BACKGROUND: Drug consumption rooms (DCRs) are harm reduction facilities providing safer and hygienic setting for supervised administration of drugs aimed at decreasing negative health and social consequences of drug use. The first DCR in Czechia was opened in September 2023 in city of Brno in a mobile form operating in a socially excluded area (SEA). A research project informed the implementation of the DCR. METHODS: A mixed methods design was applied in the following phases: desk review, research before and after the launch of the mobile DCR, and routine monitoring of programme performance. Two cross-sectional questionnaire surveys among PWUDs (n = 131 and 135), ethnographic observation, focus group (n = 19), interviews with PWUDs (n = 26 and 19), with personnel of addiction services and local officials (n = 16 and 12), and residents (n = 7 and 6) were performed prior to and after the launch of the DCR. Thematic analysis of qualitative data, descriptive and regression analyses of quantitative data were performed. RESULTS: There was a need and high willingness to use the DCR among potential clients. The significant predictors were opioid use (adjusted odds ratio, AOR = 3.4 in survey 1 and 3.9 in survey 2), drug injection in the last 30 days (AOR 4.3 in survey 1), being in the probationary period during the previous 30 days (AOR 10.0 in survey 1), witnessing an overdose in the past 30 days (AOR 8.5 in survey 2), HCV positivity ever in life (AOR 2.9 in survey 2), living in SEA (AOR 2.7 in survey 2) and Roma ethnicity (AOR 2.8 in survey 2). The beginnings of the DCR were relatively slow with low initial number of clients and drug administrations. However, with time, and programme adjustments following research results, the attendance at the facility has grown. CONCLUSIONS: Research was instrumental in shaping the DCR in Brno before and during its implementation. The DCR showed a potential to attract the most vulnerable PWUDs from SEA. Despite a slow start, the DCR has become an integral part of low-threshold services for PWUDs in Brno and has proven its feasibility in the Czech settings.

Department of Addictology Charles University 1st Faculty of Medicine and General University Hospital Prague Czech Republic

Společnost Podané ruce Brno Czech Republic

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EMCDDA, C-EHRN. Joint report by the EMCDDA and C-EHRN: Drug consumption rooms. Lisbon: European Monitoring Centre for Drugs and Drug Addiction and Correlation – European Harm Reduction Network; 2023

Hedrich D, Pirona A, Wiessing L. From margin to mainstream: the evolution of harm reduction responses to problem drug use in Europe. Drugs: Educ Prev Policy. 2008;15(6):503–17.

Rhodes T, Hedrich D. Harm reduction and the mainstream. In: Rhodes T, Hedrich D, editors. Harm reduction: evidence, impacts and challenges Scientific Monograph Series No 10. Lisbon: European monitoring centre for drugs and drug addiction; 2010

EMCDDA. Spotlight on Drug consumption rooms Lisbon: European Monitoring Centre for Drugs and Drug Addiction; 2022. Available from: https://www.euda.europa.eu/spotlights/drug-consumption-rooms_en

EMCDDA. Prevence smrtelných předávkování. Zaostřeno. 2019;2019(1):1–8

ECDC, EMCDDA. Prevention and control of infectious diseases among people who inject drugs: 2023 update. Stockholm: ECDC; 2023 2011

Roux P, Jauffret-Roustide M, Donadille C, Briand Madrid L, Denis C, Célérier I, et al. Impact of drug consumption rooms on non-fatal overdoses, abscesses and emergency department visits in people who inject drugs in France: results from the COSINUS cohort. Int J Epidemiol. 2023;52(2):562–76. PubMed

Levengood TW, Yoon GH, Davoust MJ, Ogden SN, Marshall BDL, Cahill SR, et al. Supervised injection facilities as harm reduction: a systematic review. Am J Prev Med. 2021;61(5):738–49. PubMed PMC

MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V, et al. Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. Int J Drug Policy. 2014;25(1):34–52. PubMed

Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend. 2014;145:48–68. PubMed

Myer AJ, Belisle L. Highs and lows: an interrupted time-series evaluation of the impact of north America’s only supervised injection facility on crime. J Drug Issues. 2017;48(1):36–49.

Wood E, Tyndall MW, Lai C, Montaner JSG, Kerr T. Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Subst Abus Treat Prev Policy. 2006;1:13. PubMed PMC

Folch C, Lorente N, Majó X, Parés-Badell O, Roca X, Brugal T, et al. Drug consumption rooms in Catalonia: a comprehensive evaluation of social, health and harm reduction benefits. Int J Drug Policy. 2018;62:24–9. PubMed

Hedrich D, Kerr T, Dubois-Arber F. Drug consumption facilities in Europe and beyond. In: Rhodes T, Hedrich D, editors. Harm reduction: evidence, impacts and challenges. EMCDDA Scientific Monograph Series. Lisbon: European monitoring centre for drugs and drug addiction; 2010. p. 305–31

Behrends CN, Paone D, Nolan ML, Tuazon E, Murphy SM, Kapadia SN, et al. Estimated impact of supervised injection facilities on overdose fatalities and healthcare costs in New York City. J Subst Abuse Treat. 2019;106:79–88. PubMed

Wilson DP, Donald B, Shattock AJ, Wilson D, Fraser-Hurt N. The cost-effectiveness of harm reduction. Int J Drug Policy. 2015;26(Suppl 1):S5-11. PubMed

Enns EA, Zaric GS, Strike CJ, Jairam JA, Kolla G, Bayoumi AM. Potential cost-effectiveness of supervised injection facilities in Toronto and Ottawa. Canada Addiction. 2016;111(3):475–89. PubMed

EMCDDA. Infographic. Location and number of drug consumption facilities throughout Europe Lisbon: European Union Drugs Agency; 2023 [Available from: https://www.euda.europa.eu/media-library/infographic-location-and-number-drug-consumption-room-facilities-throughout-europe_en

ENDCR. Location and number of drug consumption rooms throughout Europe. Amsterdam: Correlation – European Harm Reduction Network; 2024

Harm Reduction International. Global state of harm reduction 2022. London: Harm Reduction International; 2022.

Ricciardelli R, Whitten C, Johnston M. “How are we gonna get them off the drugs if they’re allowed to stay on it?” correctional officer perspectives on Overdose prevention sites in prisons. Crim Justice Stud. 2024;37(1):39–58.

McKendy L, Biro SM, Miron M, Keown LA. Understanding overdose incidents in Canadian federal custody. Int J Drug Policy. 2021;92:103131. PubMed

Moura J, Darragh L, Perez Gayo R, Jeziorska I, Schiffer K. Drug consumption rooms in Europe – operational overview. Amsterdam: correlation – European harm reduction network; 2023

Zábranský T. Aplikační a uživatelské místnosti: přehled dostupných zkušeností a výzkumu [Application and User Rooms: an Overview of Available Experiences and Research]. Praha: Městská část Praha 1; 1999. p. 20

Mladá K, Pavlovská A, Novák P. Vybrané harm reduction služby v Berlíně. Adiktologie. 2010;4:252–8.

Zábranský T. Aplikační místnosti, nebo šlehárny? Praha: Listy Prahy 1 a Neviditelný pes; 2001. Available from: https://www.minarcik.cz/noviny/aplikacni.htm

Procházková L, Herzog A. Kauza o Václavák aneb případová studie monitorující aktivity směřující k řešení situace výskytu otevřené drogové scény na Václavském náměstí v Praze. 2010

Janíková B. Aplikační místnosti – centra pro zdravotnicky supervidovanou aplikaci omamných a psychotropních látek. Zaostřeno na drogy. 2011;9(1):1–11.

Remešová R. Zřizování a provozování aplikačních místností pro uživatele drog: přehled zahraničních zkušeností. Praha: Univerzita Karlova; 2017.

Janouškovec V. Aplikační místnosti pro uživatele drog - analýza potřeb. Praha: Univerzita Karlova; 2013.

Moravcová M. Ne/zavedení aplikačních místností v České republice. Praha: Univerzita Karlova; 2014.

Mravčík V. Mobilní aplikační místnost v Brně - prezentace. Seminář o aplikační místnosti v Brně; 29. června 2023; Podaná kavárna, Brno: Společnost Podané ruce; 2023

Společnost Podané ruce. Společnost Podané ruce spouští v Brně první program bezpečnější aplikace a prevence předávkování v České republice Brno: Společnost Podané ruce; 2023 [Available from: https://podaneruce.cz/spolecnost-podane-ruce-spousti-v-brne-prvni-program-bezpecnejsi-aplikace-a-prevence-predavkovani-v-ceske-republice/

Společnost Podané ruce. Program aplikační místnosti v Brně a jeho východiska. Brno: Společnost Podané ruce; 2023

Mravčík V, Janíková B. Nastavení programu a hodnocení výsledků Mobilní aplikační místnosti v Brně - protokol projektu. Brno: Společnost Podané ruce; 2023

Stimson G, Fitch C, Rhodes T, Ball A. Rapid assessment and response: methods for developing public health responses to drug problems. Drug Alcohol Rev. 2009;18:317–25.

Mounteney J, Atkin-Brenninkmeyer E, Ruiz MJ, Bo A, Matias J, Jekabsone I, et al. Trendspotter manual: a handbook for the rapid assessment of emerging drug-related trends 2018

Nepustil P, Přibylová P, Veselý O, Vrbová K. Zpráva o situaci v oblasti drog a závislostí v Brně za rok 2021. Brno: Magistrát města Brna, obor sociální péče, Koordinační centrum prevence; 2022

AdRes Institut. RDS studie – seroprevalenční studie a odhad problémového užívání drog ve statutárním městě Brně. Závěrečná zpráva. Brno: Magistrát města Brna; 2019

Fanfrlová M, Nepustil P, Veselý O, Vrbová K. Zpráva o situaci v oblasti drog a závislostí v Brně za rok 2022. Brno: Magistrát města Brna, obor sociální péče, Koordinační centrum prevence; 2023

Společnost Podané ruce. Výroční zpráva 2022. Brno: Společnost Podané ruce o.p.s.; 2023

Mravčík V, Škařupová K, Orlíková B, Zábranský T, Karachaliou K, Schulte B. Use of gelatine capsules for application of methamphetamine: a new harm reduction approach. Int J Drug Policy. 2011;22(2):172–3. PubMed

Kopic J. Aplikační místnost jako součást harm reduction služeb: diplomové práce. Brno: Masarykova Univerzita; 2017.

Miovská L, Miovský M, Gabrhelík R, Charvát M. Analýza potřeb klientů nízkoprahových zařízení. Praha: Úřad vlády ČR; 2005

Hedrich D. European report on drug consumption rooms. Lisbon: European monitoring centre for drugs and drug addiction; 2004.

Duncan E, Shufelt S, Barranco M, Udo T. Acceptability of supervised injection facilities among persons who inject drugs in upstate New York. Harm Reduct J. 2022;19(1):87. PubMed PMC

Ickowicz S, Grant C, Nosova E, Boyd J, Brar R, Milloy MJ, et al. Factors associated with the use of supervised consumption facilities among women who inject drugs in a Canadian setting. J Addctn Med. 2020;14(5):e226–32. PubMed PMC

Rouhani S, White RH, Park JN, Sherman SG. High willingness to use overdose prevention sites among female sex workers in Baltimore. Md Drug Alcohol Depend. 2020;212:108042. PubMed PMC

Trayner KMA, Palmateer NE, Hutchinson SJ, Goldberg DJ, Shepherd SJ, Gunson RN, et al. High willingness to use drug consumption rooms among people who inject drugs in Scotland: findings from a national bio-behavioural survey among people who inject drugs. Int J Drug Policy. 2021;90:102731. PubMed PMC

Chappuy M, Lack P, David B, Penavayre G, Thabourey D, Landulpho M, et al. Willingness to use a drug consumption room among people who use drugs in Lyon, France, a city with no open scene of drug use (the TRABOUL survey). Harm Reduct J. 2023;20(1):149. PubMed PMC

León C, Cardoso L, Mackin S, Bock B, Gaeta JM. The willingness of people who inject drugs in Boston to use a supervised injection facility. Subst Abus: Off Publ Assoc Med Educ Res Subst Abus. 2018;39(1):95–101. PubMed

Kenney SR, Anderson BJ, Bailey GL, Herman DS, Conti MT, Stein MD. Examining overdose and homelessness as predictors of willingness to use supervised injection facilities by services provided among persons who inject drugs. Am J Addict. 2021;30(1):21–5. PubMed PMC

Chomynová P, Kozák J, Mravčík V. Substance use in Roma population in contact with social workers in the Czech Republic: A cross-sectional questionnaire survey. Journal of ethnicity in substance abuse. 2020:1–20 PubMed

Taylor H, Curado A, Tavares J, Oliveira M, Gautier D, Maria JS. Prospective client survey and participatory process ahead of opening a mobile drug consumption room in Lisbon. Harm Reduct J. 2019;16(1):49. PubMed PMC

Woods S. Drug Consumption Rooms in Europe - organisational overview. Researchgate: 2014. 10.13140/RG.2.2.34829.15842

DeBeck K, Kerr T, Lai C, Buxton J, Montaner J, Wood E. The validity of reporting willingness to use a supervised injecting facility on subsequent program use among people who use injection drugs. Am J Drug Alcohol Abuse. 2012;38(1):55–62. PubMed PMC

Danosová M, Machálková L, Mazalová L, Bubeníková Š, Pastucha D. Vnímání zdraví u romského etnika. Med praxi. 2015;12(5):256–9.

Herzog A, Kocian M, Plaček J. Zmenšování drogového trhu v centru Prahy. Adiktol prevent léčeb praxi. 2019;2(2):98–105.

Mravčík V, Chomynová P, Grohmannová K, Janíková B, Černíková T, Rous Z, et al. Zpráva o nelegálních drogách v České republice 2021. Praha: Úřad vlády České republiky; 2021.

Mravčík V, Vařeková Z, Janíková B. Destigmatizace užívání psychoaktivních látek a adiktologických služeb. Strategický souhrn a doporučení pro drogovou politiku. Praha: Společnost Podané ruce a Hlavní město Praha; 2022

Jauffret-Roustide M, Cailbault I. Drug consumption rooms: comparing times, spaces and actors in issues of social acceptability in French public debate. Int J Drug Policy. 2018;56:208–17. PubMed

Houborg E, Jauffret-Roustide M. Drug consumption rooms: welfare state and diversity in social acceptance in Denmark and in France. Am J Public Health. 2022;112(S2):S159–65. PubMed PMC

Jauffret-Roustide M, Houborg E, Southwell M, Chronopoulou D, Granier JM, Frank VA, et al. Different paths and potentials to harm reduction in different welfare states: drug consumption rooms in the United Kingdom, Denmark, and France. Am J Public Health. 2022;112(S2):S99-s103. PubMed PMC

Mravčík V. Dekriminalizace a chytrá regulace psychoaktivních látek – moderní alternativa prohibice [Decriminalisation and smart regulation of psychoactive substances: a modern alternative to prohibition]. Čas Lék čes. 2023;162(6):231–7. PubMed

Malliori M, Galinaki S, Papakonstantinou AK. ODYSSEAS: supervised use of drugs versus bureaucracy in Greece. Lancet Psychiatry. 2015;2(2):e3. PubMed

Skretting A. The Nordic countries and public drug-injection facilities. Drugs Educ Prevent Policy. 2006;13(1):5–16.

Jelínek J. Trestní zákoník a trestní řád s poznámkami a judikaturou. Praha: Leges; 2014

Ščerba F. Trestní zákoník: komentář. Praha: C.H. Beck; 2020

Mravčík V, Janíková B, Černíková T. Koncept aplikační místnosti v podmínkách ČR. Praha: Úřad vlády ČR, Sekretariát Rady vlády pro koordinaci politiky v oblasti závislostí; 2022