‘This decision will save lives’: Call for evidence-based approach to drugs Australia-wide

‘Whether we like it or not, drug use does happen. So, we have a choice in front of us – we can either stick our heads in the sand, say “drugs are bad” and pretend the situation will magically resolve itself, or we can focus on what actually works and saves lives.’
 
That is Dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine.
 
She has welcomed the Victorian Government’s decision to make the medically supervised injecting room (MSIR) based in the inner-Melbourne suburb of North Richmond an ongoing service.
 
Formerly the acting medical director at Sydney’s Kings Cross MSIR, Dr Wilson told newsGP that while it is only part of the response required to address the health impacts of illicit drug use, that there is no denying it is ‘a system that works’ – and one she would like to see other jurisdictions follow the lead on.
 
‘It’s not just a compassionate and humane model, it’s a successful model, and one that I hope other premiers and chief ministers adopt right around Australia,’ she said.
 
‘Each state and territory needs to look at what is actually going on for them; what are the issues in their local area? Certainly, New South Wales, Victoria and Queensland … have the largest number of people who have opioid dependence. But all our states do have people that have opioid dependence and do use opioids in risky, hazardous, harmful ways.
 
‘The bottom line is, what you want is to be making decisions that are based on evidence. Certainly, in Sydney and Melbourne having medically supervised injecting centres has made a huge impact on people’s lives.’
 
Victoria’s decision to introduce legislation to make the MSIR ongoing was announced on Tuesday based on the recommendations of an independent review calling for its continuation, as well as expanded support for people accessing the service and increased safety and amenity in the area.
 
The Ryan Review, released on 21 February, was undertaken by an independent panel chaired by John Ryan who found that since the North Richmond trial’s commencement in 2018, almost 6000 overdoses have been successfully managed and 63 lives have been saved.
 
The evidence for MSIRs is also backed by the experience at Sydney’s Kings Cross facility, which opened in 2001. Since its inception up to the end of April 2022, data shows there have been more than 1.2 million injections without any fatalities. Almost 11,000 overdoses have been managed successfully and more than 20,000 referrals have been made to health and social services.
 
RACGP President Dr Nicole Higgins welcomed the announcement and applauded the Victorian Government for their ‘courage and conviction’ in standing firm on their decision.
 
‘This decision will save lives,’ she said.
 
‘Alcohol and other drug use, including intravenous opioid drug use, must be seen through a health lens. We will get nowhere by declaring a “war on drugs”, throwing the book at people, and pretending that a punitive approach will deter drug use.
 
‘Instead, we need to think differently and look at what does work.’
 
The Victorian Government also flagged plans for a second safe-injecting site in 2020, having purchased the former Yooralla building in Melbourne’s CBD in 2021. However, a timeframe has yet to be given.
 
Dr Hester notes that MSIRs also play an important role when considering that many of the those who access them have often experienced trauma and have ‘infrequent or negligible’ contact with the healthcare system or social supports. 
 
‘Many of the people using this service feel as though they are on the margins of society,’ she said.
 
‘When they visit this service, they come into contact with people opening up their arms and offering to help; it’s the best way to reach them and get them on the right trajectory free of stigma and shame.’
 
This was acknowledged by the panel undertaking the independent review in Victoria, resulting in the recommendation that further action be taken to provide access to integrated treatment, care and support for vulnerable groups.
 
To deliver on this, the state government has confirmed a permanent committee will be established, bringing together the Department of Health, Victoria Police, Ambulance Victoria and the Department of Families, Fairness and Housing, including Homes Victoria.
 
RACGP Victoria Chair Dr Anita Muñoz said this committee will have a ‘vital role to play’ and welcomed the government’s commitment to carefully consider the review’s recommendations. However, the Melbourne GP says more action needs to be taken.
 
‘I hope now that the Victorian Government follows the lead of Queensland and the ACT and extends its commitment to harm minimisation via pill testing – another move that would save many lives,’ Dr Muñoz said.
 
While MSIRs have a history of attracting backlash from certain sectors of the community, the RACGP has been vocal on the importance of approaching policy around alcohol and other drugs from a health-based perspective.
 
But Dr Wilson believes that we are ‘seeing a shift’ in community attitudes, with opposition coming from a vocal minority.
 
‘Since the 1990s, or even earlier actually, we’ve had a harm minimisation approach to illicit drug use that has been federally supported, sometimes very quietly by conservative governments, but still supported and is core to how we do things,’ she said.
 
‘I do understand that emotional response and the idea that it’s a honeypot, but there is no evidence that it encourages more people to come into the area.
 
‘When we look at the Australian Institute of Health and Welfare surveys, there’s actually quite high levels of understanding … that this is a health issue and that it needs treatment, and that while policing and customs is important, that what we want is people to be able to access care. So I do think we’re seeing a shift.’
 
Reflecting on the positive outcomes of both MSIRs in Melbourne and Sydney, Dr Higgins says it is clear that the services provide opportunities for intervention which would otherwise be lost – all while easing the burden on other health services.
 
‘The evidence is already in – medically supervised injecting facilities save lives,’ she said. ‘Each one of those referrals is an opportunity to turn someone’s life around.
 
‘It is also taking pressure off already over-burdened hospitals and reducing ambulance call outs.’
 
Dr Wilson agrees. She says the Victorian Government’s decisive action is another step forward in ending the futile ‘war on drugs’ and helping people who have a health problem.
 
‘I know for myself, I don’t want my kids to use drugs; I don’t want them to drink or smoke or vape,’ she said.
 
‘But I know that prohibition doesn’t change that; I know that what helps is for people to be able to have access to credible information that helps them make informed choices – and if they do get into trouble with it, that they can safely seek help.
 
‘So, once again, well done to the Victorian Government for ignoring shrill and judgmental critics and doing the right thing.
 
‘At the end of the day, every person’s life matters.’
 
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