Supervised injecting rooms: an alternative approach to the war on drugs

When Ms A, a 34-year-old mother of two, fatally overdosed on heroin in the bathroom of a Richmond Hungry Jack’s restaurant, Victorian coroner Jacqui Hawkins saw a need for change.

As part of the Coroner’s prevention function, one recommendation made in Hawkins’s report on Ms A’s death was to trial a supervised injecting room in North Richmond – an “essential intervention” that could save lives.

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What is a supervised injecting room?

A supervised injecting room, also known as a safe injecting room or drug consumption room, is a centre designed to allow drug users to be able to inject their drugs under clinical supervision.

These rooms generally feature clean and safe injecting equipment for users, with medically trained staff on site to assist in the event of an overdose. Staff members also educate drug users on safe injecting practices and the risks of injecting.

Additionally, these facilities are linked to support networks, including a variety of health and social supports, which provide drug users with direct and immediate referral pathways to assist with drug addiction and associated health issues.

The first supervised injecting room was established more than 30 years ago in Switzerland. There are currently about 90 supervised injecting centres worldwide, with Ireland the latest European nation to receive Cabinet approval that will introduce and legalise these facilities.

 

Do they actually work?

Studies from existing centres demonstrate that these centres have a positive impact on the reduction of death by overdose.

The only centre that currently exists in Australia is the Medically Supervised Injecting Room in Kings Cross, Sydney. In the 10 years that this centre has been operating, it has seen no fatalities, has lowered the average number of overdoses in public locations near the centre, and has reduced ambulance call outs to the Kings Cross area by 80 per cent.

In fact, this facility has successfully managed more than 4400 drug overdoses without a single fatality, and has seen 8508 accepted referrals for drug dependence and other healthcare needs. The overwhelming success of this centre led it to receiving the tick of approval by both sides of politics to continue operating indefinitely.

In 2015, the City of Yarra was linked to 35 of 172 fatal heroin overdoses in Victoria, with drug-related deaths either taking place in the area, or fatal overdoses suspected to have been linked to drugs purchased in the City. This suggests that an injecting room in the City of Yarra, an area well known for drug use, would be an appropriate response to help minimise the number of fatal drug overdoses in Victoria.

Furthermore, there is no research to suggest that supervised injecting centres attract more drug users or dealers to the area. They also do not appear to increase drug use or result in higher rates of drug-related crime. Take the Sydney centre for example. From its 2001 opening, the Australian Bureau of Statistics showed no increase in crime in the surrounding area for three years in a row.

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Is it legal?

In order for the trial to work, there must be legislation passed to protect drug users from prosecution for being in possession of, and using, small quantities of illegal substances in or around the centre. This would involve police discretion when patrolling the area, similar to the discretion currently seen around needle exchange facilities.

Safe injecting centre staff members would also need to be exempt from criminal and civil liability around their awareness of the drug use. Such exemptions have successfully been seen around the Kings Cross centre in the Drug Misuse and Trafficking Amendment (Medically Supervised Injecting Centre) Act 2010 (NSW).

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What about the public?

Strong local community support was a big factor in the introduction of the Kings Cross centre, and community support has increased over time.

The City of Yarra Council has backed the North Richmond trial, and whilst community input regarding the proposed trial is still being sourced, locals recognise that there is a problem with drug use in the area, and support for the trial has grown.

So, with a coroner’s expert recommendation, a community in need of a solution, evidence of effectiveness, and legal avenues to facilitate the implementation of a supervised injecting centre, what’s the problem? Why is Australia resistant to the implementation of safe injecting rooms?

It comes down to the politics.

Despite sentiments that “no-one wants to see a family member or a friend suffer the horrors of addiction”, Victorian Health Minister Martin Foley has stated that there are “no plans” to introduce a trial.

Victorian Shadow Minister for Mental Health Emma Kealy has proposed that increasing police presence is the answer to the current overdose crisis, suggesting that a government decriminalising drug use sends “the wrong message to users”.

Sex Party leader Fiona Patten strongly supports the recommendation, having introduced a private member’s bill before Parliament proposing an 18-month trial of this facility. According to Patten, the Coroner’s report is “measured” and strongly backed by the medical and health community, and to ignore it would be “beyond the pale”.

In fact, having seen the positive effects of the Kings Cross centre in action, Jeff Kennett, who once opposed these facilities, is now a strong advocate for the introduction of a Victorian centre.

This political debate demonstrates a clash between the criminal “war on drugs” approach, and the harm-minimisation public health approach.

Since the release of the report, the Victorian Government has agreed to an inquiry into drug law reform, which will look at the evidence behind the proposed injecting room.

Will the proposed trial go ahead? Perhaps with so much evidence to support the positive impact of supervised injecting rooms, the better question for the government to address is what are we waiting for?

The views and opinions expressed in this article are those of the author and do not necessarily represent those of the Doctus Project.