A Drug Consumption Room in the Spanish Basque Country
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A Drug Consumption Room in the Spanish Basque country A professional interest in substance misuse having no effect on local crime levels or areas for drug consumption are provided, coupled with a love of the people, culture, individual drug consumption. 4 alongside education around safe injecting. and language of Spain led me to investigate The Netherlands, Germany, Switzerland, It’s run by a multidisciplinary team of social Bilbao’s Sala de Consumo Supervisado or Canada, and Australia all have DCRs. And of workers, educators, nurses, and Drug Consumption Room (DCR) last course, so does Spain. A country which little psychologists. The service is open for February. more than 30 years ago was gripped in the 8 hours daily, every day of the year. Bilbao, capital of the Spanish Basque clutches of a fascist dictatorship now Outreach work is also provided for hard-to- Country (País Vasco) is Spain’s largest port. It supports one of the most progressive reach groups. These include women, young flanks the green and winding Rio Nirvión, a democracies in Europe. people, ethnic minorities, and groin or neck back drop of hills on both sides completes DCRs are distinct from consumption injectors. (Obviously, unsafe injecting is not the scene. The streets are clean, sunny, and services provided by programmes which allowed in the DCR). welcoming. The small 16th century shops prescribe and dispense opiates for Javi shows me the three different areas: and bars of the old town (Casco Viejo) buzz dependent users. 5 There are three such ‘La Sala de Inyección’ (Injection Room), ‘La with tourist activity. Bilbao, like many pilots in the UK. 6 However, we have no Sala de Inhalado’ (Smoking Room), and La European cities has undergone much consumption rooms. Why not? This is a Sala de Relax (which speaks for itself!). Here regeneration in recent years. The spectacular good question which an editorial in The clients talk to each other and staff about their and surreal Guggenheim Museum is its most Independent addressed succinctly. 7 current concerns, while enjoying free filter famous achievement. ‘El Gugg’, as its known Readers can guess at the answers. The coffee and smoking tobacco. (Staff do not to the locals, is a pleasant half hour riverside government’s stance persists despite a have the right to indulge in the latter walk from our hotel in Casco Viejo. recommendation from the highly respected activity!). Workshops on topics such as basic In common with many thriving European Joseph Rowntree Foundation that a number life support and overdose management are cities, Bilbao has a darker side. The of pilot rooms be introduced. 4 provided regularly. More involved projects revitalisation strategies tended to focus The coordinator of the DCR, Javi Rio have centred round exhibitions of the clients’ mainly on the physical regeneration of the Navarro, remembers the pre-Gugg era when art work and the production of a magazine city, while ignoring socioeconomic aspects. 1 the streets were dirtier and declining ‘La Calle de Todos ’ (Everybody’s Street). Social exclusion persists; directly below our industrial heritage was all the city had to Seventy to a hundred regular users come walk the riverside arches provide shelter for boast. He has clear memories of the through the salas each day. There will only the city’s homeless. Although País Vasco is overdose related deaths which were a be about one new contact. These have to the most prosperous of Spain’s autonomous feature of the ‘80s and ‘90s and modestly register, provide a medical history and sign a regions, the more disadvantaged informs me that there have been no such contract. This ensures they understand the neighbourhoods of Bilbao have fatalities since the sala opened. basic rules of the sala. unemployment levels at around 14%. This is Centrally situated in an area with high A major frustration felt by the workers is inevitably linked with the related social rates of drug use and dealing, the sala their inability to influence the purity of the issues of poor educational achievement, occupies two floors of a conspicuous early drugs, or even know what people are street crime, prostitution, poor health, and 20th century building on the edge of the injecting. What’s the solution? We debate drug misuse. Nirvión, which Javi describes as ‘our first the pros and cons of decriminalisation and Against this background, the Basque sky scraper’. heroin prescription for entrenched users. I government commissioned Médicos Del From inside the DCR, I look out of the imagine my patients being cared for and Mundo to provide the DCR, which opened in window and ask ‘How can anyone need to empowered in a place like this. It’s much 2003. 2 DCRs are defined as ‘protected use drugs with views like this?’ We smile, easier to educate about risk reduction and places for hygienic consumption of pre- knowing the question is naïve and safe injecting when you have the person and obtained drugs in a non-judgmental rhetorical. Javi shows me the staircases the goods in front of you. environment under the supervision of trained leading down to the river where drug-taking I visited the sala before the official opening staff’. 3 They have links with the wider used to be rife. He points upstream to time of 11.30 at Javi’s request. It would have network of drug services and have been Bilbao La Vieja where deals are done many been fascinating to see the sala in action. If I shown to enhance the uptake of medical times a day. I see a side to life to which the were a real investigative journalist I would care and reduce overdose related deaths. majority of tourists are oblivious. have hung around the side door later and They are likely to curb the transmission of The sala’s objectives are to reduce approached people as they left. But I had a blood borne viruses. DCRs reduce mortality and morbidity by minimising risk. family who wanted some time with me and, homelessness and social exclusion, while Access to needle exchange and hygienic ultimately I know what I would have heard; 810 British Journal of General Practice, November 2008 Essays stories of damaged lives, difficult childhoods, their hospitality and for allowing me some insight European Communities, 2004. shattered dreams. But, here in Bilbao, I was into the service. 4. Joseph Rowntree Foundation. The Report of the Independent Working Group on Drug Consumption Rooms. York: Joseph heartened to learn about a really radical Rowntree Foundation, 2006. service which supports and protects drug REFERENCES 5. Sheldon T. More than a quick fix. BMJ 2008; 336: 68 –69. 1. Nieto M. San Francisco: marginalidad en el centro: Los users, offering the chance to improve futures guetos en Espana . San Francisco: marginalisation in the 6. Laurance J. Heroin: The solution? 2006, The Independent. town centre: ghettos in Spain. Madrid: Elpais.com, 2006. http://www.independent.co.uk/news/uk/crime/heroin-the- and heal the wounds of the past. solution-480734.html (accessed 9 Oct 2008). 2. Gutiérrez Estíbaliz B. Una Sala de Consumo Supervisado en Bilbao: Evolución y resultados tras dos años de 7. Anonymous. Editorial: an injection of reality. 2006, The Meg Thomas funcionamiento. A drug consumption room in Bilbao: Independent. http://www.independent.co.uk/opinion/ Progress and results after 3 years in operation. Report for leading-articles/leading-article-an-injection-of-reality- the Cadiz government. Cadiz: 2002. 480718.html (accessed 9 Oct 2008). Acknowledgements 3. Hedrich D, European Monitoring Centre for Drugs and Many thanks to the Médicos del Mundo team at Drug Addiction. European report on drug consumption the Sala de Consumo Supervisado, Bilbao for rooms. Luxembourg: Office for Official Publications of the DOI: 10.3399/bjgp08X342714 Down the rabbit hole ‘Down, down, down. Would the fall never most used word in America. Choice is a visiting neither is portrayed as bold by his come to an end?’ Just as Alice followed the value when the country is so flush that health loyalists and as thumbing his nose at the rest white rabbit, so have all of us gone down the plans, like brands of breakfast cereals, each of the world by everyone else. economic hole and we don’t know where it offer something different. But, cereal is Obama’s plan for universal coverage will end. 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