacts with the broader welfare system to get help with things like housing and medical care.
"We are getting to know them; we are building up relations with them," he says. "And when we are building up relations, they will also come to us when they have problems."
The program is changing the mind of former skeptics, like Deputy Police Inspector Kaj Lykke Majlund.
"We used to think police could solve all these problems alone. But that doesn't work," he says. "We have to understand that drug users — the severely addicted — they need help. They need treatment, not punishment."
To that end, Majlund has established a 2-square-mile "free zone" in the Vesterbro neighborhood where officers don't arrest adults for possession — though dealing is a different story.
Of course not all Danes support DCRs. Critics, like Conservative People's Party member Tom Behnke, say the "fix rooms" condone criminal activity. But even he says the bigger problem is that DCRs give Denmark an excuse not to do more to fix a broken treatment system.
"I have met people who have struggled for years to come into treatment," he says, adding that "it's a lot easier to live on the streets as a drug-addicted person."
And it's true, while staff members are friendly and chatty, they do not actively push treatment or even ask very many questions. So it may seem counterintuitive that at least one case study suggests DCRs actually increase the rate of admission into detoxification programs.
But one heroin addict who gives his name as Jimmy says that doesn't surprise him at all.
"I reckon this helps people because ... [users] can see normal people around and how things work, and that normal people have fun too, at work, and that life is not just drugs," he says. "If they see a little bit of that close to them ... I don't think that encourages them to continue using drugs."
AUDIE CORNISH, HOST:
The fall has been full of news about drugs, from communities decriminalizing marijuana to Toronto's mayor admitting he smoked crack cocaine. Meanwhile, Denmark has been quietly trying out a new approach to its own drug-related problems.
Sidsel Overgaard has that story.
MARTIN JENSEN: From hell to heaven.
SIDSEL OVERGAARD, BYLINE: Hell to heaven, that's the way Martin Jensen describes what this year has been like for him. Jensen smokes heroin. He used to do it in public, wherever he could - elevators, stairwells, the train station.
JENSEN: Scandinavian hotels...
OVERGAARD: He hated the idea of being seen by kids or harassed by police.
JENSEN: I don't have that feeling anymore because I can come here and smoke it.
OVERGAARD: Here is one of Copenhagen's two new Drug Consumption Rooms or DCRs, places where adults with addictions can bring illegal drugs and take them legally.
RASMUS CHRISTANSEN: The first time you come, you are making what we call an anonymous registration.
OVERGAARD: Rasmus Christansen is the manager.
CHRISTANSEN: So you are telling me a nickname, you are telling me a year of birth, but it's not like East German border control to get in. We want people to get pretty fast into the rooms, so where we can get drug consumption out of the streets.
OVERGAARD: The room itself is divided into two sections. On one side, smokers stand behind a glass wall, filling their enclosure with haze from improvised pipes. On the other side, a handful of people sit along a stainless steel table, injecting themselves with heroin, cocaine or both. In the middle of it all sits a nurse in street clothes, taking in the scene. Every day, these nurses witness between four and 800 injections; during this first year, 135 people have OD'd.
CHRISTANSEN: And in all the cases, all the situations, our nurses have done the job and nobody has died in the room.
OVERGAARD: Given that two years ago Denmark saw a record high number of overdose deaths, that says Christansen is a sign of success. Another is that these hard-to-reach users have made more than a thousand contacts with the broader social system to get help with things like housing and healthcare.
CHRISTANSEN: We are getting to know them. We are building up relations with them. And when we are building up relations, they will also come to us when they have problems.
OVERGAARD: Denmark is not the first place to try DCRs - eight other countries have them, most established over a decade ago. These can be tricky places to gather data, but there is a growing body of evidence suggesting that DCRs can save lives, reduce risky behavior and may even increase the chances of getting people into treatment. And that is leading other cities, including some in the U.S., to give the idea more serious consideration.
And where does the law stand on all this?
KAJ LYKKE MAJLUND: (Through Translator) If you asked me 20 years ago, I would probably have said this will never work.
OVERGAARD: With his handlebar mustache, Deputy Police Inspector Kaj Lykke Majlund could have walked straight out of a Western. But his policing philosophies are decidedly more modern.
MAJLUND: (Through Translator) We used to think police could solve all these problems alone, but that doesn't work. We have to solve this together. And we have to understand that drug users - the severely addicted - they need help. They need treatment, not punishment.
OVERGAARD: To that end, Majlund has established a two-square mile free zone in this Vesterbro neighborhood where officers don't arrest adults for possession. Dealing is a different story.
Of course, not all Danes support DCRs. Critics, like Conservative People's Party member Tom Behnke, say they condone criminal activity. But even he says the bigger problem is that DCRs give Denmark an excuse not to do more to fix a broken treatment system.
TOM BEHNKE: (Through Translator) I have met people who've struggled for years to get treatment. And it's so hard to get treatment in Denmark that it's a lot easier to live on the streets as a drug-addicted person.
OVERGAARD: Even proponents caution that DCRs are, quote, "not a Danish fairytale" and there remains work to be done. Still, the concept has been deemed enough of a success that other cities, like Aarhus, are jumping on board.
(SOUNDBITE OF CROWD SINGING)
OVERGAARD: As politicians and advocates gathered here to cut the ribbon on the country's newest DCR just last month, their choice of hymn may have summed it up best.
(SOUNDBITE OF A CROWD SINGING IN FOREIGN LANGUAGE)
OVERGAARD: If there were not anything to fight for, the song went, what would our purpose be?
For NPR news, I'm Sidsel Overgaard in Denmark. Transcript provided by NPR, Copyright NPR.