Drug Consumption Room: Different Harm Reduction Approach An Overview Between Holland And Italy

Now see how a Drug Consumption Room work with the help of a real example of a Drug Consumption Room located in Amsterdam form the 1998. As a part of The Rainbow Foundation Group, AMOC has been working for over 30 years with homeless people for various European countries. AMOC offer besides services related to basic needs (shower, bed, food, etc) and also provided advice and consultation, Drug Consumption Rooms and Professional Social Work. Initially AMOC was funded as a Drop-In Centre for German drug users living on the streets of Amsterdam. Later on the target group was diversified to all European citizen and not only drug users. So AMOC supports homeless, drug addicts, sex workers and people with psychiatric or social problem in Amsterdam. AMOC it is a Social Service split in different department, Drop-In Centre; Social Worker Department; Drug Consumption Room; Night Shelter Department. Within the framework of offering a care package to long-term drug addicts, the municipal council of Amsterdam agree in February 1998 to set of measures directed at improving the housing and living conditions of long-term addict and reducing the problems with regard to public order. Long before the opening of the Drug Consumption Room, possible parties were selected form the client list, and approached, this selection was carried out by social services. Clients interested in the project could also apply on their now initiative. At the beginning of February 1998, a meeting took place at AMOC between the neighbourhood police officer, the potential clients and the future staff members. During this meeting the purpose of the users-room was explained and the neighbourhood police officer provided information of the role that the police would play in the project. So in the 23 February of 1998 the municipal council of Amsterdam opened the Drug Consumption Room inside of AMOC. During the years a lot of changes have taken part, like the size of the Drug Consumption Room, in fact form a very small project initially with four clients now have the actual capacity of 60 clients with a max of 18 users at the same time. AMOC is a injecting and a smoking Drug Consumption Room. All the client stay in the same space together at the same time and they can stay in the DCR as long as they want to stay. So the drug users face each other during the consumption and that have two important impact, first encouraged the socialisation of the users and second is easy and fast to see if someone need help or are going in overdose so call the staff members.

The Staff member is compost by social workers, psychologists, sociologists, volunteers, peers, interns. The staff are not in the same room as the users, they come in and out of the room during the day. Staff observe the users for an enclosed room with a giant window looking onto the space. As AMOC a sort of an Integrated DCR the client have the possibility to come to the different department of the service and not only in the DCR. Fore example they can take a shower, change their clothes, eat and drink coffee or tea, and spoke to the Social Workers if they need. The DCR in AMOC is open 7 day per year for eight hours per day. The main goal of the DCR and also of AMOC Drug Consumption Room are:

- Prevention of Overdose (drug related death);
- Prevention of BTD’s (blood transmitted diseases);
- Prevention of Public Nuisances;
- Tackle loneliness of long term homeless hard drug user.

And in AMOC for reach those goal the staff operate the DCR and try to work on the three main aspect of the use: Safety; Hygiene; Stress Free.
The target group of the DCR in AMOC is:

- The Client of the DCR are long term hard drug users;
- The Client of the DCR use essentially heroine and cocaine;
- Some of the Clients use illegal methadone;
- Some of the Clients receive methadone form the PNP under certain circumstances;
- Some of the Clients use alcohol, hashish, psychotropic medication and other psychotropic substances in addiction of their main drug;
- The DCR is specifically designated for the use of illegal hard drugs;
- The use of illegal drugs like alcohol or hashish has no meaning in the DCR and therefore isn’t tolerated within AMOC.

All the users are registered and before the first approach in the DCR they need to made the intake process.
The intake process for make a contact for the AMOC DCR provides three steps:
1) First meeting between the client and the Social Worker. On this interview the Social Worker must be fill the “Intake Form of AMOC” with some general information about the client, his history, history of use and health situation. After this first meeting the Equipe of AMOC, according to the information collect in the Intake Form, take a decision if open a contract with the client or not;
2) If the decision is positive, the staff give an official form to the client and sent him to the GGD tuberculosis department to pass a tuberculosis test. The client has to show his “result card” form the TBC test dated to the staff;
3) The staff reads the contract with the client and answer eventual question. After he or she sign the contact. The staff give a brief explanation of the room and the material at disposition of the client. In addiction she staff allow client to ask for specific material.

The staff stay next to the client for the first use to verify the abilities of the clients to inject properly, hygienically, safety and with no stress.
After this three step the client can come in of the Drug Consumption Room whenever he/she want according to the time of the Drug Consumption Room and to his/here behaviour. In fact if some client don’t follow the rules of the DCR the staff can give a suspension or in extreme cases close the contract with the client.
There is no restriction in quantity of material that clients are allowed to take. Also syringe exchanged is always an act of prevention and an act of harm reduction.

The materials DCR in AMOC can provide are:
- Syringes: 2ml or 1ml;
- Acid Ascorbic/Citric Acid: used to liquefy the heroin/cocaine in the water;
- Alcohol Pad: used to disinfect the wounds before and after an injection;
- Metal Trays: used to prepare injections and maintain a clean place;
- Injection Water/ Sterilised Water: used as liquid for the injection;
- Spoon: used to cook drugs; every client who inject receive a personal spoon, each personal spoon is cleaned, dried and sterilised every week. Every spoon belongs to one bag with the name tag of the client on it, bags are also changed every week too;
- Sterilizator: used to clean and sterilise the spoons each week;
- Filters: used to filter the drug cooked;
- Tourniquet: used as a garrotte to compress arms or legs to make the venal system visible;
- Plasters - Leucoplast: used after the alcohol pad to cover up the injection wounds;
- Diverse Bandages: used for all kind of different wounds;
- Crabbers: metal sticks used to clean the cocaine pipes;
- Diverse creams: Betadine (healing of different wounds) and Calendula (healing of dry skin);
- Alcohol Bottle (Disinfection): used to disinfect everything needed;
- Hibi Scrub: hospital disinfectant used to wash, heal and prevent skin infections;
- Biohazard Containers: box throw away the biohazard material (except syringes);
- Biohazard Syringes Containers: box to throw away the used syringes;
- Personal Syringes Containers Carrier: give to every new injection client;
- Condoms: prevention of STD’s.

According to the 2015 statistic of AMOC there was 4.088 consumption events, just one overdose emergency and one Ambulance response. Until now there was zero drug related death. As we saw one of the aspect operate in the AMOC Drug Consumption Room is Stress Free.