When you clamber down under Glasgow’s City Union Bridge – where trees cling to the rocky banks of the River Clyde, their leaves unfurling in the spring sunshine – you leave behind the traffic noise and city centre buzz.
It’s not easy to get to this spot. There’s a barrier, a precarious ladder and a fair drop to the ground. But if you’re an injecting drug user looking to hide from the public gaze, the extra effort is worth it.
This summer, Glasgow will become the first city in the UK to open an authorised safer drug consumption facility. Run by the city’s health and social care partnership (HSCP), it will allow users to inject their own drugs, supervised by medical staff able to help reverse an overdose and offer additional help and services.
For the most part the response to the facility has been positive. Evidence shows similar ones have saved many lives and in Glasgow, now Europe’s drug death capital, lives urgently need to be saved. Last year there were 1,197 suspected drug deaths in Scotland, 10 per cent more than during 2022. More than a quarter – 303 – of them were in Glasgow.
The original proposal for a safer consumption facility was linked to concerns about the city’s HIV epidemic, which emerged in 2015. Yet almost a decade later, and with an “incredibly unpredictable and unstable” drug supply putting people at risk, many argue it’s needed more than ever.
But there are also concerns that – given its £2.3m price tag – the reach of this service, based to the east of the city centre, will be relatively small. Without additional investment in services like housing, mental health support and drug treatment, some fear it will not have the impact required.
So The Ferret has come to this unofficial site on the river bank to talk to John Campbell, injecting equipment provision manager for NHS Greater Glasgow and Clyde, about why he believes a sanctioned site is needed.
There are about 400 injecting drug users in Glasgow city centre, he says, and as many of them are homeless and sleeping rough or insecurely housed in hostel-style hotels they resort to injecting outside, hidden from view in lanes, car parks and other quiet spots.
“This is one of our larger, unofficial, away from home, injecting sites,” says Campbell as we stand in the dappled light surrounded by drug paraphernalia on the ground. “And I think it’s no exaggeration to say there are literally thousands of needles discarded here.”
There’s a pay off for seclusion. “If someone overdoses here, the chances of being discovered in a timely way are pretty slim,” he explains.
Scotland has the worst drug death rate in Europe but it’s not yet in the situation facing North America, where dramatic numbers of deaths have been driven by synthetic opioid fentanyl. Yet outdoor injecting is increasing and so are the risks.
NHS data shared exclusively with The Ferret now suggests that significantly more people in Glasgow city centre are injecting cocaine than heroin. In 2021 about two thirds of those reporting to the NHS WAND initiative, which provides wound care, harm reduction supplies and blood borne virus testing, were injecting heroin and about the same number injecting cocaine. But 2023 data shows just 57 percent reported injecting heroin, while 81 percent injected cocaine.
That is significant, explains Campbell, because the “binge pattern” of cocaine injecting will see people injecting 10, 15 or even 20 times in one day, while people will usually only inject heroin twice or three times. While the number of people injecting has stayed stable, suddenly those people are becoming much more visible.
The proportion of deaths where cocaine was implicated has also increased from six per cent in 2008 to 35 per cent in 2022 according to National Records of Scotland figures.
But the biggest concern is the emergence of synthetic drugs with an increase in man-made opioid nitazines, so-called tranq dope or veterinarian tranquilliser xylazine as well as bromzolam turning up in drug toxicology reports in Scotland.
Public Health Scotland’s Rapid Action Drug Alerts and Response (RADAR) first detected dangerous nitazenes in April 2022. In data running to September 2023 it reported their presence in 25 drug deaths, 18 of those in the last six months of that period.
UK charity, Transform Drugs Policy Foundation, claims the scale of the problem is likely to be under-estimated as many labs don’t test for uncommonly used substances. They also warn that as heroin – most of which originates in Afghanistan – is likely to dry up due to Taliban prohibition of opium poppy cultivation, a “looming gap in the opioid market” is at risk of being filled by nitazines and other synthetic drugs.
“Considering that nitazenes can be up to 500 times more potent than heroin and therefore pose a far greater risk of overdose, their ever-growing presence in the UK’s illegal drug market should be responded to now, treating it as a public health emergency,” explains the charity’s policy manager, Ester Kincová.
It’s into this context that Glasgow will open its safer consumption facility in “late summer” with staff recruitment and ongoing building work aiming to be completed by then.
This model will be a clinical one, with trained medical staff onsite, and be home to Scotland’s first drug checking service. The Scottish government previously said that applications to the Home Office for approval of centres in Glasgow, but also Aberdeen and Dundee, would be submitted in early 2022 but plans were put on hold.
Dr Saket Priyadarshi, medical director for Glasgow Alcohol and Drug Recovery Services, hopes it will engage as many people as possible. But he acknowledges there will be challenges and lots to learn. “As this is the UK’s first such service, we are aware that we need to listen and respond to the experience of service users,” he says.
Over the last 30 years safer consumption facilities have been implemented across more than 100 sites in 11 countries around the world. All use a variety of different models.
No-one has died in a safer consumption facility and thousands of overdoses have been reversed. But some critics have argued they promote drug use, and attract anti-social or dangerous behaviour. Others believe they fail to address the root issues connected with substance use.
Last year The Ferret visited Moss Park Safer Consumption and Treatment Service in Toronto Canada, a now authorised, indoor service which started as an unsanctioned overdose prevention site in the local park. Our one-off podcast – following a day in a life of the centre’s staff and users – will be available from Monday, 29 April.
Its grassroots approach is different from the Glasgow one. Though it now has paid staff as well as volunteers, the Toronto service has maintained its community ethos.
Sarah Grieg, who manages the service run by the South Riverdale Community Health Centre, also in Toronto, says one of its key functions is not simply to reverse overdoses but to help people heal from trauma and adverse experiences in childhood.
The approach is all about helping to re-building healthy relationships with the aim of allowing people to move forward with their lives, in whatever way they choose. “People need love and connection and community to thrive in this world,” she says. “We’re interested in the incremental changes because it is a long game.”
It’s an approach that interests Dr James Nicolls, senior lecturer in public health at Stirling University and one of the authors of a safer consumption facility feasibility study, commissioned by City of Edinburgh Council, and published in February this year.
“There is certainly evidence that informal, accessible services that involve peers in design and delivery are attractive,” he explains. “A key benefit identified by much of the research is the creation of welcoming, non-stigmatising spaces where people can develop a sense of community and mutual respect.”
The Glasgow service will allow Scotland to assess the access of one model of consumption facility, he adds. “However, we have yet to see whether we will get a chance to pilot other kinds of services, which may be more similar to the facility in Moss Park.”
While the Glasgow service will be the first approved site in the UK, there was previously a sanctioned one. In 2020 Peter Krykant, a former HIV outreach worker inspired by international activists like Moss Park site co-founder Zoe Dodd, set-up a van as an overdose prevention site in Glasgow. It ran for nine months from 2020 to 2021, oversaw almost 900 injections (about 60 percent of which were cocaine) and reversed nine overdoses.
It allows us to engage with this population in a way that we’ve never actually done before. And that’s a start – a foundation to build on.
John Campbell, NHS
But while Krykant still maintains that safer injecting sites are a necessary response to the rising risk of overdose deaths in Scotland, he is worried it will not have the reach needed to turn things around.
“The vast majority of people who will die in the next year across Scotland will not have had any access to this facility,” he says. He thinks the model is overly medicalised, not least because that means costs are so high, making it hard to replicate. He favours a more informal network of “living room type model” sites which are cheaper and provide psychological safety.
He is despondent, too, about the lack of progress in other areas. In January 2021 then-first minister Nicola Sturgeon announced what she described then as Scotland’s National Mission to end drug deaths.
While her plans to introduce both heroin assisted treatment and safer drug consumption facilities will both have come to pass in Glasgow in summer, few are convinced that her commitment to radically reform drug treatment has been upheld.
People were meant to have choice – from medication like replacement opioid drugs buvidal or methadone, legal prescriptions for drugs like benzodiazepines, psychological support like trauma counselling, or access to detox and rehabilitation. A new set of 10 standards were supposed to ensure access.
But according to most recent evaluations none of the Medication Assisted Treatment (MAT) standards have yet been fully implemented and drug users and their families, as well as workers, have told The Ferret about ongoing frustrations and concerns that people are still being let down.
“It’s really depressing,” Krykant says. “More people will die. It’s too little, too late.”
Back by the banks of the River Clyde John Campell also knows one safer consumption facility won’t be the silver bullet. “I think it’s important to be realistic,” he says. “What use is a safer injecting facility to someone who smokes crack cocaine? What use is a consumption facility to someone who resides in a different part of the city?
“But you know, it allows us to engage with this population in a way that we’ve never actually done before. And that’s a start – a foundation to build on.”
Images by Angela Catlin
