What Ohio can learn from an overdose prevention site in Denmark

‘The New York Times’ referred to safe consumption spaces as ‘one of the most daring experiments in “harm reduction.”’ But when you visit these places, it doesn’t feel daring at all. It feels right.
A safe consumption space at Kirkens Korshær in Vejle, Denmark
A safe consumption space at Kirkens Korshær in Vejle, DenmarkJack Shuler

Erik says he comes here to use drugs a few days a week. He was once an IV drug user but now he only smokes. He’s on methadone, so things are not as complicated as they used to be. 

Erik (a pseudonym) is a strong, 40-something man with a firm handshake and a throaty brogue. He grew up here in Vejle, Denmark, about two and half hours east of Copenhagen by train on the Jutland Peninsula. 

We’re sitting at one of a dozen picnic tables covered by blue and white polka dotted tablecloths in an outdoor garden in front of the nonprofit Kirkens Korshær (or KK for short). Behind me, someone is playing guitar. In a corner to my left, a group of people are laughing and smoking cigarettes. 

Inside the building, there’s a large hangout space with a pool table and couches. Paintings decorate the walls, and a kitchen constantly serves coffee and comfort food. There are bathrooms and showers and a room for washing clothes. On the far right of this large space is a doorway to a safe drug use space – a place where people can smoke or inject illicit drugs. People bring their own drugs and use while being monitored by nurses with naloxone and oxygen at the ready. 

A light on the wall indicates when the safe consumption room is in use. Other than that, you wouldn’t even know it was there.

Erik says people at the KK look after your health and well-being. You get treated differently in a hospital, he says

Johannes, a 30-something man born in Greenland, agrees with Erik. But Johannes doesn’t inject or smoke illicit drugs – he’s in recovery from alcohol. But if he did use, he would come here. “You don’t have to go out and look like a criminal in the corner,” he says. He likes KK because the folks who run it are kind to him, and because he understands the struggles of the people who come here. For him, it’s just a safe space. 

Johannes is serious and thoughtful and has lots of questions: “You’re from Ohio. Do you know Dave Chappelle?” I do not. “Why is it that jail is a ‘money industry’ in America? Why do they lock people up for having substance use disorder?” I wish I could answer that. 

Vejle, located on the southeast coast of Jutland, is a city of 60,000 people: bigger than Newark, Ohio, but smaller than Canton. If you followed the 2022 Tour de France, it’s where Stage 3 (from Vejle to Sonderborg) started. When I visited, two weeks after the race had passed through, downtown Vejle was still decorated with yellow bicycles and signs welcoming the race. It’s also the smallest city in Denmark with a government-sanctioned and supported “drug consumption room.” 

In 2012, Denmark passed legislation to allow municipalities to open their own “drug consumption rooms,” or “fix rooms” as they often refer to them in Europe. I like to use the term “overdose prevention site” because it articulates the most basic goal. 

In Denmark, there are six government-sanctioned safe consumption spaces in Copenhagen, Aarhus, Odense, and Vejle. These sites are supported by the government but run by NGOs and staffed by trained health and social work professionals. 

I’ve been to at least eight safe consumption spaces in three different countries, and each has had its own personality, conforming to the community they serve. The same is true of those I’ve seen in Denmark. The largest safe consumption space in the world is H17 in Copenhagen – a huge facility with many rooms for smoking and injecting. The smallest, I think, is Fixelance which is a mobile unit in a van. And Vejle is just cozy – or hygge, as the Danes say. 

Some argue that these places encourage illicit drug use and burden communities. But research shows that safe consumption spaces improve health and reduce overdose. And it’s not simply because the person is not using alone and has access to naloxone and oxygen, but because it increases contact with health care professionals. 

Government-authorized safe consumption spaces have not existed in the United States until recently – and they are technically still illegal under Federal law. But OnPoint’s two facilities in New York City are already proving their effectiveness. The folks who work there have intervened in 565 overdoses since last November – and no one has died.

Just after the park, walk to Flegmade 10 

Last year, more than 5,200 people died from overdose in Ohio – the majority because of fentanyl. This is a human-created crisis, manufactured through the ongoing war on drugs. Short of the decriminalization of drugs and better support for harm reduction and treatment for substance use disorder, as they’re trying in Oregon, we’re going to need other immediate interventions. 

A recent New York Times story referred to safe consumption spaces as “one of the most daring experiments in ‘harm reduction’ in America to date.”

But the truth is, when you visit these places, it doesn’t feel daring at all. It feels right. 

If we say this is a health crisis, then we need to normalize overdose prevention sites as part of healthcare. Overdose prevention sites could and should be a part of a larger effort to save as many lives as possible – alongside drug-checking, easy access to naloxone and medically assisted treatment. And like all solutions, they’re not perfect. In Ohio, access would be a huge challenge because even in cities with public transit, travel would be a barrier for many. 

Having a safe physical location where people who use drugs can be loved and not judged, is life-saving – and more importantly, life affirming. 

The main space at KK is bustling and loud – there’s a lot happening. But there are a few, simple rules in place: no violence; dogs must be leashed and remain outside; no selling drugs; you can only use drugs in the safe space; and be kind and clean up.

Despite the hubbub, there’s still a lot of love and attention for the people who visit. When I first met Regina Pedersen, a bright-faced blond woman and manager of this place, a man came up to her looking distressed and on the verge of tears. He said he couldn’t talk right now, so she simply gave him a hug. 

When it’s empty, Regina shows me the safe consumption space and explains that most of the people who come are from Vejle, though they get the occasional out of towner. Once in the space, they can sit in a booth and inject, or in a separate, filtered room, smoke. A nurse is always on hand to make sure they use safely and properly. 

One nurse told me that in the five years she’s worked here, she has only had to intervene in 10 or 12 overdoses. People in Denmark are mostly using heroin and cocaine – they don’t have a drug supply poisoned with fentanyl. But if it happens, they will know almost immediately. 

Regina’s background is in social work, and so she’s often thinking about ways to support the people who come here into better life circumstances. For example, she says, they keep track of who uses this space. The nurse takes their name (often a pseudonym), what they’re using, how long they have been using, and so on. If a pattern emerges – say someone is coming in more often than usual – the nurses and social workers can talk with them.

“We don’t judge them, but we try to help them,” Regina says. “If we see someone using more, we can talk to them about that. ‘Why are you using a lot? What’s going on?’”

KK is open every day from 10 A.M. to 3 P.M., except on Saturdays in the summer. They were even open on the day the Tour de France rolled through. Regina tells me the city depends on this space and, in turn, helps fund its existence. 

The safe consumption space opened in Vejle in December 2016, in part, as a response to a noticeable uptick in people using drugs in city parks and streets. In one view, people didn’t want drug use in their parks and on their streets, so they hid people who use drugs away. On the other hand, people don’t have to use alone or outside and face the stigma – or the possibility of overdose.

Johannes told me he wanted to show me a spot where people once went to use drugs. It was about a 10-minute walk from KK. Johannes has close-cropped hair and just-out-of-the-box Nikes. And he’s honest about his own struggles, discussing what it’s like to wake up every day and to set his intentions on not drinking. Maybe that’s where his empathy for those who are struggling comes from. 

As we walk up to the spot, he wrinkles his nose and points to a tight space under a bridge. There was once a public toilet here, he says, and the place still smelled of urine. The cement walls of the toilet and bridge are covered in tags. It’s dark and the ground is littered with cigarette butts and smashed cans. It’s a place for hiding, for not being seen. 

This is not comfortable, Johannes says. But for people who are under-sheltered or unhoused, there isn’t anywhere else to go, and at least there is a roof of sorts.

Now, though, there’s a better place to go, and there’s much more than a roof. There’s acceptance.

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