“A cup of coffee and a needle”: How a harm reduction café in Copenhagen quietly demonstrates an alternative to the war on drugs

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Behind the long counter of Café Dugnad, smells of spices and meat float out of industrial ovens. Light streams in through the glass doors of the smallish café, as loud hip-hop plays through the speakers. All day, someone hands out coffee and juice over the counter, and the café serves around 200 plates of food at lunch and dinner. At first sight, Café Dugnad has many of the markings of a regular café, one of many located in the chic neighborhood of Vesterbro, Copenhagen. Yet, upon closer inspection, things are not what they seem. Firstly, there is no cash register, no one taking payments. The guests at the tables are not speaking much, slumping instead on their chairs, often in a kind of daze. Most are disheveled and very skinny. And, behind the counter, a dozen or so boxes of syringes, measuring cups, and condoms, which are handed out to people upon request. Café Dugnad is a self-proclaimed “harm reduction café,” a space for people to do hard drugs (most commonly cocaine and heroin) in a sterile and supervised environment, whilst getting a healthy meal. In practice, this means that guests enter, pick up a meal, pick up a syringe, do their drugs, and walk out with no further questions asked.

Harm reduction is an approach that recognizes drug use as inevitable in society. The International Harm Reduction Association defines harm reduction as “practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption” (International Harm Reduction Association, 2010: 2). In this pragmatic understanding of drug use, helping the user becomes a question of lowering the risks associated with drug use, such as infection and overdose, in contrast to an abstinence approach, which aims to eliminate drug use altogether. Most of the guests at Café Dugnad are drug users, caught in the cyclical and often fatal loop of addiction. On my first day at the café (before I knew much about harm reduction) I asked Laura, the volunteer coordinator, how many users who come to Café Dugnad eventually stop using drugs? She sighed slightly, then told me in a kind and pragmatic tone: “barely any”. She continued: “there just aren’t many miracle stories. Once they come here, they are already in a very difficult place. So, we keep them alive, we keep them stable. That’s the best we can hope for.” Harm reductionists aim at preserving life, asking, as the staff at Dugnad did: what can we do so that you do drugs in the safest possible way? In many cases: what can we do to keep you alive?

To be clear: should a guest at the café ask Laura for help in getting “clean” she would naturally initiate for them to “move on in the system” i.e. direct the person towards therapists, social workers and rehab centers. Harm Reduction as practiced at Dugnad is not at odds with a recovery-based model and the staff were highly supportive of users who wished to take such steps. But the Café itself focuses on providing users with safe drug taking equipment and a place to relax and eat on their daily drug circuit. It is staffed by chefs and social workers, all of whom are trained in CPR and crisis management. Thereby the café also provides its patrons with supervision while they use, which mean that overdoses and other adverse reactions can be responded to swiftly.

About once a week, a guest overdoses in the café or its courtyard and the staff must quickly call an ambulance. The guests are generally thankful to have people observing them use. One guest in her 60s, with 30 years of drug use behind her, relayed to me the danger she had faced doing drugs at home and elsewhere in the city: “I overdosed in my bathroom once. Had it not been for the fact that I managed to throw up, I could’ve been dead. That’s why I always come to Dugnad to inject now, as long as there are people around, it can’t go too wrong”. For this guest, like many users, living with drugs is about survival, rather than rehabilitation. And, in terms of survival “harm reduction” has shown to be effective at more than an anecdotal level. The Danish government formally embraced the harm reduction approach in 2012 – by opening so-called “fixing rooms” (spaces in which users do drugs under the supervision of nurses) and endorsing other harm reduction spots like Dugnad. Since then, all 700 recipients of emergency overdose treatments in the fixing rooms have survived, and HIV and HCV infection rates have been in steady decline. The life expectancy for drug users has increased, and while drug overdose rates have soared globally in the last 10 years, Denmark’s have been stable during this period.

Dugnad is a global pioneer of harm reduction. The Café is in Vesterbro, a historically working class (now highly gentrified) area of Copenhagen, where drug use is prevalent. When psycho-active drugs arrived in Denmark in the 1970s, they permeated Vesterbro’s culture of heavy alcohol use. The Danish government responded to drug use with moral panic, much like other European countries at the time, and initially criminalized drugs and their users harshly. In Vesterbro, this meant a huge police deployment and targeted policies such as “Drug Policy 90” which designated certain zones in which drugs were “extra” illegal; in these zones, people found in possession of even a tiny amount of cocaine or heroin were harshly prosecuted. This war on drugs-style approach led unequivocally to less trust in police, less interaction with social services and a higher death rate in the drug user population in Denmark (Frantzen, 2005; Gadejuristen, 2010), proving what harm reduction advocates have been arguing for decades: that an omnipresence of antagonistic police always gives way to hasty fixes in dirty places with unsafe equipment.

In 2008, concerned by the precarity that the users of Vesterbro faced, a group of harm reduction activists opened Dugnad as a volunteer-run kitchen serving food to the “street folk” of Vesterbro. Then, as now, there were around 20,000 active hard drug users in Denmark, and around 2000 of these people frequented Vesterbro during their daily drug grind. Inevitably, the bathrooms of Dugnad soon became an unofficial “fixing room”, with the remarkable effect that the public drug scene around Vesterbrogade was almost totally depopulated overnight. This was much to the relief of newly gentrified Vesterbro’s now upper middleclass population of homeowners who were tired, as one reader letter in the national newspaper Politiken put it, of finding “syringes in their stairwells.”

By 2012, this unlikely alliance of harm reduction activists and middleclass homeowners had successfully lobbied Denmark’s newly elected moderate left government to change their policy on drug use altogether. A 2012 government policy report reads: “Denmark should learn from international experience and strengthen its harm reduction efforts.” In place of Drug Policy 90 a “decriminalized drug area” was established in Vesterbro, where possession of drugs for own use is not punishable. Local authorities started subsidizing Café Dugnad, turning the volunteer-funded project into a regulated institution under partial municipal governance[TG1] [JK2] . Radically, in 2016 the government also opened the world’s largest fixing room, H17, a mere 100 meters from Dugnad, where more than 5000 users are currently registered. Almost every year since, a new fixing room has opened in a small or large Danish city. The work started at Café Dugnad has profoundly changed how Danish society deals with drug users at both policy and social levels.

The harm reduction logic established by the founders of Dugnad and other local activists: that decriminalizing – rather than punishing – drug use creates more stable conditions for users and saves more lives has gained a place in Danish national policy. None of this concerned the guests and staff at Dugnad much on a daily basis. The latter’s focus is clear, short-term and cyclical: get the guests food, get them coffee, keep an eye on them. The staff at the Café are a colorful bunch of volunteers, chefs and social workers. A few have experience with hard drug use (like Lars, who is tasked with watering the plants of the yard). What mainly binds the staff is their activism, their cheeky pride in a still radical profession. In practice, I observed that the staff took a kind of laissez-faire, unbothered approach to drugs. Observing the busy yard, guests huddled eating and doing drugs, the Café’s manager, Nicolaj, told me matter-of-factly: “I’m not going to come and tell you to get off drugs. You have to want it. As long as you want to stand here smoking crack, we’ll accept it. We’ll cook for you and be your friend. We’re not going to come and tell you to do something else”. At Dugnad, not telling guests what’s best for them is a basic creed. Further, because of the café’s location within the novel decriminalized drug zone it helped shape, guests are awarded the dignity of not looking over their shoulder for the police, and staff the relief of not having to police guests. Instead, the atmosphere between staff and guests is jokey and familial. Throughout the day, guests smoke cigarettes and get each other coffee, listening to music and discussing various topics, sharing – if they please – their thoughts regarding drug use. The Café is, against what might be expected, cozy. 

What gives Dugnad this uniquely – to borrow a popular Danish term for cozy – “hyggelig” feel? Certainly the café’s privileged location in a decriminalized zone contributes to making guests feel comfortable. But there’s more to it. What makes Dugnad truly stand out from other harm reduction institutions is its deceptively humble aims: cooking for the users and, as Nikolaj put it, “being your friend”. I will explore how these two aims effect the experience of being a drug user at Café Dugnad below.  

Dugnad is, to my knowledge, the only harm reduction spot in the world that combines food and drugs in such an explicit way, wherein drug paraphernalia (known as “gear”) and meals are handed over in tandem. Here, food safety is actively enmeshed in more minimalist conceptualizations of harm reduction. Both the staff and the guests at Dugnad understand that the provision of drug gear not only ensures safer drug-taking; it’s also a way to provide users with a healthy meal. As Hamoud – a man who had been part of the Vesterbro drug scene for many years – told me over a big plate of lasagna: “If I have a place to take drugs and food is right there, sure, I’ll eat it”. For hard drug users, poor diet and malnourishment are prevalent consequences of a daily drug grind that rarely includes seeking out substantial meals. Like the very skinny Ashley, who told me she could never be bothered to steal food but “would always steal what was needed for a fix”.

Food and drugs are rarely connoted in the mind of a user, and even more rarely in societal discourses. Douglas has argued that “purity” and “pollution” are systems of classification that extend beyond notions of dirt and hygiene to become the basis of classifying groups in society writ large. Gould argues that partly due to the documented experiential opposition of the two, and partly due to social stigma, drugs and food are perceived as being on opposite ends of the spectrum. Food is considered nourishing, social, pure – contra drugs: toxic, lonely and polluting. Hard drugs pollute society. Drug users loitering the streets are their agential polluting figures.

Of course, this is not a natural state of affairs but a constructed one. As Annemarie Mol reminds us in her philosophical-ethnographic account of medical diagnoses in a Dutch hospital, reality does not precede practices but is constituted by them, thus as items are manipulated by various actors, reality can multiply (Mol, 2002). Her example is that of the ethnographic facts that must occur before atherosclerosis is diagnosed: a person must go to a doctor’s office, the doctor’s office must appear as a doctor’s office and attain the legal status of being a doctor’s office. All these pre-cursors must be in place before atherosclerosis can be diagnosed and come into the world, despite the fact that the pain suffered is experienced as pre-emptive by the patient. Similarly, the users at Dugnad were addicted before they arrived, yet their arrival implicated them in new ontological understandings of addiction. The ways in which the social facts surrounding any condition (ascleoperosis or addiction) are managed, naturally influence the diagnosis, the treatment – and, importantly, the experience of the patient or user, who reacts accordingly. Social phenomena are understood and created in these relational intercedes of things, so making drugs and food interchangeable fundamentally challenges the hierarchy of meaning that usually exists between them: it creates a new reality for the addict.

Every time a guest asks for a “cup of coffee and a needle”, a great gulf of value that usually exists between food and drugs is narrowed within the café. The staff were self-consciously punk about this: “drugs, food cigarettes. The way I see it, we’re not that different, we’re all addicted to something” Lars once stated. The guests at Dugnad, who usually find themselves excluded from societal ideals, are here represented by a place that caters to their most pressing needs: drug addiction and hunger. Their surroundings reflect them, and for once, their addicted bodies are not in dire contrast to the larger social body, to the norms of society.  While Denmark’s recent policies reflect changing cultural attitudes towards drug use, people who use them are still stigmatized and excluded. Dugnad offers a space of exception, a place where users feel accepted. One of the users commented on precisely this: “I feel less fucked up when I come here. It feels normal, you know, sitting down for a nice curry, even though people are still chatting shit and doing drugs”. As the symbolic normalcy of food seeped into addiction, the taboo label of “addict” loosened its suffocating grip. With a meal in front of them, and a brief respite from police aggression, “addicts” found a place with some elbow-room for other identities. A similar answer came up again and again when I asked guests why they liked coming to Dugnad. In Hamoud’s words: “well, I guess I feel like I can be myself here”.

Decriminalization, along with the pairing of food and gear discussed above, resulted in this third unique feature of Dugnad’s: offering a place where users could “be themselves.” Hamoud’s statement reveals a sense of relief and a feeling of ease drug users don’t often experience in their daily lives. For drug users, interactions with institutions that were not Café Dugnad usually involved either direct antagonism or self-conscious efforts to present themselves in particular ways in order to get what they needed from authorities and institutions. Summerson Carr (20100 demonstrates, in her metalinguistic examination of therapy at a U.S. clinic for alcoholics, how addiction is often rendered visible via a series of “signs” and “patterns” only recognizable by the sober, ensuring that the social and material benefits an addicted individual can hope to receive are all-dependent on the judgment of, for example, social workers. Ashley, a trans woman who frequented Dugnad, was involved almost constantly with various forms of local bureaucracy. Whether it was trying to check into a women’s (rather than a – for Ashley highly unsafe – men’s) shelter, trying to claim benefits, or trying to register for a legal sex change, Ashley was always constructing a certain narrative about herself in order to tactically please the specific gatekeepers of these various, complex systems and institutions. Ashley’s fate depends quite literally on what she tells the social worker, how she narratively formulates her gender or drug use. Ashley experienced interactions with social workers as a relentless assessment of her personality, her sobriety, the success or failure of her “journey.” According to Ashley, her social worker was “always judging me and telling me what to do.” Preparing a joint in the Cafés courtyard, Ashley laughed and added: “I just tell her whatever the fuck she wants to hear.” The guests at Dugnad almost all had an affiliated social worker. They were well-versed in the tiresome routine of what Carr terms “flipping the script”: re-ordering the narrative of their addiction to placate state figures; casting themselves as good candidates for various social benefits.

Dugnad offered a space wherein flipping the script in this way wasn’t necessary. The fact that the extent of Dugnad’s powers of distribution were limited to no-strings-attached food meant that Ashley’s words there held no gravitas. Like Hamoud, she liked coming to Dugnad because she could talk about “whatever I want.” The open-endedness of being able to discuss “whatever one wants” without consequence, enabled users to verbalize less neat and chronological narratives about themselves at the Café. I once spent a whole day with a user named Dennis discussing the spiritual and personal consequences of addiction: “drugs don’t only affect the mind, they affect the ego and the self. That’s why I have to quit” he told me. The next day, he was sat on the selfsame bench smoking crack and getting into a row about drug-money. This kind of back and forth is common at Dugnad. Addicts are often working through multiple versions of themselves at any given time, picturing a sober future even whilst preparing a syringe. Dugnad had nothing to offer Dennis beyond food, so he had no stake in euphemizing his narrative.

Dugnad concretely gave Dennis a space and time to reflect without fear of persecution. It is hard, when pursued by police and in search of the next fix, to think more than a few hours ahead. Lenhard (2018) observes that drug addiction on the streets of Paris imposes an intensely structured regime of hustling, injecting and hiding from the police, what he titles “drug time”. Hunger doesn’t exactly warrant peace of mind, either. As George Orwell put it in a 1931 essay on London’s homeless population: “their next meal is never secure, so they cannot think of anything but their next meal”. Often, when caught in “drug time” everything else is “subordinated” (Bourgois & Schonberg, 2009) to drugs and moments of peace and reflection are rare. As Dennis told me, his days are usually distinguished by the acquisition and consumption of drugs: his levels of abstinence and money quite literally determine whether he leaves his flat. In contrast, when I first met Dennis he was positioned briefly outside this “drug time”; considering both his current reality and his future hopes. 

Dennis, when at Dugnad, could engage in “the simultaneous nurturing of multiple and mutually exclusive life plots” and thereby foster and attend to what Cheryl Mattingly (2014) terms “multiple ethical selves”. Mattingly shows how these experimentations with the ethical self often take place in certain spaces, places and moments: spaces with particular moral properties that differ significantly from those in the outside world, and which thus sanction the small gestures of virtue and reflection through which an ethical self is formed. She calls these “moral laboratories.” Dugnad can be seen as such a “moral laboratory”: it is institutionally and ethically different from the outside world and thereby provides opportunity to create new forms of self-stylized morality through small acts (sharing food, getting coffee for staff, chatting openly about drugs). As the users expressed, they felt most at ease when openly musing and joking, most respected and sometimes the most hopeful for a drug-free future. It is clear that the point at Dugnad is not whether this drug-free future is realized, but that it can be imagined, even briefly lived, as drugs cede to food and sociality in glimpses. What we now know of recovery from addiction shows that it is not the linear process which we have so long idealized. It is often a sporadic, fragmented one, starting over many times and with motivation arriving in bursts or not at all. Apart from contributing to the more obvious benefits of longer life-spans and better diets for the drug users of Vesterbro, it is Dugnad’s pursual of a form of harm reduction in which users can enjoy a semblance of peace, reflection and hygge – amidst the tumult of addiction – that truly ensures its status as a (still) visionary project.

Johanna Kinnock (she/her) is an anthropology and politics graduate from Cambridge University. Currently working as a freelance journalist and studying a masters in modern culture at Copenhagen University. Twitter: @Johannakinnock

Works Cited

International Harm Reduction Association. (2010). What is harm reduction? (Vol. 44). London. 

Gadejuristen. (2012). Forbudszone er nu fortid! Retrieved from http://www.gadejuristen.dk/forbudszonerne-er-nu-fortid 

Douglas, M. (1966). Purity and Danger. London: Routledge. 

Gould, A. (1994). Debate Pollution rituals in Sweden: the pursuit of a drug‐free society. Scandinavian Journal of Social Welfare3(2), 85–93.  

Mol, A. (2002). The Body Multiple. (B. H. Smith & E. R. Weintraub, Eds.). Durham: Duke University Press.  

Carr, E. S. (2011). Scripting Addiction: the Politics of Therapeutic Talk and American Sobriety. Philadelphia: Princeton University Press. 

Lenhard, J. F. (2018). Making better lives – home making among homeless people in Paris. Cambridge. 

Bourgois, P. I., & Schonberg, J. (2009). Righteous dopefiend. Durham, North Carolina: University of California Press. 

Mattingly, C. (2014). Moral Laboratories – Family Peril and the Struggle for A Good Life. Oakland: University of California Press

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