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The purpose of this paper is to provide contextual information around the grass-roots activities which resulted in legislation allowing the opening of drug consumption rooms in Denmark. This background has not been included in, e.g. the annual Danish Focal Point reports to the EMCDDA.

An account by some of those involved on the grass-roots and political activities which resulted in the enabling changes in law and the provision of building-based drug consumption rooms in Denmark.

The actions described originated in a concern for the health and well-being of drug users. That grass-roots action can act as a catalyst for political changes in social policy to take account of the situations and needs of socially marginalised groups.

The paper describes the sequence of grass-roots actions from the point of view of those involved. It does not seek to represent the views of those opposed to the activists’ aims.

The use of international evidence to support policy and legal changes in one nation, Denmark, in order to improve conditions for drug users. The need for funding commitments to support and realise the legal and policy changes.

The success of long-term campaigning on behalf of a specific marginalised and socially excluded group of citizens and the countering of myths and stigma associated with this group.

This is a unique account told by those directly involved of the social and campaigning processes which led to a change in the law and a shifting of popular and political opinion and action.

Ruth Runciman helped bring needle exchanges to the UK. Now she is chairing a working group to look at the possibility of bringing drug consumption rooms to this country. Here, in a frank interview, she tells Gary Hayes why drug consumption rooms may be the next step in the fight to reduce harm among drug users. We also find out just what she makes of the recent reclassification of cannabis, following the Runciman report which criticised the current drug laws.

The purpose of this paper is to first, inform readers of the roles, activities and contexts of drug users unions in Denmark and Sweden. Second, to show the achievements and impacts of the two. Third, to illustrate the differing social and political situations in the two countries and how they determine the priorities and activity of the unions.

The paper is written by a UK commentator who bases the text on meetings, interviews and conversations with members and representatives of the two unions. Spokespersons for both unions have contributed to, commented on and clarified draft texts and provided contextual papers and information.

The two unions have differing roles and levels of acceptance and influence according to the political and legal situations in the two countries. There are differing situations and needs in Denmark and Sweden, reflected in the levels of drug-related deaths. There is no “Scandinavian” model. In Denmark the users union is involved in high-level discussions on policy making and practice. In Sweden the new unions are starting to be involved in local discussions about provision and practice.

Danish experience shows how political acceptance of the existence of a drug using population is leading to improved health and well-being amongst that population, and to social policy responses which are inclusive of this and other marginalised groups, and to a reduction of stigma and demonisation. Swedish experience differs and can be seen as essentially prohibitionist and punitive. Many Swedish drug users are moving to Denmark because of the levels of service and social attitudes. It may be of interest to UK policy to adopt a similar approach to drug users organisations – as distinct from service users’ voices.

Strengthening the role of drug users unions in all countries and including them in national policy making discussion and debate.

Accepting the existence and needs of drug using groups in society and developing responses informed by their views and experience. Adopting inclusive social policies and recognising the variety of need and choices in treatment. Combatting stigma and demonisation.

The paper is based on extensive interviews and conversations whose results and content are recorded, not interpreted. The Danish work was conducted in Danish, adding to the number of voices and conversations it was possible to include. A distinction between policy and practice in Denmark and Sweden is established which may run counter to UK impressions of “Scandinavian” rather than national realities.

This paper aims to examine policy innovation among street-level bureaucrats at low-threshold services to people who use drugs during the COVID-19 pandemic in Denmark.

This paper builds on two research projects conducted during the first pandemic lockdown in Denmark. The first is a case study of how COVID-19 impacted on people who use drugs (PWUD) and services for PWUD at the open drug scene in the neighborhood of Vesterbro in Copenhagen. The second is an ethnographic study of how users of services at the intersection of drug use and homelessness were impacted by lockdown.

Drawing on Kingdon’s “multiple policy streams” approach, this study shows how lockdown opened a “policy window” for innovating services to people who use drugs. This paper further shows how the pandemic crisis afforded street-level bureaucrats new possibilities for acting as “policy entrepreneurs” in a context where vertical bureaucratic barriers and horizontal cross-sectoral silos temporarily collapsed. Finally, the authors show how this had more lasting effects through the initiation of outreach opioid substitution treatment.

In Denmark, the emergence of a “policy window” for street-level bureaucrats to act as street-level “entrepreneurs” occurred in a context of rapid government response to the pandemic. For crises to act as “policy windows” for innovation depends on strong, preexisting institutional landscapes.

This paper adds to existing literature on policy innovation during COVID-19 in two ways: methodologically by contributing an ethnographically grounded approach to studying policy innovation and theoretically by examining the conditions that allowed policy innovation to occur.

Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s. Despite this, no sanctioned SIF has ever been implemented. The purpose of this paper is to provide information about a 10 year unsanctioned drug user-run SIF experience in Italy called Stanzetta.

The aim of the paper is to assess how Stanzetta met its objectives. Analysis was conducted compiling narrative accounts from the staff working in the NSP, which is adjacent to the Stanzetta, and conducting a simple frequency analysis of the available statistical data.

The Stanzetta unsanctioned SIF has been running for ten years and continues to be vulnerable due to its legal status. Being open 24 h/days has maximised its accessibility, but at the same time, it has encouraged a misuse of the Stanzetta. Although not trained, drug users became self-empowered to run the Stanzetta and to keep it clean, but the hygiene-health aspect is seen as one of the greatest challenges by the NSP professional staff. Over 10 years, not a single overdose death has been recorded. Drug use in the park has shifted from more visible places to the Stanzetta. As a result, the abandoned syringes have diminished in number and those disposed of correctly have increased. Moreover, no complaints from citizens or law enforcement were ever made. The neighbourhood acceptance seems to be the main goal of the peer-run unsanctioned SIF.

The paper is based on a narrative account from the point of view of the professional staff involved, and results are specific to the context in which the study was conducted. Because of the chosen approach, the research results lack scientific generalisability. A relevant limitation is that no peer was involved in this study. Despite this, the research contributes to the information based on peer-run SIFs and makes a case for the de-medicalisation of SIFs in Europe.

This paper gives visibility to a long-lasting drug user-run SIF experience that was not made public mostly for an unclear legislative background about SIF in Italy.

Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s and were undertaken primarily in response to epidemics of HIV infection and overdose (DPA, 2017). Despite this, no sanctioned SIF has ever been implemented. Primarily, this study wants to underline the urgency for an SIF pilot in Italy, and secondly the need to consider de-medicalising these services through direct support for peer-based models.

The Stanzetta unsanctioned SIF in Italy that has been running for ten years. Despite this, the venue continues to be vulnerable due to its legal status. For this reason, these results were never made public before. The experience showed a good working synergy between NSP professionals and the SIF peers. This model can be considered as a “light” de-medicalisation form to be explored and eventually to be implemented as a pilot SIF in Italy.

The Uniting Medically Supervised Injecting Centre (MSIC) opened in Sydney, Australia, in May 2001. Homelessness among people who inject drugs (PWID) in Australia has been increasing, and establishing how supervised injecting facilities (SIFs) might best support clients into housing is an important goal. The purpose of this paper is to update knowledge regarding the accommodation status of MSIC clients, thereby supporting a better understanding of the complex needs of these clients.

Client accommodation status at MSIC registration (first visit) and in a brief survey (conducted in May 2016) were compared; unstable accommodation was defined as rough sleeping, couch surfing, hostel, boarding house or crisis accommodation. The bivariate logistic regression analysis was used to explore the association between socio-demographics and accommodation status at both time points; a paired t-test was used to compare the visit records for those who reported stable and unstable accommodation in May 2016.

Of 232 clients who were present at MSIC during the week the Brief Survey was conducted, 107 participated. Most were male (79 per cent) with a mean age of 41.4 years. A total of 64 (60 per cent) identified as living in unstable accommodation; having increased from 40 per cent at the time of registration (first visit). There were significant positive associations between unstable accommodation status and unemployment, imprisonment and history of overdose, all measured at registration. In May 2016, unstable accommodation status was significantly associated with age of first injection and with unemployment status (as measured at registration); those living in unstable accommodation in May 2016 had a lower number of visits, a lower number of referrals to health and social services and a lower number of overdoses at MSIC than those living in a stable accommodation.

The rates of unstable accommodation among MSIC clients have been increasing. These findings highlight the importance of SIFs and drug consumption rooms as venue to address the essential needs of PWID, such as housing. The window of opportunity to support PWID who experience housing instability seems to be narrower than for those who live in stable accommodation.

This chapter looks at the past, present and future of international cannabis control required by the UN drug control conventions in the post-2016 United Nations General Assembly Special Session era with an eye on the next High Level Ministerial Segment (HLMS) at the UN Commission on Narcotic Drugs in 2019, and beyond. From a policy analysis perspective, the author meanders through the increasing tendency to legally regulate recreational cannabis markets notwithstanding the obligation enshrined in the UN drug control conventions to limit cannabis exclusively for ‘medical and scientific’ purposes. Taking into account relevant national and international developments, the chapter describes how the growing discomfort with the status of cannabis and the prohibitive and punitive approach stemming from the international drug control regime went through a process from soft to hard defections of the treaty obligations. The case of the Netherlands demonstrates the difficulty faced by reform-minded states in reconciling their wish for a different cannabis control mechanism with their obligations under international law, resulting in an incomplete regulation of its coffee-shop system, where small amounts of cannabis are tolerated for sale, but where the illicit supply to the shops remained unregulated. Subsequent more wide-ranging reforms to regulate cannabis from seed to sale in Uruguay, several US States and – in 2018 – in Canada, are clearly violating the obligations of the UN drug control conventions. Nevertheless, the HLMS will likely leave the elephant in the room untouched. The emerging paradigm shift regarding cannabis shows that a modernisation of the UN drug control regime is long overdue. This chapter discusses some of the options available.

The purpose of this paper is to examine the content of the strategy and assess its claims to be evidence based.

This study is a close-reading of the text with commentary on specific content and reference to wider contexts.

The strategy makes use of evidence in its sections on treatment. Much evidence, including that of the UK ACMD, is dismissed or ignored. The issue of funding in times of austerity is not considered in the strategy. The range and complexity of drug use and users are not fully considered.

The strategy can be seen as an idealised ambition with little basis in reality without funding to support its aims.

There is no consideration of the impact of macro-economic policy on the extent of drug misuse.

Other commentaries on the strategy are emerging. This paper is a more extensive consideration than has so far appeared.

The Swiss drug policy once was very progressive in the 1990s when the harm related to drug use was most visible to the public. Failure of repression opened the room for more innovative harm reduction approaches. In 2008, the four-pillar model including the legal basis for substitution and heroin-assisted treatment of opioid use disorders as well as for other harm reduction facilities was approved by the population that had learned about the success of these measures. Less violence, better health outcomes among people who use drugs and less stigma supported the change of attitudes in the population towards a public health-based approach when dealing with drug use. Switzerland first received heavy criticism for the autonomous policy change at the international level while it is nowadays often cited as best practice example for dealing with people with an opioid use disorder. Otherwise, the country has usually been quiet in drug policy discussions at the UN level. Nevertheless, Switzerland’s reappointment to the Commission on Narcotic Drugs, the central drug policy-making body within the United Nations for a period of four years starting in 2018 is promising, given their unblemished recommendation for human rights-based drug policies including the abolition of the death penalty for drug offences, among other things. Alongside cannabis policy changes at the international level, Switzerland witnessed an unexpected development in cannabis availability and sales. However, the country is still rather conservative with regard to current cannabis policies, although cannabis with less than 1% of THC can be sold legally and the possession of up to 10 g will be followed by a fine only, if at all. Switzerland is open to experiment with new regulations but only if the law allows for that. To conclude, the strong sense of connectedness with the international community may support Switzerland’s next steps towards public health and evidence-based harm reduction.

The purpose of this paper is to explore the current policy stasis in UK drug policy.

This paper examines reports, statistics and policy statements by government agencies.

Delays in revising a national strategy appear to have no clear explanation. Responses to drugs issues, including drug-related deaths, appear to lack urgency or concern at a policy making level.

Complacency and lack of regard to evidence appear to inform current policy and strategy. Ways of overcoming this stasis are not identified.

There is a need for factors leading to reform and change to be identified and implemented, by government and others.

The situations and needs of drug users do not appear as a government priority. Continued reductions in public spending – austerity – are reducing treatment provision.

The paper attempts to identify factors which inhibit policy reform in the UK so that future reform becomes more realistic.