27 May 2011 Source: Sydney Morning Herald

Author: Marianne Jauncey is a public health physician, and is the Medical Director of the Sydney Medically Supervised Injecting Centre, Australia’s only such facility.


It’s been an interesting month in the world of medically supervised injecting facilities. In Melbourne last week Yarra City Council voted to urge the Victorian state government to consider the opening of one in the inner city suburb of Richmond. In Sydney, the Medically Supervised Injecting Centre had its 10th birthday.

And in Canada, where a “sister” service operates in Vancouver, the Supreme Court began deliberating on whether it is the federal government or the provinces that has the right to run the facility.

While the establishment and continuing operation of supervised injecting facilitiesaround the world continues to be contentious, the evidence is clear and irrefutable for their benefits.

They reduce not only deaths but injuries associated with drug overdose. They reduce ambulance call-outs and hospital admissions. They get drug injecting off the streets and into a health service. They improve the safety and amenity of the local neighbourhood and they make contact with a marginalised group of people who generally have a long history of addiction.

Supervised injecting facilities refer these people into care and treatment services, often for the first time in their lives, and they operate in a cost-effective manner without significant negative consequences.

The supervised injecting facility in Sydney operates under the auspices of UnitingCareNSW.ACT and is now one of 91 such facilities around the world. Given it began operating exactly a decade ago, it is timely to reflect on 10 years’ worth of achievements. There have been 3,936 drug overdoses successfully treated onsite without a single fatality.

The centre supervises an average of 180 visits a day, and makes contact with about 10 new people each week. There have been just over 9000 referrals accepted by clients, half of which were into services that specialise in the treatment of addiction.

There has been an 80 per cent reduction in the number of ambulances called to drug overdoses in Kings Cross and a halving in the number of publicly discarded syringes.

During this time support for the supervised injecting facility in Sydney has increased.

A random sample of businesses in the local area before the service opened showed 58 per cent were in favour. This random survey was repeated last year, and now 70 per cent of local businesses support the service, along with nearly 80 per cent of local residents.

Those who live and work in the area have seen the positive changes since the service opened. Four independent reports from the NSW Bureau of Crime Statistics and Research have confirmed that the centre has no impact on drug related crime – indeed, crime in general has reduced in the area since 2001. The Sydney facility is wholly funded from the confiscated proceeds of crime, and economic analyses show the service saves more money than it costs.

NSW Police and the Kings Cross Local Area Command continue to support the operation of the Medically Supervised Injecting Centre. The new Liberal National state government in NSW has committed its ongoing support for the facility.

And the service has the backing of all relevant Australasian medical colleges, as well as national and international scientific research centres.

Opponents, such as some in the Victorian state government, argue such centres send the message that drug use is accepted or acceptable, and will be normalised as a result. The simple reality is that drug use happens. A supervised injecting centre no more normalises drug use than emergency departments normalise car accidents

Each needs to exist to make the best of a bad situation.

Some will say people who choose to use drugs do not deserve taxpayer-funded assistance. But many of those in our society who are addicted to illicit drugs are from underprivileged backgrounds. Many have lower levels of access to education, have mental health issues and are homeless.

In these circumstances drug addiction is not a simple choice. As a low threshhold health service the Sydney centre sees such people every day. Staff work with these vulnerable people, they uphold their human dignity and they reach out to offer help without judgment.

Despite the best efforts of society, drug use and drug addiction are a reality. We cannot pretend otherwise.

The other reality is that life is inherently precious.

A medically supervised injecting centre is a pragmatic and compassionate response to keep people alive and as healthy as possible until an opportunity can be reached for them to make a change.

Australia showed great leadership some 25 odd years ago, grappling with difficult and uncomfortable health issues such as HIV, and responding with a common sense, practical approach.

Australia’s national harm minimisation response has been heralded around the world as a clear success. Good public policy should always be based on good evidence.

And leadership is having the courage to act on that evidence.