Uwe E. Kemmesies

The open drug scene and the safe injection room offers in Frankfurt am Main 1995

Final report

A survey conducted on behalf of the City of Frankfurt/municipal department Women and Health - drug policy coordination office

Frankfurt am Main, Germany, 1999
(Original German version published by
INDRO in October 1995)

The English version of this study was produced by
the Coordination Bureau of the European Cities on Drug Policy (ECDP) e.V.
in collaboration with INDRO e.V.
(hard copies of the report are available via the ECDP)

 

TABLE OF CONTENTS

1. Introduction

2. Objectives
2.1 "Open drug scene" - definition of terms, background
2.2 "Safe injection room" - definition of terms, background

3. Research design - methods
3.1 Empirical access
3.1.1 Sampling - accessibility
3.1.2 Interviewing instrument
3.2 Analytical access
3.2.1 Statistical operations
3.2.2 Manner of presenting results
3.3 Quality criteria

4. Results
4.1 The "fieldwork"
4.2 The sample
4.2.1 Age, sex, marital status, nationality
4.2.2 Education level - current job
4.2.3 Current housing conditions
4.3 The "drug career"
4.3.1 Current drug use patterns
4.4 Physical condition
4.4.1 Physical, psychical general condition
4.4.2 HIV status
4.4.3 Overdose experiences
4.5 "Everyday life"
4.5.1 Practice of covering cost of living and drugs needed
4.5.2 Acquisition of drugs
4.5.3 Significance of the scene
4.5.4 Current contact intensity "drug aid"
4.5.4.1 Intensity of using the safe injection room service offered
4.6 Partial evaluation "Safe injection room statistics"

5. Summary

6. Literature

 

1. Introduction

This final report presents the results of a study initiated by the City of Frankfurt (Municipal Department Women and Health - drug policy coordination office). As you will understand from the project title "Scene inquiry Frankfurt am Main 1995", the study focuses on the empirical field of the "open drug scene" of the City of Frankfurt. This inquiry is based on a bipartite interest in achieving specific knowledge (cf. 2). Firstly, this project is aimed at getting a current insight into the composition of the open drug scene. On the other hand, the specific interest in getting pertinent knowledge focuses on the safe injection room service implemented in late 1994 within the Frankfurt drug-aid system. To what extent does this particular "harm reduction offer" (cf. 2.2) meet with the acceptance of drug users related to the open drug scene? In the interest of getting distinct knowledge this research project is based on, the methodical conception as outlined in chapter 3 has been realised. In view of the very tight time schedule (three months) and not forgetting the rather insufficient staff capacity, unfortunately a lot of aspects had to be left "unobserved" and "neglected". Nevertheless, the results presented in chapter 4 elucidate the composition and every-day situation of the open drug scene of the City of Frankfurt am Main, giving first impressions of practices of consumption adhered to by IDU (intravenous drug users) as seen from their perspective - with a view of the "newly" implemented safe injection room service offered. This target group perspective is being complemented by an exemplary evaluation of visitors’ statistics kept in safe injection rooms over a period of two months, so to get a more comprehensive impression of safe injection room practice. In chapter 5, you will find a summary of the central results of this study.

Before beginning this portrayal, we have to express our thanks to the following persons and institutions. First of all, we are very much obliged to those interviewees who have taken time to give us a partial insight into their every-day activities. Moreover, we would like to express our thanks to the interviewers - Vannessa Barth, Torsten Lay, Irene Meyer, Oliver Müller, Ilona Ostheimer, Jörg Steinmetz, Phillip Stielow. and Karsten Tögel. Without their committed field work, it would have been impossible to realise the research project within this tight time schedule. Last, but not least, we have to express our particular thanks to the institutions of the Frankfurt drug helping services - above all, to "AIDS - Hilfe Frankfurt" and Verein "Integrative Drogenhilfe" - for their willingness to cooperate.

2. Objectives

The aim of this study comprises a dual interest in acquiring knowledge on two questions that are closely connected:

1. Outline of the current structure and living conditions of the open drug scene in Frankfurt am Main

We plan to conduct a survey of the current structure (composition) and living conditions of the open drug scene (regarding the colloquial term "open drug scene", see also 2.1) in the main station area. This survey is to focus on perpetuating in some way or other, studies that have been conducted in recent years in Frankfurt am Main, in the same empirical reference sector (VOGT 1992; OSTHEIMER/et. al. 1993; KEMMESIES 1995) to get an impression of the developing dynamics of open scene structures and first hints regarding possible developments in the open drug scene of the city. Inspired by this intention, the catalogue of questions coordinated with data of former interviews on the open drug scene deals with sundry constellations of issues relating to drug consumption and life-style such as mentioned in 3.1.2. In addition, the inquiry is also pertaining to the safe injection room service system within the drug-aid system of the City of Frankfurt, this aspect touching the second interest in obtaining know - how as aimed at by the present study.

2. Survey of the utilisation intensity of the safe injection rooms by the target group (IDU)

The intention of disclosing a first survey of the utilisation intensity of the safe injection rooms by the target group may be translated into the following questions: To what extent does what consumer group make use of the safe injection room service offered? Indicators relating to the current "everyday observation" in the main station district are of specific interest in that respect. Observations according to which, notwithstanding the implementation of service offered near to the scene (mainly safe injection rooms offered), open scene structures and/or public drug consumption (with all potential negative implications - not only for the users of illegal drugs themselves, but also for the public) is continued to a considerable extent: Is there any possibility of a specific user group or partial segment of the open drug scene not being reached by the injection room service offered, and, if so, why not?
Based on drug use patterns practised, acquisition patterns as well as biographical standard data and current living conditions, we plan to give a first plastic picture of possible motives for using or not using this specific offer. When anticipating the "empirical access" (cf. 3.1), it already becomes obvious that any clarification nearing this complex of questions will require, above all, a consideration of and concentration on user perspectives as well as the visual range and experience of the target group the service offered focuses on. Only this way will it be possible to obtain information coping with specific target groups - and with current practice - and to optimise this partial offer within the scope of a well - differentiated drug-aid system.
As can be seen from the statements made so far, questions formulated are to be seen in a specific context relating, in particular, to safe injection rooms established in Frankfurt am Main. To formulate this aspect as a question: What about running safe injection rooms in practice - above all in the user perspective - ,and why does this service - bearing in mind public consumption that can be observed in many places (in particular, in the main station area) - apparently reach parts of the open drug scene to a rather limited extent only? To finally sum up this complex, it can be said that the study is aiming at (partial) explanations of the following contents and/or phenomena:

- structure of the open drug scene in Frankfurt am Main
- Intensity of using the safe injection room service offered
- Specific features of the group using safe injection rooms
- Motives regarding the use of safe injection rooms and/or (partial) reluctance to make use of these offers
- Suggestions for an improvement of safe injection rooms from the point of view of the users

To concretise the research subject of this study, we shall refer, hereinafter, in the form of a general view, to terms like "open drug scene" and "safe injection room", inasmuch as these terms are particularly representing the empirical context of this study and/or the central subject of research.

2.1 "Open drug scene" - definition of terms, background

The term "open drug scene" outlines the specific context of this study. Let us try to near the actual meaning of this term. We have to note, first of all, the disproportion between the self - evidence of using this term and notional blurredness. Who belongs to the open drug scene? The homeless alcoholic or the "established" weekend consumer buying heroin or cocaine on the "scene" as well? What’s the minimum dimension of an open drug scene? Do all forms of conduct that can be observed on open scenes really constitute forms relating to drug consumption, and do forms specifically relating to drug consumption give rise to be deemed decisive definition criteria? (cf. in this connection: KORF 1993, 36). Although the "the street junkie reduced to misery" essentially determines our concept of the "open drug scene", questions posed elucidate the fact that the "street junkie" type only describes a small segment of reality. The "marginalised junkie" as well as the social structure of the "open drug scene" only represent small segments of reality - although they considerably determine public consciousness - i.e. a small segment of a manifold culture of drug consumption (For details see KEMMESIES 1995, 77 and following pages). Therefore, observations made in the rather limited sector of the "open drug scene" cannot be extrapolated to the overall situation of "consumption of illegal drugs". In reality, such observations have only a temporary meaning - on visualising the developing dynamics within the drug consuming community - these observations being subject to a comparably strong regional aspect - on visualising the extreme regional differences as regards drug - policies and approaches focusing on practical help (cf. in this connection: BLESS/et al 1993). These differentiated preliminary remarks are very significant, (above all) as regards the representation of our results and the discussion of these results.
As interviewing or fieldwork is concerned, this conception is based on the definition by BLESS/et al (1995, 128), according to which an "open drug scene" is usually conceived as a relatively large concentration of people consuming illegal drugs in inner-city areas. However, this is only a limited approach to clarify the un-sharpness mentioned before. Consequently, this definition can be interpreted only as a "work definition" being without any more detailed explanatory contents. In this respect, it is important to emphasise that any critical consideration of results of scientific research has to bear in mind that "regional and time - specific reality" is hidden beneath the notion of a (open) drug scene. Considering the enormous processes of change (for instance, fashion trends with respect to new drugs and/or forms of consumption) as well as extreme influences or steering efforts (of social and/or regulatory nature) "drug scene" does not mean a clearly defined notion devoid of any development. Attempts to describe the structure of a (open) drug scene - as aimed at by this study -always constitute a more or less contoured instantaneous exposure under the respective (sub)cultural and social (social, health - political and regulatory) conditions existing. What is recognised, nowadays, to be "true", possibly serving as guideline for our drug policy efforts, might, perhaps already be obsolete tomorrow, just lining up instantaneous exposures continuously allows us to gain an insight into the dynamics of change of the drug consuming scene in order to achieve a better orientation of drug - political strategies according to requirements. This study endeavours to take a first cautious step, while bearing in mind the rather strained finance and time resources. While keeping an eye on the Frankfurt situation, as far as open scene structures are concerned, this study also refers explicitly to data produced by former "scene - studies" conducted in Frankfurt am Main.

2.2 "Safe injection room" - definition of terms, background

Safe injection rooms ("health rooms" or "consumer rooms") are to be seen as a specific service offered within the scope of accepting drug work focused on harm minimisation. This "Harm Reduction Service" offered in Frankfurt falls back on experience gathered in Switzerland in structures that used to be called "Gassenzimmer" (as regards this experience, see, for instance: HAEMMIG 1992; SOZIALAMT DER STADT ZüRICH 1995) .
In essence, the safe injection room service offered aims at the following health - political and regulatory objectives:

The question whether, and to what extent, maintenance of safe injection rooms in Germany is legally admissible, that’s to say, whether such a practice constitutes, above all, specific elements of criminal offences as laid down in Federal legislation on narcotic substances (important: § 29, Federal legislation on narcotic substances) has been repeatedly discussed and considered. In this context, MICHAELIS (1991) and KÖRNER (1993) are emphasising that safe injection rooms do not constitute any element of criminal offence, provided that, under the terms of legislation in force, "acquisition of, dealing in, and administration of narcotic substances are not tolerated in these rooms, hygienic, stress - free, and risk reducing consumption being ensured by adequate care and control" (KÖRNER - 1993, 19). Weighing the penal and health - political aspects concerning this specific drug-aid service offered, MICHAELIS concludes that "safe injection rooms (...) would be another important contribution to drug work focusing on the reduction of social risks" (MICHAELIS 1991, 117).
Against the outlined background of this harm reduction service offered, the City of Frankfurt am Main has been the first German municipality to realise, in 1994, a safe injection room in the crisis centre of Schielestraße ("Integrative Drogenhilfe e.V.") as well as two other service points, early in 1995, in the main station area ("AIDS - Hilfe/FFM"; "Integrative Drogenhilfe e.V.") (cf.: DROGENREFERAT - STADT FRANKFURT AM MAIN; MAIN 1995; ECDP - NEWSLETTER 1995). The three injection rooms existing hitherto are maintained in accordance with the penal opinion prepared by KÖRNER (1993); primarily, the following rules governing the use of these facilities and based, in principle, on Federal legislation on narcotic substances, are binding:

Until now, more detailed reports on experience gathered in connection with the safe injection room capacity offered in Frankfurt am Main (as well as across Germany) are not available. This deficit is intended to be eliminated by presenting this study focusing, above all, on conveying a first impression of user practice, i.e. use of this service by the open drug scene - that’s to say by the actual target group (cf. 2).

3. Research design - methods

As you can see from the dual interest in obtaining information that are subject of this study complex (cf. 2), different methodical - in particular, empirical - approaches are indispensable. We shall give you a condensed survey of methods applied in the following chapter, this partial chapter being concluded with a concrete discussion related to the research process, discussion of the potential range of the research results, presentation of these results being based on classic quality criteria (reliability, validity, and representativity).

3.1 Empirical access

"Empirical access" is the sampling method and the, inquiry methods applied. Let us consider, first of all, the methodical conception of sampling.

3.1.1 Sampling - accessibility

As the objective of this study not only consists in giving a current survey of the structure of the open drug scene, but also in looking into the question whether the group using the injection rooms might possibly be characterised by specific features, the consideration of accessibility required different approaches. In accordance with this specific interest in obtaining knowledge, interviewers had contacted potential interviewees directly in the open drug scene and in the main station quarter, but also in the three safe injection rooms of the City of Frankfurt am Main "Eastside" (Schielestr.), "Druckraum Moselstrasse" (Moselstrasse, main station area), and "La Strada" (Mainzer Landstr., main station area). The number of persons interviewed totalled 150, 100 of them having been directly contacted on the open drug scene ("Scene Inquiry") and 50 in the safe injection rooms ("injection room inquiry"):

Figure a: Place of interview arranged (n=150)

"SCENE INQUIRY" (n=100)  
Moselstrasse 30

30

Bahnhofsvorplatz (in front of main station)

19

Taunusstrasse 19

19

Poststrasse

11

Niddastrasse 8

8

Ludwigstrasse

6

Karlstrasse and Mainzer Landstrasse 7

7

"INJECTION ROOM INQUIRY" (n=50)  
"Eastside"

21

"Druckraum Moselstrasse" 17

17

"La Strada"

12

A total of 106 attempts to establish contacts proved unsuccessful. 65% of the persons refusing to be interviewed substantiated this refusal by arguing "to be pressed for time", every third person (31%) stated a "lack of interest", and four persons (4%) apparently mistrusted the anonymity of the interview. The total success rate (number of interviewees / number of attempts to establish contact ratio) was 59% ("Scene inquiry": 57% / "injection room inquiry": 61%).
This percentage may be deemed comparatively high bearing in mind the sensitivity of data to be collected. Contrary to difficulties mentioned in research literature (for instance: BERGER/et al 1980, 19), initiating research contacts with the open drug scene proved rather unproblematic - although they required a great deal of energy. The 100 interviews, scheduled to be arranged with users of illegal drugs within the scope of the "scene inquiry" have been realised by a team of six interviewers between July 12 to 24, 1995, the 50 interviews scheduled to be arranged within the scope of the " injection room inquiry" have been realised by three interviewers between August 3 to 22, 1995. To ensure inclusion of the spectrum of potentially different types (of drug use) into the visual angle of research, interviewing activities have been evenly spread over the weekdays (47% of such interviews having been held on weekends - Friday to Sunday - and 53% on work days - Monday to Thursday) and were held at fixed times (42% of them having been conducted between 10 a.m. and 3 p.m. and 58% between 3 p.m. and 8.30 p.m.).
The remarkable willingness to give information (cf. 4.1) that could not be expected in view of the hectic conditions, helplessness, and monotony normally observed on the scene (in this respect, we would like to recall to people primarily refusing to give interviews for lack of time) has been made possible by the following sensitive interviewing procedure summarised as follows.
Potential interviewees have been assured of absolute anonymity. Any information likely to identify the respective person has not been recorded. In particular, the "one-off-nature" (BRANNEN 1988, 558) of the interview contact has been, among others, of decisive importance:
Persons interviewed did not have to fear any consequences at all resulting from research contacts, such contacts not having been connected with any therapeutic or judicial setting. The open information about the research interest has also been one of the decisive elements. The intention to describe the everyday scene and the practice of safe injection rooms as people concerned use to see it, appeared, in many cases, to be a factor motivating to show more willingness to answer the interrogators’ questions. Whenever people contacted showed a fundamental readiness to be interviewed, they were promised an expense allowance in the amount of DM 5, -, this aspect having been deliberately put at the end of contacting attempts to ensure a fundamental willingness to cooperate and to avoid any "monetarily motivated" interviews with all potentially related "validity problems". We can assess, but rather roughly, to what extent interviewers succeeded in taking random samples to depict an exemplary section of the Frankfurt open drug scene, when considering the vast darkness of problems particularly relating to this research sector. We shall reconsider these aspects in 3.3.

3.1.2 Interviewing instrument

Interviewers opted for a questionnaire - based method, a structured standardised interviewing procedure, using a questionnaire with questions standardised in whole and in part with open questions, such questions having been systematically asked, in face-to-face interviews, by well-instructed interviewers partly already experienced in this field work. The set of questions asked comprised the following:

I. Social standard dates:

II. Sequence of drug consumption/current drug use pattern:

III. Current "direct" and "indirect procurement patterns":

IV. Current everyday practic

essential: Reasons for current contacts with drug-aid services and institutions and intensity of using safe injection rooms as well as motives for (partial?) refusal to use this service

Questions contained in a comparative study "Germany - Netherlands" (Amsterdam - Frankfurt am Main (KEMMESIES 1995), have been included in the questionnaire. Since this study deals with an identical empirical reference field ("open drug scene"), systematic comparisons with the open drug scene structure of 1993 (inquiry period of the comparative study: 4/1993 - 12/1993) had been possible.

Questionnaires as used in connection with the partial inquiries ("scene inquiry": n = 100 - "injection room inquiry": n = 50) are identical, except for two. As far as the "injection room inquiry" is concerned, the question whether the person interviewed is currently undergoing a substitution therapy has been waived on account of the fact that interviewers had to expect to get untrue answers particularly to this question, since interviewees had been directly contacted in safe injection rooms subsequent to having made use of this offer and having assured (by a written declaration; on the judicial background cf. 2.2) that they were not currently undergoing a substitution therapy. This specific constellation, as regards the establishment of contacts, induced interviewers to waive this question in view of validity problems obviously resulting therefrom, a further deviation of the questionnaires concerning consumption of medicaments (Benzodiazepine, Barbiturates). Persons interviewed within the scope of the "injection room inquiry" were asked concrete questions relating to their consumption of medicaments, whereas drug users interviewed within the scope of the "scene inquiry" have been asked "unspecified" questions relating to the use of medicaments, questions put in connection with a whole complex of questions asked (in both partial inquiries), i.e. "What drug did you consider most important for you last week?" (This is a "ranking" question: all subjectively relevant drugs were to be named in a decreasing rank order), the intention of this deviation of interviewing being the determination to ascertain whether persons interviewed possibly refrain from reporting the use of medicaments or elect to report clearly less, whenever interviewers fail to ask concrete questions. In this context I would like to stress that such a reluctance might express a drug use pattern tabooed or considered as "un-cool" among heroin and/or cocaine consumers (patterns they don’ t like to concede in spite of the fact that it is -possibly - wide spread).

3.2 Analytical access

3.2.1 Calculating methods applied - statistical operations

In view of the abundance of available data - more than 180 individual figures have been collected for every person inquired (150) - such data, when codified, corresponds to a data record comprising more than 37,000 digits - a computerised analysis of data has turned out be inevitable. Statistical calculations have been made by applying the evaluation system SPSS/PC4 (version 4.0). The first descriptive-statistical access consisted in making a classifying tabular approach to screen material available based on the frequency and percentage distributions: How are the characteristics distributed within the over-all sample and the two partial samples ("scene inquiry" and "injection room inquiry"). In addition, characteristic values have been determined give an overview of specific features ascertained (primarily: arithmetic series). Whenever this comparative screening of characteristic values obtained from the "scene inquiry" and "injection room inquiry" produced any differences in specific features (for instance, age groups, frequency of consumption of different substances etc.), analyses have been carried out to find out whether the differences detected were of statistical significance or whether they were to be deemed merely incidental (test procedures given priority: T-Test, Chi-Square Test). Such comparative evaluations have also been made on the basis of data obtained from the "scene inquiry" within the scope of the Dutch - German comparative study (KEMMESIES 1995/more detailed information cf. Figure 1), because a referral to SPSS data evaluation was possible. Any comparative survey of partial samplings ("scene inquiry" and "injection room inquiry") were only carried out in cases of differences becoming visible. Whenever this survey relates exclusively to the total sample (n=150), this configuration indicates the absence of any significant differences between partial samplings, as far as respective specific features are concerned.
In addition, selective correlation calculations have been made to get useful hints regarding a (possible) correlation of different specific features. By the way, we would like to refer to problems relating to the interpretation of correlation coefficients. These are not to be interpreted as causal connections, when considering the probability of such coefficients being mere research artefacts hardly to be determined.

3.2.2 Manner of presenting results

When presenting results, all data gathered by means of the questionnaire have been taken into consideration, a graphic or tabular illustration having been made whenever specific classification patterns or significant differences between partial samplings - that's to say between interviewees directly recruited on the open scene ("scene inquiry") and those recruited in safe injection rooms ("injection room inquiry") are becoming evident. In the event on this comparative consideration of individual specific features producing certain differences or correlation, any statistical significance has been illustrated as agreed upon as follows:

* p< 0.1 ** p< 0.05 **** p< 0.01 **** p< 0.0001

In accordance with this form of representation, asterisks are referring to the percentage of residual probability (about: ** - 5% level), in which the difference or correlation might be merely incidental: So, for instance, two asterisks, put in connection with a difference in average age indicate that the difference detected is likely to be incidental (residual probability of 5%), without being of any significant importance, as far as basic totality is involved. Or, in other words: There is a 95% likelihood of the difference found not being incidental, rather than reflecting a significant deviation - irrespective of its initial substantiation. Moreover, please note that all percentages mentioned are rounded values, unless they are relating to the respective partial samplings, inasmuch as they have been totally included in the calculation ("Scene inquiry": n= 100; "injection room inquiry":n=50).

3.3 Quality criteria - relating to requirements as regards quality of the project as well as generalisation

The following discussion is not intended to be a fundamental, methodologically orientated discussion of classical quality criteria like validity, reliability and representativity - in this respect, we refer to the relevant specialised literature. What is more, people are invited to consider some central issues concerning the concrete research process, enabling them to assess the possible meaning and cognition horizon of results presented, at least basically.
First of all, let us consider the criterion of reliability. This criterion referring to the reliability of a measuring instrument is defined as the degree according to which repeated measurements taken with the inquiry procedures applied produce identical measured values. In view of the dynamics of the field of phenomena to be considered (open drug scene), any repetition of measurements producing identical results must be virtually excluded, this applying all the more as this research process is dealing with a "field inquiry" inevitably producing, in case of controls, deviating results. Finally, it would not be possible in case of any controls to disentangle potential influences and define, more precisely, the intensity of these influential effects, as regards possible deviations of results: What about the scene having been subject to intermediate changes (for instance: new [sub]cultural trends, modified control measures taken by prosecution authorities, different socio-medical situations [for instance, change of substitution practice] etc.)? Did the same interviewers arrange such interviews? What about simultaneous effects of the aforementioned influencing factors? Did these factors produce cumulative or contrary effects? The preceding statements are directed, in general, against any claim to reality asserted by the drug research sector and/or the sociological research sector in general: For, reliability, a classical quality criterion, is based on the assumption of a constancy of phenomena ignoring the historical character of social phenomena in an inadmissible manner, that’s to say in a manner disproportionate to the subject involved.
Validity touches the aspect of accuracy of an inquiry instrument: Do results of such inquiries really correspond to the results originally intended, that is to say, to values formerly intended to be measured? In concrete terms, as regards such inquiries, this validity criterion is giving rise to ask, above all, the question, whether "true" statements have been obtained, that is to say statements not deliberately falsified. A factor guaranteeing the impossibility of deliberate fraudulent misrepresentations having been the interviewers' familiarity with the phenomena dealt with, familiarity attributable to existing experience in research as well as to concrete instruction of interviewers in specific questions to be asked. A further element of central importance has been the observance of absolute anonymity of interviewees, not to forget the fact that the inquiry has not been associated with prosecution authorities, and the assurance of the exclusive scientific purpose of collecting these data. Sundry studies carried out in the United States of America , i.e. studies dealing. in particular, with the issue of validity in this specific research sector (to get a general idea, cf. WOLBER/et al 1990, 550 ff) prove a high degree of validity - above all, as regards to interviewees’ reports on drug consumption. ROUNSAVILLE/et al are affirming the absolute guarantee of a high degree of "validity" and/or "truth", "as long as the research questions are independent of legal or treatment decisions" (ROUNSAVILLE/ et al 1987, 227). Notwithstanding the fact that these prerequisites (anonymity, no social consequences of these interviews) have been unconditionally guaranteed, conditions obviously recognised by the interviewees themselves showing their willingness to answer questions asked (cf. 4.1), it is not entirely possible to exclude any possible effect "likely to distort the truth": Insufficient memory - sometimes, statements made (for instance, age of starting to consume specific drugs) are based on mere estimates. Nevertheless, in view of the large extent of these samplings, this effect may be deemed relatively insignificant, since we may proceed on the assumption that "estimating errors" are balanced to a very large extent.

Finally, let us broach the criterion of representativity, this criterion being of specific importance, as regards the meaningfulness of a study, when bearing in mind that the degree of representativity of a study is a decisive element to ascertain how far results obtained are representative of the population the research is focused on. When summarising the complexity of problems ("drug research - representativity") with due care to time available, we have to keep in mind that it is, more or less, impossible to guarantee representative samples. For, in view of the mysterious character of the research field, it is not possible to define who really belongs to this basic totality ("intensional definition") (KROMREY 1983, 137) and, in addition, it cannot be precisely proved "what sort of element characterises the components of said basic totality [intentional definition (This definition has been dealt with under 2.2 with concrete reference to the field of investigations)] (cf. 137). And, although it might be roughly possible to take representative random samples, representativity always appears to have a temporary character, when bearing in mind the historical character of social phenomena as already mentioned in connection with reliability criteria.
Representativity is fading due to the permanent change of the drug scene, this change being attributable to structural displacements resulting from changes of drug legislation, drug-aid structures, and (sub)cultural (fashion) trends as well as from corresponding drugs and consumption patterns. But, what does this mean in the light of the correlation of research issues discussed in this paper?
Consequently, the spot-check underlying the study does not meet - as is typical of drug research - the criterion of representativity. Nevertheless, it may be deemed an element of comparatively high exemplary quality to picture the Frankfurt open drug scene in the summer 1995; this view being supported by the fact that, in terms of quantity, the open drug scene in the main station quarter is estimated to comprise about 200 persons (reference period of the study), people staying, daily fluctuations excepted, more or less permanently in the main station district. On the other hand, said exemplary picturing quality of the mentioned spot-check is substantiated by the fact that interviewees have been recruited at relatively identical intervals weekdays and times of the day, so to cover - as already mentioned (3.1.1) - the widest possible spectrum of different types of drug consumption. Above all, we must not ignore that interviewees have been directly contacted in the interesting research field of the open drug scene (contrary to, "institutional" research approaches, for instance in therapy institutions or prisons), this practice ensuring, to a certain extent, that interviewees are deemed representatives of the environment ("drug scene") this scientific project intended to study.

4. Results

The results to be presented in this chapter are examined in the light of the data basis of research projects carried out in Frankfurt am Main in recent years, in a comparable empirical reference field. We intend to disclose elements indicating possible development trends and/or apparently steady manifestations of Frankfurt scene structures. To convey a rough orientation, as regards the adequacy of comparisons, the following figure gives a "short profile" of the studies that form the basis of the results reflected on.

Fig. 1: Project profile of studies referred to for the purpose of analytic reflections

Author(s)/Source

(year of publication)

Inquiry period

Interest in obtaining knowledge Objective pursued by the inquiry Target group /

Data basis

(access)

n

=

Method /

research design

OSTHEIMER/et al

(1993)

2/1993 - 5/1993

Changes of composition and living conditions of the open drug scene in Frankfurt am Main due to the reduction strategy pursued by the City of Frankfurt am Main (strategy focusing on references to the open scene) Drug users on the open drug scene in the main station quarter of Frankfurt am Main (accessibility via the project "mobile syringe exchange") 137 quantitative:

structured questionnaire containing standardised questions - direct scene inquiry

VOGT

(1992)

10/1991 - 12/1991

Structural composition and living conditions of the open drug scene in Frankfurt am Main Drug users on the open drug scene in Frankfurt am Main (Establishment of contacts in open scene places) 237 quantitative:

structured questionnaire containing standardised questions - direct scene inquiry

KEMMESIES

(1995)

4/1993 - 12/1993

German - Dutch comparative study: Influence exerted by different drug - political contexts on structure and forms of expression of the open drug scene Compulsive drug users (consumption of heroin and/or cocaine (substances consumed nearly every day)of the

open drug scenes of Amsterdam and Frankfurt am Main

(direct access in the environment of the open drug scene)

100 quantitative - qualitative: questionnaire - based structured interview (standardised and open questions,) - field observation - direct interview in the environment of the open drug scene

4.1 The fieldwork

Interview times averaged nearly half an hour [mean: 27.6 (minutes), SD: 10.2/min:10 - max: 60], clearly exceeding the time initially scheduled for the questionnaire (interview times of 15 to 20 minutes). These particulars illustrate the interviewees’ high readiness to answer questions and to be interviewed. We perceive this as a clear indicator that the interviewers obviously succeeded in establishing an open and trustful interviewing situation encouraging interviewees to report. This is true all the more as interviews within the scope of the "scene inquiry" have been initiated exclusively in the form of direct scene contacts in public places. Nearly every third interview (71%) of this scene inquiry was arranged directly, that is to say publicly. The remaining 29 interviews have been arranged in drug-aid institutions and services in the vicinity of the scene. As far as initiation of contacts and arrangement of interviews for the "injection room inquiry" are concerned, these took place directly in the safe injection rooms (cf. 3.1.1).
Every fourth interview has been conducted in the presence of a third person, a procedure expressly approved of by interviewees and even, sometimes, expressly desired. Except for some particular cases, where friends of interviewees helped them to remember certain times, dates etc., these third persons present assumed a passive attitude. The manner in which interview contacts have been initiated clearly proved that the majority of partners interviewed had been under the influence of drugs. Interviewers have deemed two of three interviewees to be slightly to considerably influenced by recent drug consumption. Nevertheless, the physical and mental condition of interviewees never has given reason to break off talks, although two interviews were characterised by partial contradictions. But, in spite of being influenced by drugs, the vast majority of persons interviewed (70%) appeared to be concentrated on the subject. In summary, the atmosphere of the interviews may be characterised as very relaxed and communicative. All in all, conversations proved to be trustful and open. Interviewers obviously succeeded in establishing a confidential conversation atmosphere substantiated by the fact that only four persons addressed refused to be interviewed, their refusal apparently being attributable to a lack of confidence in the anonymity of the interview (cf. 3.1.1.).

4.2 The sample

4.2.1 Age, sex, marital status, nationality

Figure 2: Age groups (n = 150)

2o - 25 years

27/18%

26 - 30 years

57/57%

31 - 35 years

34/23%

> 35 years

32/22%

Mean:

SD:

Min-Max:

30.6

5.7

20 - 44

The average age ascertained (30.6 years) indicates, in comparison with former studies, that the average age of the "scene population" is seemingly rising. VOGT (1992) ascertained an average age of 27.7 years (SD: 6.1), OSTHEIMER/et al (1993) 28 years, and KEMMESIES (1995) 29.9 years (SD: 6), the tendency of increasing age are also being reflected in the fact that , as far as the VOGT study (1992) is involved the group of older persons (35 - 45 years) totalled 15% of all samplings, whereas the present inquiry shows that every fourth interviewee (25%) belongs to this age group. A rise in age of the scene population is indicated, also indirectly by criminal-statistical data (only referred to as indicative signs and only restrictedly comparable) relating to the drug related mortality rate registered in the City of Frankfurt am Main. Statistical material gathered by detective police authorities brings evidence of a continuous increase in the average age of drug deaths registered (from 28.7 years to 30.8 years for the years under report, that's to say 1988 through 1994 POLIZEIPRÄSIDIUM (police headquarters) Frankfurt am Main: 1190, 27; 1991, 39, 1992, 17; 1993,21; 1994, 176; 1995, 143). Obviously, the horror scenario regularly depicted by mass media of a drug scene, where we can meet consumers of increasingly lower age, is not substantiated by any facts, the majority of interviewees being considerably older than 25, only one of them had not yet completed his 21st year of life when being interviewed.
37 of all persons interviewed (137) had been women, this number representing a rate of 25 % ranging within the scope of correlative values shown by corresponding research projects. Women interviewed have been - according to tendency, although not significantly - younger than the group of male persons (about half a year)

Figure 3: Marital status (n=150)

Unmarried

102/68%

married

22/15%

divorced

18/12%

other

8/5%

Separated/5

Widowed/3

The vast majority of drug users interviewed consisted of unmarried people. Please cf. VOGT (1992, 120) and KEMMESIES (1995, 134) for a nearly identical repartition.
90% of all people interviewed had been German citizens, the percentage of foreigners (10%) however not reflecting the real proportion of different nationalities on the Frankfurt open drug scene, since - due to language barriers - it has been hardly possible to establish interview contacts with foreign drug users.

4.2.2 Education level - current job

Figure 4: Completed school education (n=150)

Currently in school education

1/1 %

Extended elementary school ("Hauptschule")

72/48%

Secondary school ("Realschule")

40/27%

Technical college ("Fachschule")

10/6%

Grammar school ("Gymnasium")

7/5%

NO SCHOOL BACKGROUND

20/13%

Figure 5: Completed vocational training (n=150)

Currently in vocational training

5/3%

In vocation requiring an apprenticeship

66/44%

Study (university)

1/1%

NO VOCATIONAL BACKGROUND (never started)

24/16%

NO VOCATIONAL BACKGROUND (abandoned)

54/36%

In general, the education level of partners interviewed is to be deemed very low, values ascertained ranging between those shown by the VOGT study (1992) and the KEMMESIES study (1995): 13% of all persons interviewed did not have any completed school background (VOGT: 4%; KEMMESIES: 28%), and 78 interviewees (52%) so far failed to commence a vocational training or abandoned such a training (VOGT: 44%; KEMMESIES: 58%). Experience gathered by VOGT (1992, 15) stating that women have, in general, a better school education, was not reflected in the data material available. Although, it could be observed - in accordance with the VOGT study - that more male than female persons have completed a vocational training (women: 30% - men: 49%; chi-square: 4.1 * */DF:1).
Only every tenth person has a gainful employment (regular job), the absolutely predominant majority (79) of partners interviewed being jobless at present. The high unemployment rate also shown by VOGT (1992,16) and KEMMESIES (1995, 219) seems to be a feature typical of the open drug scene. To what extend and in what form deficits in income derived from regular jobs are reflected in specific forms of financing costs of living and drugs required will be dealt with in 4.4.1.

4.2.3 Current housing conditions

Figure 6: Current housing conditions (n=150)

"HOMELESS" 

69/46%

"Emergency accommodation"

"Street"

"Acquainted people"

41/59%

19/28%

9/13%

"PERMANENT RESIDENCE" ò

81/54%

"Lodging of their own"

"with partner/user"

"with partner/non - user"

"Flat shared/user"

"Flat shared/non - user"

"Parents"

40/50%

9/11%

4/5%

5/6%

5/6%

18/22%

The shortage of housing among drug users interviewed ("scene inquiry") seems to be extraordinarily vast. As already stated by VOGT (1992, page 13 ff) and KEMMESIES (1995, 136), 46% of all partners interviewed being homeless at present. The fact that emergency sleeping places offered by drug-aid services and institutions apparently reflect the real emergency of many drug users is substantiated by about 59% of all homeless people making current use of overnight accommodation facilities offered by drug-aid services and institutions.
As far as the groups of persons living out of Frankfurt is concerned, housing conditions appear to be comparatively favourable: In this case the portion of homeless people approximated about 20%, whilst amounting to 51% for "native inhabitants of Frankfurt" (chi-square: 48.16 ***/DF:1) The group of interviewees living out of Frankfurt (in Greater Frankfurt) comprises 25 persons, representing 17% of the sample inquiry in toto. 23 interviewees stated to have a current residence in Greater Frankfurt (RMV commuter - belt), 102 persons interviewed having stated to live directly in Frankfurt am Main. The question whether being registered with the Frankfurt police has been answered in the affirmative by 63%, every third person (37%) being, at present unregistered, that's to say neither with a police authority out of Frankfurt nor elsewhere. The share of persons registered in Frankfurt am Main is clearly exceeding the percentage given by the VOGT study (1992, 12, showing a corresponding percentage of 40%). This discrepancy possibly evidences effects of measures motivated by the policy of law and order pursued in Frankfurt am Main, as regards non - local drug consumers. The fact that the Frankfurt drug scene is continuing to attract drug users from neighbouring regions - obviously attributable to the rather attractive drug market (price level, supply) - is substantiated by the number of non-local drug users appearing on the scene "for small visits": They usually come to the Frankfurt drug scene, on an average, four times weekly (mean:3.6, SD: 2.5). Failing any systematic inquiry, these trips might be motivated by the following main reasons: 1) Enormous attractiveness of the drug market, 2) Frankfurt scene deemed "an informal job market" ("dealing activities"), 3) anonymity on the scene of a large city (uncomplicated drug-related activities like purchase, consumption, etc., activities entailing a rather limited risk of being discovered).

4.3 The "drug career"

This chapter is to give a summarised survey of typical drug careers - based on drug sequences. For this purpose, we should like to present, first of all, a survey showing the average age of starting a drug career; life time prevalence (percentage of persons that have ever tried this substance) and the portions attributable to experimental users [relating to the substance consumed (percentage of persons that stopped the use of this substance after an experiment of consumption)]

Figure 7. Sequence of drugs (n=150)

Drug Age of start

Mean
(SD; Min-Max)

"Life Time Prevalence" experimental use only
nicotine 12.4 (2.7; 6-23)

100% (150)

-----

alcohol 13.3 (2.4; 8-23)

97% (146)

1% (1)

cannabis 14.8 (2.8; 11-38)

99% (149)

-----

LSD 16.9 (3.0; 12-30)

81% (121)

19% (23)

heroin 18.4 (3.8; 12-34)

99% (148)

1% (1)

medicaments / prescription drugs
(the use of medicaments was only been asked for in the "Injection room inquiry" (n-50, cf. 3.1.2)
18.7 (5.7; 11-36)

90% (145)

2% (1)

speed 19.4 (4.8; 13-40)

79% (118)

19% (22)

cocaine 20.2 (5.7; 12-40)

99% (149)

1% (1)

crude opium / opiates 20.7 (5.0; 14-36)

68% (103)

26% (27)

ecstasy 23.7 (4.8; 13-36)

33% (49)

43% (21)

crack 26.5 (6.6; 15-44)

41% (61)

10% (6)

"hard drugs"
(the definition of "hard drugs", as used in this context, relates to the following substances: Heroin, cocaine, Speed, crude opium and/or pharmaceutical opiates as well as Crack. As far as the aforementioned substances are concerned, the lowest age of starting consumption, age relating to the respective case, has been considered as one of the elements used to calculate the average age of starting consumption of "hard drugs".)
17.0 (3.6; 12-40)

100% (150)

-----

"Career hard drugs"
(these figures relate to the length of the experience with hard drugs)
13.7 (6.1; 0-28)

up to 5 years: 11 (7%)

6-10 years: 46 (31%)

11-20 years: 75 (50%)

>20 years: 18 (12%)

 

The average age of starting consumption of the different substances ranges within the span of respective data of pertinent research reports (for instance: PROJEKTGRUPPE RAUSCHMITTELFRAGEN 1991, 83; KREUZER/et al 1991, 129). There are no significant deviations. Such deviations ranging within a tolerance level of (maximally; + / - ) 12 months. Equally, a direct systematic comparison (t - test) with the respective average age as ascertained in the study of KEMMESIES (1995, 200) resulted in no significant differences. So, the average age of starting the consumption of "hard drugs" as ascertained in the present study (17 years) is nearly identical with the respective value as ascertained in the KEMMESIES study (17.4 years; ibid. 201). A similar correspondence has been established, as regards previous experience careers (consumption of hard drugs) [13.6 years - 12.5 years (ibid. 206)]. Considering these data, it is neither surprising that the KEMMESIES study (1995) has included a similarly high share of drug users who had been consuming (more or less continuously) hard drugs for already more than 10 years [62% - 58% (ibid. 206)] [the gradually higher figures concerning the length of the drug carreer can be seen as another indication for the thesis that there is an increase in age among the users on the open drug scene]

Looking more closely at the preceding figure, we could observe some peculiarities. Experience gathered in connection with the consumption of legal drugs like nicotine and alcohol as well as illegal drugs like cannabis, heroin, and cocaine is, obviously, an element of the "collective experience" of people consuming in the open drug scene. Interviewees are confessing, nearly without exception, relevant experience in consumption, their experience exceeding, by far, a mere experimental use.
9 out of 10 interviewees (88%) also mention consumption of medicaments exceeding a merely experimental stage. The people had been interviewed in the course of interviews in injection rooms. A high life time prevalence - although considerably lower in comparison with the substances already mentioned - can also be stated, as regards drugs like LSD, Speed, and crude opium (and/or pharmaceutical opiates). Nevertheless, every fifth (in case of crude opium: every fourth) person abandoned consumption of these substances following a phase of experiments. Observation of a considerably lower life time prevalence and a considerably larger group of experimental users suggests the presumption that these drugs are of minor importance within the open drug scene or have lost some importance - due to changing consumption, (fashion) trends and developments in the market. In this connection, three (hypothetically formulated) declarations relating to the specific substance are suggesting themselves, however, they need to be subject to a more differentiated analysis characterised by the inclusion of previous studies: Consumption of LSD has lost its sub-cultural correlation as formerly embedded in the "hippie" movement. In addition, consumption of LSD is hardly compatible with daily life in the scene and a rhythm of life (frequently dictated by physical addiction), this incompatibility being attributable to the hallucinogenic spectrum and the long-time effects of LSD. In the late sixties/early seventies, opiates ("pharmacy junk") met with ever increasing acceptance, a reorientation of international markets beginning in the early seventies and in the middle seventies resulting in replacing this substance more and more by heroin (regarding sub-cultural development trends as addressed in this connection, cf., for instance, SCHEERER 1989, 285 ff).
Therefore, it is not surprising in this context of declaration that the group of interviewees experienced in the consumption of crude opium and LSD is considerably older than groups of persons who, up to this point, never consumed these substances or abandoned consumption following a merely experimental use [crude opium: 32.4 (SD: 5.3) as against 28.9 (SD: 5.5) years; t: 3.9.1 ****/LSD: 31.5 (SD: 5.6) as against 29.2 (SD: 5.4) years; t: 2.38 **].
It also seems that speed (amphetamine, methamphetamine) - a stimulating drug which has been very popular in the open drug scene of the seventies - has also lost a great deal of its former popularity. Apparently, speed has been superseded by cocaine, a natural stimulating drug, this replacement being attributable to an extension of the cocaine market on the basis of a price level (relatively low in comparison with previous years) and to rather competitive packaging units (sold in very small quantities at prices of DM 20,-- onward). But, above all, the loss of importance of LSD, crude opium, and speed as indicated in this case is reflected in current consumption patterns of partners interviewed. Only exceptionally, reports are dealing with current use of these substances (cf. 4.3.1).
As far as newer drugs like Ecstasy (XTC) and crack are concerned, the picture is rather irregular. Like already practised on the occasion of the scene inquiry carried out in Frankfurt am Main in 1993 within the scope of a comparative study "Netherlands - Germany" (KEMMESIES 1995, page 185 ff), every third person concedes having tried Ecstasy at least once. Apparently, there has not been any extension of the group of people experienced in consuming Ecstasy within the open drug scene - although we must concede that this observation is founded on a comparatively limited empirical basis. Most obviously, Ecstasy is not well accepted in open scenes, this development being implicitly substantiated by the fact that a large segment (43%) of the "experimenting group" uses to abandon consumption of Ecstasy following first experimental tasting, and by the fact that, in practice, Ecstasy appears not to play any role regarding current consuming habits of the drug users interviewed (cf. 4.3.l.). Possibly, the rather marginal importance of Ecstasy in the (heroin) scene can be explained by some form of sub-cultural incompatibility: Ecstasy is closely associated with specific sub-cultural references and "styling processes" (Techno-, Rave-scene) having undergone intensification to form a (sub)cultural environment characterised by a very high degree of independence, an environment obviously having very few points of contacts with the open drug scene. In contrast to that, consumption of crack seems to gain increasing importance in the open drug scene (in the slip-stream of cocaine gaining in importance, so to say). While, a total of 16% of drug users interviewed in a sampling interview held in the scene in 1993 (KEMMESIES 1995) stated to have consumed crack already once, the corresponding percentage as stated in the present study is approximately 41%, a percentage exceeding the aforementioned rate by 25% (chi-square: 10.1***,DF:1). The fact that we may assume crack to have gained in importance in the open drug scene not only illustrates the apparently rising prevalence rate as far as experience in consumption of crack is concerned, crack also seems to play an important role, as far as current drug consuming habits of a large segment of interviewees are concerned.

4.3.1 Current drug use patterns

The following figure gives a first impression of drug consumption patterns practised at present (drugs consumed in the last 24 hours and last week):

Figure 8: Drug consumption during the last 24 hours/in the last week (n=150)

 

Last 24 hours

Last week

None

2

-----

alcohol (Alc)

2

2

cannabis (C)

2

1

cocaine (Co)

3

2

crack (Cr)

3

-----

heroin (H)

11

5

Alc/C

-----

1

Alc/Co

4

2

Alc/H

5

4

Alc/C/Co

3

2

Alc/C/H

2

4

Alc/H/Co

19

19

Alc/H/Cr

2

2

Alc/C/H/Co

22

39

Alc/H/Co/Cr

3

2

Alc/C/H/Co/Cr

1

13

C/Co

2

2

C/H

2

-----

C/H/Co

10

22

C/H/Co/Cr

1

5

Co/Cr

1

-----

H/Co

45

17

H/Cr

1

-----

H/Co/Cr

3

6

At first glance, this figure discloses that people apparently practice extremely different consumption patterns, 21 persons (14%) stating to have exclusively consumed but one substance during the last 24 hours. As far as the last week is concerned, only 10 persons (7%) state to have consumed but one single of the substances mentioned. In toto, a polyvalent drug consumption pattern is recognisable. The day before, nearly every second interviewee (47%) has consumed three (or more) different drugs. (mean:2.5, SD:1.1). Regarding the last week, three of four drug consumers interviewed (78%) followed this consuming practice (mean:3.3,SD:1.2), this rough sketch of predominantly polyvalent consumption patterns also applies to partial samples ("scene inquiry" / "injection room inquiry"). In this respect, we should visualise that 38 persons (38%) of 100 partners interviewed are persons currently undergoing a methadone-based (33) or codeine-based (5) therapy [The issue of substitution therapies, if any, has been exclusively dealt with within the scope of the " scene inquiry" (n=100) (cf. 3.1.2)]. Moreover, as already mentioned in 3.2.1, it has been only within the scope of the injection room inquiry that interviewees had been asked to state the concrete time of their last consumption of medicaments. Here, interviewers interrogated a group of 20 persons (40%) who have consumed medicaments (mostly "Rohypnol") in the course of the previous week.
An intrinsically differentiated consideration of current drug consumption patterns reveals specific features. Let us consider different drugs in detail:

Figure 9: Frequency of consumption of alcohol

every day 37/25%
once, or several times a week 26/17%
once, or several times per month 20/13%
less than once monthly / nothing 67/45%

Figure 10: Last consumption of alcohol

last 24 hours 64/43%
last week 26/17%
last month 10/7%
long time ago / never 50/33%

As regards the drug consumption patterns of the persons interviewed, alcohol seems to play an important, though not a predominant role. The partial samples seem to be "polarised" on questions about the frequency of consumption and the date of the last consumption of alcoholic beverages. On the one hand, we have a large group of persons conceding daily consumption of alcohol (also in the last 24 hours). On the other hand, nearly every second interviewee states that he/she drinks alcohol less than once per month (or not at all). Anyhow, every third drug user interviewed discontinued consumption more than one .month ago. The break-down of consumption patterns (different partial samples) as shown in the figure does not differ significantly. Let us reduce the figure (last consumption) to the question "Consumption of alcohol during the last 24 hours: Yes or no?". Such a question is likely to produce gender-specific differences, inasmuch as we will find among male persons a far larger group of persons having consumed alcoholic beverages during the last 24 hours (women: 24% - men: 49; chi-square: 6.75 *** DF:1).

Figure 11: Frequency of cannabis consumption

every day 22/15%
once, or several times a week 37/25%
once, or several times per month 27/18%
less than once monthly / nothing 64/43%

Figure 12: Last cannabis consumption

last 24 hours 46/31%
last week 43/29%
last month 17/11%
long time ago / never 44/29%

Obviously, cannabis, like alcohol, does not play any eminent role, as regards consumption practices in the open drug scene, this is also being substantiated by the fact that during the week before, only four persons exclusively consumed alcohol and/or cannabis. Interviewers did not observe any considerable differences between female and male persons as well as different samples. Apparently, cannabis is consumed in addition to other substances, that is to say occasionally (on invitation) with consumers not making any remarkable efforts to acquire the substance or attaching much importance to its use. It is true that 89 persons (60%) stated to have consumed cannabis during the last week, however, only every fourth (26%) of this group stated to have spent more money for this drug or attached much importance to this drug, as far as current consumption is concerned.

As already mentioned and discussed in 4.3, ecstasy seems to be of only marginal importance in the context of the open drug scene. Only one interviewee stated to have consumed this substance in the last 24 hours and to follow this practice at regular intervals (several times per week/weekend). Moreover, there are only two other interviewees who have consumed ecstasy in the preceding month. Observations made already in 1993 (obviously marginal importance of ecstasy in the scene, cf. KEMMESIES 1995, page 185 ff) are, apparently, also confirmed, as regards the present situation on the open drug scene.

Virtually, LSD no longer plays any role within the Frankfurt open drug scene. A total of only three persons interviewed (2%) reported on LSD consumption during the preceding month. As regards the possible background of this obvious loss of importance of this drug enjoying particular symbolic importance at the turn from the sixties to the seventies, we refer to 4.3.

Crude opium as well as pharmaceutical opiates are also substances bought by a rather limited group of consumers, these substances being, at present, scarcely sold in the illegal drug market. Only in some exceptional cases have we heard about current consumption. One person has consumed such substances in the last 24 hours, three interviewees having consumed them in the course of the last week and eleven persons in the preceding month. Consuming practice is suggesting to believe that heroin has become, a market leader, as far as the group of "opiates" is concerned.

Figure 13: Frequency of heroin consumption

every day 87/58%
once, or several times a week 40/27%
once, or several times per month 7/5%
less than once monthly / nothing 16/11%

Figure 14: Last heroin consumption

last 24 hours 127/85%
last week 11/1%
last month 2/1%
long time ago / never 10/7%

As far as current drug consumption patterns followed by interviewees are involved, heroin is the drug mostly consumed - although only at a gradual distance from cocaine (still to be referred to). Four of five persons interviewed (85%) stated to consume heroin at least once per week, more than half the drug users interviewed (58%) consumed heroin on a daily basis, the absolute majority (85%) having consumed heroin in the last 24 hours. Let us reduce the degree of differentiation of the preceding figures to the information: "heroin consumption every day: Yes or no?" and "Last heroin consumption in the last 24 hours: Yes or no?". Then we shall observe considerable differences between partial samples. Whilst 79% of the drug users interviewed within the scope of the "scene inquiry" mentioned to have consumed heroin the day before, 96% of the drug users interviewed within the scope of the "injection room inquiry" mentioned to have done so (chi-square:7.42***, DF:1), the percentage of people consuming heroin on a daily basis as interviewed in the partial sample ("injection room inquiry") being higher (64% as against 55%) - although not to a significant extent. These results indicate a possible difference in consumption patterns, differences correlated with the intensity of using the safe injection room service offered. The frequency of application (per day) of interviewees consuming heroin on a daily basis also points to this direction, the average number of drug users directly contacted in the scene stating to consume heroin much more frequently than consumers interviewed in Frankfurt’s safe injection rooms (Total average: mean: 482, SD: 2.7, Min - Max: 1 12) "Scene inquiry": mean: 5.5, SD: 2.7 - "injection room inquiry": mean: 3. 6, SD: 2. 1; t: 3.6 ****).
Quantities of heroin consumed per day (in grams) do not differ significantly between the different samples - although the sample ("Scene inquiry") has shown a higher value (about o.5 grams more) (total average: mean:2.9. SD:1.9. Min - max.: 2 - 10). When relating the average daily application frequency to the heroin dosage required every day (in grams), we can observe that persons interviewed in the safe injection rooms use to apply a considerably higher average dosage of heroin (per consumption) [(Total average: mean:.67, SD: .38, Min - max.: 11 - 2.0)] "Scene inquiry": mean:.58,SD:.34 - "injection room inquiry": mean:.82, SD: .39; t: 2.85 ***) These differences concerning practices of consuming heroin are attributable to specific preferences of partial samples carried out for substances consumed in parallel - above all, cocaine (referred to in a chapter to follow). For the moment, this assumption apparently does not prove to be true when considering the answers to the question, whether heroin is currently consumed directly in connection with other drugs.

Figure 15: Combined consumption of heroin and other drugs

"Scene inquiry"

(n=100)

"injection room inquiry" (n=50)

Total

(n=150)

No 10/10% 6/12% 16/11%
infrequently 14/14% 12/24% 26/17%
frequently 19/19% 8/16% 27/18%
preferably always 48/48% 23/46% 71/47%
(currently) no consumption of heroin 9/9% 1 / 2% 10/7%

The absolute majority (65%) of persons interviewed states to currently consume heroin "frequently" and/or "preferably always" in combination with other drugs - partial samples did not differ at all. When including the category "infrequently", we’ll see that 88% of current heroin users use to combine - at least occasionally - heroin with other substances. Also the question which drug is given preference to on parallel consumption did not produce any differences, the overwhelming majority of people interviewed (90%) preferring cocaine as a combination drug, a minority (5%) mentioning medicaments and 5% of these people are stating medicaments and cocaine to be of identical importance. "Injecting", the primary method of heroin application, is quasi perpetuated when practising combined use of drugs, intravenous use of heroin (97%) being, by far, the most popular consuming method - only two interviewees stating to confine consumption mainly to sniffing, two other persons mentioning "foil smoking" (inhalation of vapours of heroin heated on aluminium foils, inhalation by means of a small tube). As regards combined use of drugs, intravenous application of heroin is given preference to by all people interviewed (100%). People interviewed use to favour, by far, joint preparation of heroin and cocaine (or medicaments; term used in the scene: "Cocktail") subsequently injected intravenously (94%); another 6 persons giving preference to successive intravenous application of heroin and cocaine ("stereo injection"), two persons stating to inject heroin , while consuming, in parallel, medicaments (oral use).
The following figures give an impression of the dominant practice of intravenous drug consumption within the empirical reference field ("open drug scene") as considered by this study.

Figure 16: Frequency of cocaine consumption

every day 71/47%
once, or several times a week 45/30%
once, or several times per month 10/7%
less than once monthly / nothing 24/16%

Figure 17: Last cocaine consumption

last 24 hours 118/79%
last week 11/7%
last month 5/3%
long time ago / never 16/11%

When comparing these figures with the respective figures 13 and 14 (heroin) , you will see that, as regards our interviewees' drug consumption pattern, cocaine is being consumed at a nearly identical intensity, differences being only of gradual, but not of fundamental nature. Every second interviewee (47%) has been consuming cocaine on a daily basis (heroin: 58), whereas three of four persons interviewed have been using cocaine at least once per week (heroin: 85%). It seems that cocaine has become firmly established within the open drug scene to be, in addition to heroin, one of the most important drugs consumed in the drug scene, this development giving, in particular, rise to a comparison with consumption patterns as ascertained in the KEMMESIES study (1995) of 1993: Whilst, two years ago, six of ten interviewees (62%) stated to have consumed cocaine in the last 24 hours, the present random test is proving that eight of ten persons had been doing so (79%) compared to (chi-square: 5.48 **, DF: 1).
However, when comparing these partial samples, we get a picture of clearly differing cocaine consumption patterns. As far as persons interviewed within the scope of the scene inquiry are concerned, gradually more of these people are stating to have consumed cocaine in the last 24 hours ("Scene inquiry": 83% - "injection room inquiry": 70%; chi-square: 3.36 *, DF:1). Also, clearly more interviewees from the scene inquiry mention daily cocaine consumption ("Scene inquiry": 54% - "injection room inquiry": 34%; chi-square: 5.3 **,DF:1), this group also states a clearly larger number of daily situations of cocaine consumption (In toto: mean: 6.9, SD:48, min - max.: 1 - 20) ("Scene inquiry": mean: 7.6, SD:5.0 - "injection room inquiry": mean: 4.7, SD: 3.5; t:261 ). As already mentioned when considering heroin consumption patterns, we have to clear up, in this respect, a question still to be analysed, namely the question whether different intensity of cocaine consumption is connected
with possibly different intensity of using safe injection rooms as ascertained by partial samples.

As already mentioned in 4.3, speed has apparently lost its former importance as "cocaine of the poor" to a very large extent, this drug having obviously been pushed out of the market by cocaine. Only two interviewees reporting of speed currently used on a daily basis, another three persons reporting of consumption on a "weekly basis" (at least, once) and two persons interviewed reporting consumption of this substance on a "monthly basis" (at least once). So, only five persons were consuming speed the day before - in total, only 14 interviewees (9%) have consumed this substance in the preceding month at least once. In contrast to that, the share of current cocaine consumers (consumption during the preceding month) belonging to the group of persons whose last speed consumption had taken place more than one month ago (or who never consumed speed so far) amounts to approximately 90%(!). This situation clearly substantiates the fact that a loss of importance of the group of "stimulating substances" within the open drug scene cannot be observed, rather than proving cocaine having pushed speed out of the market to a large extent.

We already referred to the obviously significant increase of importance of crack within the open drug scene in 4.3. We can observe an incomparably higher share of persons experienced in consumption than in the Frankfurt sample carried out within the scope of the Dutch - German comparative study (KEMMESIES 1995, page 190 ff). The fact that crack is obviously gaining in importance also, as far as currently practised consumption patterns are involved, is impressively substantiated by the observation that every fifth person interviewed (20%) reports crack consumption in the course of the preceding week, whereas none of the drug users interviewed in 1993 in the course of the aforementioned comparative study reported of current crack use (ibid. 191; chi-square:11.76 ****, DF:1). As to current consumption of crack, we can observe a gradual difference between the partial samples, inasmuch as - by analogy with observations made in connection with cocaine - we have found among interviewees interviewed in the scene inquiry a relatively large group of persons who still consumed crack in the preceding week, this group tends to increase ("Scene inquiry": 24% - "injection room inquiry": 12%) .

As already mentioned in 3.1.2, concrete use of medicaments has only been the subject of questions asked within the scope of the partial sample "injection room inquiry" (n=50): Every second interviewee (54%) reported of regular (additional) consumption of medicaments, six interviewees (12%) consuming medicaments (primarily Benzodiazepine. "Rohypnol") on a daily basis and another 14 persons (28%) once to several times per week. When being asked to state the time of their last use of medicaments, 68% of the persons interviewed reported of such a use in the preceding month and still 40% of a last use in the preceding 24 hours. These figures may be seen as an indication of barbiturates and Benzodiazepine being used obviously continuing to be very popular substances in the open drug scene. They are consumed to avoid and bridge consumption of heroin (cf. for instance: SCHNEIDER 1994).

To enable interviewers to get a better impression of the aspects of "last consumption" and "frequency of consumption", interviewees have been asked (in the form of a question of order of precedence) to state the drug deemed personally most important for them in the preceding week and to specify the drug for which they spent most of their money. The following figures show the types of drugs classified by interviewees as important as well as the drugs for which they spent money.

Figure 18: Drug(s) deemed "significant" / last week (multiple statements)

 

Scene inquiry

(n=100)

injection room inquiry (n=50)

chi-square

(DF:1)

Total

(n=150)

heroin

78/78%

48/96%

8.03***

126/84%

cocaine

85/85%

35/70%

4.68**

120/80%

alcohol

25/25%

10/20%

-----

35/23%

medicaments

21/21%

7/14%

-----

28/19%

cannabis

18/18%

5/10%

-----

23/15%

others

7/7%

4/8%

-----

11/7%

Figure 19: Drug(s) bought / last week (multiple statements)

 

Scene inquiry

(n=100)

injection room inquiry (n=50)

chi-square

(DF:1)

Total

(n=150)

heroin

78/78%

49/98%

10.3***

126/84%

cocaine

85/85%

36/72%

3.6*

120/80%

alcohol

35/35%

11/22%

-----

35/23%

medicaments

25/25%

6/12%

3.4*

28/19%

cannabis

16/16%

7/14%

-----

23/15%

others

5/5%

2/4%

-----

11/7%

At a first glance these figures give rise to the assumption that, at present, heroin and cocaine apparently have an enormous importance and acceptance as regards drug consumption patterns favoured in the open drug scene, these substances ranking far before any other substances. Furthermore, percentages shown in the figures confirm observations crystallised in the previous analysis. These observations indicate that the drug consumption patterns of the partial samples differ, above all, regarding substances like heroin and cocaine: The vast majority of our interviewees within the scope of the injection room inquiry stated to have spent money for heroin in the preceding seven days. Frequently heroin has the status of a subjectively significant drug. The same applies to cocaine regarding the partial sample "scene inquiry" - although in a moderate form.
Another consciousness was observed with regard to medicaments (prescription drugs). Although our interviewees from the scene inquiry had not been asked to state details of concrete use of medicaments (unlike those interviewed during the injection room inquiry), they are frequently - though not significantly - attributing to medicaments a certain importance. These people more frequently state to have spent money for medicaments within the period under report. Even though we may proceed on the assumption that this tendency to differentiate is insinuating a different drug consumption pattern oriented by medicaments according to the partial samples, this phenomenon is, nevertheless, to be considered to evidence that interviewees concede the use of medicaments. But, at least, it is rather questionable to evolve the thesis that, in general, persons interviewed in the course of such studies use to state too low quantities of medicaments consumed, such use "contradicting the image of cool users" (VOGT 1992, 21). When reconsidering the exceptional rank of heroin and cocaine, we get a picture as vividly illustrated in the following figure:

Figure 20: Most important drug - drug with financing priority / last week

most important drug: chi-square: ---, DF:2

drug with finance priority: chi-square: 6.2**, DF:2

88% of all persons interviewed stated that heroin (49%) or cocaine (39%)[The respective share of cocaine as ascertained in the study of KEMMESIES (1995, 210) is 16%. This significant difference (chi-square: 916 ***, DF: 1) gives evidence again for the clear increase in importance of cocaine within the open drug scene] were their most important drug. No less than 91% spent most of their money for such drugs (heroin: 49% - cocaine: 41%) during the previous week. Above all, the diagram on "drugs with financing priority" illustrates, that cocaine is being attributed more importance in the scope of the partial sample "Scene inquiry".
Let us try to draw a summary picture of the drug consumption pattern as currently primarily practised in the Frankfurt open drug scene. When doing so, we can first of all observe that by now cocaine is obviously being attributed an importance nearly identical with that attributed to heroin: Seemingly, heroin only hardly maintains its dominating position as the drug used in the open drug scene. When, considering further that - as already mentioned - consuming practices tend to be characterised by polyvalent drug consumption patterns, the definition of an "open drug scene" as a "heroin scene" is not (no longer) applicable. To get a better survey of extremely different individual drug consumption patterns, the following chapters are to summarise typical different drug consumption - patterns in accordance with VOGT (1992, 18).

Habitual consumers of hard drugs

This group of consumers (89%) represents the vast majority (133) of interviewees. It comprises persons consuming "hard drugs" (heroin and/or other opiates and/or cocaine and/or speed and/or crack) several times per week or every day. As regards the persons to be classed with this type, 89% (118) of them have been intravenously consuming on a daily and 9% (12) on a weekly basis. Only three interviewees currently smoke (preferably) crack. Therefore, intravenous application can be considered as an essential characteristic of "habitual consumers of hard drugs".

Occasional consumers of hard drugs

8% [12] of persons interviewed are to be assigned to this type defining - by referring to so-called "weekend users" - consumption patterns according to which hard drugs are consumed once a week at most, however, at least once per month. Also, consumers to be assigned to this category currently favour the intravenous use of drugs.

Habitual consumers of soft drugs

The remaining 3% (5) of persons interviewed are to be assigned to this type, this consumption pattern comprising interviewees habitually consuming, at present, exclusively "soft" drugs (alcohol and/or cannabis and/or Ecstasy - notwithstanding the fact that all of them are experienced in consuming hard drugs, two of these persons using, at present, hard drugs still sporadically (once to three times quarterly). In this connection, we have to observe that two of the five interviewees to be assigned to this category are currently undergoing substitution therapies.

As far as the typology of consumption patterns outlined in this context are concerned, there are no differences between the different partial samples (or gender - specific differences). The drug consumption patterns as practised being characterised, to an absolutely predominant extent, by the parallel use of sundry substances, different partial samples tending to differ, as regards consumption patterns orientated to heroin and cocaine: The present consumption pattern as typical of interviewees directly contacted in the open scene is orientated by cocaine, that is to say, to a greater extent than consumption patterns established by the random sample "Injection room inquiry". Heroin on the other hand, is comparatively more popular among persons interviewed in the safe injection rooms. Moreover, against the background of the specific interest in obtaining knowledge this study is based on, we have to note that "injecting" is the consumption form absolutely dominating within the Frankfurt open drug scene, 96% of people interviewed being, at present, assigned to the group of IDU. Therefore, drug users in the scene must be assigned, almost without exception, to the target group the safe injection room offer is aimed at. We observe however, a conspicuous tendency towards differences between the partial samples: On an average, the group of users injecting intravenously on a daily basis (groups composed of almost identical numbers of people interviewed in the course of the partial samples), i.e. people interviewed in the scene inquiry, signify clearly more situations of consumption per day (Altogether: mean:6.14, SD: 4.9, min. max.: 1 - 20. "Scene inquiry": mean:7, SD:5.5 - "injection room inquiry": mean:4.1, SD: 2.6; t 3.9 ****). The conspicuously higher consumption intensity/frequency is, most probably, attributable to the consumption pattern of drug users directly contacted in the open scene who show consumption patterns orientated, to a great extent, by cocaine. This also relates to the fact that intensive (simultaneous) consumption of cocaine generally motivates shorter intervals of application and use. "Because of the short lasting effects and the subsequent high frequency administration schedules, the perceived availability of the drug is for most users much lower than of heroin (although the drug may be just as easy to purchase, provoking increased drug craving and thus higher drug use levels)" (GRUND 1993, 76). Thus, the application frequency of drug users injecting on a daily basis is typical of the sub - group of people stating cocaine use on a daily basis. The frequency more than doubles the frequency rates of groups of people not consuming cocaine on a daily basis ore even abstaining from using this substance (mean:8.3, SD:5.4 - mean:3.2, SD: 1.9; t: 7.11 ****). When considering this constellation, the increasing importance of cocaine, as far as the open drug scene is concerned, embodies considerable implications for the (quantitative) conception of safe injection room services offered.

4.4 Physical condition

4.4.1 Physical, psychical general condition

Let us "approach" the general physical condition of interviewees by considering first their subjective self-assessment of their physical condition. Although 47% (70) of the persons interviewed assess their present physical condition, on the basis of a five-degree scale (1= "very good" to 5 = "very bad"), between good to very good (cf. figure 20), the majority of 53% (80) assesses their general physical condition less sufficient up to very bad. In this respect, we cannot observe any differences in individual partial samples or in gender. Nevertheless, we have to observe that homeless people generally assess their physical condition as worse.

Figure 21: Self-assessment of physical condition

chi-square: 14.9**, DF:4

The picture as shown in this figure is more or less identical with the observations made by VOGT within the scope of the Frankfurt scene inquiry in 1991. So - to speak in terms of VOGT (1992) - we can draw the following "interim conclusion": "While nearly half of the persons interviewed are - contrary to common opinion - physically very well or well, one quarter of them are stating to be in a bad or very bad physical condition " (ibid. 23).
To get a concrete idea of the general condition of drug users interviewed, they have been asked to report on physical and mental troubles they had been suffering from in the last three months or still have been suffering from and whether they had been or still have been undergoing medical treatment:

Figure 22: Physical troubles - medical treatment / last three months

(n - 134 / several mentioned)
[
16 interviewees stated that they did not suffer from any troubles during the last three months]

 

(was/is) acute

(was/is) being treated

Liver troubles/hepatitis

52/53%

30/20%

Heart/circulation

35/23%

14/9%

Lungs/bronchial tubes

47/31%

25/17%

Stomach/bowels

49/33%

14/9%

Cold/influenza

35/23%

11/7%

Toothache

48/32%

20/13%

Abscess

45/30%

27/18%

AIDS

27/18%

15/10%

Epileptic attacks

7/5%

1/1%

Depressions

63/42%

11/7%

Other

13/9%

8/5%

Except for "Epileptic attacks" and "Other", all clinical pictures as indicated in the figure are mentioned by every fifth or even every fourth interviewee, the respective therapy quota being clearly lower. In this respect, we had to observe in particular that two of five interviewees - above all women (women: 57% - men: 37%; chi-square: 4.4, ** DF: 1) - reported of having suffered from depressions in the last three months. In this context, we may proceed on the assumption that these depressions are, in general, depressions due to exhaustion, a phenomena that may be deemed a reaction on the enormous psycho-social stress potentials in the every day scene (primarily: Pressure of procurement, cf. here: KEMMESIES 1995, 247) [To what extent depressions possibly caused by increased consumption of cocaine are meant (cf., for instance: GUNKELMANN 1989, 358; COHEN 1990, page 137 ff) (cocaine meeting with increasing popularity within the open drug scene), remains unanswered considering the insufficient degree of differentiation of the evaluation instrument, justification of this presumption being supported by the observation that the percentage of people suffering from (temporary) depressions (group of habitual [daily] cocaine consumers) is higher (although not significantly) than the respective percentage of people consuming cocaine at a moderate level (48% - 37%)]. In general, interviewees are complaining of three different troubles (mean:2.9, SD:2.1, min. - max.: 0 - 8), this average nearly doubling the value ascertained by the VOGT study (1922, 22) showing a respective value of 1.5 (own evaluations based on data presented). Even the average number of medical treatments stated (a comparatively "harder" indicator) (1.9) (SD:1.4, min. - max: 0 - 6) is still considerably higher than the average number of troubles mentioned (figures showing the VOGT study). Presumably, this dissimilarity is attributable to the fact that the present study reflects a situation following massive suppression of public scene concentrations (cf. in this context: OSTHEIMER/et al 1993, 20). We may proceed on the assumption that the currently considerably reduced open drug scene (quantitative reduction) represents a somewhat "negative picture" of drug users confronted with specific problems, differing entirely from the situation preceding the expulsion of the scene from "Taunusanlage" in 1992/1993. The mentioned phenomenon relates to drug users facing specific problems, i.e. people who - in the absence of any other alternatives - are dependent on the social context of the open drug scene (in particular, the large group of homeless people).
Considering the fact that no more than 16 interviewees (11%) stated they did not suffer from any troubles during the last three months, we may summarise the aforementioned observations by stating that, apparently, the vast majority of drug users of the open drug scene has been still in an extremely bad physical condition.

4.4.2 HIV status

Except for two cases, so far all interviewees have undergone a HIV test. 39 (26%) of the 148 persons tested (99% of the total sample) stated to be HIV positive. It is interesting to observe that the percentage of HIV positive women exceeds the percentage of interviewed male drug users by more than 100% (women: 47% - men: 20%; chi-square: 10.7 ***,DF:1) - an observation resembling an observation made by OSTHEIMER/et al (1993, 16), however, contrasting with the VOGT study (1992, 24) which shows an identical HIV prevalence rate for women and men. Whilst in the present study every fourth interviewee states to be HIV positive, scene inquiries made by OSTHEIMER/et al (1993, 16: 17%) did not produce such results. Nevertheless, for every fifth interviewee this rate should not be deemed an absolute indicator of an increase in HIV prevalence rate among IDU in general. On the contrary, we should proceed on the assumption that the present composition of the open drug scene in Frankfurt am Main is representing, primarily, an extreme picture of drug users facing extreme problems.

4. 4. 3 Overdose experiences

65% (97) of 150 consumers reported to have taken an overdose at least once. In comparison with the KEMMESIES study (1995, 192), the percentage of interviewees experienced in overdosing as produced by the present sample is somewhat lower (65% as against 72%). This difference is not significant. Nevertheless, we might recognise here, though only with utmost caution, a tendency towards a slight decrease in overdosing risks, this interpretation being based on the following two hypothetical assumptions that will be subject of further investigation:

Let us give a more detailed consideration of the overdoes experience gathered by our interviewees, by taking a look at the numbers of "overdoses" first:

Figure 23: Numbers of "overdoses"

never 35%
once 17%
2-5 times 36%
6-10 times   5%
> 10 times   7%

This survey representing the total sample gives us an impression of the overdose frequencies. The partial samples producing an almost identical picture without any significant deviations. On an average, the last overdose dates back for 21 months (SD:26, min - max: 0 - 120); nearly every fourth interviewee (22/23%) of those experienced in overdosing having experienced overdose during the last four weeks.

Figure 24: Place of last "overdose" (n=97)

apartment (at home / at friends’)

32/33%

in public (street, park, etc.)

48/50%

public buildings

6/9%

drug-aid services

8/8%

Every second person experienced in overdosing had their last overdose in public, every third in a self-contained apartment. This phenomenon proves the fact that our interviewees prefer to consume in public (this situation being attributable, last but not least, to the high rate of homeless people) and/or, the fact that public drug consumption involves a relatively high risk of having an overdose (due to the rather hectic situation in public places).
Furthermore, we have to stress the fact that 28 of all persons interviewed (29%) had been alone when they experienced their last overdose, whereas eleven interviewees (11%) stated that they have been left without any help when they had their last overdose. These figures are remarkable on account of the fact that, failing any help or in case of help (or medical care) coming too late, an overdose might involve an extremely high risk of death.
Against this background, the safe injection room service offered seems to be of great importance, above all, in view of the group of homeless people, inevitably consuming, partly in public, in "undiscovered" niches, inasmuch as direct care of overdosed persons has been ensured. Apart from the eleven persons who have not been given any support, 35 (36%) of the people interviewed were being taken care of by a doctor on emergency call, another six persons (6%) needed intensive medical care in a hospital. Further 32 (33%) consumers were helped by friends, when taking the last overdose (80% of these helpers being people also experienced in drug use). In eight cases (8%) people involved had been taken care of by staff members of drug-aid services, five (5%) interviewees stated to be unable to remember the last overdose.
Considering the fact that only in two of five cases (42%) of the last overdose a doctor on emergency call has been consulted, this is to be deemed a clear evidence of drug emergency situations in the social environment of the open drug scene being much more complex than published in statistical material on rescue actions. When being asked to state the decisive background of their last overdose, the majority of people interviewed (44/44%) had been adducing reasons like "unknown drug quality": The effects of substances consumed had been wrongly judged or even underrated. 30 persons (31%) stated combined drug consumption, the specific overdose risk being attributable finally to synergistic effects of individual substances consumed in parallel. These effects can hardly be rated. Another 14 interviewees (14%) emphasised that, being unaware of the present tolerance level, they had taken, inadvertently, a too high dose following a relatively long "clean phase". Nine persons (9%) stated to have deliberately taken an overdose intending to commit suicide. Six persons of this group stated physical reasons (HIV positive), thus being without any prospects.

4.5 Everyday life

4.5.1 Practice of covering cost of living and drugs needed

The analysis under consideration has to be viewed particularly with the following reservations. Data material presented produces, to a large extent, values of merely approximative nature, this vagueness being - apart from difficulties of exact memory - particularly due to the fact that income and expense in the specific research field of this study are subject to enormous, also short-period fluctuations. In addition, we have to visualise that income derived consists, to a considerable extent, in natural produces (primarily: Drugs). This aspect has been taken into consideration when preparing and asking pertinent questions.
Our interviewees have stated an average income of DM 1,000 during the previous week (Interviewees have been expressly asked to state income in cash). For distribution of income, we refer to the following figure:

Figure 25: Income/last week (in DM)

No income 3/2%
Up to 250 25/17%
251 - 500 23/15%
501 - 1,000 48/32%
1001 - 2000 38/25%
More than 2000 13/9%

Mean:

SD:

Min-Max:

1.077

1.135

0 - 10.000

As illustrated, differences in income are considerable. Taking as a basis a welfare rate of DM 1.000 (511 Euro) per month, cash income derived by every fifth interviewee (19%) is lower than welfare payment. On the other hand, every fourth person (25%) has realised an income of DM 1.000 to DM 2.000 in the last seven days, nearly one tenth numbering among the group of "top earners", this group representing primarily people who pursue either lucrative drug transactions or activities like prostitution. One woman being the top earner earned DM 10.000 within the previous week; this woman stated to derive a very attractive income from her activities as a "Domina" working for a well - off regular clientele. When ignoring the group of "top earners", we can observe an average income of DM 818 (reduced by nearly 25%) (SD:551), this income level being commensurable with respective data produced by studies based on comparable empirical references (KORF/ HOOGENHOUT 1990, page 86 ff; GRAPENDAAL/et al 1991, 108). Furthermore, we have to bear in mind that the majority (54%) of people interviewed stated to get drugs in exchange for certain services (primarily: "Mediation activities" in the drug market and prostitution). When being asked to state the countervalue of drugs obtained this way, our interviewees stated an additional income averaging DM 604 (SD: 995). In this respect, we would like to reaffirm that this sum is an estimated value.
To get an idea of the ratio of "cash income/income in the form of natural products, we have correlated the respective total income stated by the 150 interviewees (Cash income: DM 160.344 - Income in the form of natural produces: DM 90.690), this correlation resulting in about 36% of total income derived in the form of natural produces. The enormous importance attached to income in kind within the scope of drug acquisition patterns is evidenced, in particular, by comparing purchase of drugs paid in cash and acquisition of drug paid in kind. On an average, persons interviewed paid, last week, DM 181 (SD:1.013) for drugs. whereas drugs received in exchange for services approximated about DM 604 (estimated value), that’s to say, that 44% of drugs needed have been acquired on a non - cash basis, percentage nearly being identical with observations made by KREUZER/et al (1991) within the scope of a study of drug - related crime committed by addicts. Authors are proceeding on the assumption of a respective share of approximately 40% (ibid. 187).
When considering, more closely, the average cash expenditure for drugs, we see that the very popular assumption that addicted drug users are spending DM 300 to DM 400, even up to DM 1.000, per day, to meet their daily requirements of drugs turns out to be a myth, such sums being, apparently, very rare exceptions due to a temporarily favourable income situation. The present sample has produced drug expenditure averaging DM 111 (SD:144)corresponding with the estimate by KREUZER/et al (1991, 201), according to which "the assumption of an amount of DM 100 to DM 150 spent, per day, for drug consumption, related to the whole drug career, seems to be realistic". Even when including the average income in kind, the requirements and/or consumption of drugs (per day) corresponds to the equivalent of DM 198, an amount clearly remaining under common estimates and estimates published by mass media.
However, the phenomenon that drug use is obviously being given financing priority in every day life of the open drug scene is evidenced by the fact that only 28 interviewees (19%) have spent, last week, more money to finance living (food, rent etc.) than to finance purchase of drugs, ten persons stating identical expenses, whereas the absolute majority (75%) of drug consumers interviewed uses to spend more money for drugs than for food et cetera. As against an average expenditure of DM 780 for drugs (amount spent last week), expenditure for living (same period) averaged DM 226 (SD:233, min - max.: 0 - 1.000). That’s to say expenses for drugs are exceeding expenses for food by approximately 300%.
When considering the ratio of (cash) income and expenditure, we have, on an average, a positive balance (mean:69 [DM], SD:589, min: - 1.500 [max.: 3.290]). Nevertheless, this phenomenon should not - as signalled by the enormous dispersion - obscure the fact that two of five persons interviewed (38%) show a negative balance.
Data presented thus far does not show any spectacular deviations between the partial samples. However, more detailed analyses of the structure of acquisition patterns practised (kind of financing sources, "legality" of financing and acquisition patterns) resulted in certain differences depending on different partial samples. First of all, we have to notice that cash income realised last week is coming, mainly, from legal financing sources (59%). Income from legal financing sources (
As regards further representations, we have to observe that, in this case, prostitution is deemed a legal financing source, although we have to proceed on the assumption that the majority of prostitutes are failing to adhere to obligations like registration and regular medical examination (cf., in this context, for instance: HEDRICH 1989, page 218 ff) averaging DM 633 (SD:971, min - max:0 - 10.000), - this income exceeding (t:1.74 *) the income derived from illegal sources (mean:444, SD:762, min - max.: 0 - 3300). However, in this respect, we have to observe a clear difference between different partial samples: Legal income as stated by persons interviewed in the safe injection rooms was clearly exceeding legal income as stated by persons interviewed in the open scene ("injection room inquiry": mean :916, SD: 916 - "Scene inquiry": mean:491, SD:587; t:2.58 **), the picture of illegal income being contrary ("injection room inquiry": mean:225, SD:439 - "Scene inquiry": mean: 553, Sd:861; t: 3.09 ***), this constellation being a first clear hint regarding different acquisition patterns. We have every reason for supposing that the group of persons contacted within the scope of the scene inquiry tends to prefer illegal acquisition patterns.

Figure 26: Sources of income/last week (multiple answers)

   

'scene inquiry’

(n=100)

'inhection room inquiry’'

(n=50)

TOTAL

(n=150)

welfare

yes

62/62%

30/60%

92/61%

payments

no

38/38%

20/40%

58/39%

 

chi-square

----

 

yes

58/58%

20/40%

78/52%

drug dealing

no

42/42%

30/60%

72/48%

 

chi-square

4.33 * *

 

yes

38/38%

18/36%

56/37%

parents / partner

no

62/62%

32/64%

94/63%

 

chi-square

----

 

yes

19/19%

21/42%

40/27%

work/jobs

no

81/81%

29/58%

110/73%

 

chi-square

9.02* * *

 

yes

21/21%

7/14%

28/19%

various illegal activities

no

79/79%

43/86%

122/81%

 

chi-square

----

 

yes

18/18%

4/8%

22/15%

various legal activities

no

82/82%

46/92%

128/85%

 

chi-square

----

 

yes

9/9%

8/16%

17/11%

prostitution

no

91/91%

42/84%

133/89%

 

chi-square

----

The preceding figure shows a breakdown of all financing sources mentioned. It seems to be typical of the present life of drug users interviewed to follow different parallel courses regarding financing. On an average, interviewees use to mention two financing sources (mean:2.4, SD:1.1, min - max.: 1 - 8), only 27 persons interviewed (18%) meet their financing requirements by availing themselves of only one income source; two of five interviewees (39%) state three financing sources or more. Sources most frequently mentioned are public welfare payments (primarily official public welfare payment), such payments constituting for the predominant majority of people interviewed (61%) some kind of "basic financing". Every second interviewee (52%) engages in drug - related transactions comprising (in a descending order of importance), essentially mediation, dealing and service activities (Making available "fixer utensils" used to prepare and apply drugs. In exchange for these utensils, the service maker is handed over clients’ contaminated filters (see in detail: KEMMESIES 1995,216). In this respect, it is rather interesting to observe the relatively high percentage of people who have been financially supported by intimate friends and relatives (parents and/or partner) during the previous week. 40 interviewees (27%) mention an income derived from regular employment or "jobbing", the corresponding percentage of people interviewed in safe injection rooms being clearly higher. In this context, we have to observe that only eleven of these 40 persons are pursuing a full - time job, five of these "full - timers" presently serving in an education/training programme.
17 persons interviewed (11%) engaged in activities like prostitution during the previous week, such activities being a relevant and mostly lucrative income source particularly for women (Women: 35% - Men: 4%)."various illegal activities" comprise criminal offences (primarily: theft, receiving and reselling stolen goods, burglary), offences not being punishable under the Federal legislation on narcotic substances. During the previous week, every fifth interviewee has financed his/her financial requirements (at least partly) by committing sundry criminal offences as summarised in this category. "Sundry legal activities" are comprising, above all, activities like begging ("sponging"), approximately every seventh interviewee deriving his income from such activities (15%).
We'll be getting a more decisive impression of current acquisition patterns, when seeing the different main sources of income (income realised last week) as mentioned in the following figure:

Figure 27: Main source of income/last week

Drug-dealing has been the main source of income (last week) mentioned by every third interviewee (35%), followed by public welfare payments (19%) and income derived from legal work or jobbing (17%). Sundry illegal activities being for every tenth interviewee (10%) the most important source of income.
This distribution significantly differing between specific partial samples is mainly attributable to differences relating to categories like "drug - related transactions" (preponderance of " scene inquiry") and "work/jobbing" (preponderance of "injection room inquiry"). When reducing the degree of differentiation of the former picture to the information "Acquisition pattern: legal or illegal?", we have a distribution picture clearly illustrating that partial samples - as already mentioned - are differing as regards legality:

Figure 28: Legal status (legality)/acquisition pattern/last week

The above figure shows that illegal financing sources seem to be rather typical of drug users directly interviewed in the scene. As far as persons contacted in safe injection rooms are concerned a slight preponderance of the importance of legal sources of income is to be observed. In this stage of analysing, there are no means to explain these manifest differences of partial samples. Possibly, these differences express a higher level of social marginalisation within the sample of the scene inquiry level, giving rise to a large diversity of explanations.

4.5.2 Acquisition of drugs

The absolute majority (93%) of people interviewed acquire the substances consumed mainly in the "open drug scene" - only 7% of interviewees stating to acquire (illegal) drugs mainly via "home addresses". Three of five interviewees (60%) state to purchase drugs primarily in the familiar environment of a "scene where they are buying as regular customers", a regular dealer being the best guarantor of comparatively "high" and constant drug quality (also being a method to prevent overdoses caused by changes of quality). Two of five interviewees (4.0%) use to rely on changing dealers, most of them being known dealers (sometimes, drug users contact other persons to inform them about the respective "purchase source"). In many cases, we may proceed on the assumption that consumers are "customers" of several "regular dealers", this practice minimising the risk of suddenly having to adjust oneself to a new source of supply frequently involving a new drug quality, whenever a specific "regular dealer" should be unavailable (illness, detention etc.).
To gain insight into what is happening in the black drug market, I would like to refer to the statements on quality (changes) and prices (price development), as regards heroin and cocaine. As far as heroin is concerned, we asked interviewees to assess the quality of heroin currently bought and consumed. Interviewees have been asked to rate the quality of heroin bought (five - degree scale from "very good" to "very bad"). 51% of the persons interviewed rated the quality to be bad (29%) to very bad (22%), 29% of them rating the quality of heroin to be good (25%) to very good (4%). Every fifth person (20%) deploring the less good quality of heroin currently sold. In total, interviewees tend to assume a less good quality (mean: 3.4, SD: 1.3), the degree of purity of heroin being rated to average 11%. This estimated value exceeds the average degree of purity of "street heroin" (3% to 8%) officially presumed by police authorities (POLICE HEADQUARTERS Frankfurt am Main 1993, 190). However, this value as officially estimated is based on an evaluation made in 1992 (expert opinion by Hessisches Kriminalamt). It cannot be excluded that, meanwhile the quality has really improved, although slightly, this improvement being substantiated by the following three indications: Firstly: Although the majority of people interviewed (65%) is stating that the quality of heroin sold has significantly deteriorated, this percentage is clearly smaller than the percentage attributable to people interviewed in the scene inquiry by OSTHEIMER/et al (1993,10), their interview reveals that 85% of people interviewed assumed a deterioration of quality.
Secondly: Although not being significant, the average degree of purity as assumed by people interviewed (11%) exceeds the degree produced by the sample carried out within the scope of the KEMMESIES study (1995, 157), where drug consumers interviewed in 1993 had been assuming a portion of heroin chloride averaging 9%. Thirdly: Whereas interviewees of the KEMMESIES study (ibid. 157) tend to rate heroin quality "bad", the present study shows a tendency of more positive rating ("less good") (t: 1.69 *). Such indications substantiate a stabilisation or even gradual improvement of heroin quality, although on an extremely low level.
There are also signs of a lower price level of heroin sold in the black drug market. The predominant majority (70%) of people interviewed stating that heroin is available at a more favourable price than a year ago, 21% stating an identical price level or a rise in price by only 9%. There is a clear tendency to state declining prices (chi-square: 87.44 ****,DF:2) (Chi - square test for a sample (procedure 'npar Tests'/SPSS). This phenomenon being impressively evidenced by the fact that, on an average, interviewees are stating a clearly lower purchase price for a "half bag" [Average packaging unit for heroin sold in the open drug scene (about 1.8 to 2.5 grams)] than two years ago (cf. KEMMESIES 1995, 158/ mean:73.7, SD:19.0 - mean: 99.3,SD:21.6; t:7.39 ****).
The question about the reasons of the slight improvement of quality and price reduction for heroin can be - apparently - only answered in connection with the market development of cocaine. With cocaine being firmly established in the open drug scene (cf. 4.3.1), there are certain signs of competition between the heroin and cocaine market, this competition focusing on extension and/or stabilisation of existing market shares. To achieve these objectives, there are market strategies having positive impact on consumers, in the form of price reduction and/or improved quality.
Another phenomenon matching this picture of a competitive heroin and cocaine market is the fact that a disproportionately high percentage (54%) of people interviewed also state a decline in cocaine prices last year, 35% of them stating it remained the same and 11% that the prices rose. As already observed in connection with heroin, we can observe a clear rating tendency (chi-square:38.25 ****,DF:2) giving rise to suggest declining cocaine prices. We still have to continue observing the further development of the market in case the tendency towards increasing importance of crack should clearly continue.

4.5.3 Significance of the scene

The fact that the open drug scene apparently ranks high in the current everyday life of the interviewees is already illustrated by statements relating to frequency and length of stay: On an average, persons interviewed use to stay five times per week (mean:5.1, SD:2.6, min - max.: 0 - 7) for more or less 8 1/2 hours (i.e. about "one working day") on the open scene (mean: 8.4, SD: 7.7, min - max.: 0 - 24), ten interviewees stating that they are, at present, abstaining from going to the open drug scene. Another 25, persons (17%) going to the scene no more than twice per week. The majority of interviewees (60%) can be met on the scene nearly every day. Every fifth (20%) of the persons goes to the scene at least once per week (20%) and stays there for about one to two hours per visit, 33% of people interviewed stating an average length of stay of three to six hours, and 30% stating to stay on the scene more or less the whole day (at least twelve hours). When summarising the statements on frequency and length of stay, we observe a picture crystallising a partial group for which the social structure of the open drug scene might apparently be deemed a dominant living space. 42 of a total of 150 drug consumers interviewed (28%) stated that they spent at least 12 hours every day in the social context of the drug scene. This group being predominantly (83%) composed of interviewees who are homeless at the moment, people identically represented in the partial samples.
However, it is rather astonishing to observe that the group of persons going to the scene every day is represented clearly differently in the partial samples ("Scene inquiry" 35% - "Injection room inquiry". 7%; chi-square: 7.3 ***,DF:1). In contrast to that, we find in the partial sample ("Injection room inquiry") a noticeably larger group of persons who go to the scene never or no more than twice per week for maximally two hours ("sporadic scene callers") ("Scene inquiry": 6% - "Injection room inquiry": 30%; chi-square: 15.95 ****).
Apparently, partial samples are characterised by a clearly different nearness - distance relationship with the social atmosphere of the open drug scene. This phenomenon is also substantiated by significantly deviating average data on "Scene contacts per week" ("Scene inquiry": mean: 5.7. SD:2.2 - "Injection room inquiry": mean: 4.9, SD:5.8; t 4.62 ****). In connection with this, we should recall the general observation already made by KEMMESIES (1995) that there is obviously a connection between the number of contacts (per week) and the average length of stay (per contact) (r:.54 ****).
To also understand the importance of the open drug scene for the group of consumers interviewed in terms of "quality", interviewees have been requested to state the motives for scene contacts. In the first place, we have to observe that the majority of scene contacts is motivated by several reasons. On an average, people interviewed use to state two reasons for their stay (mean: 2.2, SD:1, min - max.: 0 - 5). On the other hand, we have to observe a clear deviation between different partial samples, inasmuch as drug users interviewed in the course of the "scene inquiry" stating several motives for their stay there ("Scene inquiry": mean:2.4, SD:9 - "Injection room inquiry": mean: 1.6, SD:1,t: 4.63 ****).

Figure 29: Motives "Scene contacts" (multiple statements)

   

'Scene inquiry'

(n=100)

'injection room inquiry'

(n=50)

TOTAL


(n=150)

  yes 74/74% 35/70% 109/73%
purchase of drugs no 26/26% 15/30% 41/27%
  chi-square ----
  yes 63/63% 23/46% 86/57%
Social contacts /

meeting point

no 37/37% 27/54% 64/43%
  chi-square 3.94 * *
  yes 28/28% 5/10% 33/22%
drug dealing no 72/72% 45/90% 128/78%
  chi-square 6.29* * *
  yes 19/19% 3/6%% 22/15%
'provide service' no 81/81% 47/94% 128/85%
  chi-square 4.5* *
  yes 35/35% 15/30% 50/33%
'business'(Prostitution / receiving or selling stolen goods etc.) no 65/65% 35/70% 100/67%
  chi-square ----
  yes 24/24% 1/2% 25/17%
boredom / consumption no 76/76% 49/98% 125/83%
  chi-square 11.62* * * *

The "purchase of drugs" is by far the most common motive for contacts mentioned. Three of four interviewees go to the open drug scene with a view to acquiring drugs. Thus, the open drug scene presents itself, primarily, as a trading place. Nevertheless, the importance of the open drug scene as a place of social reference, can be assumed for drug consumers interviewed within the scope of the "scene inquiry". Apparently, for a clearly larger number of people interviewed in the course of this partial sample the scene seems to have a marked importance as a place for establishing and maintaining social contacts, a place where people use to establish firm and close contacts. Just so, the open drug scene seems to have an incomparably higher economic importance within the partial sample "scene inquiry", the open drug scene apparently being a somewhat "informal labour market", as far as acquisition of money and/or drugs is concerned, pictures substantiated by the imbalance of motives like "dealing", "servicing" and - although only gradually - "doing business". A particularly conspicuous feature being, moreover, the fact that people directly interviewed in the scene use to state, clearly, more often, motives like "'boredom/consumption", a clear indication showing that interviewees of this partial sample seem to have a deficit in alternatives as regards places to stay and/or jobs (as already briefly indicated in 4.5.1).
An overall view of different tendencies indicated seems to draw sharper contours of the thesis of a different "nearness - distance relationship" to the social context and environment of the open drug scene. Obviously, the open drug scene is ranking high in the life of drug users interviewed in the course of the "scene inquiry", being even for many of these drug users the exclusive reference of their life. Nevertheless, we cannot find any declaration sufficient to explain the manifested different "connections to the scene" as shown in the partial samples. Apparently variables to explain the background can be found outside the interviews and questions of this study.

4.5.4 Current contact intensity "drug aid"

On an average, interviewees are stating five weekly contacts with various Frankfurt drug-aid institutions and services (mean: 5.2,SD:2.6, min. - max.: 0 - 7), the large majority of people interviewed (64%) stated to avail themselves daily of at least one drug-aid service offered. Only twelve persons currently being without any contacts with drug-aid services, these persons being covered, without exception, by the partial sample "scene inquiry" (not surprising, when considering the sample procedure). Let us refer exclusively to persons directly interviewed in the open drug scene: we can observe that 88% (!) of people interviewed have been maintaining close contacts with drug-aid services - for one reason or the other. Like scene contacts (4.5.3), contacts with drug-aid services have mostly several reasons: On an average, people use to state three different motives (mean:3.3, SD: 1.8, min - max.:1 - 7) - a clear indication that drug-aid services evidently meet different everyday requirements of the open drug scene, as already shown by the "broad approval radius" of drug-aid services offered. However, in this connection, we observe again a difference between different partial samples: Not only that, after all, every tenth interviewee (12%) interviewed in the course of the "scene inquiry" has currently not maintained any contacts with drug-aid institutions, we also observe a conspicuously small average number of contact motives mentioned ("Scene inquiry": mean: 3, SD: 1.8 - "Injection room inquiry": mean: 3.7, SD: 1.6, t: 2.14 **). This observation indicates, in total, a trend proving that drug users interviewed in the open drug scene tend to be rather reluctant to avail themselves of help offered by drug-aid institutions. Let us now refer to details of these different motives presenting first a survey of such motives (A representation of data specific to different partial samples has been waived, failing any conspicuous differences - except for one):

Figure 30: Motives "Drug-aid services contacted" (several motives mentioned/n=138)

'needle exchange'

103/75%

'drug consumption'

89/64%

'stay / meeting point'

77/56%

'food'

57/41%

'counselling'

47/34%

'medical treatment'

45/33%

'shelter / accommodation'

40/29%

All contact motives most frequently mentioned - " needle exchange", "drug consumption", and "Stay/meeting place" - concern harm reduction and acceptance-orientated services offered by drug-aid institutions. This may be deemed an indication that, most obviously, expectations popular among experts that it is possible to extend the contact field of drug-aid institutions by offering such forms of service have been fulfilled. As regards the motive "drug consumption" relating to safe injection room services offered, there is a clear difference between partial samples ("Scene inquiry": 47% "Injection room inquiry: 96%; chi-square: 34 ****DF: 1).
This difference should be interpreted not only as a sample artefact attributable to the sample procedure, as will be shown in the next section (4.5.4.1) relating to the Intensity of using the safe injection room service offered. Two of five interviewees deem the eating service offered by different institutions a motive for establishing contacts, every third interviewee mentioning "counselling service" and/or "medical treatment" and/or "accommodation/shelter" to be motives for establishing contacts. It is rather interesting to observe that, as regards utilisation practices of drug users of the open drug scene, the central field of activity of drug-aid services in the classical "compound system of drug-aid institutions" still plays an important but nevertheless, rather subordinated role.

4.5.4.1 Intensity of using the safe injection room service offered

To begin with, we have to recall the fact that, irrespective of consumption patterns currently practised. Nearly all drug users interviewed are to be numbered among the target group aimed at by a specific harm-reduction service offered ("Safe injection rooms"): 96% of all interviewees are currently practising intravenous drug consumption. Let us first broach the question whether safe injection room service offered has already been made use of:

Figure 31: Safe injection room service used so far (n=147)
(Three persons interviewed mentioned never having applied drugs intravenously so far)

no 10%
yes/once so far   9%
yes/several times 81%

So far, nine of ten IDUs interviewed have used one of the three safe injection rooms ("Druckräume") established in Frankfurt am Main at least once. The absolute majority (81%) availed itself of this service already repeatedly. A first indication of the fact that partial samples relating to utilisation practice, differ from this service offered is given, inasmuch as persons who, so far, never or only once used an "injection room", are people covered, without exception, by the partial sample "Scene inquiry".
At present - related to the previous week - three of four (75%) IDUs interviewed have (also) called on an injection room to consume drugs. Even direct interviews in the open drug scene produced a comparative percentage of 62%. The aforementioned figures prove that, apparently, this specific harm - reduction service offered is reaching a large segment of the target group aimed at "IDUs of the open drug scene".

Figure 32: Frequency of using safe injection rooms/last week (n=147)

 

Scene inquiry

(n=97)

injection room inquiry

(n=150)

TOTAL

(n=147)

Never

37/38%

----

37/25%

1-2 times

20/21%

13/26%

33/22%

3-6 times

15/15%

16/32%

31/21%

> 6 times

25/26%

21/42%

46/32%

chi-square

26.5 * * * * , DF: 3

Mean:

SD:

Min-Max:

4

5.5

0 - 25

8.4

8.0

0 - 30

5.5

6.8

0 - 30

t:

3.5 * * * *

The above figure reveals two things. Firstly: in general, the use of an injection room is obviously no exception as regards current consumption practice of the open drug scene. An injection room having been used, last week (7 days), on an average, five to six times. Every third interviewee is to be deemed a "regular user" (using this facility seven times or more per week). Secondly: There are considerable differences between different partial samples, as far as the current intensity of use is involved. We find among intravenous users interviewed in the scene inquiry a large group (38%) of current "non-users" and (correspondingly) a considerably smaller group of regular injection room users, a phenomenon resulting in a clearly lower average utilisation rate.

Figure 33: Main motive for last using safe injection rooms (n=150)

 

Scene inquiry

(n=150)

injection room inquiry

(n=150)

TOTAL

(n=150)

'never used it so far'

18/18%

----

18/12%

'just wanted to try out the service offered'

14/14%

----

14/9%

'just happened to pass by and drop in'

9/9%

5/10%

14/9%

'wanted to consume without hurry'

56/56%

33/66%

89/60%

'go to injection room almost every time'

3/3%

12/24%

15/10%

chi-square

31.3 * * * * , DF: 4

It is quite astonishing to observe that six out of ten persons interviewed substantiated their last use of a safe injection room by giving essential reasons like their desire for consuming or applying the respective drug/s in an undisturbed environment. Rather often, interviewees mentioned that their essential motive for calling on such rooms had been some kind of reduction of "prosecution stress" attributable to a presence of police forces on the street. The different distribution picture as shown in the figure is mainly due to the inclusion of the group of people, who have never used such a room until now or having used it only once. On the other hand, we find in the partial sample "Injection room inquiry" an incomparably larger group of evidently regular injection room users.
The different intensity of using safe injection rooms is also shown by the fact that there are signs of clear differences between partial samples, as regards present consumption in public. This development was meant to be counteracted by establishing the safe injection rooms, being the specific political intention behind this harm reduction service offered. Let us consider, first of all, consumption places primarily used last week:

Figure 34: Place of consumption preferred/last week (n=150)

 

Scene inquiry

(n=150)

injection room inquiry

(n=150)

TOTAL

(n=150)

at home

23/23%

8/16%

31/21%

in public

68/68%

13/26%

81/54%

safe injection rooms

6/6%

26/52%

32/21%

others

3/3%

3/6%

6/4%

chi-square

45.5 * * * * , DF: 3

The distribution picture considerably diverging in different partial samples results, above all, from different percentages of the categories "In public" (focal point "Scene inquiry") and "Safe injection rooms" (focal point "Injection room inquiry"). Irrespective of any differences typical of specific partial samples we can state that more than half the people interviewed are conceding to currently consume drugs preferably in public. Above all, homeless interviewees (46% of the total partial sample) use to fall back - driven by necessity - to public consumption places (Group of "homeless people": 74% - group of "people with permanent residence": 37% chi-square: 20.4 ***, DF:I). However, this observation - although relevant to the organisation and structure (opening hours, capacities) of injection rooms - does not explain the different tendencies between partial samples, since these show quasi identical percentages of homeless people. And, to avoid any misunderstandings: On a weekly average, the group of homeless persons is using the safe injection room service offered considerably more frequently than the group of people with permanent residence (mean:7.2, SD:7.5 - mean: 4, SD:5.8; t: 2.08 ***). But, apparently, injection room capacities available at present and current opening hours don’t correspond to drug-use - related daily routines. This is why consumption continues to take place, preferably in public places, failing any acceptable alternatives.
The aforementioned differences between samples seem to be due, in essence, to differences in consumption patterns as mentioned in 4.3.2: Apparently, the drug consumption pattern of drug users interviewed within the scope of the scene inquiry - a pattern generally orientated more by cocaine consumption - and the resulting higher frequency of consumption give rise to preferably public consumption, this phenomenon being, among others, attributable to the fact that people don’t choose to stay permanently near an injection room, opening hours are rather limited, waiting times are incompatible with the spontaneous higher consumption frequencies of habitual cocaine users etc. Whereas 75% of the people consuming cocaine daily stated to consume drugs preferably in public, only 35% of the people who don’t consume cocaine at all or not every day, choose to consume in public (chi-square: 23.1 **** D F : 1)

Figure 35: Frequency of public drug consumption/last week (n=150)

 

scene inquiry

(n=100)

injection room inquiry

(n=150)

TOTAL

(n=150)

never

15/15%
(
One person stated not to consume any illegal drugs at present)

18/36%

33/22%

once

3/3%

7/14%

10/7%

several times

32/32%

18/36%

50/33%

daily

50/50%

7/14%

57/38%

chi-square

24.3 * * * * , DF: 3

Mean:

SD:

Min-Max:

27.7

29.1

0 - 105

7.9

17.2

0 - 90

20.5

27.2

0 - 105

t:

5.16 * * * *

Related to the total sample, three of four (71%) interviewees state they consumed repeatedly or every day in public during the previous week (street, public places, subway stations etc.) - on an average, people stated 20 public consummations, partial sample differing widely: The number of public consummations mentioned in the "scene inquiry" is exceeding, by three and a half times, the number of public consummations mentioned in the "injection room inquiry". When comparing the statements on public consumption with the data as shown in the figure on intensity of use of injection rooms last week, we see that drug users interviewed (above all, partial sample "scene inquiry") prefer to consume in public: On an average, we have 20 public consummations as against five in safe injection rooms (t: 6.77 ****) The total sample (150 drug users) alone produces a total of 3,080 public consummations (as against 803 in safe injection rooms) for the reference period of one week [This number exclusively relating to the sample involving 150 IDUs we interviewed (users consuming in the main station area) is likely to correspond to an injection room capacity of ten places to be available daily for 15 hours in order to cover the corresponding need for consumption [when supposing a typical use/consumption time averaging 20 minutes, a value based on experience made in Switzerland (cf.: SOZIALAMT DER STADT ZÜRICH 1995, 10)]. However, when referring exclusively to drug users interviewed in injection rooms, we can observe a balance between drug consumption in injection rooms and in public. But, the partial sample "scene inquiry" shows, on an average, that public consummations exceed consummations in injection rooms by seven times.
Obviously, there is a group of drug users that cannot be reached to the extent desired by the injection room service offered or that cannot be reached due to different consuming practices and an insufficient density of service offered to contribute to a clear reduction of public consumption. Especially in the main station district, this group apparently consists - as shown by the comparative analysis - primarily of habitual (everyday) cocaine users characterising, in particular, the partial sample "Scene inquiry" (see above): This group representing, 47% of the total sample mentions, on an average, a number of public consummations exceeding, by six times, the number of consumers who don’t consume cocaine at all, or less intensively (mean: 36.6, SD:31.3 - mean: 6.3, SD:9.3; t:7.83 ****).
The imbalance expressed by the figures of utilisation of injection rooms and public drug consumption is substantiating that the current (quantitative) dimension of the injection room-services offered in Frankfurt am Main obviously does not suffice to produce lasting relief, as regards public drug consumption. And this is true apparently, not on account of any supposed non-acceptance of this offer by the target group but primarily due to insufficient capacities (places offered, opening hours) of this harm-reduction service especially considering the high and possibly increasing degree of popularity of cocaine-orientated consumption patterns and the high rate of homeless people.

The above mentioned deficit in capacity is impressively documented by interviewees stating the reasons why they continue (at least partly) to consume (illegal) drugs in public in spite of the availability of safe injection rooms. The following survey gives the main reasons mentioned by interviewees (reasons given in the order of importance ascribed to):

Figure 36: Reasons for public drug consumption in spite of safe injection rooms offered (multiple statements of motives/n=150)

1. "opening hours too limited"

96/64%

2. 'waiting time'

68/45%

3. 'distance / location' (insufficient density of services offered)

45/30%

4. 'place of purchase (mostly) also place of consumption'

36/24%

5. 'drug sharing prohibited in safe injection rooms’

36/24%

6. 'athmosphere (too crowded, noisy and hectic)'

26/17%

7. 'no admission for people in methadone programme'

11/7%

8. other reasons

7/5%

The three reasons mentioned most frequently for a continued drug consumption in public are all motivated by an obvious lack of capacity and/or deficit in numbers of safe injection rooms available. In essence, limited opening hours hardly corresponding to drug consumption patterns due to a physical addiction force people to consume drugs in public - in particular the group of homeless people. Motivations like "waiting" and "distance/location (insufficient density of service offered)" are to be interpreted similarly. Possibly, the arising withdrawal symptoms and high consumption frequency of habitual cocaine users - embedded in the feverishness and restlessness of the everyday scene characterised by prosecution stress - are incompatible with waiting times inevitably resulting from capacity bottlenecks. This also applies to the density of injection rooms offered in Frankfurt am Main, since the three injection rooms existing at the moment seem to cover the "range of action" of the target group but rather insufficiently (cf. in this respect 4.5.4.2 location of injection rooms). In this connection, the argument "place of purchase is also place of consumption", an argument stated by every fourth interviewee (24%), is relevant as well, the immediate urge to consume drugs, a requirement frequently intensified by withdrawal symptoms, conflict with the readiness to continue attempting to call on a safe injection room - particularly, when people have to reckon with long waiting times.
The rule that prohibits drug sharing in the injection facilities according to legislation in force, obviously also induces every fourth drug consumer interviewed (25%) to (sometimes) consume in public. This phenomenon also elucidates that a prohibition of drug sharing obviously also conflicts with the usual everyday scene practice of sharing a certain quantity of drugs with friends or partners.
A considerable percentage (17%) of interviewees also mentions an insufficient climate, a loud and hectic atmosphere, in the safe injection rooms which conflicts with positive feelings when taking drugs. This motive has been mentioned, much more frequently, by habitual cocaine users. As stated by some interviewees, hectic bustle in the injection rooms exerts an unpleasant influence on the stimulating effects of cocaine (in the form of somewhat "negative increase in effects"). Some interviewees also mentioned that rules prohibiting access for people in the methadone programme are a decisive motive for continuing public drug consumption.
The aforementioned motives are also reflected in the following recommendations for improvements with regard to meeting actual requirements that were mentioned by our interviewees:

Figure 37: Suggestions for improvements of injection room service offered

[several suggestions made, n = 138 (Twelve drug users interviewed in the "scene inquiry" stated to be unable to make suggestions for improvements because they had not yet used the facilities)]

establishment of additional safe injection facilities - extension of opening hours

116/84%

improvement of atmosphere (enlarge the facilities / a "chill out" area to relax in etc.)

 

71/51%

mitigation of the atmosphere of control - especially: (abolition of the rule prohibiting access for people on methadone and prohibition of drug sharing)

27/20%

others

5/4%

Suggestions for improvements by interviewees primarily press for a quantitative improvement of services offered: People demand additional injection rooms offering extended opening hours. Nevertheless, when striving for optimisation of the services offered, we should also bear in mind that, after all, every second interviewee desired improvements in the atmosphere (design and decoration of rooms). Considering the intention of improving response within the target group, these suggestions should give rise to certain considerations, also applying to the suggestion for improvement relating to "mitigation of control atmosphere", which was mentioned by every fifth interviewee (20%). Above all, this context should give rise to reflect on an abolition of the rule prohibiting access for people in the methadone programme, because this prohibition is extremely doubtful. According to recent research findings the simultaneous consumption of other substances (also intravenous use) - especially at the beginning of a substitution therapy - is to be deemed a typical practice. Considering this typical development regarding substitution therapy recently presented in a differentiated "longitudinal study" (cf. RASCHKE 1994), this limitation of access should be subjected to a new intensive review since the logical consequence is an exclusion of a group of drug users from the safe injection rooms that contradicts the original intention of this service oriented towards a limitation of harm.
The question of requirements to be made for abandoning public drug consumption has been answered as follows:

Figure 38: Preconditions for a cessation of public drug consumption

(n=150)

'extension of safe injection facilities offered’

67/45%

'private flat’

32/21%

'changes in drug policy' (establishment of rooms where users are tolerated and/or substitution therapy based on administration of original substances and/or legalisation)

18/12%

'abstinence'

7/5%

'I do not consume in public'

26/17%

A majority of the people we interviewed (45%) is deeming the extension of safe injection facilities (density of service offered, opening hours) an absolute prerequisite for an abandonment of public drug consumption to a very high degree. Another conspicuous element being the fact that every fifth interviewee (21%) is mentioning a flat of his/her own to be an absolute essential, this phenomenon substantiating again the problem of homelessness within the open drug scene and the resultant pressure of urgent demand put on drug-aid services and institutions. A considerable percentage of persons interviewed (17%), people met, above all, within the scope of the injection room inquiry, stated to currently abstain from public drug consumption, every tenth interviewee requesting fundamental drug-political changes. The range of demands is being marked by corner points ranking between "establishment of tolerance rooms with free access" and "legalisation", requirements deemed to be prerequisite for abandonment of public drug consumption as well as a reduction of the phenomenon of "open drug scene" the public is exposed to and its negative consequences. Seven persons interviewed stated abstinence to be the only way to discontinue public drug consumption.

4.6 Partial evaluation "Safe injection room statistics"

In the preceding section, we dealt with current safe injection room practice in the perspective of the target group this harm reduction service implemented in Frankfurt drug-aid structure in the last nine month is aimed at. The analysis focuses essentially on two specific issues: To what extent do people make use of the service offered? And: Why do we observe public consumption to a considerable extent, in spite of the availability of consumption facilities offered; that’s to say, what group of consumers will possibly not be reached to the extent hoped for? To round off the picture of everyday practice in safe injection rooms, we now present an evaluation of daily statistics kept in services and institutions. In this respect, we refer to data gathered for the period from June to July, 1995. Considering the comparatively short period of observation, it becomes obvious, that the evaluation made cannot give more than a first impression of everyday practice.
Let us first present a brief summary of the three safe injection rooms that currently exist in Frankfurt (Data - in particular concerning opening hours - relates to the situation as of June - July, 1995).

"Druckraum Moselstrasse"

Run by: Integrative Drogenhilfe e.V. a.d. FH Frankfurt am Main

Location: Moselstrasse/main station district - located directly in the centre of the present main places where the open drug scene meets/facility in the vicinity of a contact café offering a different range of services (Café Fix)

Capacity: Eight consumption places

Opening hours: Mo 2.30 p.m. through 7.30 p.n.

Mo through Fri 4 p.m. through 9.20 p.m.

(weekly opening hours totalling 38.5)

Injection room at "Eastside"

Run by: Integrative Drogenhilfe e.V. a.d. FH Frankfurt am Main

Location: Schielestrasse/outskirts of the city - located in an industrial area at the periphery of Frankfurt (not to be reached on foot - the city has organised a specific shuttle service between this service facility and the main station district); this injection room is a part of an institution conceived as a point of contacts during the day, facility offering a diversified range of services ( among others, overnight accommodation)

Capacity: Eight consumption places

Opening hours: Mo through Sun 2.p.m. through 9 p.m.

weekly opening hours totalling 49

Injection room at "La Strada"

Run by: AIDS - Hilfe Frankfurt e.V.

Location: Mainzer Landstraße/located at the outskirts of the main station district - at a distance of about 500 meters from the main scene: this safe injection room has been conceived as a drug contact shop offering, among others, one overnight accommodation place

Capacity: Six consumption places

Opening hours: Mo 3 p.m. through 7.30 p.m. Thu 11 a.m. to 2 p.m.

Tue 9.30 a.m. through 2.30 p.m. Fri 9.30 a.m. through 2.30 p.m.

Wed 3 p.m. through 7.30 p.m. (weekly opening hours totalling 22),

These three service facilities are offering a total of 22 consumption places, weekly opening hours totalling 108,5. However, we have to bear in mind that only one facility is available on weekdays in the morning. In the morning (before 9 a.m.) and nights (after 9.30 p.m.) injection rooms are not available at all. These opening hours of Frankfurt injection room facilities don’t correspond with life on the open drug scene, considering, above all, the high part of homeless people (4.2.3); this structure corresponding partly to consumption patterns predominantly based on physical addiction. Thus, as already outlined in 4.5.4.1 and perceptible every day in the main station district, continuously intensive public drug consumption in the environment of the drug scene is not surprising at all. The following figure illustrates the intensity of use of injection rooms on the basis of situations of consumption and opening days/hours registered:

Figure 39: Intensity of using injection rooms /number of registered situations of consummations

(June - July 1995)

 

total number

weekly average

daily average

hour average

'Moselstraße'

6.614

760

108

20

'Eastside'

2.612

300

42

6

'La Strada'

1.383

159

38

9

Total

10.609

1.219

173

12

An overall view of these figures illustrates the fact that, although these services opened in Frankfurt only recently, safe injection rooms meet with large acceptance and apparently evoke vital interest and/or real need on the part of the open drug scene. In the period under review (two months only) observers registered a total of 10.609 injections made in these facilities ensuring both better hygienic conditions for consumption and immediate help in case of an overdose. Thus, the manifold risks connected especially with the consumption of illegal drugs could be dramatically reduced (by more than 10.000 injections). In addition, people did not inject in public, thus reducing public annoyance and - as laid down in a recent study - uncomfortable feelings of many people observing intravenous consumption in public (cf. in this context: RENN/LANGE 1995, page 42 ff).

Safe injection room services in Frankfurt am Main with an average number of 1.219 consummations per week these facilities have already reached a degree of care identical with that of the three Zurich safe injection rooms established in 1992; for 1994, officials have stated a number of 1.322 (SOZIALAMT STADT ZURICH 1995, 24) [The three safe injection rooms ("Gassenzimmer") existing in Zurich have a total capacity of 24 consumption places (the annual report 1995 did not mention precise opening hours for 1994)].

The percentage of female users of this user group amounts to about 25% (statistical data of people calling on the injection room Moselstrasse did not differentiate by sex) thus being identical with the percentage as shown in the study available (cf. 4.2.1). A summary of all institutions shows a total weekly number of consumptions approximating, without any significant deviations, to the average daily number as shown in the figure. However, as far as facilities like "Moselstrasse" and "Eastside' are concerned, the number of weekend consummations (Sat/Sun) is significantly lower - by 13% and/or 21% - than the number of consummations on working days.
During the period under review the number of drug-related emergency cases registered in the safe injection rooms totalled 24 (18 men, 6 women), having been overdose cases resulting in respiratory troubles and/or circulatory problems that made an intervention by service staff members as well as, for some cases (details are not available) consultation of a doctor (sometimes, also hospitalisation) necessary. When relating the number of emergency cases (24) to the total number of consummations registered (10.609), we have a complication rate of 0.2%: That’s to say, that two of one thousand injections were entailing complications. Compared to the complication rate of 0.2%, the report on experience made in connection with the Zurich "Gassenzimmer" project shows a complication rate of 0.05% for the period under review (1993/1994) (SOZIALAMT STADT ZÜRICH 1995, 25). This seems to be lower in absolute terms but has to be relativized as follows:

    • The present period under review (June/July) has been a time of rather detrimental weather conditions (high temperatures) that enhanced physical problems and the risk of an overdose.
    • Drug users consuming on the Frankfurt open drug scene are possibly in a worse physical condition, sometimes practising drug consumption patterns involving a higher risk of overdose.
    • It cannot be excluded that the Frankfurt drug market might be characterised by more significant variations of drug quality to increase the risk of an overdose.

Although comparisons with experience made in Zurich might be, for the time being, somewhat irritating, the complication rate of 0.2%, is to be deemed, nevertheless, comparatively low, since the risk of an overdose - a lethal development - increased disproportionately with increasing times preceding commencement of treatment. On account of the fact that the well-trained staff of safe injection rooms are able to offer almost immediate help, the risk of a lethal overdose is minimised - contrary to consumption in a public alleyway, in secluded backyards, in public lavatories etc
As illustrated in the aforementioned figure, there are clear differences regarding the average frequency rates of service and institutions existing. This different intensity of use being attributable, above all, to different distances of these facilities to the main places of the drug scene (at present, main station district). This phenomenon is also elucidated more clearly when we compare the degrees of utilisation of different facilities. Calculation of degrees of utilisation are based on the typical "ideal" assumption that consumption places are permanently occupied during all opening hours, an incident of consumption being estimated at an average of 20 minutes (that is to say we have three injections per hour and places of consumption) [Based on experience gathered in connection with three - year safe injection room practice in Zürich (cf. SOZIALAMT STADT ZÜRICH 1995,31)]. During the months of June/July, the degree of utilisation of Frankfurt safe injection rooms reached 52% (overall degree of utilisation) a value to be considered very high. Keeping in mind that people have been interviewed during the summer months, excellent weather conditions in this year give rise to assume that people tended or used to consume in public. We are to suppose that increasingly bad weather conditions (especially during winter months) are likely to result in a drastic increase in the degrees of utilisation. We should also not forget that this is an average value including (daily) fluctuation peaks. Thus, we must proceed on the assumption that, during rush hours, capacity limits use to be entirely reached. This applies above all to the "Druckraum Moselstrasse" which shows a degree of utilisation of 82%(!). Most probably, the high frequency rate of Moselstrasse, a rate that clearly exceeds the capacities in rush hours, is primarily due to the location in the direct vicinity of the scene. In comparison with this facility, injection rooms like "La Strada" (48%) and "Eastside"(25%) show a clearly lower degree of utilisation being unfavourably located (large distances to the open drug scene).
Possibly, a better utilisation of services offered might be achieved by shifting capacities/resources and improving synchronisation of opening hours (first approaches in this respect have already been made). But: Maximum capacity of the service structure offered so far totals about 2,400 injections weekly. On the other hand, 150 drug users interviewed (all interviewees) mention a total number of more than 3,000 public consummations last week (cf. 4.5.4.1). This number relating only to a small segment of the scene population is clearly exceeding capacities available at present (these capacities being, we remember, exhausted already to an extent of 52%).
Consequently, from the point of view that these measures are to realise health policy intentions aimed at shifting consumption from the "street" to safe injection rooms, an extension of the safe injection room services offered will be indispensable considering the present structure of the drug scene in Frankfurt an Main.

5. Summary

The present study had to be conducted in a rather short period of time (only three months from initiation/conception to presentation of the final report). Consequently it can only give an overview of the current structure of the Frankfurt open drug scene and - for the first time in the Federal Republic of Germany - an impression of this particular form of harm reduction policy in practice ("Safe injection rooms"/"Druckräume"). Altogether 150 drug users have been interviewed on the basis of a comprehensive questionnaire (face to face interview). 100 persons having been interviewed directly on the open scene (street, public places, etc.) (partial sample "Scene inquiry") and 50 in the three safe injection rooms currently provided in Frankfurt (partial sample "Injection room inquiry").
Although this sample cannot be deemed representative - a circumstance that is typical of drug research - we have, nevertheless, reason to assume that this sample has a comparatively high exemplary quality to illustrate the Frankfurt open drug scene in summer 1995 (cf. 3.3).

Description of samples based on biographical standard data (cf. 4.2)

Compared to former studies, the average age ascertained (30,6 years) indicates an increase within the "scene population". The percentage of women (25%) ranges within the scope of respective data produced by corresponding research projects. In general the educational level of our interviewees proved to be extremely poor. Unemployment seems to be a typical feature of the empirical reference field of the "open drug scene", only every tenth interviewee having a regular job. Considering the extremely high rate of homeless interviewees (46%), homelessness appears to be a phenomenon typical of the social environment of the open drug scene. The percentage of people currently registered with the Frankfurt police (63%) proved to be higher than that produced by former studies, which might be interpreted as an indication of tendencies towards a decline in the number of non-local consumers in the Frankfurt open drug scene.

"Development of the drug career - current drug use patterns" (cf. 4.3)

The absolute majority of people interviewed in the sample (62%) can be characterised as long-time users of "hard drugs" (cf. footnote 6), i.e. people who have been consuming hard drugs for at least ten years (though more or less continuously). These people have an average experience of hard drug use of almost 14 years. The respective average age relating to the use of specific substances as ascertained by this study range within the scope of other drug research projects. In the course of the analysis, indications of a decreasing importance of "classical scene drugs" (LSD, Speed, and crude opium) grew stronger. In contrast to this we observe an obvious increase in importance of cocaine and crack in the open drug scene. Ecstasy, (XTC), a drug associated with the Techno and rave scene, is apparently not meeting with any significant response within the open scene.
A synopsis proves the dominance of poly drug use and intravenous application. We met mostly with "habitual consumers of hard drugs" (89%, consuming heroin and/or other opiates and/or cocaine and/or crack every day or at least several times a week). Although heroin is still to be deemed the "No 1 drug" in the open scene, cocaine is also consumed very frequently and intensively and seems to rank, more and more, as "Co - No. 1". With regard to the partial samples "Scene inquiry" and "Injection room inquiry" we had to observe a central difference in tendency relating to specific consumption patterns: Whilst cocaine is being more intensively consumed by users we contacted directly on the scene, drug consumption patterns preferred by persons contacted in injection rooms are keyed to heroin. Shorter consumption intervals connected with habitual (daily) consumption of cocaine could be observed much more frequently in the partial sample "Scene inquiry". A generally "more spontaneous" consumption involves implications essential for the conception of injection room facilities.

"physical condition" (cf. 4.4)

We have to observe a generally bad physical condition of people consuming in the open drug scene. Only every tenth interviewee (11%) did not complain of any troubles in the preceding three months. On an average, people interviewed mentioned three different kinds of troubles (from toothache to complex clinical pictures relating to their AIDS status [liver diseases/hepatitis: 35%!]), while adding to have undergone (on an average twice) medical treatment ensured by medical staff - often within the scope of medical therapy service offered by Frankfurt drug-aid institutions. Bad physical conditions observed in general as well as a (comparatively) high HIV prevalence rate of 26% more than sufficiently give rise to call for an improvement of basic medical care aimed at harm reduction.
The absolute majority (65%) of drug users interviewed mentioned having experienced an overdose at least once. The complexity of drug emergency cases to be observed in the environment of the open drug scene demonstrates the many risks resulting from drugs bought on the black market.

covering cost of living and drugs needed" (cf. 4.5.1)

In current everyday practice the satisfaction of needs for drugs is the absolute financing priority. The expenditure for drugs exceeds the expenditure for covering the cost of living by about three times, average expenses for drugs amounting to approximately DM 111, - per day. This clearly falls below common opinions (shaped by mass media). Moreover, it is worth noting that a large part (44%) of drugs needed is purchased on a cashless basis, in exchange for services rendered within the scope of prostitution or drug-related "commercial activities" (establishment of contacts, providing "service" etc.). Acquisition patterns are mostly based on several sources of income, public welfare payments taking a central position and being completed by various other financing sources - both legal and illegal. It is rather conspicuous to observe that the partial sample "Scene inquiry" has shown that illegal sources of income (primarily: drug dealing) are being attached to a greater importance. This phenomenon implicitly insinuates a higher degree of social marginalisation of people directly contacted in the scene.
With regard to the practice of drug acquisition (cf. 4.52) it has been particularly surprising for us to note that development of heroin and cocaine prices and quality is a clear indication of keen competition in the heroin and cocaine market - an indirect indication of increasing importance of cocaine and resultant "adaptation to the market".

"Significance of the scene" (cf. 4.5.3)

The majority of interviewees attached central importance to the scene in everyday life - be it for its importance as an "informal job market" and/or social reference field and/or a place to acquire drugs or simply an expression of a deficit in alternatives regarding jobs and places to stay. Another rather conspicuous phenomenon was the quite mysterious nearness/distance relationship to the social environment of the open drug scene, as shown in the partial samples: In summary, the scene appears to be of (still) greater importance for those people directly interviewed in the drug scene.

Current intensity of contacts with drug aid/intensity of using the safe injection room service offered (cf. 4.5.4, 4.5.4.1)

At present, the absolute majority (88%) has been maintaining contacts with sundry drug-aid institutions and services in Frankfurt, preferring to make use of services oriented towards an acceptance of drug use and so called low threshold services (primarily: syringe exchange services, safe injection rooms, contact cafés, etc.). Substitution services offered enable daily contacts to be permanently maintained with the drug-aid system. We observed certain differences in tendencies depending on specific partial samples. Regarding the sample directly carried out on the scene there is an obvious tendency of pronounced reserve - although on a lower level - towards drug helping services.
As to safe injection room service offered, we observed that this service - although established only a short time ago - has apparently met with broad acceptance within the target group of IDU: 90% of these people having visited, until now, an injection room at least once, and 75% last week. On an average, our interviewees mentioned five to six consummations in a specific injection room (during the preceding week). Nevertheless, people interviewed still consume in public more frequently. The number of public consummations stated exceeds, by about four times, the number of injections made in safe injection rooms. Above all, the partial sample "Scene inquiry" has shown intensive public drug consumption, a phenomenon obviously attributable to the consumption patterns attributable to cocaine that are practised by consumers directly contacted in the scene. Such patterns are above all characterised by shorter consumption intervals.
When summarising observations made in connection with the intensity of use of drug-aid services and institutions, we have to recapitulate the following: Variability as well as complexity of contact motives mentioned and, above all, the rather high average contact intensity substantiate that the spectrum of different services offered by the local drug-aid system apparently meets with vital interests and requirements of the open drug scene. Most obviously, the increasing differentiation and intensification of the spectrum of services offered in recent years has produced a very high presence in the everyday life and "everyday consciousness" of the drug scene, this impression being supported by the answers of people interviewed.

Partial evaluation "Statistics of people calling on safe injection rooms"

The analysis of people calling on Frankfurt safe injection rooms for consuming purposes clearly shows that, already following a period of existence of approximately six months, the safe injection room service offered by the city is being used rather intensively. Capacities are entirely exhausted in "rush hours". The aforementioned analysis is based on an observation period of two months. Altogether more than 10.000 consummations have been registered within a period of 61 days only (June - July 1995). 24 of these consummations (two of one thousand, corresponding to a complication rate of 0.2%) resulted in an overdose. Nevertheless, further complications (above all, potential overdose with leads to death) could be avoided by medical treatment directly available in contrast with the danger potential in social seclusion (for instance, in backyards, public lavatories etc.). In this connection, we have to emphasise the fact that the intensity of utilisation of services and institutions seems to depend on their location, their distance to places where drug consumers use to stay.

Conclusions

When bundling the observations on the intensity of utilisation of safe injection rooms made in the overall study, we come to the imperative conclusion that any lasting relief of the public domain from public consumption might be expected only if we succeed in reducing the obvious disproportion of capacity available and existing demand for such capacities. In addition, there are clear indications suggesting the absolute necessity of specific rearrangements as regards contents and conceptions in order to achieve an improvement of the structure of service offered and (changing) forms of drug use (central catchword: homelessness), as regards the user group these approaches are focusing on.
When we consider new theories attaching decisive importance to the setting, to the social, local and physical environment, having an eye for effects of drugs (in particular, ZINBERG 1884; in summary: KEMMESIES 1995), we come to the conclusion that the structure of this range of services offered should also form a counterpole to the situation in public places. Developments we use to perceive as a spectrum of drug effects are mostly to be deemed phenomena reflecting the environment of the open drug scene, being characterised by restlessness attributable to compulsive feelings of prosecution as well as mistrust and the resultant forms of behaviour and interaction. Moreover, we must not forget the following, when envisaging further extension of injection room capacity offered: Drug use must not be deemed exclusively an approach aimed at compensation of a deficiency triggering withdrawal-related effects: When we intend to initiate a response as comprehensive as possible within the target group regarding the utilisation of this service offered, we should always consider the sensual and social components of drug consumption which are elements that should be included in any conception of helping services (see in this context: TRAUTMANN 1995, 218). Finally, let us summarise as follows: A conception oriented towards a harm reduction paradigm will not be realised without abstracting from the classical notion of a street junkie consuming heroin and being only perceived by applying the standardising screen of physical addiction. This notion fails to reflect "scene reality". Safe injection rooms in particular, as well as drug-aid services in general, need to be subject to permanent critical reviews in order to achieve an accuracy of adaptation commensurate with a ‘drug scene’ continuously changing which is also always to be deemed a socially constructed reality (cf. in this respect, i.e. LENSON 1995; SCHNEIDER 1996; KEMMESIES 1997).

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