“For years, the idea of a safe consumption space captivated the imagination of drug users everywhere,” says Isaac Jackson, president of the San Francisco chapter of the Urban Survivors Union. “It was like the promised land. A place where we would take care of each other and no one would get busted or get sick or die from an overdose. I hope folks aren’t going to get too disappointed when they finally open.”

There’s been a lot of discussion lately, in the harm reduction movement and the media, about something with a lot of different names. The Collins dictionary, for example, lists only “shooting gallery,” as “[slang] a house where heroin addicts inject themselves.” Harm reductionists variously prefer “safer injection facilities” (SIFs); “safer consumption sites” (SCS), “overdose prevention sites;” or the one I choose to use for this article: “drug users’ safe spaces” (DUSS).

“There’s no heaven on earth but it’s got to be better than the hell we’ve all been through the last few years.”

Their public-health benefits have been proven, and activists in a several US cities are fighting to establish the first legal one in the country. “There’s no heaven on earth,” says Jackson. “But it’s got to be better than the hell we’ve all been through the last few years.”

But the semantic differences I mentioned make clear that we’re going to have to come up with our own definitions for what we mean when we talk about safer places for people to use drugs. What are they exactly, and how should they work in practice?

The Urban Survivors Union (USU)—a national network of drug users, with chapters and partner organizations dedicated to drug users’ safety and well-being—is one organization taking on this work. As Louise Vincent, the USU’s executive director, has said, “a safe place for drug users can mean the difference between life and death.”

Reggie Thomas, USU’s Seattle chapter president, says, “A safe place for drug users means an area with cultural competency run by and for drug users to look after their brothers and sisters.”

And Mona Bennett, an outreach worker at Atlanta Harm Reduction Coalition, says that such a place should be “under the police radar, staffed by culturally competent [people], and connected to the community, with an ample amount of supplies for injection and smoking [and] with an incredible amount of love that is both peaceful and lively.”

Based on these ideas, and on many discussions with my fellow drug users, I suggest the following reasonable expectations for DUSS:

First and foremost, they must have naloxone/Narcan on site, and people who know how to administer it.

Second, it is also reasonable to expect that this place would have someone staffing it, making sure that everyone is safe, and assisting anyone who needs help.

Third, it’s reasonable to expect a clean and safe space, supplied with all of the injection and smoking equipment you will need to use best practices to stay safer and stop the spread of diseases.

Fourth, it is also reasonable to expect that the space has hours that accommodate drug users’ needs, including a minimum of at least eight hours per day.

With those guidelines established, let’s start defining where and what DUSS are.

Can they be your friend’s house, where everyone goes to party or to get high? If we stick to the reasonable expectations above, it is possible to define those as DUSS. If we define a DUSS in this way, there could already be hundreds if not thousands of DUSS operating (though not legally) across the United States.

But some might argue that you need to meet more than just those reasonable expectations to call yourself a DUSS. For example, you might need much more infrastructure, like scheduling people for shifts, and connecting people to other services. And some groups are doing just that.

For instance, in Toronto, organizers created a massive pop-up tent in a park, assigned people for shifts, and educated drug users on how to safely use.

In Seattle, where I live, there are three underground groups that have each set up safe spaces for people to use drugs. They are vastly different from each other and have completely different policies; they therefore illustrate a diverse range of possibilities for what a DUSS can be.

I’ll call them “Group A,” “Group B,” and “Group C.”

Group A

Group A—made up of 20 to 30 volunteers—has rented a house, and turned it into a place where people can safely use. When I toured their facility six months ago, the space was organized around a stainless steel table in the shape of a crescent moon. This table is a one-of-a-kind design, specifically for this location: A person can stand in the middle of the table and assist people as they use. This table was located in the living room where people could safely inject, along with multiple sharps containers for people to dispose of their syringes.

The bedrooms had been turned into smoking facilities, where people could smoke drugs safely. Volunteer staff members made sure everyone was OK, and helped teach people how to use safely.

The location of this space is not advertised, and they have asked me to keep it anonymous. Their typical clientele seemed to be a middle-class, stable drug users, with lots of people coming on their lunch break and after work.

Group A does not allow drug dealing to happen on the premises, so the clientele must bring their own drugs.

Group B

Group B—a small group of five or six people—has rented a three-bedroom apartment. It contains a long wooden table, on which they’ve placed a piece of stainless steel to create a clean surface. There are couches all around the table for people to be comfortable after they inject. This group also allows people to help each other inject if they’re having trouble.

This group seems to serve much more of a low-income, street-based population of drug users; they do not allow smoking at the apartment, as they feel like that will be an easy way for them to be caught.

To enter, you must know the password; it’s a little like an old speakeasy—only the nature of the “moonshine” is different.

Group C

Group C is run by just one person, with a handful of helpers. It has a small storefront, through which you can go down into a basement and safely inject and smoke drugs. Group C’s space is another kind of membership-only space. It’s physically a much darker area. There are mirrors along the wall, and tables right in front of them, with chairs against the tables, facing the wall. There’s also an old La-Z-Boy chair from which one person can monitor everyone else.

The atmosphere here includes lots of jokes, and everybody’s teasing each other constantly—it reminds me of a barbershop feel. It seems like some people there are just hanging out for hours, chatting and laughing with each other.

Group C seems to be serving approximately 50 people in a week, with at least 20 people per day. It is the most welcoming space I have ever seen. They have a large Bob Marley flag on the ceiling, with music playing at all times. This group is also doing a small needle exchange program for the folks they serve.

“They talk, we die.”

These three examples are underground places; you need to know about them to be able to access them. Should we consider them DUSS? They are following all of the guidelines described above. Along with written policies and procedures about what happens at their space, they also have oxygen tanks to prevent overdoses, epinephrine for allergic reactions, and much more.

It would still be preferable if the legalization of such spaces meant they could be openly available to all who need them. But we can’t just wait for that to happen.

As cities and states debate the merits of DUSS, people are already creating them for themselves—making policies and creating their own best practices without the input of health departments and governments. Their staff members are risking their safety and their freedom to provide a safer space for fellow drug users.

At the International Harm Reduction Conference in Montreal last year, Zoë Dodd of Toronto Harm Reduction Alliance said: “They talk, we die.” She was protesting the fact that Canada has not gone far enough in giving services to drug users. Her words are exactly applicable to DUSS in the United States.

There were an estimated 72,000 overdose fatalities in the US last year. There was a combined total of zero deaths in all consumption rooms throughout the world.

“I never thought we would ever again allow fellow citizens to die in hundreds of thousands like what happened with AIDS,” says Isaac Jackson. “But here we are. So in that sense these safe-using spaces will be a game-changer.”

Cities, counties, and states will eventually have to engage these programs and services and find ways to work with them. For now, brave drug users are looking after their communities in the only way they can—by giving unconditional love, support and safety.

Photo by Belinda Fewings on Unsplash