Urban environments provide numerous concealed settings that may be used on a regular and frequent basis for the injection of illicit drugs. In addition to general public amenity (car parks, stairwells, toilets) these places may include derelict buildings, marginal wasteland and squats. Each of these latter examples may be typically used and frequented almost exclusively by injecting drug users who may consider such places as providing temporary safety and sufficient privacy to administer drugs without detection/interruption. When such places are made known to the relevant authorities they are typically subject to some form of sanction (closure, eviction, demolition, clearance, blocked, screened and/or fenced) that prevents further access.

However, such reactive responses may be criticised for failing to consider the needs and rationale of those frequenting such places and the physical consequences of such punitive action. One such outcome is that public injecting continues to take place beyond the site of closure and possibly in yet more marginalised, more concealed and more claustrophobic, unhygienic conditions. Further, those injecting in such places are typically some of our most vulnerable members of society experiencing a wide range of social problems and dependency issues, and consequently have to ‘seek out’ alternative injecting sites. To make matters more complicated, the state’s left hand provides the means to inject (via needle and syringe programmes) whilst the heavy right hand smashes the street-based settings of public injecting (via clearance etc). As such, harm reduction intervention is problematised and made more difficult for vulnerable people to actually apply.

Alternative approaches

There is perhaps a need to further consider the way in which such concealed sites of injecting are more appropriately ‘managed’ by authorities; in a manner that considers both public health of the community concerned and the individual health concerns of affected injecting drug users. One such consideration may involve a complementary, proactive response to the inevitable reactive response of closure and sanction? For example, following the imminent closure of a given location used for injecting purposes, the following procedures may be considered as exemplars to reduce the harmful effects caused by and/or associated with displacement:

• An organised and structured multi-agency response that is led by the body responsible for the closure/demolition of a given location. This response would focus upon the wider health concerns of injecting drug users as well as consider the immediate health/social concerns of the local population.
• Contact with local Needle and Syringe Programmes (NSP) and/or Harm Reduction Practitioners to notify relevant others of the proposed/imminent closure procedures.
• Harm Reduction Practitioners could then disseminate this information to service users – verbally or with an appropriate leaflet. For example:
  (Name of site) is now closed. Don’t go there – find somewhere safer. You may be subject to arrest for trespass as the site has been served a clearance order’.
• The above information would provide informed choice, aim to protect liberty (of those possibly involved in the criminal justice system) and essentially encourage service users to seek more suitable, safer injecting locations.
• Prior to immediate closure/demolition, (and where possible) drug related litter bins could be positioned inside, outside and adjacent the relevant settings. This would encourage safer discarding amongst those individuals more determined to access the setting following closure (and possibly less concerned about their liberty in their prioritisation of injecting needs). Such bins should not be regarded as ‘encouraging drug use’ (as injecting pre-existed their presence) and would need to be cleared/emptied on a frequent basis.
• At the risk of appearing to promote the ‘Big Society’ model of ’empowerment’ as advocated by the current UK Coalition government, community residents could play a role in promoting community safety. For example, community activists could provide a rapid response notification role (to police, local authorities or ‘other’) of any injecting sites that may emerge in adjacent settings following the closure of such sites. These may include alleys, parks, gardens, doorways. This aspect of participation would not aim to ‘penalise’, but instead, ‘protect’; in which residents inform authorities who in turn inform practitioners who then respond accordingly (notifying/informing/advising service users). Indeed, a ‘protective chain of socially orientated harm reduction’ may emerge.

Nothing new

There is nothing radical or subversive in any of these suggestions. Each suggestion listed above currently exists as standard practice within existing local policy and procedures with regard to other issues (which may/not be drug-related). Instead, these suggestions have been ‘resituated’ within the context of public injecting in which the needs of vulnerable people and the potentially harmful effects of displacement have been more ‘considered’.