Push for expansion of safe injecting facilities

A group of researchers and clinicians are pushing for more safe injecting sites to be set up, citing evidence from a long-running facility in Sydney.
 
The authors of an opinion piece published this week in the Medical Journal of Australia (MJA) say the supervised injecting site in Kings Cross founded 21 years ago is proof of the approach’s efficacy.
 
The writers, led by the University of Sydney’s Associate Professor Carolyn Day, who was previously a director of Addiction Medicine Education at the Sydney Medical School, highlight the scale of the work carried out at the Medically Supervised Injecting Centre (MSIC).
 
From the time it started until the end of April this year, MSIC had recorded a total of 1,232,951 injections at the facility without any fatalities, the researchers state.
 
They also write that almost 11,000 overdoses have been managed successfully, while 20,420 referrals to health and social services have been made.
 
The authors say that the MSIC enables a clear reduction in harm for those attending, with adverse events occurring in fewer than 1% of all injections.
 
‘Put simply, when a safer place to inject drugs is provided, the associated short-term harms are greatly reduced,’ the opinion piece reads.
 
‘The longer-term harms are also reduced with increased access to services, including drug treatment, hepatitis C care, and smoking cessation.’
 
Dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine, agrees.
 
With first-hand experience of the facility, having worked there as an acting medical director in 2009–2010, she said it is a system that works.
 
‘It is a successful and humane model,’ Dr Wilson told newsGP. ‘While we may not condone drug use, the fact is that it happens.’ 
 
She says the service reaches high-risk people who are often not having treatment and supports them to seek help.
 
‘This is a group who find it hard to access treatment, who have had significant adverse experiences with stigma and discrimination when accessing healthcare,’ she said.
 
‘For most of those accessing the MSIC, their drug use has severe impact on their lives and the MSIC supports them to change their lives for the better.
 
‘It was set up for overdose prevention and it’s important to remember that you can’t treat someone who has died from overdose.
 
‘The referral rate is wonderful and the result of a lot of work and engagement with MSIC staff, sometimes over an extended period of time.’
 
Despite the strong resistance faced by advocates of the centre before its work began, Dr Wilson believes it is now broadly supported.
 
‘When it opened there was some local community concern, but it is part of the landscape now and local amenity has improved with less needles in the community and locals no longer being woken by ambulances racing to assist overdoses in the street,’ she said.
 
The researchers also say there is now a ‘substantial evidence base’ on the impact of the supervised injecting facilities (SIFs), and again suggests the concerns originally expressed have been unfounded.
 
‘Early research established that the MSIC did not result in a “honeypot” effect [ie, attract new users to the area], but led to improved and sustained public amenity,’ they wrote.
 
They also point out that there are only about 120 supervised injecting facilities operating around the work, including two in Australia, and highlight legal obstacles that prevent further centres from opening – including one law that means an amendment to state legislation is required to allow more than one facility in NSW.
 
‘The key themes to emerge are that good policy, with clear legislation and careful management of clients within a harm reduction framework, can and does alleviate problems that may be perceived as inherent to the operation of such services,’ the article reads.
 
‘Given the solid evidence, current governments, in Australia and elsewhere, should expand SIF services without unnecessary protracted trial periods.’
 
In 2018, another safe injecting site opened in North Richmond in Melbourne, a move that again met with considerable local resistance.
 
Since it opened, data has suggested that centre is also preventing deaths.
 
For the writers of the MJA perspective piece, the arguments are already won – particularly with the backdrop of increasing opioid overdose deaths and coroner recommendations for more SIFs.
 
‘Questions regarding the scientific and operational merit of SIFs have been answered,’ they conclude.
 
‘After 21 years of success, it is time for robust support for further services to be implemented both within Australia and internationally.’
 
Dr Wilson also believes the case has now been made successfully.
 
‘We need to be able to respond to people’s needs where they live,’ she said. ‘MSIC has shown this can been safely done and results in good outcomes.’
 
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