Federal Health Ministry

(German delegation to the 43rd CND)

Bonn March 2000

Drug injecting rooms in Germany

A General Information

I. Since when? Where? How many?

The first drug injecting room for opiate-dependent persons in Germany was opened in Frankfort on the Main in December 1994. In January 2000 there were 15 drug injecting rooms altogether in the Federal Republic of Germany: 7 in Hamburg, 4 in Frankfort, 3 in Hanover and 1 in Saarbrucken. Thus these ccities provide for 154 drug injecting places; they are used every day by an average number of 2,600 addicts several

times

II. History and background information

Drug injecting rooms are the outcome of a successful co-operation between representatives of the municipal authorities the police, the administration of justice and of the organizations of drug-addict care services. They were motivated for this task by the obviously growing health-related and social destitution of hard-core drug addicts on the open drug scene of the big cities. Their joint objective was to minimize - by direct assistance on the spot - the risks and problems resulting from illicit drug use for the individual drug addicts themselves but also for their social environment (harm reduction)

III. Objectives and concept

The following objectives, preconditions arid measures are applicable in all 15 drug-injecting rooms - with the exception of certain local peculiarities. Therefore, they have also been accordingly stipulated in the main by the new German legislation (see below chapter B "New German Legislation on Drug Injecting Rooms")

The following objectives for drug addicts are pursued:

- Deliverance from life-threatening patterns of drug abuse and

stabilisation of health

- Improvement of assistance in cases of emergency (first aid, medical care by emergency doctors)

- Improvement of the accessibility of hard-core drug addicts who could so far not be cared for

- Conveying offers of assistance organized by drug-addict care services and aiming at confirming the drug users in their desire to abandon these illicit activities

- Prevention of infectious diseases by hygienic and stressless conditions for the injection of carry-on-drugs, in particular prevention of HIV infections

The following requirements have to be met;

Drug injecting rooms require that the relevant city has already organized a wide range of offers and programmes of assistance of addict-support. The drug injecting rooms have to be interlinked with other already existing offers of assistance (counseling, medical outpatient care, therapy etc.). They particularly complement the so-called drug abuse emergency services (contact-caf , lunch table, syringe-exchange, emergency overnight shelter, crisis intervention etc.).

- The target group consists of intravenous drug users, their minimum age should be 18 years as a rule. Methadone-using patients are excluded

- First aid and medical care by emergency doctors have to be guaranteed

- Addicts have to be purposefully influenced to make use of the following offers of assistance aiming at a life without drugs:

- Counselling and care

- Placement of addicts in institutions of detoxification and withdrawal and/or drug substitution treatment

- as well as medical care.

- Drug trafficking and the supply of drugs in the drug injecting room are prevented: in the vicinity of these rooms the police ensures the compliance with these preconditions.

- Drug users are allowed to bring only one consumption unit with them into the drug injecting room.

- Only the injecting equipment provided at the drug injecting room shall be permitted for use

- The entire work done at the drug injecting room has to be documented and evaluated.

The following organizational measures are applicable, inter alia, to the daily routine at the drug injecting rooms:

A multiprofessional team (full-time social workers and nursing staff, supported by trained auxiliary personnel) ensures that the drug injecting room is run regularly and under supervision. Everyday opening hours (up to a maximum of 16 hours) are geared to the local demand. Every first-time user shall present his/her identity card and sign a user contract. In this connection it is checked whether he/she actually belongs to the target group. There are house regulations which have to be complied with. In case of an infringement there is a bar on entering the drug injecting room. Professional drug dealers shall be reported to the police. In every drug injecting room a maximum number of 12 drug infecting places is made available and these can be permanently supervised by the staff. The rooms provide users with the necessary injecting paraphernalia including injecting equipment One or several rooms serve as waiting rooms. Drug injecting rooms are strictly separated from premises for other offers of assistance, alt

hough they are frequently housed under the same roof. Usually the drug injecting rooms are located in the immediate vicinity of the drug scene of the city.

IV. Successful outcomes:

Drug injecting rooms proved to be an important constituent in the so-called harm-reducing approach in all four cities mentioned before. This is clearly demonstrated by:

- the decline in the number of drug-related deaths:

- the improved accessibility of severely ill drug addicts who were unknown thus far;

- the reduction of the open drug scene;

- an improved public security in the city.

The usefulness of drug injecting rooms for the purpose of demand and harm reduction on the whole is made clear, inter aha, by the following data:

- The number of drug4eiated deaths declined in Saarbrucken from 22 in 1998 to 17 in 1999, in Frankfort on the Main, the number was reduced from 35 to 26, in Hanover from 27 to 16 and in Hamburg from 132 to 111 during the same period. In this context, it has to be stated that the total number of drug-related deaths in Germany was slightly increased from 1674 in 1998 to 1708 in 1999.

- So far no drug addict has died in a drug injecting room

- Among 288,291 drug injections (in 1998) in drug injecting rooms of Frankfort on the Main only 589 cases of drug addict emergencies (0.2 percent) were reported.

However, the most important outcome is the large number of counselling contacts initiated in the drug injecting rooms and the placement of addicts into further-reaching offers of assistance, in particular therapy which is the main objective of these rooms. This can be seen. e.g. from the following table on the work achieved in the drug injecting rooms in Hanover and Saarbrucken:

All injection in 1999 Counselling contacts Placements in therapies

(almost daily users) Per day per annum

outpatient inpatient

methadone treatment

therapy

_______________________________________________________________________Hanover 78,000 (about 350) 15 30 5

Saarbrucken 31,500 (about 90) 50* 11 69*

* In Saarbrucken several low-threshold institutions, such as the drug injecting room consultation at the doctor's office, contact-cafe, emergency overnight shelter and crisis intervention centres, have been combined in one "multipurpose centre for drug users" with the result that a particularly large number of counselling contacts and placements

in therapies is taking place there. Similar centres work in Hamburg where also a large number of counselling contacts per day and placements in therapy take place.

V. Result

In the open drug scene of big German cities drug injecting rooms proved to be an efficient measure for providing assistance in surviving, stabilizing the drug users' health and delivering them from drug addiction This success could only be achieved because the offer of drug injecting rooms in big cities can be integrated into a well-developed and widespread network of measures providing counselling, assistance,

treatment and social reintegration. It is carefully seen to it that the establishment of drug injecting rooms does not place the already existing and proven other types of offer at a disadvantage On the contrary, they actually reinforce these measures and enable more and more addicts 10 abandon their illicit drug use and their drug addiction

B. New German Legislation on Drug injecting Rooms

In December last year the German Parliament (Bundestag) adopted an amendment of the Narcotics Law in order to provide a legal basis for the establishment of drug injection moms. In February 2000 the Council of the Federal Slates (Bundesrat) consented to the amendment. The amendment will shortly come into force.

The main purpose of the new legislation is: first to ensure by provision of a licence of the competent state authority that drug injecting rooms comply with recognised standard requirements of drug demand reduction programms, in particular of harm reduction measures for hard-core drug addicts. Second to provide a sound and uniform legal basis for the work of the personnel in drug injecting rooms and to protect it from being at risk of unlawful action. To that end the new

legislation contains, inter alia, the following amendments in section 10 a and 29

Section 10 a

Licence to operate drug injecting rooms

(1) A licence of the highest Land authority is required by whoever wishes to operate an establishment in the premises of which drug-addicted persons are afforded or granted an opportunity to use narcotic drugs the latter bring with them and that have not been medically prescribed (drug injecting room. A licence may only be issued if the Land government stipulated the requirements for such issue in a statutory order in accordance with subsection 2.

(2) The governments are authorized to stipulate, by means of a statutory order, the prerequisites for the issue of a license pursuant to paragraph 1. These stipulations must establish in particular. minimum standards for the following to ensure the safety and supervision of the use of narcotic drugs in drug injecting rooms:

1. Appropriate equipment of the premises that are to serve as drug injecting rooms;

2. Arrangements to ensure immediate provision of medical emergency care;

3 Medical counselling and assistance for the purpose of risk minimisation in the use of the narcotic drugs brought by the drug-addicted persons;

4. Placement of these persons in abstinence-oriented follow-up counselling and therapy services;

5. Measures to prevent criminal offences under this Act from being committed in drug injecting rooms; other than the possession of narcotic drugs pursuant to Section 29 sub-section 1, first sentence, No. 3 for personal use in insignificant quantities:

6. The cooperation with the local authorities responsible for public order and safety required to prevent, to the greatest possible extent, any criminal offences from being committed in the immediate surroundings of the drug injecting rooms;

7. A precise definition of the group of persons entitled to use drug injecting rooms, specifically as regards their age, the type of narcotic drugs they may bring with them and licit consumption pattern: obvious first-time or occasional users are to be excluded from using these rooms;

8. Documentation and evaluation of the work done in the drug injecting rooms;

9. Continuos presence of a sufficient number of reliable staff whose professional training qualifies them to comply with the requirements mentioned in numbers~1 to 7;

10. Appointment of a qualified person who shall be responsible for compliance with the requirements mentioned in numbers 1 to 9, the duties imposed by the authorities issuing and orders issued by the supervisory authority (responsible person) and who can permanently comply with the obligations incumbent on him/her.

(3) Section 7, first and second sentence, Nos. 1 to 4 and 8, Sections 8. 9 subsection 2 and Section 10 shall apply mutatis mutandis to the licensing procedure; for the purposes of the latter, the competent highest authority of the Land involved takes the place of the Federal Institut for Drugs and Medical Devices, and the Federal Institute for Drugs and Medical Devices takes the place of the highest Land authority

(4) A licence pursuant to subsection 1 does not entitle the staff working in an drug injecting room to conduct assays of the narcotic drugs brought by its clients or to provide active assistance in the actual use of these narcotic drugs

Section 29

Criminal offences

(1) A term of up to five years or a fine shall be imposed an anyone who

1. - 10 (unchanged)

11. - affords or grants an opportunity; for illicit use of narcotics to another person without holding a licence pursuant to Section 10 a or communicates, out of selfish motives, if it is not an establishment pursuant to Section 1O a, publicity an opportunity for such a use

12. and 13. (unchanged)

14. acts in contravention of a statutory order pursuant to Section 11 subsection 2. Second sentence. No. 1 or Section 13 subsection 3, second sentence, nos. 1 or 5, where such statutory order refers to the present criminal provision in respect of a specific offence.

The supply of sterile disposable syringes to drug addicted persons and the information of the public on this supply shall not constitute affording and public reporting of an-opportunity for use within the meaning of No ii of the first sentence."

C. Legal Aspects of Drug Injecting Rooms

The establishment and operation of drug injecting rooms has to be managed in conformity with the international Drug Conconventions and the domestic law. The German legislation on drug injecting rooms conforms with these legal instruments for the following reasons:

1. The offences listed in Article 3 of the 1988 Convention have been established as criminal offences under the German Narcotics Law. It is also fully applied if these offences are committed in drug injecting rooms or in the vicinity thereof.

2. In drug injecting rooms and the vicinity thereof criminal offences have to be prosecuted according to the German principle of legality Exemptions thereof are explained in Nos. 3 and 4

3. Under the German legislation the operations of the staff working in drug injecting rooms are not established as a criminal offence in the sense of "facilitating of the offences" pursuant to Article 3 Section 1 lit. c iv 1958 Convention. This follows from the application of Article 3 Section 11 which reserves "the description of the offences and the legal defences thereto" to the domestic law of a Party. By providing an official license for all operations in drug injecting rooms the German law makes use of Art. 3 Section 11 and clarifies that tolerating drug possession in authorized drug injecting rooms is a legal action which cannot represent "facilitating of an offence" in the sense of Art. 3 Section 1 lit. c, iv of the 1988 Convention

4. The addict who carries drugs for personal use into the drug injecting room is committing a crime of "possession". However, pursuant to the German law, inter alia, the possessor of drugs in insignificant quantities for personal use will not be prosecuted as a rule.

This practice is in full conformity with the Drug Conventions which leave the decision on prosecution with the Parties. This principle can be taken in particular from Art. 3 Section 6 of the 1988 Convention which refers to "the discretionarry legal powers of the Parties under their domestic law relating to prosecution."

Finally, the German legislation and practise with regard to drug injecting rooms does not infringe neither the spirit nor the sense of the Drug Conventions. That is why tolerating the possession and use of drugs does not represent the decisive purpose of drug injecting rooms. Rather, the main porpose and objective of drug injecting rooms is to deliver drug addicts from illicit drug use and adiction and to bring them in contact with programms of treatment, rehabilitation and social reintegration. This work implements at the same time the obligations of Art 38 Section 1 of the Single Convention 1961. The experience and results gained so far demonstrate that these objectives are reached for many addicts. Consequently, drug injecting rooms do not infringe the spirit and sense of the Drug Conventions.