Evaluating the impact of the UK's first saNctioned sAfer drug Consumption faciliTy (ENACT): A mixed-methods natural experiment study

2025-2029

This project is funded by the National Institute for Health and Care Research (NIHR) Programme Grant for Applied Research (NIHR207273) (£3.1 million)

Project Summary

Background
Scotland experiences among the world’s highest level of drug-related deaths. The problem is severe in Glasgow where there are also concerns over people injecting in public places. In response, the Scottish Government committed £2.3 million per year to set up the UK s first official Safer Drug Consumption Facility, providing a safe place for people to inject their drugs under medical supervision. Staff can also offer support for health and social needs.

Aim
To evaluate the impact of the UK s first Safer Drug Consumption Facility on people who inject drugs, local residents and businesses, and on public services.

Design and methods
We will work with those developing the facility to understand how it operates and whether it improves the health and social outcomes of those who use it. We will interview clients and staff (from a range of services) to find out their experiences and whether the facility is working as intended, or what changes may be needed to improve it. We will use routinely undertaken surveys to assess changes in behaviours of people who inject drugs. We will analyse a range of data to assess changes in use of emergency and other services (e.g. drug treatment) among people who use the facility, compared to those who don’t. We will count discarded syringes around the facility and other measures of interest to the public, comparing changes to other areas. We will conduct surveys, group discussions, and interviews with nearby residents and businesses to measure changes in wellbeing, attitudes, and perceptions of safety, and compare these to people in other areas. Combining this information, we will estimate how many overdoses and other harmful events have been prevented by the Glasgow facility. We will explore how these benefits may change if the facility was delivered differently, and how many drug harms would be prevented if other towns and cities introduced one. We will assess whether the service is a worthwhile investment for the NHS, as well as whether benefits outweigh costs for the local community and government.

Patient and Public Involvement
We have held meetings with local residents and businesses, as well as workshops involving people with living experience, with the help of colleagues in the NHS and the Scottish Drugs Forum. These have provided important insights to help us develop our research plans. We will ensure continued involvement of people with living experience and the wider community in our study through regular advisory meetings and annual workshops.

Dissemination
We will report findings to decision-makers in Glasgow and Scottish Government, as well as others throughout the UK considering implementing a facility. We will summarise the implications of our research and share them in forums with people who have living experience and the public.

Abstract

Background
The UK s first sanctioned Safer Drug Consumption Facility (SDCF) opened in Glasgow in January 2025. People who inject drugs (PWID) experience very high morbidity, mortality, homelessness, and imprisonment. Expanding harm reduction through SDCF approaches is of major policy interest to address injecting risk and health harms, particularly among individuals injecting in public places.

Aim
To evaluate the impact of the UK s first SDCF on health, social, community, environmental, and economic outcomes.

Methods
Mixed-methods natural experiment study, with strong involvement from stakeholders and co-production with PWID, delivered through five work packages (WPs) running simultaneously.

WP0 - Study coordination and integration: A systems map will inform study design and integration of findings across WPs, describing hypothesised pathways through which impacts may arise and considering how different intervention components interact together and with contextual factors. Co-produced plans for research, capacity building, and dissemination will be created.

WP1 - Process evaluation: Qualitative interviews with service users, service providers, and stakeholders will explore implementation, users experiences of service engagement, barriers and facilitators to delivery, and the role of context in shaping intervention delivery and outcomes. Quantitative measures of engagement with the SDCF, referral pathways, and adverse events will be captured.

WP2 - Impact on health and social outcomes of PWID: Changes in outcomes (overdose-related ambulance call-outs, other drug-related health and social outcomes, injecting risk behaviours, and quality of life) for PWID in Glasgow City pre- and post-SDCF will be assessed using health records and a national bio-behavioural survey, and compared to control areas and according to intensity of intervention exposure.

WP3 - Impact on the wider community: Potential adverse or beneficial impacts on the community in which the SDCF is located will be assessed using repeated community surveys to examine trends in community cohesion, wellbeing, and perceptions of safety/crime compared to control areas. Systematic social observation will detect potential changes in the physical environment (e.g. drug-related litter) over time. Repeated focus groups with the local community will explore how perceptions evolve as the intervention becomes embedded. Potential adverse consequences on the local economy will be assessed.

WP4 - Economic analysis and epidemiological modelling: Within-study cost-effectiveness and cost-utility analyses will quantify SDCF costs and value health outcomes from a health and social care perspective. A broader cost-consequence analysis will capture impacts on service users and wider community and adopt a societal perspective to quantify costs and benefits holistically (including criminal justice, housing market, and local economy). Mathematical modelling will estimate the potential long-term impacts on a range of health harms (e.g. non-fatal and fatal overdose, HIV and hepatitis C transmission) to enable a lifetime cost-utility analysis. The modelling will also consider the potential impact of implementing SDCF models in other UK settings.

Timelines for Delivery
4.5 years, with WP0-WP3 running throughout and WP4 active in the last three years.

Anticipated Impact and Dissemination
Findings will directly determine whether the Glasgow SDCF is continued, as well as inform the adoption of similar interventions throughout the UK (including if legislative change is warranted) and generate multiple major scientific outputs.

Project Team

Chief Investigators: Professor Sharon Hutchinson (Glasgow Caledonian University) and Professor Vittal Katikireddi (University of Glasgow)

Co-Investigators: Dr Adelina Artenie (University of Bristol); Professor Kathleen Boyd (University of Glasgow); Professor Peter Craig (University of Glasgow); Professor Matthew Hickman (University of Bristol); Kirsten Horsburgh (Scottish Drugs Forum); Professor Jim Lewsey (University of Glasgow); Professor Andrew McAuley (Glasgow Caledonian University); Professor Kirstin Mitchell (University of Glasgow); Dr James Nicholls (University of Stirling); Dr Norah Palmateer (Glasgow Caledonian University); Dr Saket Priyadarshi (NHS Greater Glasgow & Clyde); Dr Tara Shivaji (Public Health Scotland); Professor Peter Vickerman (University of Bristol); Jason Wallace (Scottish Drugs Forum).

Funding

This study is funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research (NIHR 207273: Evaluating the impact of the UK’s first saNctioned sAfer drug Consumption faciliTy (ENACT)). The views expressed here are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. In addition, we acknowledge Public Health Scotland for funding projects which will contribute to the evaluation, specifically in relation to baseline data collection and preparatory work (relating to the community survey, SSO, administrative data and linkage) and the national NESI survey.

Further Info 

Contact: ENACT@gcu.ac.uk

Link to Glasgow City Health and Social Care Partnership SDCF info: https://glasgowcity.hscp.scot/sdcf

Link to NIHR funding announcement: https://www.fundingawards.nihr.ac.uk/award/NIHR207273