A brief disclaimer: due to the fact that Denmark’s supervised injection facilities or “fix rooms” are a relatively new phenomenon, it is not possible to provide extensive historical information and it is difficult to find many academic sources about this topic. As a result, the scope of this entry will be relatively limited and images and links may be from non-academic sources that may have an agenda. Another possible reason that academic sources are scarce is stigma surrounding drug use and people who use drugs (PWUD). This could cause research into this topic to be scarce or poorly funded since it deals with an illicit subject.
Background: what is a “fix room,” and how did they emerge in Denmark?
“Fix rooms” are used by people to smoke, snort, and/or inject illegal drugs without fear of arrest and while under the supervision of medical professionals. In addition to Denmark’s facilities, “fix rooms” have been established in Switzerland, Germany, Spain, Norway, Australia and Canada (Kappel et al. 1). The most common drugs used in these facilities are heroin and cocaine, while some clients use a mix of the two or methadone (Toth et al. 1). There are currently five drug consumption rooms (DCRs) operating in Denmark, after legislation passed in 2012 which allowed for them to operate legally (Kappel et al. 1).
According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), an organization that tracks drug use in the EU and is involved in generating statistics and informing policy, “Denmark’s national illicit drug policy is comprehensive and covers prevention and early intervention, treatment, harm reduction, and law enforcement” (“Denmark: National drug strategy and coordination”). Harm reduction is at the center of Denmark’s drug policies, and this is manifested in their needle and syringe exchange programs, naloxone distribution, DCRs, and assistance getting off of heroin (“Denmark: Harm reduction”). Harm reduction is a strategy that aims to mitigate the negative consequences of drug use (“Principles of Harm Reduction”). It acknowledges and accepts that people use illegal drugs, and tries to protect their rights and health (“Principles of Harm Reduction”). Naloxone is the drug used to revive people during an overdose, and its distribution is an example of the Danish government putting its philosophy of harm reduction into action. One of the ways to help get people off heroin is by weaning them onto methadone. Methadone a drug that acts by mitigating the painful side effects of opiate withdrawal and blocks the action of drugs like heroin, codeine, and prescription pain-killers, making their effects less pleasurable (“Methadone”). Needle exchange programs provide a mechanism for users to switch out used needles with clean ones for injecting drugs. These programs aim to reduce the spread of infectious disease due to intravenous drug use.
The idea of “fix rooms” in Denmark was made a reality in 2011 when Danish NGOs bought two old ambulances and converted them into mobile DCRs in an act of civil disobedience (Kappel et al. 2). This protest continued until 2012, when legislation was passed to allow municipalities to legally establish their own DCRs. Over the past twenty years, approximately 250 people have died each year of drug overdose or intoxication in Denmark (Toth et al. 2). The number of overdoses had been on the rise in the decade leading up the establishment of DCRs – the hope is that this number will decrease with access to the DCRs.
These rooms were created to serve three general purposes: preventing and treating overdoses, making the lives of PWUD safer through access to medical care and social services, and keeping the use of illegal drugs out of public spaces (Kappel et al. 2). These supervised injection sites are staffed by medical professionals, usually nurses and their assistants, who are available to prevent overdoses and advise the clients about the safest drug intake methods. They are also able to serve as contact points between PWUD, a vulnerable population, and the medical system (Kappel et al. 2). At these facilities, users are provided with clean drug paraphernalia, such as sterile water, syringes, and needles, as well as alcohol wipes, bicarbonate, and tools for cooking and smoking their drugs (Toth et al. 3). Providing access to unused or sterilized equipment is important for preserving the health of PWUD and preventing the spread of diseases such as HIV (“Denmark: Harm Reduction”). Below is a kit of tools, including some of the drug paraphernalia described above, which serves as an example of what client of the H17 DCR in Copenhagen may receive (see fig. 1).
Fig. 1: Supplies from Drug Consumption Room ‘H17’ in Copenhagen (Løftgaard)
Users are also helped by staff to find the safest injection point and method. Many people who use drugs (PWUD) have great difficulty finding a vein if they have been injecting drugs for a significant period of time, so vein finding devices are available for use in some facilities. A brief demonstration of someone shining a vein finder on their arm can be found at www.youtube.com/watch?v=NS68ePykav0. Due to the unavailability of an academic video of this nature, it should be noted that this link features a sales representative for Accuvein, the vein finder’s manufacturer. Users may also be advised by nurses to inject intramuscularly or consume their drugs orally, but most still prefer to take their drugs intravenously (Kappel et al. 8).
Internal Perspectives and Additional Context
Many PWUD say that they use these facilities because they feel safe and accepted (Kappel et al. 1). In fact, the “welcoming, non-judgmental attitude” of the staff is cited over and over by clients as the reason that they keep returning (Kappel et al. 1). Angelea, a client of the Skyen fix room, told the BBC why she uses drugs and the DCR in this report: www.bbc.com/news/magazine-38531307. Like many addicts, Angelea visits the “fix rooms” many times per day, saying “I’m here again because I’m in so much pain” (Talwar). Staff at these clinics learn to recognize the faces of many of their clients because of such frequent visits. However, visitors still use aliases, with many using several in an attempt to conceal the regularity of their visits (Kappel et al. 11). This anonymity may also show that users do not feel completely safe in these rooms. This has also made research into these facilities more difficult since individuals cannot be tracked with certainty (Kappel et al. 11).
In Toth et al.’s study of “fix room” users, 75% of participants were male and 25% were female (5). However, this may not be representative of the population of DCR clients, since individuals of one gender may have refused to participate in the study at a different rate than another.
Denmark is one of the most prominent countries with fix rooms, with five in operation as of 2016 (Kappel et al. 1; Toth et al. 1). Four of these are stationary facilities, with one mobile unit (Kappel et al. 1; Toth et al. 1). DCRs have also been established in Switzerland, Germany, Spain, Norway, Australia and Canada, so Denmark is not unique in providing this kind of service (Kappel et al. 1). Even in a country with a commitment to providing care for PWUD, resources are relatively limited. Four out of the five DCRs in Denmark are only open for 7 hours a day or fewer (Kappel et al. 3). As a result, many clients end up using in their normal locations until the building re-opens. This provides important context to consider, since PWUD must be able to access resources in order to benefit from them. There is one exception to the limited hours: Copenhagen houses the world’s largest DCR, H17, and it is open 23 hours every day (see fig. 2) (Kappel et al. 3). It seems that Denmark’s DCRs are being watched by other countries as they consider or begin to open programs of their own; as a result, it is important to keep in mind the successes and short-comings of the program (Overgaard). As seen in the image below, DCRs commonly feature “stalls” so that users are able to inject with relative privacy and anonymity. However, the glass would allow staff members outside to look in and monitor the clients in case of an overdose, providing a mechanism to protect the safety of PWUD, an already vulnerable population.
Fig. 2: “Rooms at Copenhagen’s H17, the world’s biggest drug consumption room” (Gotfredson)
External Perspectives on “fix rooms”
Proponents of supervised injection rooms argue that these facilities do not encourage drug use, but provide a safe environment for those who are already using, which can provide medical care and advice and keep users out of public sight. The supplies provided by the DCR can stop the spread of disease and prevent infection in users (Toth et al. 3). In addition, they maintain that medical staff at these facilities can serve as bridges to other care, such as medical or social services, which can improve the health and well-being of these individuals (Kappel et al. 2). Kappel asserts that DCRs also provide “low-threshold nursing attention,” and thereby improve the general health of the clients even if they do not necessarily see another doctor or visit the hospital (2). Most public health officials in Denmark are supporters of these “fix rooms,” given Denmark’s philosophy of harm reduction when it comes to drug policy (“Denmark: Harm Reduction”). As detailed in the “Internal Perspectives and Additional Context” section, the staff and clients of fix rooms view them as a safe place to relieve pain and take their drugs, which they would be taking anyway. These fix rooms provide a safer environment to do so, where supervision can prevent overdoses and treatment can be provided quickly.
Opponents of this phenomenon argue that these “fix rooms” normalize addiction and help people abuse drugs, potentially increasing addiction rates (“France’s first drug room for addicts to inject opens in Paris”). While not all supervised injection sites are funded by the government, some opponents assert that the facilities are using tax-payer money to fuel addiction and preventing people from making life changes (Dooling and Rachlis 1442). While some politicians and private citizens alike hold negative views about fix rooms, conservative political figures are often the most out-spoken about their views. For example, Steven Harper, a Canadian Conservative Party leader, said that “we as a government will not use taxpayers’ money to fund drug use” (Dooling and Rachlis 1442).
However, it is worth noting that this controversy is not as prominent in Denmark. Since their approval 2012, DCRs have been integrated into the health system as part of Denmark’s drug policy (“Denmark: Harm Reduction”).
How are “fix rooms” connected to “Politics of Health” concepts?
The issue of DCRs can be looked at through the lens of medicalization; this is because they are an example of a social issue being drawn into a medical sphere. In “The Shifting Engines of Medicalization,” Peter Conrad cites alcoholism as a key example of social movements leading to the medicalization and subsequent classification as a disease (4). The medicalization of drug addiction seems to follow a similar pattern, since it is another example of addiction, which is often seen as a personal or social issue, being classified as a medical condition.
Addiction is another form of “medicalized deviance,” which these DCRs directly supervise by watching their clients use drugs (Conrad, “Medicalization and Social Control” 213). When DCRs were set up, one of their goals was to move the perceived social nuisance of drug use from the public sphere and put it into a medical context (Kappel et al. 2). Conrad also argues that the pharmaceutical industry has served as a major driving force behind medicalization in recent years (“The Shifting Engines of Medicalization” 3). Methadone could be seen as an example of this phenomenon, as it is pharmaceutical solution to drug addiction. Many people from Denmark’s DCRs take methadone in order to try to wean themselves off of pain-killers (Toth et al. 1), further connecting these facilities to the concept of medicalization as discussed in class. Before such a drug was developed, someone would just have to taper themselves off of opiates slowly and cope with the negative side effects; now that this process has experienced medicalization, and a pharmaceutical fix is available.
Not only has addiction become a medicalized phenomenon, but the families of addicts have become medicalized too (Conrad, “Medicalization and Social Control” 221). The idea of a genetic predisposition towards addiction has classified blood relatives as an at-risk population. The National Institute on Alcohol Abuse and Alcoholism has released a publication describing the risks that relatives of addicts face, and outlines precautions that they ought to take – pubs.niaaa.nih.gov/publications/FamilyHistory/famhist.htm. Now, individuals who may have never taken drugs can be considered predisposed to addiction. Seeing them as potential addicts justifies more heavy surveillance for signs of substance abuse or addiction than the rest of the population, which medicalizes them as being “pre-ill.” Addiction presents both medical and social issues, and DCRs such as the ones found in Denmark serve as a means to reach out to PWUD, even though there is still debate over whether or not they are the best way to help this vulnerable population.
Additional Resources:
- European Monitoring Centre for Drugs and Drug Addiction. http://www.emcdda.europa.eu/emcdda-home-page_en. Accessed 3 March 2018. As described in the text of the entry, the EMCDDA has information about drug policies and data about drug use in the European Union.
- Harm Reduction Coalition. http://harmreduction.org/. Accessed 3 March 2018. The Harm Reduction Coalition is a group in the United States dedicated to providing a support system for drug addicts. They have useful information surrounding the idea of harm reduction and potential treatments to help addicts.
- Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/. Accessed 3 March 2018. SAMHSA has information about treatment for drug addiction. For example, they have pages addressing Naloxone and Methadone, the first of which can save people in the event of an opioid overdose, with the second often being used to help wean users off opiates.
Works Cited
“A Family History of Alcoholism: Are You at Risk?” National Institute on Alcohol Abuse and Alcoholism, June 2012. pubs.niaaa.nih.gov/publications/FamilyHistory/famhist.htm. Accessed 16 February 2018.
Conrad, Peter. “Medicalization and Social Control.” Annual Review of Sociology vol. 18, 1992, pp. 209-232.
Conrad, Peter. “The Shifting Engines of Medicalization.” Journal of Health and Social Behavior vol. 46, March 2005, pp. 3-14.
“Denmark: Harm Reduction.” European Monitoring Centre for Drugs and Drug Addiction, 2017. www.emcdda.europa.eu/countries/drug-reports/2017/denmark/harm-reduction_en. Accessed 16 February 2018.
“Denmark: National drug strategy and coordination.” European Monitoring Centre for Drugs and Drug Addiction, 2017. www.emcdda.europa.edu/countries/drug-reports/2017/denmark/strategy-and-coordination_en. Accessed 16 February 2018.
Dooling, Kathleen, and Michael Rachlis. “Vancouver’s supervised injection facility challenges Canada’s drug laws.” Canadian Medical Association Journal, vol. 182, no. 13, 21 September 2010, pp. 1440-1444. doi:10.1503/cmaj.100032.
“France’s first drug room for addicts to inject opens in Paris”. BBC, 11 October 2016. www.bbc.com/news/world-europe-37617360. Accessed 16 February 2018.
Gotfredsen, Nanna W. “Rooms at Copenhagen’s H17, the world’s biggest drug consumption room.” TalkingDrugs, 15 August 2016, www.talkingdrugs.org/world-largest-drug-consumption-room-opens-in-copenhagen. Accessed 16 February 2018.
Kappel, Nanna, et al. “A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugs.” Harm Reduction Journal vol. 13, no. 20, 2016, doi:10.1186/s12954-016-0109-y.
Løftgaard, Kasper. “Drug Consumption Room ‘H17’ in Copenhagen (Vesterbro) – Denmark.” Global Platform for Drug Consumption Rooms, www.salledeconsommation.fr/photos-dcr-h17-in-copenhagen-photo11.html. Accessed 16 February 2018.
“Methadone.” Substance Abuse and Mental Health Services Administration, 28 September 2015. https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone. Accessed 3 March 2018.
Overgaard, Sidsel. “Denmark’s ‘Fix Rooms’ Give Drug Users a Safe Haven.” NPR, 16 December 2013. www.npr.org/sections/parallels/2013/12/16/246606797/denmarks-fix-rooms-give-drug-users-a-safe-haven
“Principles of Harm Reduction.” Harm Reduction Coalition. http://harmreduction.org/about-us/principles-of-harm-reduction/. Accessed 2 March 2018.
Talwar, Divya. “Why addicts take drugs in ‘fix rooms.’” BBC, 9 January 2017. www.bbc.com/news/magazine-38531307. Accessed 16 February 2018.
Toth, Eva Charlotte, et al. “A cross-sectional nation survey assessing self-reported drug intake behavior, contact with the primary sector and drug treatment among service users of Danish drug consumption rooms.” Harm Reduction Journal vol. 13, no. 27, 2016, doi:10.1186/s12954-016-0115-0.
“Vein Finder Demonstration.” YouTube, uploaded by Cookie Jar TV, 23 September 2015, www.youtube.com/watch?v=NS68ePykav0. Accessed 16 February 2018.
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