Right: Councils have received complaints of discarded needles in places like parks and playgrounds, where some injuries to children have been recorded.
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Arguments in favour of injecting rooms in built-up areas
1. Injecting rooms in built-up areas reduce the drug-related pollution and public drug-taking witnessed by residents
Supporters of medically supervised injecting centres (MSICs) argue that they do not bring addicts into an area. Rather, they claim, injecting facilities are only set up where there is a significant pre-existing drug culture. They further argue that these centres serve to reduce the community's distress at public drug-taking and the visible pollution associated with drug use on the streets of the affected area.
It is claimed that injecting rooms are established to address an already established problem, that is, they are set up to assist large numbers of drug users in an area where they already congregate. Prior to the establishment of the North Richmond facility, the Victorian corner had twice drawn attention to the need for a medically supervised injecting room (MSIR) in that vicinity. 34 people had died of drug overdoses in a four-block area near Victoria Street in one 12-month period.
This area overlaps the location where the Richmond MSIR is now situated. The medically supervised service is currently run at North Richmond Community Health, which was already handing out a million syringes every month before the MSIR was set up. Prior to the establishment of the Richmond facility, the Australian Alcohol and Drug Foundation argued, 'The supervised injecting centre will reduce the discarded needles in the [school] playground, it will reduce the likelihood of primary school children being exposed to drug using, it will reduce the open drug using scene. This is based on fact. There are over 220 peer review papers that show facilities like this work.'
Where drug-taking is not monitored it is claimed it is likely to have a larger impact on local communities. An Occasional Paper tabled in the Victorian Parliament in March 2000, titled 'Safe Injecting Facilities' stated, 'Street-level use is typified by users making quick, small purchases of heroin or cocaine...and then consuming the drug very soon after, and very close to the point of purchase - often in close-by streets, secluded laneways, or public toilet facilities. In Smith St. Collingwood, for instance, 68 percent of syringes collected from syringe disposal bins are collected from bins in public toilets. Once the Richmond facility had been set up, its supporters have claimed that it has succeeded in reducing some of the drug-related pollution the community faced because of drug-taking in the area. James Merlino, the acting Victorian premier and Minister for Education, has noted that the school situated next to the injecting room has reported significant improvements since the room was set up. Mr Merlino has stated, 'The advice from the school community and the principal is that the number of syringes found in the area has significantly decreased since the time of the medically supervised injecting room - there's [less] drug paraphernalia and fewer incidents of anti-social behaviour.'
It has been noted that ,medically supervised injection centres(MSICs) spare the community the distress of seeing users inject in public places. A review of the Kings Cross MSIC noted '49 percent (of those who used the facility) indicated that they would have injected in public had they not been able to access the Sydney MSIC on the day of registration. Based on these data an estimated 191,673 public injections were averted by the presence of the MSIC.' Anne-Maree Kaser, chief executive officer of Windana, a St Kilda based organisation that works with people to assist them in recovering from a dependency on drugs or alcohol has similarly pointed to what she claims are the benefits that have been gained from establishing a supervised injecting centre in North Richmond. Ms Kaser stated, 'You see the amenity of the local community improve. Less needles and syringes, fewer ambulance call outs. Spend any time in St Kilda and you'll hear the constant wailing of sirens. We should expect to see far fewer people experience harm and die [if a facility were established in St Kilda].'
Other defenders of the North Richmond injecting facilities argue that claims the centre has made the community less safe and more polluted are inaccurate. 86-year-old Katrin Ogilvy, who has lived in York Street for 42 years has stated, 'The stories that as an old person you can't go down Lennox Street without getting into deep trouble is not true.'
Another Richmond resident, Karen Hovenga, has indicated that she used to watch a procession of drug users come into her front yard every morning to use her garden tap for water to shoot up heroin. However, she has claimed that this stopped abruptly when the safe injecting room opened in June 2018 about 100 metres from her home in Smith Street. She has stated, 'There hasn't been a syringe in my front yard since the centre opened. I often feel like I am living in a different neighbourhood to people who talk negatively, who talk about terrible things.' The Kings Cross injecting facility appears to be part of a scheme which works systematically to reduce the impact of drug-related pollution on local communities. A primary health care service in Kings Cross, provides a Needle Clean Up service which collects discarded needles and syringes in Eastern Sydney and Darlinghurst, Kings Cross and Woolloomooloo on weekdays. A designated worker collects any injecting equipment discarded in public locations identified as "hot spots", which are monitored and adjusted when patterns of public injecting change. Most hot spots are located within a 500-metre radius of the Sydney MSIC. The worker also responds to calls from the public to the New South Wales Needle Clean Up Hotline.
2. Injecting rooms in built-up areas reduce the drug-related dangers faced by residents
Supporters of medically supervised injecting centres (MSICs) claim that these facilities make the local community safer - reducing the risk of needle stick injuries and violent anti-social behaviour sometimes associated with drug taking.
It has been noted that some of the behaviour associated with drug-taking, such as the careless disposal of used syringes, poses as significant risk for local communities which supervised injecting facilities can help to reduce. It has been claimed, for example, that the pre-existing drug problem in North Richmond created major public safety issues for the inhabitants of this area. Victorian state coroner, Sara Hinchley, told a parliamentary inquiry in June 2017 that the extent of unmonitored drug use in North Richmond placed the rest of the community at risk. She gave the example of a Richmond toddler who was stabbed by a needle that had been left in the tanbark at his childcare centre. The coroner stated, 'That was a very disturbing incident for his family and an example of why it is not just something that should be looked at as an aesthetic issue, but also as a health-related issue for those who are exposed to the debris associated with injecting drug use.'
Paramedics and others seeking to assist drug users suffering an overdose in an unsupervised street environment have been said to be placed at similar risk. In October 2017, a paramedic treating an unconscious heroin patient on a street in South Yarra received a needlestick injury to her finger while lifting the patient. The hospital to which he was taken later confirmed the patient was HIV+ and had Hepatitis C and there were fears the paramedic may have been infected. Those seeking a second supervised injecting centre in Melbourne saw this incident as evidence of the need, arguing that drug taking not only affects users but also the communities within which they live and the paramedics who are first on the scene to treat overdose patients.
Injecting facilities with properly organised and staffed clean up services have been claimed to be an important means of reducing the risk associated with needlestick injuries, such as contracting AIDS or hepatitis C. A 2017 submission from the Victorian AIDS Council to an Inquiry into Medically Supervising Injecting Centres noted, 'At the Sydney [Medically Supervised Injecting] site, where a nearby health service provides a needle clean-up service, the number of needles collected within 500 metres of the MSIC has decreased by almost 50 per cent since the establishment of the centre. This results in an improvement in the public amenity in the area, and a reduction in the risk of needlestick injuries and potential exposure to BBVs (blood borne viruses).'
It has been further claimed that the anti-social behaviours of some drug users are better handled by staff at a supervised injecting centre than they are occurring on the street where members of the public might be endangered. A review of the Kings Cross injecting facilities conducted six years after it had begun operation found that there had been '36 behavioural issues requiring removal from the premises; 62 acts involving violence/harassment; four acts of vandalism/theft and 141 other episodes noted by staff as "adverse events.'
Supporters of the service argue that without it all these 'events' would have occurred in an unsupervised and so more dangerous manner on the streets of Kings Cross. A closer look at the operation of the Kings Cross Centre shows that it has been particularly effective at reducing the risks to the public associated with the use of crystal methamphetamine. An article published in The Australian on April 20, 2018, noted, 'Despite meth injections [at the Kings Cross facility] having soared from a monthly rate of 268 in January 2012 to 1212 in June 2017, rates of abuse and aggression are trending down. In the 10 months to June 2017 there were eight cases of abuse or aggression at the Sydney facility. In four months, there was nothing. So, the injection use soars, and the incidents fall in trend terms.' A article published by the Australian Alcohol and Drug Foundation on April 22, 2018, suggests that supervised injecting centres, because of the regulated environment that they provide, contribute to a reduction in the violence often associated with the use of methamphetamines. It stated, 'The very nature of the [Kings Cross] centre allows for the drug user to remain in the centre in a calm, safe space post injection.' 3. Injecting rooms save the lives of drug takers
Supporters of medically supervised injecting centres (MSICs) argue that their primary function is to save the lives of drug users by helping them to recover from overdoses and by linking them to medical services which can help them with health issues such as hepatitis and also help them to recover from addiction.
Supporters of supervised injecting centres stress their importance in saving the lives of drug users. After the North Richmond injecting room was opened in 2018, a government spokesperson stated, 'The medically supervised injecting room was established to save lives and reduce the harm caused by drugs - which is exactly what the data shows it's doing.'
In November 2018, four months into the operation of the medically supervised injection room (MSIR) in North Richmond, it was claimed to have saved the lives of many of its clients. Dr Nico Clark, Medical Director of the safe-injecting room, stated, 'We [have] had 18,800 visits; more than 1,500 separate people have come through. We've had 321 overdoses in the first four months, 61 of which required naloxone. We have needed to call an ambulance for only five of those...' Dr Clark further suggested that had the Richmond centre not been open many of the hundreds of overdose victims may have died. He stated, 'If there had been no room the last four months, that would have been another 20,000 injections that would have taken place elsewhere. We know there are approximately 20 fatal opiate overdoses a year in Richmond, and [we don't want] to take the chance that somebody would find them.
These positive results have continued through the centre's first nine months and then its first year and a half of operation. In June 2019, Reason Party MLC Fiona Patten, detailed some of the life-saving interventions made by the Richmond injecting centre during nine months of operation. She noted that the centre had managed more than 1,130 overdoses - an average of three a day. The staff at the injecting centre had carried out more than 3,300 health and social support interventions. More than 250 people had started opioid replacement treatment or had been referred to other forms of drug and alcohol treatment, while 40 had entered treatment for hepatitis. Ambulance data from February 2019 for callouts for North Richmond, revealed that callouts halved when the injecting centre was open. The results of an independent review of the centre's effectiveness found that after 18 months of work, the medically supervised injecting room in North Richmond had safely managed 3,200 overdoses over 119,000 visits and saved at least 21 lives. The report also found that the North Richmond facility is the busiest supervised injecting room in Australia, with 4,350 clients registering since it opened.
The Kings Cross injecting facility has revealed a similar record of success in saving the lives of drug users. When it was reviewed in 2003, two years after it began operation, the Kings Cross facility was found to have treated more than 500 drug overdoses without a fatality.
Nineteen years after the Kings Cross centre had opened in 2001, the Australian Alcohol and Drug Foundation noted there had been 'more than 1 million injections supervised and more than 8500 overdoses managed without a single fatality.' The ADF noted similar success with overseas facilities. Regarding the medically supervised centre that opened in Vancouver in 2003, the ADF noted, 'In operation since 2003, evaluations have demonstrated that this MSIC led to a 35 percent reduction in fatal overdoses in nearby areas.' A 2014 review of 75 studies examining the effectiveness of supervised injection centres found that as of the year of publication, no death had been reported at an injection site and overdoses had been reduced. Supporters of supervised injecting rooms argue that the lives they save should mean that their work is above politics and is supported by governments of all political persuasions. Referring specifically to the injecting centre in North Richmond, Dr Clark noted, 'I'd like to think that whatever government is formed after the [next] election, once it realises the benefits of the service, will certainly continue to trial it.' The same view has been expressed by Dr Cameron Loy, the chair of the Royal Australian College of General Practitioners, Victoria. Dr Cameron has stated, 'The people dying from overdose in North Richmond were sons, daughters, brothers, parents, friends. Closing the safe injecting room places vulnerable Victorians at risk.'
4. Injecting rooms can assist drug takers to improve their health and overcome their addictions
Supporters of injecting facilities in built-up areas where drug takers gather argue that these services help drug users avoid a range of diseases and connect with programs that can assist them to overcome their addiction.
Supporters of supervised injecting centres stress their importance in allowing drug users to access a wide range of services. After the North Richmond injecting room was opened in 2018, a government spokesperson stated, 'The medically supervised injecting room... is a vital gateway linking clients with other services including dental, mental health and housing - all the wrap-around support that clients need on the road to recovery."
In 2019, Reason Party MLC Fiona Patten, detailed some of the life-changing interventions made by the Richmond injecting centre during nine months of operation. She noted that the staff at the injecting centre had carried out more than 3,300 health and social support interventions. More than 250 people had started opioid replacement treatment or had been referred to other forms of drug and alcohol treatment, while 40 had entered treatment for hepatitis.
results of an independent review of the North Richmond injecting centre's effectiveness found that after 18 months of work, the staff of the medically supervised injecting room had provided more than 13,000 health and social support interventions for issues like mental health, housing and family violence. It has been claimed that the access to additional services which supervised injecting rooms supply are uniquely valuable for people who live as marginalised an existence as many drug takers. In a review conducted after its first 18 months of operation, the North Richmond facility was found to have provided important screening, assessment and treatment initiation and monitoring of blood-borne viruses to approximately 300 people. Staff provided 10,540 services beyond the supervision of injecting during the trial period. This was most commonly health promotion, dressing wounds, providing medication and first aid. It also provided social welfare needs, mental health, counselling, and family violence support. Similar success has been reported by the Kings Cross Centre in encouraging its clients to adopt behaviours that reduce their risks. In a 2010 report, current clients reported an increase in knowledge of the risk of spread of blood-borne viruses and described behavioural changes that reflect safer injecting practices to minimise this risk.
The Richmond Centre's director, Dr Clark, has stated, 'By providing a safe space for people to inject which, for a complicated set of reasons, is what they feel like they need to do, often on a daily basis, we are able to gain their trust and link them in with...other healthcare services.' Dr Clark has indicated that this has been particularly important in the treatment of Hepatitis C to which heroin users are prone. Clark has stated, 'Hepatitis C is a national and a global treatment priority now that we can cure it with these new direct-acting antivirals. We've set up a treatment pathway where we test them, and we organise and give them the medication. If we were able to systematically test everybody that has come through so far, that would be about 500 people, which would put Victoria over its targets.' It has also been noted that in addition to directing drug users toward health and social support services, injecting centres are valuable in guiding clients toward treatments that can help them overcome their addictions. In July 2020, Dr Clark noted that about 100 clients at the North Richmond room were trying long-acting buprenorphine, a newly available treatment for heroin users.
Similar success has been observed elsewhere in the clients of injecting facilities subsequently undergoing addiction treatment. A 2003-2004 study of the Vancouver injecting centre found that the safer injecting facility served as a referral centre for many community resources. More than 800 referrals were made each quarter (period of three months), and about 40 percent of referrals were for various forms of addiction treatment. 5. Injecting rooms are a harm minimisation strategy that is preferable to punitive approaches to drug taking
Many jurisdictions around the world appear to have decided that what is often termed 'the war on drugs' approach is a failed policy which has not resulted in the reduction of addiction or of the deaths and crime associated with drug taking. The war on drugs is essentially a criminalizing approach which makes drug-taking a crime and presents prohibition (banning) as a key element in reducing the problems linked to drug taking.
Among the consequences of this approach has been a large increase in prison populations and a growth in crime. Though access to some drugs has been reduced, death and ill-health because of drug taking has grown. Critics have called for a rehabilitative approach which supports rather than blames the drug taker. Many have sought the decriminalisation of what have traditionally been designated as illegal substances and others have suggested full legalisation of all drugs. Injecting centres are part of this harm minimisation approach as they seek to reduce the harm drug seekers suffer because of their addiction.
There are many doctors within Australia who support a harm minimisation approach. Dr Cameron Loy, the Chair of the Royal Australian College of General Practitioners , Victoria, has indicated that he believes the issue of a safe-injecting room should be approached from a health perspective, rather than a criminal one. He has called on politicians to move away from their moral condemnation of drugs and to instead consider what policies would improve the health of drug takers and reduce the harm drugs cause. Referring to the Victorian Liberal Party's growing opposition to the supervised injection centre in North Richmond, Dr Loy has stated, 'It is disappointing. I had hoped we could have evidenced-based policy, not ideology-based policy.'
Anne-Maree Kaser, chief executive officer of Windana, a St Kilda based organisation that works with people to assist them in recovering from a dependency on drugs or alcohol, has expressed a similar view. She has stated, 'As a society, many people in the community favour punishment and retribution over treatment and rehabilitation. I know which one works and costs a lot less. We achieve much better outcomes through treatment than locking people up in prison.' Though it is illegal to deal in many drugs in Australia (these are termed illicit drugs and include heroin and methamphetamines) and though there are limits to the quantity of illicit drugs which it is legal to possess, Australia has progressively moved toward a harm minimisation approach. The introduction to Australia's current National Drug Strategy 2017-2026 states 'Since its first iteration in 1985, Australia's National Drug Strategy has been underpinned by an objective of minimising the harms associated with alcohol, tobacco, illicit drug and pharmaceutical drug use.' Australia's Strategy adopts what is referred to as the 'three pillars of harm minimisation'. These are demand reduction (which includes restricting the advertising of addictive products and supporting recovery initiatives); supply reduction (which includes attempting to prevent the supply of illegal drugs and regulating the supply of legal ones); and harm minimisation (which involves reducing the adverse health, social and economic consequences of the use of drugs).
Supporters of this nationally adopted harm minimisation approach argue that supervised injecting rooms are an important element in this strategy. The current National Drug Strategy specifically nominates 'medically supervised injecting centres and drug consumption rooms' as a means of promoting safer injection practices. These facilities also assist in meeting several of the national strategy's other objectives, including 'BBV (blood borne viruses) and STI (sexually transmitted infections) testing, prevention, counselling, and treatment'; 'preventing and responding to overdoses'; and aiding the police in implementing their policy 'to exercise discretion when attending drug overdoses'.
It has been noted that few opponents of supervised injecting rooms any longer argue against them per se. They do not argue that these centres should never be established, rather they argue against where they are currently set up. The supporters of injecting rooms in built up areas argue that they need to be established in communities which drug users already frequent in large numbers. They also argue that this offers advantages for both drug users and others living and working in these areas. Professor Peter Miller, a director of the Deakin Centre for Drug, Alcohol and Addiction Research, has stated, 'Punitive measures have never worked and lead to more deaths in users, more crime in the community and a more scared local population...[We need to respond] to the issue of addiction compassionately...making our streets safer for users and the community.'