SHOOTING UP CAN BE A CLEAN DEAL.

"Emergency!", shouts Gil Bietmann across the hallway of INDRO, the drugs support organisation in Münster. All of the staff drop what they are doing and run into the injection room of the establishment: bright tiled walls, shiny metal tables. Bernd* is lying on the floor, his lips have turned blue, his eyes are closed, he has stopped breathing. The man of about 60 has just given himself a shot of heroin. It was stronger than expected.

Fortunately for Bernd, he injected himself with the drug at INDRO, Gil Bietman was in the room and he was watching what was going on. The pulse oximeter, a thick plastic clip that Bietmann has fixed to Bernd's index finger, is now going "beep – beep – beep": the regular sound indicates that Bernd's heart is beating normally, but the effect of the drug has paralysed his respiratory muscles. There is a risk that Bernd will suffocate.

"IT'S A GOOD FEELING WHEN SOMEONE CAN STAND ON THEIR OWN TWO FEET AGAIN"

One of Gil Bietmann's colleagues has called the emergency doctor, but he has warned that it could take some time. There has been a serious traffic accident, all of the ambulances are in use. "I need three people", Gil Bietmann decides, "we can alternate with the resuscitation."

Bietmann knows what to do, he worked as a paramedic for a long time. What happens next is familiar to anyone who has completed a first aid course: Bietmann presses a resuscitation bag over Bernd's nose and mouth and breathes for the lifeless man. "In a drugs emergency, we do this until our clients can breathe again on their own", explains Bietmann.  This is no easy task in Bernd's case. It takes 15 minutes before the sirens herald the arrival of the ambulance.

Bernd's collapse dates back ten years, but he is "still firmly stuck in my memory", as Gil Bietmann puts it. Now the 39-year-old social education worker is leading the drug support organisation Kick in the Aids support service in Dortmund. Here, too, there are about 20 serious drugs emergencies every year.

"The risk is difficult to assess", says Bietmann. "Although people tell us what they have bought, all we see is white powder or grey powder." That's why it is essential that the addicts are not alone when they inject themselves with the dangerous substances. "We often prevent anything worse from happening because there is always a member of staff in the drug injection room with the clients", says Bietmann. "We resuscitate 40 to 50 percent of people with our methods, the others have to go to hospital."

In most situations, the teams in the injection rooms can intervene much earlier: they recommend to their clients to filter the drugs Advise them to inhale rather than inject. Anyone who still wants to inject is given a sterile syringe set at cost price. Nobody has to rely on used needles – which can pass on HIV and hepatitis C.

STERILE SYRINGES PREVENT INFECTION WITH HIV AND HEPATITIS C

"One thing is crucial in drugs support work", Gil Bietmann stresses: "You must set yourself small targets! If people insist on taking drugs, we help them to keep the damage to their health within limits."

Since 2000, it has been legal to set up drug injection rooms in Germany and the number of drugs-related deaths has halved in that time. Nevertheless, most of Germany's regions still do not have such life-saving organisations (see box).

Bernd has survived, too, although his life has often been in the balance. He has been taking illegal drugs for over 30 years, lives with HIV and hepatitis C. When he was able to leave hospital after his collapse, he often visited Gil Bietmann at INDRO. "It's always a great experience for me when people recover from an emergency situation", says Bietmann. "It's a good feeling when the person is no longer down and out but can stand on their won two feet again."

At the same time, meeting again was a good excuse for a chat. "Bernd wanted to know: what went wrong? How did it happen? We were able to reflect on that together because we had shared the experience. That's why drug injection rooms make sense: you can discuss calmly what might help – that doesn't work out on the street!"

Philip Eicker

*Name changed