Inhalative heroin exposure in drug consumption rooms

Status:

completed 08/2025

Aims:

Drug consumption rooms provide drug addicts with a way of consuming drugs (e.g. heroin, cocaine or amphetamines) in a safe environment under the supervision of medically trained staff. The provision of clean drug consumption paraphernalia, assurance of the availability of emergency medical care and the offer of further social opportunities contribute substantially to the protection of addicts. Recent years have seen a significant shift in heroin addicts’ consumption patterns, from injection to consumption by inhalation. Drug consumption room facilities are also observing a rising frequency in the consumption of heroin by inhalation. Consumers usually use a cigarette lighter to heat the heroin on a piece of aluminium foil, then inhale the fumes through a tube. This produces significant quantities of fumes that are released into the ambient air rather than being inhaled. Depending on the layout of the premises, staff may at times be exposed directly or indirectly to these environmental fumes. To enable the risk to employees to be assessed, a method was to be developed for measuring the concentration of heroin in the atmosphere in different areas of the drug consumption rooms and for collection of exposure data in a range of such facilities. Together with ventilation data recorded in the facilities, the measurement data obtained in the project were to be used for the formulation of basic recommendations to be considered during renovation measures and the construction of new consumption rooms in the future, by which exposure could in turn be reduced.

Activities/Methods:

The Institute of Forensic Medicine in Düsseldorf was enlisted as a partner for development of the method for measuring heroin in indoor air. In conjunction with the Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), tests for the sampling of heroin were conducted at the institute, and the analysis method was adapted to the requirements of atmospheric measurements. The measurement method that has been developed can be used for measurements on site in institutions. Operators of several drug consumption rooms in North Rhine-Westphalia were contacted by the German Social Accident Insurance Institution for the health and welfare services (BGW) and agreed to have their premises inspected and to measurements being conducted in them. A harmonised sampling strategy for drug consumption rooms was developed in discussions between the facility operators, the BGW and the IFA. Measurements were carried out in six drug consumption rooms by means of static sampling equipment and equipment worn on the person. In each consumption room, eight to twelve measurements were carried out, depending on the conditions on site. The BGW provided support to the IFA on site for measurement of ventilation data in the drug consumption rooms. Due to the considerable interest shown by the operators of consumption rooms, the number of measurements was increased compared to the initial plan, and in some cases the consumption rooms were visited several times for measurements.

Results:

The results of the workplace measurements were evaluated continuously during the project term. As expected, the highest heroin concentrations in the room air were measured directly in the smoking area in the drug consumption rooms. An average heroin value of 16 µg/m³ and a maximum value during a two-hour period of 28 µg/m³ were measured here. In adjacent areas, which were also occupied continually by staff working at the drug consumption room facilities, the average heroin concentrations were below 1 µg/m³, and in most cases significantly lower. Isolated measurements of concentrations in the order of 2 to 3 µg/m³ were found to be caused by incorrect air routing, which was rectified by the facility operator. Interim results concerning workers’ exposure in individual drug consumption rooms were communicated immediately to the consumption room operators through the BGW during the course of the project as part of recommendations for reducing exposure. Proposals were formulated for reducing exposure further by means of organisational and technical measures. Here, the focus lay on reducing the time spent by staff in the heavily contaminated consumption rooms, and on optimising ventilation control with the aim of capturing contaminated air from consumption areas effectively and reducing its spread to adjacent areas to a minimum.

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