REPORT – In Strasbourg, the consumption room has opened its doors, to the great relief of drug users and risk reduction actors.
At the Strasbourg Civil Hospital, the walls of the former thoracic surgery department now house a room. It is called “Argos”: it is a room for the consumption of drugs with less risk (SCMR). “It bears the name of Ulysses’ dog, the only one to have recognized it on his return from the Odyssey,” says the team that manages it. Like him, we are the ones who recognize the users as needing help and care. “
Some say “shooting rooms” but the clumsy phrase struggles to describe the place and its ambitions. We are indeed far from the high club that shapes fantasies – and this is not the kind of place that the Mildeca came to visit this Thursday morning, (Interministerial Mission for the Fight against Drugs and Drug Addiction), accompanied municipal and associative teams from Paris and Strasbourg, which carried out SCMR projects in the two cities.
Ergonomic
Together, they have just closed the first steering committee for these two systems; the results already seem favorable. The Strasbourg room has around thirty daily visits, most of which are people who inject cocaine. Women represent more than a third of this audience, aged 30 to 45 on average.
In the different rooms – reception, rest, infirmary, injection and inhalation stations – there is a sanitized but cozy atmosphere, similar to that of these brand new clinics that are built with the well-being of patients in mind. The ergonomics of the site also meet the most precise needs of the user community, from the large lockers to store the luggage of this sometimes itinerant public, to the dedicated areas for leaving dogs and soon, compartments for put down his beer.
“They often buy large cans of strong beer that they don’t want to give up – they don’t have a lot of money,” the team recalls. So they drink it all in one go before entering and consuming, which increases the risk when taking drugs. We can avoid this by reserving a space to store the cans ”.
The difficult acceptance of risk reduction
In France, risk reduction (RDR) has been applied since the end of the 1980s and the establishment of syringe exchange programs (PES). It is then a question of providing new syringes to users and of taking back those which have been used, in order to limit the prevalence of infections among this population. The prescription of opioid substitution treatments (methadone, subutex, etc.), possible from 1996, is another pillar of this policy.
DRR is a pragmatic approach which consists in reducing the damage linked to a practice, even if it is illegal. Proponents of RDR assume that a drug-free world is as desirable as it is illusory. Since the people consume, we might as well teach them how to limit damage.
This view may offend advocates of a more moral approach to drugs. The heated debates on the SCMRs and their difficult establishment in France illustrated this ideological divide – even if, a few months after their opening, the fears raised (increased traffic, incitement to consumption, etc.) did not materialize.
Standing, a large red notebook in her hands, Danièle Bader-Ledit, the president of the Ithaque association which manages the room, recites the notes left by the users. Like a guestbook or a grievance book, consumers write down on these pages what the room brings them. They tell of the comfort of a caring place, and then the discomfort, sometimes too – the quality of the coffee seems unappreciated. “I learned from the booklets you provide that I had risky practices and I was shocked. How do you ensure that people who cannot read well have access to this information? », Writes a user, read by the president visibly moved – this is after all why she fights so vigorously.
Danièle Bader-Ledit, president of Ithaca: ” It is very important to have this feedback. We are planning to put screens to broadcast messages for those who cannot read … “
Prick cleanly
You don’t come to “Argos” to prick yourself, but to prick yourself properly, which makes all the difference. The users who will hurry when 1 p.m. rings – the room does not open before – are aware of the damage associated with their practices, and express a desire to reduce them, whatever society may think of these uses. “But there can be a world between the moment when we explain, in theory, how to avoid the risk of infections and the moment of the injection itself”, underlines Karine, a specialist educator who works at “Argos”.
The risk reduction community has known for years the need to deploy this type of device to reduce the transmission of infections (hepatitis, HIV) and the risk of overdose. Since their launch 30 years ago in Switzerland, SCMRs have proven their worth – and it’s not just a question of hygiene and the prevalence of infectious diseases.
Karine, special education teacher : ” Some people explain that they have spaced their consumption here, because they rest more, while they would have chained two takes at home “
“Narcissization”
A visit to a Caarud (Reception and Support Centers for Risk Reduction for Drug Users) may allow us to better understand the role of these tools so disparaged because they do not encourage withdrawal, according to the argument that we often hear. This Thursday, about twenty users are gathered in the reception room of the center, called “Espace Indépendance”. They have coffee, discuss, call to each other, laugh. Here, they are no longer junkies, drug addicts or social cases: they are just humans chatting around a table.
In the Caarud, you learn about harm reduction and proper injection, but it is strictly forbidden to consume drugs on the spot. The mission of this center goes beyond the sole health objective. Users have a postal address, a washing machine, showers, medical, psychological and social assistance, cooking workshops and even a driver.
Unlike other somewhat murky Caaruds, this one breathes new and clean. “It was out of the question for me to receive them in an unworthy place,” insists the head of the center. We want to encourage a process of narcissization. Understand that some particularly marginalized users do not meet anyone other than members of the team ”. Or the art of regaining an ego when everywhere, society explains to you that you are its dregs.
Admittedly, to consider a possible discussion around weaning and consumption, the conditions seem more favorable in these centers than in the street or squats. But it is true, this is not the primary objective of these places, where it is a question of respecting the user’s choice and adapting the follow-up according to the needs that he himself formulates.
Francine Gatto, head of Caarud: ” We are working on the practices, it takes a lot of time. The user has a first interview, we talk about reducing consumption if this is the wish he expresses “
“I could go to the doctor …”
Riley is prescribed methadone in this Caarud. “I could go to the general practitioner, I have CMU, but I come here”, says the young woman. She is 33 years old, lived on the streets and used heroin a year ago, before pushing the doors of this center and meeting Nadia, the social worker. Droplets bead on her cheekbones, she apologizes. “It’s the lack,” she says.
She comes here three times a week to have her substitution treatment, to talk to the psychologist, the users, the team. “It’s still better than going to the doctor and lying on my bed doing nothing, or taking several medications without knowing where I am. Here, I am taught to manage ”.
She wants to go to treatment, she says, but it’s still too early, the team told her. “I am surrounded, it is important. I know myself, I am in a state of depression, they took custody of my son away from me because when I went to look for him, my face was swollen … The presence of people here makes me feel good. This afternoon, she has to go to court to try to recover her parental rights. She is stressed. In the Caarud, she takes advice from the team and tries to allay her fears but when she mentions the absence of her son, her gaze darkens.
Riley : ” Fortunately there are associations and places like that … “
It is for all these medical, social and psychological reasons that the theaters have opened, overcoming the limitations of the Caarud who close their doors on weekends, leaving consumers in the countryside. The people of Strasbourg know these systems and their benefits: in the neighboring country, in Germany, they have existed for about twenty years. It only remains to extend them to other French cities – Bordeaux had applied for – and, above all, to find them another name than “shooting room”.
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