What works and what gets in the way at Athens' drug consumption room: views from users and non-users

What is it about?

This rapid-ethnographic study evaluated Athens' drug consumption room (DCR), known as Steki 46. Over seven weeks, researchers conducted around 200 hours of observation inside the facility, five focus groups with 24 regular DCR clients, and 25 street-based interviews with people who use drugs nearby but do not access the service. Regular clients reported three core benefits: physical and structural safety from overdose, police harassment and theft; emotional safety and privacy; and meaningful connection to food, hygiene, healthcare, legal advice and social relationships. People who did not use the DCR could see its value but identified specific barriers including distance, fear of surveillance and cameras, the time required by the intake process, restrictions on drug sharing and assisted injecting, and a policy excluding people already enrolled in opioid substitution treatment.

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Why is it important?

Athens provides a rare and important case study: a southern European city that reopened a DCR in the wake of a COVID-19-era HIV outbreak among people who inject drugs and escalating homelessness linked to the 2010 financial crisis. This study is the first qualitative evaluation of the Athens DCR from the perspective of both clients and non-clients, addressing a gap that most DCR research leaves unfilled. By deliberately seeking out the views of people who do not access the service, it identifies precisely which design and policy features create exclusion, and several of these have already been acted on, demonstrating a direct line from community-based research to service improvement. At a moment when the UK, Ireland and other countries are planning or piloting their first DCRs, the findings offer transferable, evidence-based guidance on how medicalised service models can unintentionally generate new barriers, and what peer-led, low-threshold adaptations can do to close that gap.

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