Drugreporter: On October 10, 2016, the first supervised injection site in France was opened in Paris. It took 7 years for this program to open - why was this process so slow? Who was against the idea and why?
Charlotte Mévil-Blanche: The DCR (Drug Consumption Room) project started back in 2009, when harm reduction civil society organisations came together and installed a mock DCR to attract public and political attention, which was successful. Following this event, a concrete DCR project for Paris was established in partnership with Médecins du Monde France and Gaïa, the health and social structure in charge of the current DCR in Paris. However, in 2013, even if some in the right wing government were in favour - such as Roselyne Bachelot, Minister of Health at the time - and although Rémi Féraud, the mayor of the 10th district of Paris, welcomed the structure in his district, the Council of State stopped the process when they declared that the current law was not adapted to protect the establishment of the DCR. We had to wait for the new public health law of January 2016, which allows the experimentation of DCRs but foremost protects the staff from penal offences under the 1970 illicit substances law, and tolerates the consumption of illicit products in the DCR, protecting the users of the facility.
Drugreporter: Serge Lebigot, the president of the organisation Parents Against Drugs, set up a website which asks people to “report incidents“ in the vicinity of the site. Do you think this hostile environment will change over time? What can be done to convince people in the neighbourhood?
Charlotte Mévil-Blanche: We are already seeing some changes: for example, there are fewer and fewer small billboards against the DCR on windows of the building across from the DCR, and in adjacent streets. Over the past year, we have been building relationships with people in the neighbourhood and we try to be as available as possible, especially when people face situations involving drug users and ask for our help. There is also a local committee that has been implemented, involving different local actors (public institutions, inhabitants, local NGOs, DCR staff…) that allows people to bring up issues, but also positive elements. As of today, this committee has met four times, and no major issue has been brought up. We believe that some people will never be convinced of the benefits of a structure such as a DCR, but we wish to maintain contact and improve the atmosphere of the neighbourhood. From our experience so far, people have been reassured after meeting with members of the team of the DCR, and visiting the facility (hundreds of people have already had the possibility to visit it, outside of operating times.)
Drugreporter: The DCR is located in a hospital. Why did you decide that this would be the best place to open this service?
Charlotte Mévil-Blanche: The choice of the location did not come from the association. It was more of a political choice and also something asked for by the inhabitants. As it turned out, this location is perfect for us as it is at the heart of the open drug scene in this area, which is really important in order to actually have a positive impact, both for drug users and the neighbourhood. Being located in a hospital, although it is a different entrance, has also allowed us to develop more relationships with certain services of the hospital and a protocol has been set up in case of a vital emergency.
Drugreporter: Can you explain what happens to a drug user when he or she enters the site? What are the steps and rules, what kind of drugs can be used and how?
Charlotte Mévil-Blanche: When the drug user comes in for the first time, he/she has to answer a survey about his/her practices and other health and social related questions. We then read through the rules with them, that they have to agree to and sign, and we explain the functioning of the DCR. Drug users have to have injection practices and be over 18. The program is anonymous and free and we only ask for a pseudonym and a date of birth. The first time that they use the facility, it must be for an injection. The DCR is divided into three areas. The first is the waiting area: users come in, have to show what they are going to consume, they get a ticket and have to wait for their turn. The second is the consumption room: there are 12 injection booths and also an inhalation room (with 4 spots). They come in, and have to wash their hands and use the materials given in the consumption space. They have to clean up after themselves after consuming. Each consumption is limited to 20 minutes, and one ticket equals one consumption. People are then free to stay in the resting area as long as they want, they can bring their food, get some rest, chat with the professionals, but also see the social assistant or receive medical attention from a doctor or a nurse. This is also a socialising space where different activities can occur such as meetings to talk about the functioning of the DCR, games, drawings … We have also been working on a project where peer users can work in the DCR and have a defined role. There are no restrictions on what they can consume. As of today, the great majority inject morphine sulphate and smoke crack cocaine.
Drugreporter: What other services do you provide to drug users and how do you connect them to other programs in the city?
Charlotte Mévil-Blanche: Regarding the services provided, we continue to have our needle exchange program at the entrance of the DCR, so people can get material even if they don’t want to stay to consume in the DCR. We also respond to a wide variety of demands regarding housing, orientation for substitution treatment, onsite medical care, orientation to other programs, social work… There is also a social insertion program, called “Labo Fabrik,” where people can work on their CVs, benefit from an individual accompaniment but also work collectively on creating objects (such as lamps, bags… from recycled materials) and other occupational activities. Gaia already has a great network and has been working with other programs in the city for years, but also in other parts of France. The opening of the DCR is a new occasion to expand this network and create new partnerships.
Drugreporter: It is estimated that the DCR will cost 1.2 million USD a year. It is a lot of money. How can you explain to tax payers why they should spend this money on this intervention?
Charlotte Mévil-Blanche: A great part of the budget is allocated to human resources and clean and sterile material. We strongly believe, and it has been scientifically demonstrated by many researchers in Vancouver and Sydney, etc, that the DCR is cost-effective: by avoiding new cases of Hepatitis C and HIV, but also other infections, diseases, abscesses… These kinds of treatments are very costly for social security and therefore taxpayers. The DCR might actually save tax payers money in the long run. The reduction of risks and of overdoses also justifies the need for such a facility.
Drugreporter: You expect this site will serve only 200 people but tens of thousands of people inject drugs in France. Do you think there is a need for more DCRs? Is there any plan to open more?
Charlotte Mévil-Blanche: DCRs target a vulnerable public, usually people living in precarious conditions, and consuming in public spaces. Therefore, not all drug users need access to such a facility. Concerning our clients, we are actually aiming to reach more than 200 people, as we already have over 1000 clients in our needle exchange program. Over 400 people have already registered at the DCR (although they do not all come every day), and we are still including new people regularly. About the situation in France: there is definitely a need for more DCRs, even in Paris. Another one has also opened in Strasbourg, on the 7th of November 2016. Even though it is big progress, it is not enough. Cities like Marseille for example are in great need of one, if not several, Drug Consumption Rooms. There is currently no plan to open more DCRs in France. We are hoping that the experiences in Paris and Strasbourg can be comforting enough for other cities to take the lead.
Interview by Peter Sarosi