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4 –
Daily Update
– DAY ONE/TWO – Sunday 11 and Monday 12 May 2008
Culture of consumption
Barcelona is not only the host city for this year’s conference. It has also embraced
harm reduction by providing safe, supervised ‘consumption rooms’ for service users.
The Daily Update
speaks to a physician working in the largest, the Sala Baluard.
LIKE MANY PORT CITIES
, Barcelona has a long history of drug
culture and drug use, particularly around the once notorious El
Raval or ‘barrio chino’ area. A few years ago, however, concerned
by the social and public health implications of widespread intra-
venous drug use, the city authorities took the decision to open the
first of Barcelona’s injection facilities, or ‘consumption rooms’. Here
service users could not only go to inject safely, away from the
dangers of the street, but gain access to vital health and social
care services as well.
Opening in November 2003, Sala Baluard was the first, and is
still the largest, of the city’s five consumption rooms. Unlike the
others, which open for between eight and ten hours at a time, it is
open 24 hours a day, seven days a week. A nurse and an auxiliary
are available at all times, and doctors work at the facility in shifts
that add up to around 20 hours cover each week.
Manel Anoro is a general physician in Barcelona’s primary
healthcare services with a long-standing interest in drug treatment,
and he works at Sala Baluard one morning a week. So what is a
consumption room actually like? ‘It’s not a large room,’ he says.
‘There are six injection points, which are basically chairs with a small
table, and people are allowed to stay for 30 minutes after they have
injected. There is also a needle exchange facility in the reception area.’
Barcelona’s consumption rooms grew from relatively primitive
beginnings. Previously the city’s injecting drug scene had become
concentrated in the Can Tunis area near the harbour. Dr Anoro was
part of a team that had been visiting the district since the late
1990s, offering a needle exchange service and providing food. ‘It
was the same sort of area that you can find in other cities in
Europe – a place where you could buy and consume, with no
police around,’ he says. The team began providing a special
injection room in a large tent, and then in a van – ‘a very simple
place,’ as he describes it.
Things changed when the city authorities decided to turn the
area into a major parking facility for the harbour, which had the not
altogether surprising consequence of displacing all of those selling
and using drugs back to the city centre. ‘After they all went to the
city, the council debated what to do,’ he says. ‘Whether there
should be a new special quarter, or whether an injection room like
they had in Germany or Switzerland should be opened instead.
They decided to provide facilities inside the city.’
Consumption rooms in Spain operate on two different models. Of
the three cities to have them – Madrid, Barcelona and Bilbao – the
latter two are the only ones that have agreed to have the main
facilities inside the city itself. ‘They said “OK, we have this problem in
our city so we’ll start to resolve it in the city – it will be a city
solution”’, he says. ‘In Madrid, it’s a different kind of solution – it’s a
large injection room, but it’s outside the city. It’s horrible, like a drug
Disneyworld, and some people never leave. They live and die there.
Maybe that’s an easier solution, but I don’t think it’s a good solution.’
Perhaps surprisingly, Sala Baluard is in Barcelona’s old city, by
the Monument a Colom and just minutes from the prime tourist
area of the Ramblas. So how did the city react to the consumption
room being sited there – was it a controversial move? ‘Barcelona
has a long tradition of people who consume drugs, so it didn’t
really seem strange,’ he says. ‘But some people said they didn’t
want the facility near their homes. You have to explain to the