Coverage of target populations: some examples from city level

In the early 1990s, the cities of Frankfurt, Hamburg and Zurich were confronted with large open drug scenes. In all three cities, consumption rooms were introduced as part of a wider local response to the public health and order problems arising from this situation.

Zurich

After closing down the large, centralised public drug scene in Zurich in 1992, three consumption rooms were opened to provide alternative locations for drug injecting. However, an evaluation study conducted in 1993 and 1994 found that the capacity of the three rooms did not meet the demand and, in particular, was insufficient to achieve a significant reduction in public nuisance (Sozialamt der Stadt Zürich, 1995). Following an increase in the number of rooms to six in 1995, public drug consumption in the city has successfully been reduced. The number of supervised consumptions was stable around 3 000 per week during the period 1997–99 (Spreyermann and Willen, 2003) but declined in 2000 when one of the services was closed. New facilities for drug inhalation were opened in 2001 and 2002.

In 2002, the five consumption rooms in Zurich provided 36 places for drug injecting and

inhalation and operated seven days a week for a total of about 250 coordinated weekly opening hours, hosting about 3 100 consumptions per week (see Figure 4). A service evaluation study conducted in 2002 found that, on average, clients use consumption rooms more than five times per week (R. Blättler, ADH Zurich, personal communication August 2003).

Figure 4: Total number of supervised drug consumptions in all consumptions rooms in Zurich, 1997 - 2002

Source: Spreyermann and Willen, 2003, p. 19.

Frankfurt

In Frankfurt, a wide range of services for drug users, including outreach health education, shelters and methadone maintenance treatment, were introduced in the early 1990s as the result of a new local policy programme (Stadt Frankfurt am Main, 1991). The primary target group of the consumption rooms was a population of 300–400 highly problematic street injectors (of a total estimated number of 6 000–8 000 drug users who obtained their supply of drugs in Frankfurt) who continued to inject in public around the train station and in a nearby public park despite the availability of various drugs services. Between December 1994, when the first consumption room was opened, and August 1996, capacity was gradually increased while the effect of the rooms on the open drug scene was monitored.

In his study of the first months of operation of three injecting rooms in Frankfurt in 1994/95, Kemmesies (1995) found that there were queues during busy periods, and cocaine injectors in particular were not willing to wait and continued to use in public. The study concluded that the existing capacity of 22 places open for a total of 100 hours per week was insufficient to tackle public drug use effectively.

A significant reduction in the visible drug scene in Frankfurt was achieved only when a fourth consumption room was established in August 1996, increasing the number of available places to 35, and opening hours of all four rooms together were extended to a total of about 300 hours per week. Service delivery was coordinated so that capacity during periods of high demand was increased and supervised injecting possibilities available daily between 6.00 o’clock in the morning and midnight. A recent study found that this expansion of service provision and coverage coincided with a reduction in drug-related deaths in Frankfurt (see section 4.2).

One room is integrated into an emergency shelter for 70 drug users and the other three are located in the train station area at varying distances from the places where drugs are sold (Körner, 1995). The rooms admit only drug injectors. All four rooms are open from Monday to Saturday and three are also open on Sundays (¹²); increased capacity is provided during times of high demand, e.g. in the evenings (until midnight). In 2001, a total of about 4 100 injections were supervised each week in the four rooms. The distribution of the consumptions across the five facilities in Frankfurt is presented in Figure 5 below. This capacity is considered to be sufficient to meet demand by the local target population of problematic, long-term injectors (R.

Ernst, Head of Drogenreferat Frankfurt/M, personal communication, June 2002).

Figure 5: Weekly average number of supervised injections in consumption rooms in Frankfurt, 2001

(¹²) In August 2001, the total opening hours of the four rooms were reduced to 290 per week. In 1998, a further small consumption room was opened at an institution for the homeless in Frankfurt. Its use is restricted to those who live at the shelter; the average level of use reported in 2001 was 38 consumptions per week.

Source: Poschadel et al., 2003

Hamburg

In Hamburg, police estimate the total number of drug users to be between 7 000 and 8 000 (Zurhold et al., 2001). Since 1994, eight consumption rooms have been established, providing a total of 58 places for supervised drug injection and inhalation for a total of 300 hours per week.

The city follows a policy of ‘decentralisation’ of the drug scene via consumption rooms (see Box 5). Hamburg has considerably more consumption places than Frankfurt and Zurich, and a lower overall rate of consumptions per available place: about 2 860 (¹³) supervised consumptions take place each week. The distribution of the consumptions across the eight facilities in Hamburg is presented in Figure 6 below.

The use of ‘decentralised’ rooms is low, whereas services close to the illicit drug market cannot meet the existing demand and public nuisance problems resulting from open drug scenes persists. One decentralised service was closed in 2002. The political decision to shut down a further service in Hamburg was announced in summer 2003.

Figure 6: Weekly average number of supervised consumptions in consumption rooms in Hamburg, 2000/2001

Source: Poschadel et al., 2003.

A contact café with consumption room was opened in Biel, Switzerland, in August 2001 after the authorities had closed a ‘scene’ restaurant, where about 20–40 drug users met daily. The room aimed to prevent the emergence of an open drug scene in the city. When the consumption facility was planned, it was assumed that 10–20 % of an estimated target population of 600 drug users would use it and five places for drug injecting and four inhalation places were made available for 42 hours per week. During its first year of operation however, a total number of 515 individual drug users registered with the service and the average weekly number of

consumptions was 480. A client survey conducted as part of the evaluation study found that a high proportion of clients were regular users of the service (Spreyermann and Willen, 2002).

(¹³) Based on annual data for 2001 from consumption rooms C to H and data for 2000 for consumption rooms A and B, reported in Poschadel et al. (2003).