On 13th January 2025, Glasgow opened the United Kingdom’s first Safer Drug Consumption Facility, The Thistle.
This blog post outlines key information about Safer Drug Consumption Facilities more generally, as well as The Thistle specifically, and the Scottish context within which it was established.
What are Safer Drug Consumption Facilities?
Safer Drug Consumption Facilities (SDCFs) are healthcare services where individuals can self-administer drugs in hygienic conditions supervised by qualified medical professionals. These facilities provide clean injecting equipment and harm reduction guidance, such as safer injecting procedures.
SDCFs aim to prevent deaths caused by drug overdoses and minimise wound-related infections and the transmission of blood-borne viruses (BBV) including HIV and hepatitis B and C. They also aim to benefit the surrounding community by reducing public drug use and associated drug-related litter in local communities.
Staffed by a range of health and social care professionals, SDCFs can offer service users BBV testing, and refer them on to additional support, such as addiction services, social care, and support for housing issues.
Crucially, SDCFs serve as an initial point of contact for engaging vulnerable and marginalised populations who may otherwise struggle to engage with health or wider services, such as people experiencing homelessness.
Do other countries have SDCFs?
The first SDCF was established in Switzerland in 1986 in response to high rates of drug-related harms and fatal overdoses from people injecting drugs in unsanitary and dangerous conditions.
Since then, over 200 SDCFs operate globally across 12 different countries. This has allowed extensive international research and evaluation on their effectiveness in reducing drug-related deaths, health harms, and the impact on local communities.
What is the evidence for SDCFs?
Evaluations of SDCFs worldwide demonstrate their effectiveness in reducing drug-related deaths, rates of infection transmission, public injecting, and drug-related litter. Research published in 2010 found that no overdose deaths had occurred in any SDCFs globally.
Several long-term evaluations indicate that attendees of SDCFs engage safer injecting practices and reduce public injecting, leading to significant declines in in HIV and Hepatitis C transmission and fewer ambulance callouts for overdoses.
This research also shows that SDCF attendance reduces unsafe needle disposal, lowering council spending on needle uplift and disposal while improving local community safety and public amenities.
SDCF attendance is linked to increased engagement with addiction recovery services, especially among marginalised and vulnerable populations who typically do not engage with health services, including those who are homeless or have no fixed address. At a SDCF in Sydney, staff made 8508 referrals, half for drug treatment, among long-term drug users, 40% of whom had never accessed drug treatment. More frequent attendance at the SDCFs increased the likelihood attendees would accept referrals for drug treatment. Evidence from a SDCF in Canada shows that regular SDCF attendees were 33% more likely to initiate addictions treatment and 72% more likely to engage with a detoxification programme.
Studies examining the financial impact of SDCFs indicate considerable cost savings. These facilities contribute to reduced spending by significantly lowering the number of drug-related hospital admissions, A&E visits, and ambulance callouts for overdoses. This frees up ambulances and emergency medical services for other critical emergencies in the area. They also reduce costs associated with clearing drug-related litter in the nearby areas. One study evaluating the cost-effectiveness of a SDCF in Canada estimated that over a 10-year period, more than $18 million would be saved due to HIV prevention through reduced needle sharing and uptake of safer injection practices among people injecting drugs. A further study of a SDCF in Baltimore estimated that the opening of a single facility would prevent 108 overdose-related ambulance callouts, 78 A&E visits, and 27 drug-related hospitalisations.
The context in Scotland: Drug deaths and related harms
Drug-related deaths pose a major public health challenge in Scotland, which reported more than double the number of drug-related deaths compared to other UK countries in 2022. Scotland also has the highest rates of drug-related deaths in Europe, with 224 drug-related deaths per million people in 2023, compared to 22.5 per million reported across the European Union in 2022.
While 2022 saw the lowest level of drug-related deaths since 2017, this number increased in 2023. In 2023, there were 1,172 drug-related deaths, a 12% increase from 2022 and 4.2 times as high as in 2000.
Drug-related deaths are primarily linked to the use of opiates and opioids, such as heroin, morphine, and methadone, which were involved in 80% of all Scottish drug-related deaths in 2023. The rise in poly-drug use and increasing availability of new synthetic drugs is also contributing to recent increases in drug-related deaths. The strong potency of synthetic drugs makes them unpredictable, even for experienced drug users.
There is also a strong link between drug-related deaths and social deprivation, with deaths more than 15 times higher in the most deprived areas of Scotland compared to the least deprived areas.
In response to rising drug deaths, the Scottish Government made addressing drug-related deaths a key priority. To this end, a new treatment strategy was introduced in 2018, a Drug Deaths Taskforce established in 2019, with a final report published in July 2022, and a National Mission to reduce drug-related deaths launched in 2021, with a National Drugs Mission Plan: 2022-2026 published in 2022. As part of this broader initiative, plans included piloting SDCFs in areas with identified needs.
Why was Glasgow chosen for the SDCF pilot?
Common concerns around the opening of a SDCF often include fears of increased crime and antisocial behaviour in the surrounding areas. However, SDCFs are most effective when implemented in areas which already have high rates of public injecting. These facilities provide a private and supervised space, encouraging individuals already engaging in drug use within the area to use the facility instead of injecting in public spaces. Studies have shown that the introduction of SDCFs can lead to a decrease in drug-related crime, including reduced public injecting and suspected drug dealing within the area. SDCFs have also been shown to reduce the volume of publicly discarded syringes and drug-related litter in the vicinity. This improves health and safety for both the people injecting drugs and the community members of the surrounding areas.
Glasgow was selected to pilot Scotland’s first SDCF for three years due to high rates of public injecting and drug-related deaths, which have risen by 85%, from 157 deaths in 2015 to 291 in 2020.
A vulnerable cohort of people inject drugs publicly within the city centre, with significant increases in HIV transmission rates among this population since 2015, and public injecting having previously been linked to outbreaks of infectious diseases. An NHS Glasgow and Greater Clyde study found that among 377 people who prepared and injected drugs in the city centre in 2020, 53% had not been tested for HIV, and 50.1% had not been tested for Hepatitis C.
Drug-related litter is also a major problem in Glasgow, with unclean injecting equipment negatively impacting community safety and local amenities. Glasgow City Council regularly receives 10-20 needle uplift requests per month.
Glasgow has also seen a significant recent increase cocaine injecting, which is linked to more frequent injecting. This can exacerbate existing problems with drug-related deaths, disease transmission, and drug-related litter.
The Thistle: Glasgow’s SDCF
Glasgow’s new SDCF, The Thistle, is located within the existing Hunter Street Health and Care Centre, within the Calton area of the city and accessible from the city centre. It already provides related health services to people who use drugs, including the Enhanced Drug Treatment Service (EDTS).
The Thistle is a confidential service, described as offering compassionate and person-centred care to people who inject drugs in Glasgow. Its aims are to reduce drug-related deaths from overdoses and minimise the impact of public injecting on local residents and businesses. The facility is staffed by a multidisciplinary team, including nurses, psychology, harm reduction workers, social workers, and medical staff.
Service users have access to a hygienic, supervised injecting space and clean injecting equipment to self-administer drugs obtained elsewhere. Staff do not assist service users in administering drugs, and service users are not allowed to share drugs or assist each other with injecting. An aftercare lounge is available for support and advice on health and social issues, along with private interview rooms, health rooms for BBV testing and wound treatment, a shower, and laundry facilities.
Policing and the Lord Advocate’s Statement on Prosecution
Previously, the law regarding possession of drugs presented a barrier to the opening of SDCFs in Scotland. It is governed by the Misuse of Drugs Act 1971, a UK piece of legislation. This changed in September 2023 when the Lord Advocate stated that she “would be prepared to publish a prosecution policy that it would not be in the public interest to prosecute drug users for simple possession offences committed within a pilot safer drugs consumption facility”. The Lord Advocate subsequently issued a Statement of Prosecution Policy and Lord Advocate’s guidelines: safer drug consumption facility in January 2025. This statement is explicitly limited to the SDCF in Glasgow for the three-year duration of the pilot and does not apply to the surrounding area, where drug offences will be policed as normal.
Financial costs
The Scottish Government has committed to providing up to £2.3 million per year to fund the development, set up, and running of the three-year pilot SDCF from 2024-25. They will provide a total of £1,277,000 for the financial year 2024-25.
The opening of a SDCF might be expected to result in financial savings due to fewer drug-related hospital admissions, A&E visits, and ambulance callouts for overdoses, as well as reductions in costs of clearing drug-related litter in the surrounding areas.
Numbers attending
In the first two weeks of operation, 239 people attended the Glasgow facility, with some already receiving support to engage with housing and addiction recovery services. Of the attendees, 85% were male and 15% were female. The most commonly injected drug was cocaine, used by 87% of attendees. Since opening, no medical emergencies related to drug use have been reported.
Evaluation
An independent evaluation of the Thistle is underway as part of its three-year pilot. This will evaluate how well the Thistle achieves its desired outcomes and identify any unintended negative impacts. Public Health Scotland (PHS) and Glasgow Caledonian University (GCU) have formed a collaborative partnership to conduct the evaluation. PHS has provided £202,000 in funding for the necessary planning, preparation, and baseline assessment. Researchers at GCU are leading the evaluation, conducting systematic observations of drug-related litter in the surrounding area and collecting data on individuals attending the Thistle. This data will enable the evaluation of the uptake in BBV testing and use of other services.
UK Parliament Inquiry
The Scottish Affairs Committee has launched an inquiry into the Thistle’s three-year pilot. This will investigate the legal and policy challenges associated with the introduction and running of the facility and examine its effectiveness in reducing drug-related deaths in Scotland. The inquiry will consider potential legal changes at the UK level that might be required to ensure the facility’s sustainable operation beyond its initial three-year pilot phase.
Annamae Burrows, Trainee Researcher, SPICe & Kirsty Deacon, Senior Researcher, SPICe