 Good morning, my name is Cedric Chavez. I'm the coordinator of this drug consumption room, one of the three drug consumption rooms of the Regenburg Hoop. I am also working for Correlation Network as field officer. I am promoting the establishment of drug consumption rooms in Europe and worldwide. I personally think that the drug consumption rooms are extremely efficient ways to tackle many problems and I will repeat now what are the goals of a drug consumption room worldwide and this one included. There are three main goals. One is to reduce the public nuisance associated to drug use. One of the other goals is to limit the drug overdose death and the last one officially is to reduce the possibility of contamination HIV, hepatitis C. Regarding the public nuisance, since the opening of the very first drug consumption room in the Netherlands, the associated drug public nuisance has almost disappeared. I don't know if you've been walking in the street of Amsterdam but there is very few visible signs of homelessness and drug use. So that means that the job has been done. If you imagine that in the late 80s there was 30,000 drug users in the street of Amsterdam in what we call open scene. Regarding the hepatitis HIV, specifically on HIV, the drug consumption rooms have proven their impact on the general HIV situation. Before the establishment of drug consumption rooms, the HIV ratio within injectors in the Netherlands was between 12 and 18%. Right away after the opening of the drug consumption room we dropped under 4% which is the general public average contamination. In the last 10 years there is only one case reported among registered injectors in the health authority of Amsterdam which means we almost eradicated HIV with all the measures in place, including drug consumption room. The drug consumption room is not the answer to the problem but it's one of the pieces of the puzzle. The other one being access to needle exchange, possibly to be tested, access to prep, etc. We have, as you can see, a room with smokers and injectors. On the table with containers it's purely for injection. On the tables without containers people can smoke. Whatever drugs people like we don't discriminate. All drugs are allowed in this room but no alcohol. That's the only drug that we do not tolerate in the room because we know that in combination with a lot of downers it leads to much more incident and to much more stressful behavior that we cannot monitor when people are too much under influence of alcohol inside the drug consumption room. Our target group is using in priority heroin cocaine, a little bit of amphetamine, benzodiazepine and cannabis. For the rest I've seen every single drug coming in this drug consumption room from crystal meth to, I don't know, even Viagra. Not that you get high from it but people probably trade Viagra for amphetamine or whatever it is but really what I can say is the client are really conservative. They started in their country of origin with heroin. They bring their addiction here and they stick on heroin. Same with cocaine and we've seen people who have been trying to switch from cocaine to amphetamine. They constantly come back to cocaine because it's absolutely not the same high and people are always in search of the original high. So the male or high of cocaine cannot be replaced by any other upper. So what we see is that really people stick to heroin cocaine and the rest is what we call parallel use. As you can see in this drug consumption room we have been focusing on the social aspect. It's one of the few or if maybe not the last drug consumption room is a sofa, very colorful chair, colorful furnitures, a lot of art on the wall. This is a choice for us. A lot of our practice is based on the theory of the rat park from Bruce K. Alexander who explained very clearly within his research that socialization and human interaction is extremely important for us as human and we try to recreate what he called the rat park. Instead of being a rat alone in a cage with experience experiencing the most stress, rat in cages who live in their families experience less stress and we try to reproduce this at the human level. That's why people are facing each other when they are using. They can come here, they can listen to their radio, they can read the newspaper. We really promote the social interaction more than being only focused on the drug use. We are not really focused on the drug itself. The drug use a bit to monitor that the way of using is correctly done but we are very busy managing or let's say monitoring the behaviors here. The most problem that we encounter in a drug consumption room in such a small space with a lot of drug users is tension due to a lot of people in one room under influence but the drug itself is not a major concern since we have a very very low amount of overdose per year. On a significant year we call the ambulance three to six time which is very few if we compare to other local realities like in France in Canada or else. This comes from different factors. Our clients are how can I say it, conservative. They stick to heroin cocaine. We see very few new drugs. There is no NPS. There is no fentanyl yet and therefore we are very aware of the risk of taking drugs, heroin cocaine. The client also and they make sure they don't come into the overdose situation. The overdose that we encounter are mostly related to high consumption of alcohol during the night and benzodiazepine in combination with other drug use during the day here and an addition of all those products with tiredness make that overdose may occur. When I say we call the ambulance is for backup we have never had a lethal overdose in any of the drug consumption room worldwide so that is something very important to remember. I would like to just say a couple of words about the room itself. We have been focusing on the stress by copying the Rat Park experiment here but we are very focused on two other aspects and I will repeat a lot of times the same words that is safety, hygiene, stress-free. Everything in this room is based on this so the safety just basic features we have no tables with corners if somebody is falling at least is not going to break his skull we have metal plates so at least it's no glass nothing is breakable this is not a mirror this is aluminum plates and all the windows they have a security on it it's like a winch of a car if somebody will throw something at the window it will not break it will just make a big spider web so there is a lot of safety features I'm not going into more detail but safety is important but before we talk about the features itself what is important is the feeling of safety for sure you are safe because it cannot break you will not break your skull on the table but the idea of feeling safe is very important and how do you feel safe in a drug consumption room in the Netherlands it is legal to use drugs so first the police will not come here to arrest you because you are a drug user so you can feel more comfortable to use your own drug the dealers are not allowed to come here to ask you for the debt you owe them your friends your family is not supposed to know you are here it's an individual contract where we respect the privacy of the client so you are comfortable safe and with not a high level of stress when you are using drugs so you feel safe and you are safe being safe is also having access to hygiene the hygiene is very important so feature again hygienic material always in display people can access as much as material as they want we have no limit of material that people can use the material is offered for free from the health authority since the creation of the drug consumption room the health authority give us as much material as we need because the health authority decided that the drug consumption room are part of a global plan to eradicate HIV hepatitis C and therefore they don't see why they should limit the amount of material because every needle coming out of the health authority or out of the drug consumption room is an act of prevention every contamination today of HIV will cost the taxpayer a million euros so let's give free needles in term of hygiene as you understand we make sure that everybody use on a clean plate and everything in this room can be cleaned with heavy-duty cleaning material the wall can be clean the floor is a particular floor I will say something in a second about it we limit the human contact that means everything is pretty much simple that you don't have too much human contact because what are the enemies of the drug users that's bacteria reason dirt so we have to clean this room very well at the end of the day and limit human contact what you will see in this building there is no interrupters for the light in the toilet the light come by itself the same there is no more tissues for the toilets to dry your hands only in the drug consumption room the rest of the building is blowers this is all to limit human contact to limit bacteria is and dirt you can have access to an hygienic environment to use but it's not enough we consider the hygiene as a packet and therefore we want that the clients access not only a hygienic place to use under supervision but also a place where they can have a shower change their clothes rest sleep drink water and eat food because this is part of a whole hygienic packet who makes the engine running when you take drugs it takes a lot of energy from you so you have to refill the engine and we have seen a lot of our users through the years who have more impact of bad hygiene than using drugs and I give you an example in the summer a lot of our homeless population is walking the street of Amsterdam with a very heavy backpack and when they walk with a sweat the backpack start to scratch the shoulders then it's get an infected wounds and we have people with major size abscess on the shoulder like the size of a fist this is extremely painful it can bring to a lot of bacterial infection septicemia whatever it can lead to and therefore we want not only that people use in an hygienic environment but we also promote that they take regularly shower change their clothes take very good care of their foot or feet sorry a homeless with with with dead feet is not able to survive the street so we really promote that the people watch their feet regularly they dried very well and we promote that they wear new socks clean socks dry socks we live in the Netherlands it's a very humid country and humidity can lead to a lot of skin rash bacterial infection on the foot we have an extremely strong ventilation for the room itself we have a lot of people here who are injecting and smoking drugs mostly heroin cocaine the heroin and specially the cocaine smoke is a very fat smoke it will obstruct all the filters of a normal ventilation so when we created this room we had to ask for a specialized company to come to measure the cubic meter of this room and the the sort of the type of smoke which is smoked in there and they realized that the normal ventilation will not do so for a room like this one which is eight by eight it's pretty much the size of a ventilation for a nightclub with filters who are in a room downstairs which are pretty much the size of this green cabinet and the filters are changed every three months in this room everything is considered as contaminated we have no normal trash we have only biohazard container as you can see the biohazard side and the needle container have a safety door so if it falls the needle don't fall out of it once they are full whatever it's a container or the needle container we close it I seal it nobody can open it and a company come once a week they recycle it and they bring us new containers we have an average of 18 client a day we 1818 we can have up to 36 clients under the supervision of two staff members and if we will have more request of client which mean more than 36 per day I will have to ask another budget and actually it's very simple the regulation is one worker 18 client 236 354 and so on it has been decided in collaboration with the fire brigade the police and the organization we created the whole concept around the stress because we realized that we work with a group of long-term hard drug users and the long-term hard drug users feel very lonely outside in the street and the fact that we are working around the socialization is also to tackle loneliness of hard drug users loneliness make the human very stressful and as a user how do you respond to stress by using more drugs but using more drugs isolate you for more from your beer from your family so you get even more lonely so it's a non-stop triangle that is really hard to stop and to break this cycle we try to work ourself on tackling the loneliness people talk to each other and another thing to to go even further in the concept of tackling loneliness a drug consumption room is theoretically designed for homeless population but we know that we have some of our clients who did and do have a house now they have housing first because they managed to have an address to stay permanent and quite stable but they still request to come to the drug consumption room and for us it's fine because we know too well that they will be so lonely in their house alone the TV is never gonna ask them how they are doing today so we allow people who are in transition for at least two year after they acquire a house or a housing to come here for the socialization aspect it's very hard for a person who have been 25 years in the street using heroin cocaine to join the salsa club of the neighborhood or the bridge club so this is their pier this is the place they feel better and there is somebody we're asking them how are you doing today did you go to see your doctor did you call your mother whatever it has to be but there is a bit of empathy and attention given to a group that people otherwise will ignore the company itself the regular group there is 250 paid employees and 1000 volunteers that gives you a bit of an idea of the size of it we are one of the three biggest one in terms of homelessness addiction and psychiatry but we do service in dropping center drug consumption room but we do a lot of ambulance care that mean one-to-one meeting outside of the usual drop-ins and many other organized many other project for example social firm we have some companies who produce things to be sold in the private sector but were still helped by the Regenburg who for example there is a neighborhood farm which is a cafe restaurant which is open for anybody there is another company who is making beer and this is part of a reintegration program for people who used to be in the street and who are now working to make beers and sell the beer in different cafe restaurant there is a company with printing books report flyers t-shirt anything like that this is also what we call a social company so if you take a moment on the website you will be lost through the thousands to the hundreds of projects all of them in the interest of the homeless population of Amsterdam