‘Bang! I was out’

On​ a sunny afternoon last month Ryan arrived at the Thistle, a one-storey pebbledash building in the east end of Glasgow.* The Thistle is the UK’s first Safer Drug Consumption Facility (SDCF). Ryan is a regular there. He wasn’t its first customer – three men raced one another to the door on 13 January – but he comes often enough to have claimed injecting booth eight in what looks like a chorus-line dressing room, with bright lights and tilted mirrors so the nurses can supervise users without intruding on their privacy. That morning, the begging trade had been sluggish. It had taken a while for Ryan to make enough to pay his dealer. Now, at last, he was sitting in the Thistle, antsy yet affable, going through the familiar pre-injection registration ritual.

The Thistle is based in a health centre in the Calton, an area known for the Barras flea market and the Barrowland Ballroom, once a famous dance hall and now a popular music venue. I had been told that in its first four months, the Thistle oversaw 2010 injections and prevented thirty overdoses. ‘Do you know how many times you’ve used here, Ryan?’ Arthur Jarvis, a social worker, asked. ‘Two hundred and sixty-two’. Ryan made a whistling sound. ‘That’s mad, isn’t it?’ he said, before reciting the centre’s rules: ‘Don’t sell drugs, don’t share drugs and only bring with you what you intend to consume.’

For a long time, heroin was the drug used by most of Glasgow’s four or five hundred street injectors, but cocaine use has rocketed in the last few years. In the Thistle, more than 60 per cent of injections are of cocaine. Some people mix the two to create ‘snowballs’; Ryan alternates between them. In 2023, there was a 30 per cent increase in the number of people requiring hospital treatment for cocaine use in Glasgow, though heroin is still responsible for more deaths. A heroin overdose can be reversed by naloxone, which is held at the Thistle. It’s a highly effective antidote, if someone is there to administer it.

The most powerful argument for SDCFs is this ability to prevent fatal overdoses, something particularly important in Scotland, which has the highest rate of drug deaths per capita in Europe (1172 in 2023). In the UK, where drugs are a criminal justice issue and governed by the Misuse of Drugs Act 1971, such centres are controversial. It took ten years to get this one off the ground. But there are some two hundred SDCFs in other countries, including Canada, Germany, Norway, the Netherlands and Australia. Different countries have different models: standalone facilities, hospital-based facilities, housing-based facilities and mobile facilities. Some are more medicalised than others. Studies suggest that as well as preventing deaths they also lower transmission rates of HIV, reduce ambulance callouts and A&E visits, and shift drug consumption off the streets. Deaths at SDCFs are very rare; I could only find evidence of one, in Ontario last October.

A few weeks after the Thistle opened, a batch of so-called ‘green heroin’, which contains nitazenes (synthetic opioids as powerful as fentanyl), arrived in the Central Belt, and the nurses had to deal with two or three overdoses a day. The green heroin was so potent that people injecting outside the centre were dying with the needle still in their arm. Ryan overdosed on green heroin at the Thistle. ‘I pushed the first half of the syringe in, and I started to feel a bit woo,’ he told me. ‘As soon as I pushed the second half in: bang! I was out.’

Many professionals who engage with drug users in Glasgow – police officers, paramedics, outreach workers – now carry naloxone. It rids a person’s system of all opioids: not just the heroin that resulted in the overdose, but any methadone they may have taken. This means that the user often wakes up ‘rattling’ and angry at the people who helped them. At the centre, the first response to a heroin overdose is to administer oxygen. Often this is enough to bring people round, but if it isn’t, and naloxone is required, a nurse will administer small doses incrementally, to make the impact less dramatic.

Ryan, who is in his twenties and lives in a homeless hostel, isn’t ready to stop taking drugs: ‘Being sober is worse; I spend my whole time crying.’ He was obviously affected by the nurses’ care; I suspect that he hadn’t seen much kindness. ‘One of them stayed with me for four and a half hours,’ he told me. ‘I said: “Go take your break,” but he never left my side. He washed my feet because I had blisters.’ This wasn’t Ryan’s first brush with death. ‘Twice my heart has stopped,’ he said. The first time, he injected in a forest and woke up on a hospital ward. He doesn’t know who found him. The second time, he overdosed in his room at the hostel and had to be shocked back to life.

After his most recent overdose, Ryan was referred to the Enhanced Drug Treatment Service (EDTS), next to the Thistle, where those identified as being at high risk of death are prescribed diamorphine, self-administered under supervision. The diamorphine leaves him ‘gouching’ – drowsy and lethargic – which makes it harder to beg. ‘People see me asleep and they think: “He’s a smackhead,” which is true.’ But his use of the EDTS means he is using the Thistle less, mostly for cocaine. ‘Who knows what would have happened to me if I’d overdosed in the forest or the hostel again,’ he said. ‘There’s only so many times you can be lucky, sweetheart.’

For some critics, providing a safe space to inject seems too much like enabling or endorsing drug taking. But for those working in the field, treating addiction as a public health issue is an obvious response. A Glasgow SDCF was first mooted in 2015 during an outbreak of HIV in the city (the largest in the UK for thirty years). Soon, the SNP government, which had cut funding to Alcohol and Drug Partnerships and admitted to having ‘taken [its] eye off the ball’, seized on the idea as a way of tackling the drugs emergency (or to be seen to be tackling it). MSPs from the party travelled to other countries to observe the impact of safe injection sites and the Scottish government tried to persuade the Home Office to allow local authorities to run pilots.

The stasis that followed was the result of Westminster intransigence and a lack of courage (plus an exercise in grievance politics) on the part of the SNP and its then lord advocate, James Wolffe. Wolffe refused to issue a statement confirming that it would not be in the public interest to prosecute people who injected at an SDCF. Frustrated by the situation, an activist called Peter Krykant set up an unsanctioned drugs consumption van on a Glasgow street in 2020, and in September 2023, the new lord advocate, Dorothy Bain, agreed to waive prosecutions for a three-year pilot run by the Glasgow Health and Social Care Partnership – what became the Thistle. Krykant’s sudden death earlier this month was widely mourned. ‘His tireless work to deliver safe consumption rooms,’ the first minister, John Swinney, said, ‘leaves an important legacy which will be remembered.’

By the time the Thistle opened this year, the tide seemed to be changing in many countries, with abstinence-based schemes on the rise and SDCFs branded as ‘state-sponsored pushers’. In Canada, nine of Ontario’s drug consumption rooms have been turned into homelessness and addiction recovery hubs, while in British Columbia, a three-year experiment to decriminalise the use of hard drugs ended early after concern about public disorder. In Scotland, the SDCF was described as a betrayal of those with an addiction and critics argued that the money – £2.3 million a year – would be better spent providing inpatient rehab places. Such places are culpably scarce. Three days before the Thistle opened, Annemarie Ward, the head of a charity called FavorUK (Faces and Voices of Recovery) and a former addict, wrote in one of many X posts about the centre that ‘by focusing on consumption rather than recovery, these rooms communicate a devastating message: “We don’t believe you can get better.” That is not kindness – it is surrender.’

Reform, trying to boost its fortunes in Scotland in the run-up to next year’s Holyrood election, realised that the SDCF was an effective wedge issue. Within weeks, the party’s most prominent Scottish member, Thomas Kerr, who until January led Glasgow City Council’s Conservative group, had claimed that the Thistle was responsible for drug-related paraphernalia found in the car park opposite the centre, while Niall Fraser, of the right-wing Scottish Family Party, who once threatened to ‘brick up’ a sexual health clinic, claimed that Thistle nurses were handing out heroin and helping users to inject it. Every day I see social media posts and news stories accusing the centre of destroying the local area.

Afew weeks ago​ , I walked around some of the injecting sites in the Calton with a Thistle harm reduction worker called Jim. At each site, one of the centre’s leaflets fluttered on a fence or lamppost. Some of the places we visited were close to the railway line, others opposite smart new houses or near student flats. In one, we found an empty tent. In another, dozens of used syringes had been plunged into a tree trunk. None of this is new. The area has had a drug problem for a long time. Jim hasn’t used in more than ten years; when he did this is where he injected and bought his drugs. The Barrowlands is the area’s best-known landmark, but the local dealer’s house comes a close second. Everyone can point it out: an unremarkable property on an unremarkable street. A quick look at the Daily Record archives throws up a surname and a story about the imprisonment in 2016 of a man who is said to have made £42,000 a month supplying local addicts. Officers carrying out a surveillance operation recorded more than two thousand visits to the house in fifteen days.

Jim stopped under a Peppa Pig billboard to point out a spot that was much used during the HIV outbreak. All the people who injected there are dead, he told me. Except him. Was he more careful? ‘Maybe,’ he replied. ‘And luckier, too.’ Jim thinks that if there has been an increase in dirty needles it’s a result of the upsurge in the use of cocaine. Heroin users inject two or three times a day, cocaine users up to a dozen. Cocaine users are also likely to be active at night when the SDCF is shut.

Although there is no evidence to suggest that the centre has brought about an increase in crime, or a new problem with discarded needles, the Thistle has been blamed at a series of public meetings fronted by outsiders, but with local residents in the audience. At one of them, Colin McGowan, who owns a football stadium in Hamilton and runs a charity called Blameless that helps ‘children and families affected by alcoholism and addiction’, produced a tub of fifty used needles, which he claimed had been collected in one minute from some nearby wasteland. Some residents held up a banner telling John Swinney it was time to act. ‘If [the Thistle] is a blueprint for a national rollout,’ McGowan said, ‘then Calton is not just fighting for itself: it’s fighting for the whole country.’ Thomas Kerr of Reform was there too, talking again about needles ‘lying in the streets’.

Councils and charities across the UK still hope that the Thistle will provide a template for tackling drug deaths, a buffer against nitazenes and some protection against fentanyl, which is fifty times stronger than heroin. The hour-long tours held every other Thursday before the centre opens in the morning are booked up until October. The 31 people who work at the Thistle – including nurses, social workers, health support workers and harm reduction workers like Jim – try to focus on their jobs. Some believe the Thistle’s success should be measured by the number of clients who go on to use other services – one reason for placing it in a health centre that also offers a complex needs service, EDTS and Housing First office. Some of those who use the service have been tested for HIV and hepatitis; others have secured a tenancy.

‘There are those who divide recovery and harm reduction as though they are two separate things, whereas, for me, they go hand in hand,’ Jim said. On our walk, we bumped into a man whose recovery he had supported. I had met the same man myself in 2022 while working on a different story. Back then, he was still taking the opioid substitute buprenorphine; now, Jim told me, he isn’t using and has a full-time job. ‘If someone comes through the doors of the Thistle and says: “I have had enough now,” I will go out of my way to help that person to get well,’ Jim said. ‘But often that’s not the case because people need to get to where they need to get to.’

Most drug users have to be coaxed into the Thistle, and treated carefully so that they come to trust the workers. They are allowed to register under a false name, and staff can’t pass on their details to other services without their consent. Every effort has been made to create a homely environment, despite the obvious constraints. There are no screens, the staff don’t wear uniforms and there is a lounge to sit in after injecting, with free tea and coffee. The centre also has a shower, a laundry and a supply of donated clothes, shoes and sanitary products. Visitors can use all these facilities without injecting.

‘Everyone who comes in here has a story of neglect from childhood, just decades of PTSD,’ Paul, a nurse at the Thistle, told me. ‘Their experiences are beyond what you and I will ever know.’ ‘You have to imagine what it would be like for a sex abuse survivor to come round [from an overdose] and find half a dozen men looming over them,’ a social worker added. ‘And to consider why someone threatened with a suppository might shout: “Get the fuck away from me.”’ A former paramedic, Paul finds it ‘difficult to accept the fact you can’t do everything you would with someone who does not have such a chaotic life. If a 70-year-old granny was suffering from infected wounds, you would phone an ambulance, and off she’d go to hospital. That is not always possible here.’ Staff are also hampered by the wider lack of resources. If someone is sleeping rough, they will do their best to find them a bed for the night, but Glasgow is one of thirteen Scottish local authorities to have declared a housing emergency. Sometimes there is a bed, sometimes not.

One thing the Thistle can do is to help people inject more safely. A nurse held an infrared device called an AccuVein over my right arm until a criss-cross of green lines appeared like the back of a sycamore leaf. ‘If people can see the veins in their arms, they are less likely to inject into their groin,’ she told me, where they would be at more risk of infection or hitting an artery. Two days after our first encounter, Ryan agreed to let me accompany him into the injecting room. It felt voyeuristic, but it did correct some of my misconceptions. I had imagined users would enter, inject quickly and leave, but Ryan was in the booth for around fifteen minutes, and many people take longer. He had split his cocaine into two doses. The first syringe slipped in easily, but the second was more difficult. Every few minutes, a nurse handed him a fresh needle in case the original had bent or been blunted. The Thistle has finer needles than those you can get in the nearby pharmacy. Ryan’s arm was bleeding, and from time to time, he got up to wipe it. Eventually, the second syringe found its target. Ryan’s wounds weren’t serious, but if left untreated infection and abscesses can result, even amputation – addicts tend to have poor circulation. Once you know that, you begin to notice the number of youngish people in the Calton using wheelchairs and crutches.

After they start to trust the nurses, service users become more willing to have their wounds treated. The first time I met Mark, his hand was red and throbbing and the size of a melon. He had missed the vein while injecting cocaine one morning before the Thistle opened. ‘When I came in the next day, I asked one of the nurses to look at it and she said: “Get yourself up to the hospital.” They kept me in over the weekend because I needed to be put on an antibiotic drip. I know it still looks awful, but it’s better than it was.’ Some users don’t want to go to hospital because they have had bad experiences and are scared of being kept somewhere they will not be able to inject, so nurses at the Thistle are being trained to dispense antibiotics.

Mark told me a bit about his life. He moved to Scotland twenty years ago after getting divorced. He met a woman in a soup kitchen in Hamilton and they were together for seven years until she was murdered in 2020. ‘I have lost a lot of loved ones in my lifetime,’ he said. ‘My stillborn daughter with my ex, my mum and dad, my 95-year-old gran and then, last year, my younger sister. That’s why I started using cocaine.’ He wants to stop. ‘I’m hoping to go to a recovery café on Wednesday nights,’ he said. ‘I’ve already met an addiction nurse and she said she’d try to help me stop.’

While I was at the Thistle everyone was talking about a man who had overdosed in the grounds of a local church that had been converted into a music venue. A friend of the man phoned the centre and two of the nurses ran to help. It took both of them and a paramedic to haul him out of the enclosed, roofless space at the side of the building where the men had gone to inject. They gave him naloxone and he survived. The man had never used the Thistle and his friend had only used the shower room. Why were they injecting in a dank, dark space when a clean room was just a few hundred metres away?

A possible explanation is that the Thistle has to comply with the lord advocate’s guidelines and so has tight rules, some of which seem perverse. Take the AccuVein device. Nurses are allowed to hold it over a user’s arm before they inject so they can mark the spot they want to hit but they are not allowed to hold the device while the person is actually injecting. They are allowed to hand out needles, but not tourniquets – some people use their own belts. People who come to the centre together are not allowed to inject each other and must split their drugs before they enter. Although smoking heroin or cocaine is safer than injecting it, it is banned at the Thistle because smoking is banned in all NHS buildings.

The Thistle has funding for three years and its performance will be evaluated by Public Health Scotland and Glasgow Caledonian University. The Scottish Affairs Committee at Westminster has also launched an inquiry, which will consider potential statutory or policy changes that might be needed for the facility to carry on beyond the pilot phase. There are no other pilots underway in the UK (though a Medically Supervised Injecting Centre opened in Dublin in December). Although there is nothing to prevent other proposals – in England, such centres could operate with a memorandum of understanding from the appropriate chief constable – it seems likely that the cities which have expressed an interest, including Dundee, Cardiff, Edinburgh and Bristol, will wait for the Thistle evaluation.

Megan Jones, a director at Cranstoun, a charity that has developed a less formal model, believes it makes sense to try out a range of SDCFs in Scotland, where the political will exists. ‘It’s amazing they got the Thistle over the line,’ she told me. ‘My concern is – because it is expensive, or because it gets caught up in the polarisation – the verdict might turn out to be: “Yes, it made an impact, but we are not going to continue.”’

In the meantime, the Thistle is expanding its services. There are now weekly clinics for blood-borne viruses – such as HIV or hepatitis B – and sexual health. The health centre has applied for a licence from the Home Office to set up a drug-checking pilot: this would ensure drugs weren’t stronger than expected or cut with something dangerous. The Scottish government is being pushed to make an exemption to the smoking ban. Yet the talk on the streets and in the newspapers is not of lives saved, but of local nurseries using metal detectors to sift dirty needles from sandpits and a neighbourhood that has allegedly become ‘a warzone’. Glasgow City Council, whose efforts to clear up the injection sites have been, at best, piecemeal, hasn’t helped matters. It recently installed two new needle bins – one at the car park opposite the centre and another at a disused school – with two more to follow, and cleaned up the wasteland McGowan complained about. A spokesman told me that the council is also cutting back the undergrowth that provides shelter for users at a number of vacant sites. When I asked why this hadn’t been done sooner and why some of the worst spots remain untouched, he fell back on old excuses: that the council relies on residents to report concerns and that a lack of clarity over land ownership means it’s difficult to work out who should pay for the clean-up.

It is easier to blame the Thistle than local dealers, a criminal justice system that has failed to halt their lucrative trade or landowners who have left injection sites to fester. The Thistle staff are doing their best to counter the vested interests that want the centre to fail. Twice a day, outreach workers pound the pavements, like Mormons spreading the Good Word, and local residents are encouraged to come and see the service for themselves. But attendance is tailing off. The figures for May are expected to be significantly down on April, and some workers at the SDCF worry there is a reluctance among injectors to be associated with a service that is never out of the headlines. It’s too early to tell whether the centre will succeed, but it shouldn’t be allowed to become a casualty of the culture wars.