Montana Journalism Abroad

With its funding reliant on political favor, the U.K.’s first supervised injection site must prove its worth to not just the local community, but the entire country

GLASGOW, U.K.–Martin first started using heroin at age 14. Now, at 43, he frequently uses cocaine. 

He would inject drugs in alleyways, parking lots and other corners across Glasgow. But on a cloudy day in late May, he’s lined up outside of The Thistle — the United Kingdom’s first supervised injection site.

It’s close to 9 a.m. In just a few minutes, The Thistle will open for the day, and Martin will be able to walk in and receive clean injecting equipment and a controlled environment to shoot up. Nurses will supervise him as he uses, monitoring him closely for indications of overdose.

The site is the latest effort to reduce the country’s stubbornly high rates of drug-related deaths, which are three times higher than the rest of the United Kingdom’s. But as a pilot program only made possible through a legal loophole, the pressure is on to prove the program’s worth, both to the local community and the nation at large. 

Critics of the experiment point to what they say is a large price tag and have also expressed concern that investment in a site like The Thistle means less support for drug rehabilitation. Local residents near the Glasgow injection site have also worried the service will draw more drug users and drug-related crime to their part of town.  

Experts in support of the site maintain it will decrease drug-related deaths, create a bridge to rehabilitation services and ease the economic strain of the drug problem. As the site passes the six-month mark since opening, it’s too early to determine success. But with parliamentary elections on the horizon for May 2026, The Thistle is not only mounting a war against drug deaths, it’s fighting to prove it should receive continued funding. 

As of April 2025, the site has had 246 total service users. According to the site’s supervisor, Lynn MacDonald, Glasgow has around 400 to 500 people who inject drugs in the city center. By the end of this day in mid-May, Martin will have visited the service multiple times to inject cocaine, a drug that more than half of users shoot up, according to MacDonald. At 9 p.m., when The Thistle closes for the day, Martin will go back to using drugs in dingy, hidden spaces. But for now, for part of his daily routine, he has somewhere he can go made for people like him.

‘Keeping people alive, first and foremost’

After nearly a decade of discussion, the site officially opened in January this year. The Thistle, named for the country’s national flower, costs the National Health Service of Scotland £2.3 million annually, about 1% of the country’s budget to battle drug and alcohol abuse. The process to open it was tenuous, requiring specific permission from the Scottish Lord Advocate and strict operating rules. But MacDonald and other advocates say the site is crucial for saving lives. 

In 2024, 1,130 Scottish people died from drug-related causes. Although it decreased by 5% from the year prior, the country of 5.5 million considers the situation a health crisis. 

The Thistle is intended to help both rein in the number of people dying and keep drug users from passing on infectious diseases. 

It’s designed to protect its clients. When Martin enters the using room, mirrors reflect back the eight injecting booths, each equipped with a needle disposal bucket and a lighter. The mirrors allow nurses to see users’ faces. Clean needles of different sizes are offered. A special device using near-infrared light illuminates veins so users can inject in safer spots of the body instead of high risk areas like the neck. 

When someone overdoses, nurses bring out a soft mat from a nearby closet to lie them on. Then, they deliver naloxone, a medication similar to narcan, to help reverse the effects of the drug. After a user is in a more stable state, they are sent to the hospital. 

Out of the more than 2,000 injections that have taken place on site, 30 have led to medical emergencies, typically overdoses, according to staff.

The using room also connects to a small space with a hospital bed, where users can be treated for common injuries from previous injections, including wounds and infections. Many users are also screened there for bloodborne diseases — one of the other factors that spurred support for the site after a 2017 outbreak of human immunodeficiency viruses (HIV) saw 10% of drug users in the Glasgow and Greater Clyde area diagnosed with the disease. 

For Martin, though, it’s not the medical aspects of the program that draw him in. “It’s somewhere quiet, somewhere warm. I can get something to eat, a warm cup of soup,” he says, as he sits outside the facility. 

But next to him, another user grumbles the service is “too clinical” and says he refuses to visit. 

The site has received criticism for its cost, which will total £7 million over three years, or around 9.2 million in U.S. dollars. Glasgow City Councillor Allan Casey is one advocate for the benefits provided for his city. While there’s no price tag for human lives, he insists the site saves Glasgow and the NHS money in emergency services, needle cleanup and treatment for bloodborne diseases, although he adds it’s hard to directly outline at this time how much savings the city will see. 

Casey was elected at age 27 and is a member of the more liberal Scottish National Party. His argument for The Thistle is simple, he says: “Harm reduction has a role in terms of providing that safe space, keeping people alive, first and foremost.”

Funding hangs by a thread 

The Scottish experiment may be novel in the U.K., but it is not a new idea. Supervised injection facilities started popping up in Europe in the 1980s and the United States opened its first site in 2021. While the U.S. has primarily run its sites through private funding, The Thistle is funded entirely by the Scottish National Health Service, meaning parliament could vote to stop footing the bill at any time. 

The site required specific permission from the Lord Advocate, head of the Scottish criminal justice system, to open this site only. If other areas across Scotland wanted to implement a similar facility, that would require either a change in legislation or specific permission from the Lord Advocate again. 

Casey says he doesn’t think funding being pulled is on the horizon, but “it would be wrong not to mark it down as a risk in the future.”

If the site stopped being paid for by parliament, Casey says the city would try to fund it, but with slim budgets, it would be difficult. 

The future of the program may hinge on what role the government sees for “harm reduction” in its drug policies. Historically, the United Kingdom has taken a harder line on drug use. Those against harm reduction, generally those in the U.K.’s Conservative Party, argue it enables drug use without addressing addiction and advocate for prioritizing rehabilitation and abstinence practices. 

The Scottish experiment is trying to make its case even as some countries are scaling back their harm reduction efforts. Recently, nine drug injection sites in Toronto closed after an Ontario law banned sites within 200 meters of a school or daycare. Like The Thistle, the injection sites in Ontario were funded through the government. 

The government stated safety and security concerns, especially for children, as reasons for the closures. The sites have been transitioned into homelessness and addiction recovery hubs and will receive about four times as much money as the injection sites did, according to the Canadian Press. 

The Ontario government already stated earlier this year that it will not allow new safe injection sites to open either, meaning once the current sites are shuttered, they will not be granted new licenses elsewhere. 

Currently, the Scottish National Party, which generally supports harm reduction policies, has the majority vote in parliament. But with the May elections next year, Casey, for one, worries the policy could turn into a campaign issue.

“There is a threat of this becoming one of these culture-war things. There’s a danger that could happen,” Casey says. “I hope it doesn’t and I really hope that we can demonstrate that it works.” 

Looking beyond the drug 

In the final room users visit before they leave the facility, warm lights and comfortable seating create a welcoming space. Two thistle flowers sit on the table. Here, users can hang out and eat, drink coffee or relax on the couches. 

It’s a room that speaks to the longer term goals of the service: to build trust with drug users and create a bridge between them and rehabilitation services. It is part of The Thistle’s mission that the site supervisor acknowledges is critical for the service to continue. 

“People were very clearly [not] interested in the benefits of the service when it came to the people using the service, but wanted to know how it was going to benefit their community,” says Lynn MacDonald, who’s been working in drug and alcohol services for the past 22 years. “You had to listen to some really challenging views, people who are not sympathetic towards people who use drugs. And some of the language, it was awful.” 

The local criticisms echo sentiments that have accompanied services catered to underserved people for decades, especially among those who live close to those services. Local residents worry the site is attracting more drug dealing and violence to the area and increasing drug use in their neighborhood. There is also frustration that the site is drawing attention away from the other streets in the impoverished neighborhood, which are also in need of clean up and support. 

The Thistle has been mounting a public relations campaign to ease anxieties by hosting frequent public forums and offering tours of the facility before it opens. Linda Watson was at several of these forums. She’s lived in the neighborhood around the site her entire life. She told the BBC that since The Thistle has opened, she’s seen more drug users congregating around the area. 

“[Drug users] are up and down my street now,” Watson says. 

Watson’s concerns reflect that of a larger national debate around clinics like The Thistle. Lester Morse, founder of Rehabs UK began working in the field in 1991 after going through recovery himself. Morse grew up with an alcoholic mother and a gambling father in a small town in England. At age 25, he could not read or write and was heavily addicted to drugs.

After fleeing court appearances by heading to Canada, he attended a support group and started recovery. He discovered a passion for helping other addicts and founded Rehabs UK, which helps users find detox services, addiction therapy and rehabilitation options.

Although he says he believes in some of the benefits of harm reduction, he thinks The Thistle is pulling money away from rehabilitation funding.

“Giving a safe space for people to shoot heroin and cocaine is probably going to help bring down the death rate, but it’s not going to solve the addiction problem, and it’s going to cause other problems,” Morse says. “How many of these people are surviving, or are you just keeping them alive for 10 more miserable years?”

Outside of the facility on a May morning, trash litters the sidewalks, but no needles are on the ground. Across the street is Morrisons, a local grocery. Near the entrance of the store, a man in a cast sits, slumping over. A small glasses case lying in front of him is filled with a few coins.

Paul Balarsky, hygiene manager of Morrisons since this March, says he has not seen an increase in needles in his short time there and has found only two in the parking lot. But a nearby security guard, who declined to give his name, says he has seen more drug users in the area since The Thistle opened, gesturing to the man outside.

With the site being so new, it’s impossible to gauge the long-term impacts it will have. But some research gives supporters hope. A 2022 study from the University of British Columbia found safe injection sites lowered rates of infection, as well as overdose and disease transmissions, without causing a significant increase of drug use or drug-related crime. It also found safe injection sites increased access to addiction services, although the Glasgow site has yet to refer anyone to rehabilitation or other recovery based services,  MacDonald says.

A larger evaluation of the site’s impact on drug-related deaths, addiction referral and local communities is currently taking place but will not be available to the public for another couple of years. But proving The Thistle can improve the lives of not only drug users, but those living near them will be crucial in the upcoming year. 

Before service users leave The Thistle, they pass through a door with the phrase “stay safe” written above it. So far, 246 drug users have passed through that door. Not all of them come back. But for some, such as Martin, seeing that phrase is proof they have survived another day. 

This story is part of a healthcare series produced by the International Reporting program at the University of Montana School of Journalism. Read more from this Scotland-based project, as well as reports from other countries, at Montana Journalism Abroad.