Public injection rooms in Norway – a happy compromise?

1. Public injection rooms in Norway– a happy compromise? Hilgunn Olsen Norwegian Institute for Alcohol and Drug Research (SIRUS)

2. OutlineFacts: official aims, criteria for use, number of registered users, description of the facility.Why now?Target group’s expectations to the injection facilityDilemmasConcluding remarks

3. Norwegian Safe Injection Sites (SIF)Facts First SIF opened in Oslo February 1., 2005 All municipalities can apply to join the trial scheme (2005-2008), but only Oslo has applied. Possession of one user dose of heroin is excepted from punishment (change of the law). 380 users registered (October 2006). Capacity problems – new clients refused almost every day. Opening hours: 10:00-16:00 every day

4. Evaluation of the trial scheme SIRUS(Astrid Skretting and Hilgunn Olsen) Report 2007 • Focus group interviews with target group on expectations to the SIF (Feb 2005) • Observations (2005-2007) • Survey: client satisfaction (2005 and 2007) • Access to registered data of the clients • In depth interviews and focus group interviews with personell (end of 2006) - Focus group interviews with clients on ”dignity” connected to the SIF (2007)

5. Description of the facility A ”specilalised consumption room” (Hedrich 2004) – not sited next door to other services. Four people can inject at the same time, two personell inside the room. Users bring their own heroin dose, shown to the staff on arrival. Clients get: • a syringe • needles • Alcotip disinfection swab • sterilised water • filter • ascorbin acid • heating utensil

6. Official aims • Contribute to greater dignity for heavily dependent drug users • Provide more possibility of contact and talks between drug misusers and the health/social services • Help to prevent disease and infection • Reduse the number of overdoses and overdose deaths

7. Criterias for use: • Be a heavily dependent user of heroin • Be over 18 years of age • Bring only one user dose of heroin

8. Why now?Official drug policy in Norway steadfastly to the vision of a drug free society.Skretting (2005):High incidence of overdose deathtsRapid increase in number of injecting drug usersGenerally poor state of health of drug users- Politicians need to show that they can act, and drugs offer a particularly conductive area in that sense. A rare oppurtunity to demonstrate vigour and determination, in a more or less desperate attempt to contain the growing problem. SIF – a relatively simple measure to organise, realtively affordable.

9. Target group’s expectations to the SIF Focus group interviews of 18 residents of Oslo’s low treshold shelters, a few days into the lifetime of the facility. On the criteria for use. • Resistance to the detailed information required for registration • Why the 18 year limit? • What is a ”user dose”? • Why only heroin, while other substances are injected as well? • What is a heavily dependent heroin user?

10. Dilemmas • Control vs necessity • The position of the police • Sanitation? • Unconditional help vs encouraging a harmful habit • Double message

11. Concluding remarks • To early to say if or in which way the SIF can benefit the Norwegian society. The Norwegian trial scheme is limited; will give limited knowledge to this question. • Psychological tiredness seem to be an important element of the evaluation of the SIF, not thought of beforehand. The biggest problem so far in the running of the SIF in Oslo is lack of personell. • Is it fair to proceed with a service which only benefits a small minority of drug users? Who needs the SIF most, and are those the ones registered as clients of the service? • The SIF is not a magic spell. There are clear limits to what a SIF can do, either for individuals or the community as as whole. • The project is a compromise: all parts (government, personell, drug users) partly disagree with the ”arrangement” of the SIF. The only way it could be accepted.