Drug consumption rooms: Addressing Multimorbidity and Substance Use in Glasgow’s Deep-End Communities

Paul McNamara is a GP in Glasgow and Honorary clinical lecturer at the University of Glasgow
Faiza Ahmad is a 3rd year medical student at the University of Glasgow

The challenges of addressing multimorbidity and substance use within Glasgow’s deep-end communities are complex and intertwined. As a deep-end GP, I have witnessed firsthand the struggles faced by individuals coping with both chronic health conditions and substance use disorders. The recent introduction of the UK’s first Drug Consumption Room (DCR) in Glasgow is a pioneering harm reduction initiative, offering hope for improved healthcare outcomes for some of the city’s most vulnerable populations. This innovative approach not only addresses the immediate risks associated with drug use but also represents a shift towards more compassionate, integrated healthcare practices.

Multimorbidity, defined as the coexistence of two or more chronic conditions within an individual, is increasingly prevalent in socioeconomically deprived areas¹. In the UK, approximately 57.6% of hospital admissions involve at least one chronic condition, with 31.6% of these patients experiencing multimorbidity.¹ Glasgow, known for its significant rates of poverty and social deprivation, often sees these health issues further complicated by substance use disorders. This intersection of poverty, poor health, and substance use creates a challenging landscape for healthcare providers striving to deliver effective and holistic care.²

A significant challenge in these communities is the cumulative impact of physical and mental health conditions. Patients with multimorbidity may struggle with managing multiple medications, experiencing side effects, and coordinating care between different healthcare providers. This complexity can lead to medication errors, adverse drug reactions, and treatment non-adherence, particularly in deep-end communities where healthcare access is already limited and socioeconomic challenges compound health risks. These challenges not only strain healthcare systems but also place an additional burden on patients, who may feel overwhelmed by the complexity of their health needs.³

An often-overlooked aspect is the intersection of substance use and chronic health conditions. Studies have shown that individuals with substance use disorders are more likely to develop multimorbid conditions due to factors like poor nutrition, lack of healthcare engagement, and increased risk of infectious diseases. Addressing this intersection requires a multifaceted approach that combines harm reduction with long-term health management strategies. This approach is particularly vital in urban areas like Glasgow, where social inequality and healthcare disparities are prevalent.⁴

Healthcare professionals must address both the medical needs and the complex social factors influencing health. In deep-end practices, general practitioners can offer holistic care beyond diagnosis and treatment. By integrating care for physical and substance-related health issues, GPs can reduce fragmentation of services and ensure consistent, comprehensive care, mitigating the risk of deteriorating health due to neglected chronic conditions. Furthermore, building strong, supportive patient-doctor relationships fosters trust and encourages ongoing engagement with services.⁵

Many patients avoid seeking medical help due to fear of judgment from healthcare professionals. Research shows that up to 40% of drug users have been denied pain relief or medical treatment due to perceived bias. Some GPs may refuse to register patients with substance use disorders, particularly if they have a history of missed appointments or disruptive behaviour. This reluctance results in untreated conditions and higher rates of preventable hospital admissions.⁵ Reducing stigma within healthcare settings is crucial for building trust. Training healthcare professionals to provide nonjudgmental, compassionate care is essential, and integrating harm reduction approaches into standard practice can help mitigate the negative impact of stigma on healthcare access. Developing training programs that specifically address the biases healthcare workers may unconsciously hold could be a key step toward fostering a more inclusive healthcare environment.⁵

Public stigma also contributes to policy resistance, making harm reduction strategies like DCRs controversial despite evidence supporting their effectiveness. Therefore, addressing stigma in healthcare settings and garnering support from policymakers are both vital for implementing successful harm reduction initiatives. Encouraging open dialogue between healthcare professionals, policymakers, and community members can help shift public perception towards more evidence-based and empathetic approaches to substance use.⁵

Glasgow’s pioneering DCR, located at the Hunter Street Health and Care Centre, offers a safe, supervised environment for individuals to inject drugs obtained elsewhere.⁶ Open from 9 am to 9 pm, the facility aims to reduce overdose deaths, limit the spread of blood-borne infections, and provide direct access to support services⁶. The availability of such comprehensive support within the DCR underscores its role as more than just a safe injection site—it is a facility for holistic care and harm reduction. It has been significantly impactful, with 131 people attending in the first week and over 700 individuals safely injecting substances to date. Beyond overdose prevention, the centre provides harm reduction services such as safer injecting education, mental health support, and social work referrals. By fostering a nonjudgmental, supportive environment, the DCR bridges the gap between marginalized individuals and healthcare systems, promoting consistent healthcare engagement and potentially reducing long-term health complications.⁶

The link between multimorbidity and substance use is particularly pronounced in socioeconomically deprived areas, where chronic diseases and addiction issues often coexist⁷. Substance use disorders are associated with an increased risk of developing chronic conditions like liver disease, cardiovascular disorders, and respiratory issues.⁷ Integrated care models, exemplified by Glasgow’s DCR, offer a practical application of holistic healthcare principles, addressing addiction and chronic illness simultaneously.⁷

DCRs have proven to be effective internationally. In Switzerland and Canada, overdose deaths in high-risk areas have decreased by up to 35% since implementing DCRs. Additionally, public injecting has been reduced by 50%, leading to safer, cleaner public spaces. These facilities not only reduce immediate drug-related risks but also contribute to long-term health improvements through services such as vaccinations, HIV testing, and addiction treatment referrals.⁸

Despite successes, DCRs face political and financial challenges. Some countries classify these facilities as illegal despite evidence of public health benefits. However, success stories from cities like Sydney and Vancouver demonstrate that harm reduction can coexist with community safety, reinforcing the potential of DCRs as an effective public health strategy.⁹

Expanding DCRs to other UK cities could address healthcare disparities for drug users, significantly improving public health outcomes and reducing the burden on emergency services. Successful implementation requires robust funding, community engagement, and a commitment to reducing healthcare stigma. Integrating DCRs with broader healthcare systems makes long-term care more accessible, reducing the strain on emergency services.¹⁰

Glasgow’s DCR sets a vital precedent, showing that compassion and evidence-based interventions can transform public health. As the UK continues to address the complexities of substance use and multimorbidity, expanding DCR access remains a promising step toward healthier communities.¹⁰

References:

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8. Harm Reduction International. Harm Reduction in Switzerland. [Internet]. London: Harm Reduction International; 2022 Nov. Available from: https://hri.global/wp-content/uploads/2022/11/Harm-Reduction-in-Switzerland_FINAL.pdf
9. Ng J, Sutherland C, Kolber MR. Does evidence support supervised injection sites? [Internet]. Can Fam Physician. 2017 Nov;63(11):866. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5685449/
10. Nicholls J, Livingston W, Perkins A, Cairns B, Foster R, Trayner KMA, et al. Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers. Int J Environ Res Public Health. 2022;19(11):6575. Available from: https://www.mdpi.com/1660-4601/19/11/6575

Featured photo by Claudio Schwarz on Unsplash.