Inhalation of Substances in Drug Consumption Rooms as an Important Harm Reduction Element

Abstract

Purpose Despite the mounting evidence on the harm-reducing effects of drug consumption rooms (DCR) on injecting drug use, little is known on the harm reducing effects of DCRs on non-injecting drug use. However, more evidence is urgently needed for several reasons: the population in DCR is aging, resulting in an increase in users with damaged veins due to chronic use, who cannot use intravenously anymore. Furthermore, an increase in the use of mostly smoked stimulants (such as crack) has been recorded in several European countries, including Germany. Non-injecting use is generally considered less risky, but has not been investigated in the context of DCR. The consumption of substances in the inhalation rooms of the 4 DCR in Frankfurt/M. has been systematically monitored since 2011. Due to its volume and the length of the systematic documentation this dataset is particularly suitable to assess the development of non-injecting drug use in DCR and to investigate the harm-reducing effects of non-injecting drug use. Methods We investigate the utilization of DCR and their inhalation sites and the use of injected and non-injected drugs over time. Furthermore, emergency data relating to injecting and non-injecting use were compared. Results Inhalation sites are utilized to a great extent and increasingly. Non-injected substances are mainly heroin and crack. Heroin is he most commonly used non-injected substance, after a rapid increase between 2015 and 2018. The biggest increase in the past 2 years in non-injected substances was found for the use of crack. Injecting use is declining but still the most common form of application. Emergency data show that non-injecting use is linked to less emergency calls compared to injecting use, even when adjusting for the difference in frequency of non-injecting and injecting use. Conclusion Offering inhalation sites is likely to increase the safety of users who would otherwise inject (eg. heroin). It furthermore offers the opportunity for the safe consumption of mostly smoked substances. To tailor DCRs more to the needs of consumers of smoked stimulants (like crack) could be one of the most important harm reduction measures to keep this population safe, especially should the use of these substances increase further.