A Critical Review of the Business Case for Drug Consumption Rooms in Glasgow

A Critical Review of the Business Case for Drug Consumption Rooms in Glasgow

The business case for establishing a Safer Drug Consumption Facility (DCR) in Glasgow in 2017, as laid out in several reports and proposals, rests heavily on the promise of harm reduction, public health improvement, and cost savings. Drawing back then from international evidence, particularly from cities like Vancouver and Sydney, proponents argue that DCRs can reduce public injecting, mitigate overdose deaths, and provide a pathway to addiction treatment for some of the most vulnerable individuals. However, a closer scrutiny reveals a series of assumptions, gaps in evidence, and potential misapplications of international experiences, particularly when applied to the unique socio-political and economic landscape of Scotland.

The first thing to say about this Business case for Drug Consumption Rooms (DCRs) in Glasgow, is that the options study did not include rehabilitation as a part of the available options for addressing the drug crisis. This omission is a huge point of criticism, as it limits the scope of potential solutions and fails to consider the most effective long-term approach to addiction recovery. The business case primarily focused on harm reduction strategies, such as DCRs, but did not explore or compare them against other options like increasing access to rehab, which would address the root causes of addiction.

The lack of rehabilitation options in the analysis is problematic because addiction recovery requires comprehensive treatment, including rehabilitation services, which go beyond merely reducing the immediate risks associated with drug use. By excluding rehab in the options study, the business case fails to present a full picture of potential solutions and may misrepresent the broader, more sustainable approach needed to address Scotland’s addiction crisis. But putting that aside for a moment..

The Limitations of International Evidence in the Scottish Context

The evidence cited in the business case largely comes from international examples, where DCRs have been implemented under very different conditions. Cities like Vancouver and Sydney have long-established harm reduction policies, backed by substantial healthcare systems and public attitudes that are, in many ways, more accepting of drug use than in Glasgow. While the studies from these cities show positive short-term health outcomes, including reductions in public injecting and overdose deaths, these results cannot be easily generalised to the Scottish context.

For example, the unique socio-economic challenges faced by Glasgow, including high levels of poverty, homelessness, and mental health issues, do not align with the conditions under which these international models were placed. The business case fails to sufficiently engage with the local socio-political environment, which may significantly affect the success of DCRs. Moreover, evidence from cities like Vancouver shows that while DCRs can provide immediate harm reduction, they have not led to significant long-term reductions in drug use or improvements in addiction recovery rates (Humphreys, 2024). The introduction of DCRs in Scotland therefore risks, focusing on managing symptoms rather than addressing the root causes of addiction, such as trauma, social isolation, and inadequate mental health support.

Financial Projections and Assumptions

A significant portion of the business case is dedicated to the purported economic benefits of DCRs, particularly through the reduction of healthcare costs and savings from fewer drug-related crimes. However, these projections are largely speculative and fail to account for the complexities of financing and sustainability in Scotland's healthcare system. The business case overlooks potential hidden costs, such as the funding required to expand additional social services, legal costs, and the long-term operational expenses of running DCRs (Humphreys, 2024). The argument that DCRs will save money by reducing drug-related harm lacks local data to support these claims, and the reliance on international cost-benefit models does not take into account the distinct public health and social welfare system in Scotland which again are very different to Vancouver and Sydney.

A closer look at the financial models of DCRs in other cities reveals mixed results. For example, the cost-saving projections from Vancouver’s DCR model were not as clear-cut as expected, with some studies showing that the savings from reduced overdose deaths and healthcare costs were offset by the high operational costs of the facility itself (Wodak & Coomber, 2017). In the case of Glasgow, a more realistic financial assessment would need to factor in both direct costs and the possible diversion of funds from other essential services, such as addiction treatment and mental health care, which are already underfunded. In the 2 weeks since Glasgows DCR opened It’s been used a total of 239 by 60 individuals. They also claim there has been "some referrals," that have came from it. We can assume with some certainty that these referrals were not made to rehab, because there are only 23 publicly funded rehab beds in Glasgow. The reality is, most of these referrals probably went to other services, what other services, we don’t know, but definitely not to rehabilitation.

After 27 years of my own recovery, if there’s one lesson I know better than any other, it’s that I could never predict who is ready for rehab and who isn’t. But what I do know for certain is that the vast majority of individuals struggling with addiction will never get the chance to access rehab. For the 18,060 problem drug users and 132,955 problematic alcohol users in the Greater Glasgow & Clyde area, there are only 23 publicly funded rehab beds—a disgraceful imbalance. In fact, this means that only one in every 6,565 people battling addiction will ever have the chance to go to rehab.

Let’s put this into perspective: a week of rehab in Glasgow costs on average £1,000. The £2.3 million being spent on this service equates to £1,466.67 per week for each person who uses it. That’s £1,466.67 per week just to help someone use drugs more safely, rather than helping them break free from addiction through rehabilitation which is over £400 quid a week cheaper.

This is a stark reality. Instead of investing in long-term recovery, this money is being used to maintain the cycle of addiction. It’s not just a failure, it’s a tragic misuse of resources, one that prevents people from escaping addiction and perpetuates the very problem we should be working to solve.

Community Impact and Crime Rates

But any way, back to that “Business Case” for DCRs put forward in 2017 by Dr. Saket Priyadarshi. One of the key arguments in favor of DCRs is that they can reduce public disorder and improve the quality of life in areas affected by drug-related issues. While the business case suggests that DCRs will reduce visible drug use in public spaces, this claim has not been sufficiently substantiated by evidence from comparable urban areas. While Vancouver’s experience with DCRs has shown some reduction in public injecting and discarded needles, these outcomes have not been universally experienced. In fact, some studies suggest that the introduction of DCRs may merely displace drug use to nearby areas without addressing the root causes of addiction and crime (Humphreys, 2024).

Furthermore, the introduction of DCRs in Vancouver and Sydney did not show significant reductions in local crime rates. On the contrary, critics argue that DCRs can exacerbate crime in surrounding areas by drawing large numbers of drug users to central locations, where drug dealing and other illicit activities thrive (Kerr et al., 2007). In Glasgow, where public safety concerns are already heightened due to high rates of violent crime, the impact of DCRs on local crime rates remains an open question.

The Risk of Overlooking Holistic Solutions

The business case positions DCRs as a key part of a broader strategy to address the drug crisis in Glasgow. However, the focus on harm reduction through DCRs totally diverts attention from the more fundamental issue of addiction recovery. Evidence suggests that comprehensive, long-term addiction treatment, including access to rehabilitation services, mental health support, and social reintegration programs, is essential for addressing the root causes of addiction (Loxley et al., 2017). While DCRs may provide a “safe” space for drug users, they do not tackle the underlying issues of addiction, such as trauma, mental illness, or social exclusion.

In fact, studies in both Vancouver and Portugal have shown that while DCRs can reduce some immediate harms, they have not significantly increased access to addiction treatment or recovery services (Wodak & Coomber, 2017). The introduction of DCRs without expanding access to holistic addiction treatment services which is the case in Glasgow will reinforce the cycle of dependency without providing addicts with the tools they need to overcome their addiction in the long term. This critique is particularly relevant in Scotland, where addiction treatment services are already underfunded and difficult to access.

Ethical and Legal Concerns

The ethical implications of providing a supervised space for drug use have also been raised. While DCRs are framed as compassionate harm-reduction measures, there are concerns that they inadvertently normalise drug use and reduce the perceived need for recovery (Dolan et al., 2000). Critics argue that DCRs send the message that drug use is acceptable, even if done in a controlled environment, undermining efforts to promote abstinence-based recovery and rehabilitation. Moreover, the legal status of DCRs in the UK remains uncertain, as they would require an exemption from the Misuse of Drugs Act 1971 or a change in legislation (Humphreys, 2024). This legal ambiguity creates significant uncertainty about the long-term viability of DCRs in Scotland.

Conclusion

The business case for establishing Drug Consumption Rooms (DCRs) in Glasgow, proposed in 2017, is grounded in harm reduction principles from international models, particularly in cities like Vancouver and Sydney. However, when scrutinized through the lens of Scotland's current drug crisis and the evolving trends in substance misuse, the arguments for DCRs become increasingly questionable. While DCRs may offer some immediate benefits, particularly in preventing overdose deaths related to opioids, the increasing prevalence of benzodiazepines, especially etizolam, combined with opioids in the drug-related death landscape, highlights a growing complexity that DCRs alone are unlikely to address.

The business case was made during a time when opioids were still the leading cause of drug-related deaths in Scotland, but since then, there has been a marked rise in the involvement of benzodiazepines, especially in combination with opioids. This shift in drug use patterns calls into question the effectiveness of DCRs, which are primarily designed to address opioid overdoses. The focus on harm reduction through DCRs, while important, does not adequately engage with the emerging threats posed by polydrug use, particularly the dangerous combination of opioids and benzodiazepines. The failure to fully address this emerging issue further undermines the claims that DCRs can significantly reduce drug-related deaths in Scotland.

The financial projections presented in the 2017 business case, which suggest substantial savings from reduced healthcare costs and fewer drug-related crimes, remain speculative at best. These projections rely heavily on international evidence and assumptions that may not apply to the Scottish context. For instance, the cost savings realised in Vancouver have not been universally achieved, and the true financial burden of implementing and maintaining DCRs—including the diversion of resources from other essential addiction treatment services—has not been sufficiently addressed. Glasgow’s DCR, which was established with considerable investment, has yet to demonstrate tangible benefits in terms of long-term addiction recovery or significant public health savings. The reality of addiction treatment in Glasgow, with only 23 publicly funded rehab beds available for a population of 18,060 problem drug users, starkly contrasts with the money spent on harm reduction, suggesting a significant misallocation of resources that could otherwise fund long-term recovery options.

The business case for Drug Consumption Rooms (DCRs) in Glasgow makes bold claims that the introduction of such facilities will not lead to an increase in crime rates or public disorder. It asserts that DCRs will reduce visible drug use and improve public safety by containing drug consumption within controlled environments. However, this overly optimistic view fails to acknowledge substantial evidence from other cities, including Vancouver and Sydney, where similar facilities have been implemented. Contrary to the claims made in the business case, research has shown that DCRs often displace drug use to surrounding areas, rather than eliminating it. This displacement can lead to heightened levels of public disorder, with drug users and associated activities spilling over into nearby neighborhoods, thereby worsening the situation rather than solving it.

The idea that crime will not rise in areas surrounding DCRs is contradicted by research from cities like San Francisco and Washington, D.C., where the introduction of harm reduction measures, including DCRs, was followed by a noticeable increase in both violent and property crimes. These cities experienced an uptick in drug dealing, theft, and other crimes, particularly as drug users congregated in the vicinity of harm reduction sites, creating opportunities for further criminal activity. In Vancouver, for example, the presence of DCRs led to an unintended rise in street-level drug dealing and related crimes in surrounding areas, which were not subjected to the same regulatory measures (Humphreys, 2024).

In Glasgow, where public safety concerns are already exacerbated by high rates of violent crime and drug-related issues, the introduction of DCRs risks worsening these challenges. The business case’s assertion that crime will not rise is not only misleading but dangerously dismissive of the real-world evidence that suggests harm reduction strategies like DCRs may inadvertently increase local crime, public disorder, and social instability. The unquestioning acceptance of these claims in the business case overlooks the complex realities of drug use, crime dynamics, and community impacts, presenting an overly optimistic picture that ignores the potential negative consequences for Glasgow's most vulnerable areas.

Furthermore, the emphasis on harm reduction through DCRs diverts attention from the more fundamental issue of addiction recovery. DCRs, while providing a “safe” space for drug use, do not address the underlying causes of addiction, such as trauma, mental health disorders, and social exclusion. As studies from Vancouver and Portugal suggest, DCRs alone have not been sufficient in increasing access to addiction treatment or recovery services. In Glasgow, where addiction treatment services are already underfunded and access is limited, DCRs risk perpetuating the cycle of dependency without offering a true path to recovery. I’m sorry to keep going on about this but until we wake up I will continue to repeat myself.

In conclusion, while DCRs may have a role to play in reducing the immediate harms associated with drug use, they must be viewed as only one part of a much broader, integrated strategy to address Scotland’s drug crisis. The rapidly changing drug trends, particularly the rise of benzodiazepine and polydrug misuse, suggest that harm reduction alone will not suffice. Instead, a more comprehensive approach is necessary, one that includes expanding addiction treatment services, mental health support, and long-term rehabilitation options. The speculative financial projections and the limited engagement with Glasgow’s specific socio-political and community needs raise significant concerns about the effectiveness and sustainability of DCRs. As the evidence base continues to evolve, it is essential that DCRs and other harm reduction strategies be carefully evaluated to ensure they are not only cost-effective but also truly meet the long-term needs of the communities they aim to serve.

You can find the business case Glasgow City Council put forward in order to justify the DCR here

References

Humphreys, K. (2024). The rise and fall of Pacific Northwest drug policy reform, 2020-2024. Brookings Institution.

Kerr, T., Kimber, J., & Gibbon, M. (2007). The Impact of Supervised Injection Facilities on Public Health and Safety: A Review of the Evidence. The Lancet, 370(9594), 310-316. https://doi.org/10.1016/S0140-6736(07)61283-0

Loxley, W., Toumbourou, J., & Stockwell, T. (2017). Drug Policy and Public Health: The Role of Harm Reduction. Oxford University Press.

Wodak, A., & Coomber, R. (2017). What is the Evidence for Drug Consumption Rooms? A Review of International and Australian Research. Australian and New Zealand Journal of Public Health, 41(6), 618-623. https://doi.org/10.1111/1753-6405.12775