DRUG CONSUMPTION ROOM - Muunto-hanke Schultz.pdf · drugs and known adulterants, and “ATR-FTIR...

DRUG CONSUMPTION ROOMVesterbro, Copenhagen

Mændenes Hjem – ‘Mens home.’ • Mændenes Hjem runs Skyen.

• Mændenes Hjem is a self-governing institution with an operating agreement with Copenhagen muncipalityaccording to § 101, § 104, § 107, §108 og § 110 in the Law of Social Service.

• Mændenes Hjem also offers shelter, temporary housing, a contact point, health services, a night cafe for women, a cafe with nourishing food and cooperatewith volunteer doctors and dentists.

- The first drug consumption in Copenhagen. - Opened in October 2012 – 6 years experience. - The room have 9 seats for injection and 8 seats for smoking.

Facts and results

• 1,1 million intakes

• More than 800 overdose situation – No casualties

• 7612 unique users – 1223 women and 6389 men.

• Between 80 and 90 percent of outdoor drug intake has turned inside. The drug related garbage has decreased between 80-90 percent

• 70 percent of all intakes has something to do with cocaine. The last 30 percent is Heroin, methadone, Ritalin and benzodiazepine.

Facts and results

•Open from 07,15 in the morning

untill 9,30 in the evening

•Another drugconsumtion room in

the area is open during the night

so we have a 24 hour service.

•The staff is primarily educated as

trained nurses or trained social

workers.

Social work an praxis

Skyen is an anonymous offer –

we make an anonymous

registration. User name, year of

birth, city or country, male or

female.

We believe that relation work is

the best method to make a DCR

work.

We have 5 rules. No violence,

no threats, no weapons, no

dealing drugs, follow the staffs

instructions.

Social work an praxis We are working with a minimum of sanctions

An important roll are conflict counsels

When our users have trust in us we get a chance to work with them, and maybe can be the first step to do something else. Apart of our department is a place where the users can get help to their basal needs and help to their social, mental or physiological problems.

A long range of street units is working in the area: Homeless unit, treatment unit, psychiatry unit and the police.

We are dealing with conflicts every day. We try to discover the conflicts before they develop.

Social work an praxis

• We believe in a high level of user influence. And are dealing with user meetings every 6 weeks.

• A very good cooperation with the local police

Drugs are injected or smoked – a fewsnorts.

10

80

10

Heroin Cocaine Other (metadon, pills)

DCRs future in Denmark

• All political parties in parliament except one are in favor of DCRs

• There is now 5 DCRs I Denmark in 4 different cities

• Talks about establishing more and smaller DCRs in other parts of Copenhagen

Drug tests in drug consumption room

´SKYEN´ in CopenhagenMaria Schultz & Rasmus Koberg Christiansen, Maendenes Hjem (DK)

Background

• An illegal and thereby unregulated drug marked equals a risky and uncertain life for drug users.

• We heard a lot of myth and homegrown theories about the composition of the illegal drugs.

• Denmark has DCR’s, heroin clinics, Naloxone courses but didn’t had any services for offering testing of illegal drug.

• There is a lack of relevant, accessible and honest knowledge on the drug scene

Pilot studyOne project leader 15 hours per week from February 2017 till March 2018.

Focus: setting up the hard-/software, training staff and implementing drug checking as common practice was prioritized higher than a structured data collection and evaluation of questionnaires and interviews

Questions:

1) Will the users participate as the drugs could not be returned after analysis?

2) Is it possible to improv the relational and harm reduction work with the drug users?

3) Will testing allow the staff to engage a constructive dialogue with the users about dose, habits

of consumption, adulterants, side effects etc. and do they change their drug habits based on

the information?

4) Will drug checking contribute to the overall evaluation of users’ health and planning of

possible treatments?

5) Is it possible to gather information of the drug situation on Vesterbro, CPH?

Technology • Fourier-transformed infrared spectroscopy (FTIR). Able to analyze all sample types without

the need for pricy consumables.

• More than 5-10% of a given compound should be present in a mixture before the FTIR-system can detect and thus identify it.

• To do qualitative analysis (identification), a database of relevant IR-spectra is necessary. Two databases were acquired – ”TICTAC” which is a small but focused database of illegal drugs and known adulterants, and “ATR-FTIR Complete” which is a larger and broader database. With these two search libraries it is possible to identify more than 27.000 different compounds.

• A full analysis and interpretation can be done in less than five minutes

• Analysis can be made by the regular staff in SKYEN

Protocol and User agreement• Agreement with the Legal Department so staff were allowed to recieve,

handle and possess samples of illegal drugs submitted in the area.

• When a user wishes to use the service for the first time, a user agreement must be sign prior to the submission.

• Important point: The drugs is not returned, the test is only instructional and every consumption is the user’s own responsibillity.

The Bruker Alpha Patinum ATR

Picture 1: Bruker Alpha Platinum ATR with everything required for a drug check

Quantitative analysis of cocaine

ResultsDiluent/Adulterant Count Percent

No additive 173 77

Phenacetin 39 17

Sugar 8 4

Creatine 2 1

Fake 2 1

Caffeine 1 0

Levamisole 1 0

Citric Acid 1 0

Table 2: The occurrence of diluents and adulterants in 224 cocaine samples.

Results

Table 4: The occurrence of adulterants and

diluents in 34 samples of brown heroin.

Dextromethorphan was not identified by FTIR

but by forensic analysis

Table 3:The occurrence of diluents and

adulterants in 30 samples of white heroin

Results

Drug Count

Amphetamine 6

Methamphetamine 2

MDMA 2

Ecstasy tablet 2

Crack 2

Others 4

Table 5: Summary of other submitted drug types

Results

Samples per user Amount Percent

1 80 66

2-5 35 29

6-10 1 1

10+ 5 4

Table 1:Distribution of submitted

samples per

user during the project period

Results

Table 2:Distribution of users and samples during the project

Results• More injection users than smokers

• A large group of users were not interested in the drug checking service.

• Many users have been very curious and positive.. At some point, every single user in the milieu have had a drug in hand that did not have the same appearance or effect as expected, everyone has heard a trader say “my drug is the best on the street” and everyone have been in the situation that their usual supplier were nowhere to be found…

• The test showed that the cocaine was of very high purity.

Conclusion1) Will the users participate as the drugs could not be returned after analysis? Yes

2) Is it possible to improv the relational and harm reduction work with the drug users? Yes

3) Will testing allow the staff to engage a constructive dialogue with the users about dose, habits of consumption, adulterants, side effects etc. and do they change their drug habits based on the information? Yes

4) Will drug checking contribute to the overall evaluation of users’ health and planning of possible treatments? No, not with this set up.

5) Is it possible to gather information of the drug situation on Vesterbro, CPH? Yes.

Drug test in the DCR today

• Fokus on making drug test an integrated part of our DCR

• Improving the relational and harm reduction work with the drug users. So drug checking can contribute to the overall evaluation of users’ health.

Drug test in the DCR today• We have tested 680 samples, submitted by 140 unique

users.

• Flyers with information about the results of specific test.

• Regular newsletters on the latest results.

• Dialogue with the user regarding dose, habits of consumption, adulterants, side effects etc.

The latest results• In the most recent calculated period (November 1st to December 17th).

• 64 drug samples were analyzed: 55 samples were cocaine, 6 samples were heroin, 1 sample was MDMA, 1 sample was an unknown pill and the last sample contained no active substance.

• During this period up to 30% of the cocaine samples were contaminated with either creatine, sugars, phenacetin and as something new, part of the samples were added Levamisol.

• The samples of yellow heroin were generally of very high but still of varying purity. Therefore, there is a greater risk of incorrect dosing.

Perspectives• Contribute to the start up of drug checking projects in DK

and abroad

• A new project focusing on the health perspectives

• Contribute to the development of drug checking for recreational users

Thank you for your attention!