A version of this was first published by Matter News, 17 Nov 2022
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 an overdose prevention center or 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 for me: “You’re from Ohio. Do you know Dave Chappelle?” I do not. And he has questions about the United States. ”Why do they lock people up for having substance use disorder?”
Vejle, located on the southeast coast of Jutland, is a city of 60,000 people: bigger than Newark, Ohio, but smaller than Canton. 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. In the United States, the term “overdose prevention center” is widely used because it articulates the basic goal.
In Denmark, there are six government-sanctioned overdose prevention centers in Copenhagen, Aarhus, Odense, and Vejle. These centers are supported by the government but run by NGOs and staffed by trained health and social work professionals.
I have reported on the overdose crisis since 2015. As a journalist, just like activists, public health workers, and policy makers, I’m always on the lookout for solutions to what at times feels like an intractable problem. Overdose prevention centers could 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. Like all solutions, this isn’t a perfect one. In Ohio, access would be a challenge because even in cities with public transit, travel to such a place would be a barrier for many.
There are over 200 overdose prevention centers around the world, and I’ve reported from eight in three different countries. Each has had its own personality, conforming to the community it serves. The same is true of those I’ve seen in Denmark. The largest overdose prevention center in the world is H17 located in Copenhagen – a huge facility with many rooms for smoking and injecting. It is busy and loud. There are OPCs in hospitals and clinics. One of the smallest in the world is Fixelance which is a mobile unit in a van. And Vejle is just cozy – or hygge, as the Danes say.
Government-authorized overdose prevention centers 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 1,570 overdoses since November 30, 2021 – and no one has died. Rhode Island voted to permit overdose prevention centers in the state, and after city council approval, one may open in Providence later this year.
Some argue that these places encourage illicit drug use and burden communities. But research shows that overdose prevention centers improve health, reduce overdose, and do not lead to increases in crime or calls to emergency services. 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.
I’ve witnessed at least one reversal at an overdose prevention center, but more often than not, what I see is camaraderie and interactions between staff and guests. That’s the vibe at KK.
The main space 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 room 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. The overdose prevention center 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 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.
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.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol issues, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357).
Naloxone is available through Harm Reduction Ohio, Newark Homeless Outreach, and Licking County Health Department.
“Reporter’s Notebook” is a TRP series where journalists discuss their reporting on sometimes-complex topics in context.
Jack Shuler writes for TheReportingProject.org, the nonprofit news organization of Denison University’s Journalism program, which is supported by generous donations from readers. Sign up for The Reporting Project newsletter here.