At the Thistle

At first glance, the row of booths could be mistaken for a chorus line dressing room. There are eight in all; each with its own strip-lighting, giant mirror and packet of wipes. But the yellow bins betray the true purpose. They are there for the disposal of used syringes at the UK’s first sanctioned safer drugs consumption facility (SDCF).

The last time I stood in a space set aside for the supervised injection of Class A drugs, it was in the back of a converted ambulance parked on a rundown road in Glasgow city centre. Run by an activist, Peter Krykant, the vehicle – illegal and unsanctioned – was a provocation to Westminster and Holyrood to address Scotland’s spiralling drug deaths. The rate per capita is the worst in Western Europe.

Glasgow has 400 to 500 drug users who inject in public spaces. Every time the ambulance pitched up on Parnie Street, queues would form as people made their way from nearby alleyways or the banks of the Clyde. The ambulance provided shelter from the cold and the security of knowing there was someone on hand to dispense naloxone in the event of an opioid overdose. But it was an ad hoc affair, which sometimes attracted police attention, and offered no pathway to other services.

Krykant had hoped for a repeat of what happened in countries such as Denmark, where underground SDCFs, run by activists, normalised the concept and led to the roll-out of official sites. But Scotland’s position as a devolved nation within the UK left it at an impasse, caught between the SNP’s desire to treat drug use as a health issue and the Tories’ commitment to a more punitive approach.

Krykant’s ambulance made global headlines and kept the issue in the public eye. But with Westminster refusing to budge on changes to the Misuse of Drugs Act 1971, and Scotland’s then lord advocate, James Wolffe, refusing to take unilateral action, Krykant seemed to be whistling in the wind.

Acknowledging the scale of the crisis in early 2021, the Scottish government, which had previously cut funding to the country’s alcohol and drug partnerships, began to reinvest. It introduced new Medication Assisted Treatment standards and increased the provision of rehab beds (from, it says, 425 in 2021 to 513 last November). The number of drug deaths dropped in 2021 and 2022, but rose again (by 12 per cent) in 2023.

In September 2023, Wolffe’s successor, Dorothy Bain, broke the stalemate. She confirmed that those using a proposed SDCF pilot in Glasgow would not be prosecuted for possession. Sixteen months later, after much work and a series of logistical hitches, here we are: three days away from the launch of a site that could not only save lives but transform UK drugs policy.

Glasgow’s SDCF, called the Thistle, is a discrete facility at the East End Hunter Street Health Centre, which already has GPs, a sexual health team, a blood-borne virus team, housing officers and the Enhanced Drugs Treatment Service (EDTS), which prescribes injectable diamorphine to a handful of people with intractable drug problems. The Thistle will be funded by the Scottish government for its first three three years, and open between 9 a.m. and 9 p.m. every day from Monday.

I was one of several journalists invited for a preview. What impressed me most was the effort that had gone into putting people at their ease. Glasgow’s public injectors are among its most marginalised citizens; many have had bad experiences with health services and find it hard to trust them.

An early concern was that, in order to gain the lord advocate’s approval, the Glasgow City Health and Social Care Partnership had opted for a medicalised model that would further entrench this alienation. Nurse-led, the Thistle is at the medicalised end of the SDCF spectrum, but lessons have been learned from the EDTS, with care taken to strip away clinical trappings and language. There is no glass barrier at reception. The injecting area is open plan, equipment is not locked away, and the mirrors in the booths are slanted, so the nurses can keep an eye on users without invading their personal space.

The interview rooms have been renamed ‘chat rooms’, the treatment rooms ‘health rooms’ and, beyond the recovery room, there’s a bright, comfortable lounge, with tea and coffee. Thanks to input from a lived experience forum, there is also a shower room, a supply of clean clothes and – though they are usually banned at NHS premises – an outside smoking area.

‘We didn’t think we would be allowed to have the smoking area,’ said Lynn Macdonald, who will manage the Thistle along with the other Hunter Street services. ‘But it was made clear to us that the first thing people will want when they come out of the recovery room is a cigarette, and they won’t hang around for long if they have to go elsewhere to smoke it.’

The priority is to coax the most at-risk across the threshold, so anyone turning up to inject will not be required to register their real name, address or CHI number. The hope is that, once they feel at home, they will seek other services such as housing, treatment programmes or residential rehab. At this point, they would have to provide their details, so Thistle staff would know if, for example, they were injecting on top of a methadone script. But Macdonald said this would be carefully explained, and any contact with care managers would be initiated by users.

People will not be allowed to smoke drugs on the premises – though it’s less dangerous than injecting – because smoking is banned in all public buildings in Scotland. Nurses will be limited to dispensing foils and advice as people leave. But Allan Casey, Glasgow City Council’s convenor for homelessness and addiction services, said he was continuing to push for an exemption, and it would be possible to retrofit an inhalation room.

Meanwhile, whether the Thistle can become a gateway to other services depends on their capacity. Glasgow is in the midst of a housing emergency and many of its recovery services are oversubscribed. Anyone looking for residential rehab is likely to face a lengthy wait, and there will inevitably be days when rough sleepers who come to the Thistle to inject find themselves back on the streets at closing time.

The shortage of residential rehab has often been cited as a reason not to press ahead with the Thistle which, like so much else, has found itself on the frontline of the Culture War. International research suggests that SDCFs prevent overdoses, improve communities and reduce the burden on the health system. The Thistle will be closely evaluated on all three fronts. But there are those who pit harm reduction against abstinence-based recovery, and view drugs funding as a zero-sum game.

The Scottish government insists that the £2.3 million a year going to the Thistle was not diverted from other drug services; but, self-evidently, money spent on one project is money that could be spent on something else. Some people have questioned the merits of such a significant sum being invested in an initiative with a small geographical reach.

The suggestion that it’s a waste infuriates Dr Saket Priyadarshi, the associate medical director of Glasgow alcohol and drug recovery services, who worries that the focus on the SDCF sometimes overshadows other developments, such as the setting up of Scotland’s first sixteen-bed stabilisation centre.

‘I am the clinical lead for a service which caters for a group of people with one of the highest mortality rates of any population in Scotland,’ he said. ‘If I were the clinical lead for an oncology service or a renal dialysis service, I wouldn’t be asked these questions. I don’t know why I am asked when everyone says our drug crisis is our national shame, and something must be done about it.’

The pressure on the Thistle comes not only from the critics poised to jump on its failure, but from the many SDCF advocates rooting for its success. Campaigners across the UK hope it will bolster the case for a revision of the Misuse of Drugs Act, making it easier to introduce a range of SDCFs, including less medicalised models. The change of government at Westminster has produced no obvious shift in stance, but some of the city councils eager to open SDCFs are Labour-controlled, and may be willing to lobby their own party.

Meanwhile, drugs workers in Canada are looking to Glasgow’s SDCF to halt an ideologically driven backlash against the country’s own long-established facilities.

When the Thistle opens its doors on Monday, service users are likely to be outnumbered by journalists asking if it will provide the solution to Scotland’s drugs crisis. But that’s too much weight for any small service to bear. Like everything else, SDCFs operate in a wider social context. In Scotland, people from deprived communities are eighteen times more likely to die drug-related deaths. All going well, the Thistle will reduce Glasgow’s drug death toll and support people into treatment and recovery. What it cannot do is eradicate the poverty that fuels addiction. Expecting it to fix the country’s entrenched health inequalities is folly, and a sure fire recipe for disappointment.