Research project DR/93 (Research action DR)
In the more than 35 years of international Drug Consumption Room (DCR) existence, much evidence has been accumulated about their effects. Four main domains were consistently explored: (1) public health indicators related to the population of People Who Use Drugs (PWUD) (e.g. mortality and morbidity), (2) the characteristics of the target group population of DCR users and their consumption behaviour and profiles, (3) environmental effects of DCRs on their neighbourhood, including public safety, public nuisances, and local criminality, and (4) the capacity of DCR to contribute to recovery and rehabilitation of PWUD, including access to other social and care services. A considerable bunch of published studies indicated significant positive effects, whilst most commonly negative outcomes expected, such as increase of drug use, increase of acquisitive criminality, or an attraction of PWUD in the vicinity of DCRs, were not shown.
Despite the quantity of evidence, however, several reviews indicated that the quality of evidence was moderate. Most evidence resulted from observational and cross-sectional studies from a limited number of facilities in Sydney, Vancouver, Barcelona, and recently in France. The few existing comparative and longitudinal studies covered overdose incidents, accessibility to consumption material, risky consumption practices, and crime. It is a paradox that the oldest DCRs and the vast majority of them are established in Europe, but most studies examined the facilities that are established outside Europe.
Considering this context, REVE-DROOM includes a main study component and several complementary work packages about the two DCRs that are now established in Belgium (“Såf ti”, established in Liège in 2018, and “Gate”, established in Brussels in 2022), as well as two control sites in similar urban areas in the vicinity of MSOCs in Antwerp and Ghent. The main study will consist in a natural experiment, longitudinal comparative study. Data on the users of the two DCRs will be continuously collected and compared in two time points (after 6 months and 18 months later) as well as across sites. Data will include validated indicators on risky consumption behaviours (main outcome), morbidity and mortality, as in previous research. Additionally, the study will also consider elements from the pathway to (personal) recovery of users by assessing indicators of social integration, met and unmet care needs, quality of life, and personal recovery.
Complementary study actions will include: (1) an environmental study of the sites, both experimental and control, (2) an in-depth exploration of (at-risk) drug users and their recovery pathway within a community-based participatory research with peers, (3) a cost-benefit analysis of the DCRs in comparison with MSOC/MASS and other harm reduction services, and (4) an examination of the legal and management framework of the existing DCRs.
The REVE-DROOM project is expected to result in several major impacts on scientific knowledge, policy and public services, as well as on the health and quality of life of PWUD. In particular, the study is expected to strengthen the knowledge base on DCR effectiveness, not only to reduce the adverse consequences of drug use on individuals and the society, but also as a key strategy towards the personal recovery of the most deprived and at-risk drug users. It is also worth noting that there is an important growth of the number of DCRs established recently all over Europe, and these new DCRs are provided with new features, on the one hand, and facing new types of consumptions and risky behaviours, on the other hand. Therefore, the present study aims to rebuild the evidence taking into account the ever-changing context of drug use. It is expected that innovative indicators that relate to personal recovery and users’ strengths can be tested and suggested for further evaluation and monitoring of DCRs, elsewhere in Belgium if they were to be disseminated, and across Europe. For this purpose, the study consortium will collaborate closely with national (Sciensano) and international (EMCDDA) institutions carrying out routine monitoring of services for PWUDs.
Therefore, the study is also expected to provide institutions and authorities with recommendations on the scientific, managerial, and legal frameworks as how to optimise the effects of DCRs on public health and public safety. Hence, the study also aims to contribute clarifying the legal status of DCRs in Belgium and, possibly, suggest organisational solutions that might be considered elsewhere. Finally, the present study is aiming to have a major impact on the health and quality of life of the general population, as it is well known that DCRs not only impact the health and quality of life of users, but also contribute to improve the quality of life of all the residents in generally deprived areas.
