In January, Scotland opened the first sanctioned overdose prevention center (OPC) in the United Kingdom. As of March 17, the facilty had reportedly received over 1,400 visits from 168 participants. Offering harm reduction resources and support, staff had supervised almost 1,000 drug injections.
Seventeen “medical emergencies” occured at the site in this period. Without the OPC, said Pat Togher, chief officer of Glasgow’s health and social care partnership, “It is highly likely that a number of these would have resulted in a fatality.” With care and resources on hand, none of them did.
In a historic move back in September 2023, the city of Glasgow approved a proposal to create a pilot OPC—known in the UK as a safer drug consumption facility—in the city’s east end, to be run by a local health clinic. After much planning, the Hunter Street Health Centre opened the Thistle, as the OPC is called, on January 13.
Scotland’s government, under the Scottish National Party, endorsed the site and funds it; Scotland’s top law enforcement official has promised not to enforce drug laws against it. The Labour Party government in London, where parliament sets UK drug policy, has said it does not plan to open OPC but will not interfere in Glasgow, according to the BBC.
“The team has done an excellent job of trying to engage the neighborhood … The feedback from the people using the service has been very positive.”
The facility’s rules state that it is open to participants over 18, who can bring their own drugs to use but cannot share substances or assist other people in using drugs there. Staff provide sterile injection equipment and naloxone to take home. They supervise each person using, offer harm reduction advice and intervene in case of overdose. Staff can also connect participants to resources like HIV or hepatitis C care, substance use disorder treatment and sexual health services.
Jan Mayor is the practice and innovation lead for alcohol and other drugs at Turning Point Scotland, a charity and social care provider. Her organization was not involved in establishing the OPC, but some of its clients are participants at the new site.
“It was always designed to meet the needs of a very specific subset of drug users, and I think it’s doing that very well,” she told Filter. “The team has done an excellent job of trying to engage the neighborhood … The feedback from the people using the service has been very positive.”
At the same time, Mayor noted, the site operates under some constraints that are likely to limit its impact. “One of the constraints is we weren’t able to allow inhalation,” she said, which is a significant limitation after “a shift in drug use where people who were predominantly injecting heroin are now injecting cocaine and smoking both.”
Scotland has a pressing need for harm reduction. It has the highest rate of drug-related deaths among the UK nations, and in Europe. In 2023, Scotland’s rate of 224 deaths per million population was about 10 times higher than the 2022 European Union average of 22.5 deaths per million. The rate in Glasgow is higher still. Scotland lost 1,172 lives to overdose in 2023—a total lower than in most recent years, but over four times higher than in 2000. Opioids, such as heroin and morphine, were involved in 80 percent of deaths.
“In Scotland, fentanyl has never really taken off. But we do have the same problem—the quality of the heroin was really diminished.”
Unlike in North America, fentanyl has not been a major element in Scotland’s crisis. The supply has still become riskier, with a surge in deaths involving benzodiazepines since 2015.
“In Scotland, fentanyl has never really taken off,” Mayor said. “But we do have the same problem—the quality of the heroin was really diminished. We already had a street benzodiazepine issue, so very few people were using heroin and not using benzodiazepines. What’s happening is people are moving more towards cocaine, and the heroin they’re buying is more contaminated with xylazine, street benzodiazepines and synthetic opioids like nitazenes. We’ve had a spate of near-fatal overdoses in the last couple of months.”
As in other countries, Scotland’s overdose crisis is also economic: In areas with the highest levels of economic deprivation, rates of drug use are estimated to be 17 times higher than in the wealthiest areas. An estimated 21 percent of Scottish people live in relative poverty after adjusting for housing costs.
Throughout Scotland, Mayor said, abstinence-based recovery and the Twelve Steps remain the dominant approach to substance use disorder, and local governments have resisted adopting harm reduction. Seeing a need for public gathering spaces for people currently using drugs, Turning Point Scotland launched “harm reduction cafes.” There, people can get soups and sandwiches, access education and resources, work on arts and crafts, and join discussions about drug safety and policy advocacy.
“There’s loads of places to go and get support if you’ve stopped using drugs,” Mayor said. “But if you’re using drugs, [there’s nowhere]. So we thought it would be nice to have a space where people are still using drugs and don’t even need to say they want to stop, can come and access advice and activities.”
“We make it very clear they can come intoxicated,” she emphasized. They can’t use on the premises, but they can go around the corner, use, come back in, they’re not going to get thrown out. It’s about an inclusive and welcoming space.”
“There is a really good grassroots campaign in Edinburgh for a safe consumption room. They are pushing for something less clinical, less health-led, more peer-led, more informal.”
Meanwhile, the Scottish Affairs Committee, a body of the UK Parliament which recommended as far back as 2019 that the UK government support an OPC in Glasgow, is conducting an inquiry around the Thistle.
“The inquiry will focus specifically on the legal and policy challenges faced in setting up and running the facility, its current legal position and the challenges this presents, as well as the facility’s effectiveness in reducing drug-related deaths in Scotland,” the Committee stated. “The inquiry will consider what legal changes at UK level might be necessary to enable the facility to operate sustainably beyond its three-year pilot.”
Mayor hopes this won’t be the last OPC in Scotland, and that future examples will be able to accommodate different types of drug consumption.
“There is a really good grassroots campaign in Edinburgh for a safe consumption room,” she said. “They are pushing for something less clinical, less health-led, more peer-led, more informal. The site in Glasgow really meets the need of one part of Glasgow, not the whole. They’re a high-risk group, but they’re a very small population. We need overdose prevention sites for a much bigger population.”
The movement to open overdose prevention centers in Scotland goes back many years. In 2020, a group of Glasgow volunteers took matters into their own hands, launching an unofficial mobile OPC out of a van. Over nine months, the van hosted nearly 900 injections, with just nine cases of overdose requiring intervention and no deaths.
Photograph (cropped) of Glasgow by Lewis Ashton via Pexels
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