Push for expansion of safe injecting facilities


Researchers say “substantial evidence” should encourage governments in Australia and beyond to allow more medically supervised sites.

Lots of needles

No deaths have occurred as a result of injections at the medically supervised injection center.

A group of researchers and clinicians are pushing for the establishment of safer injection sites, citing evidence from a long-established facility in Sydney.

The authors of an opinion piece published this week in the Medical Journal of Australia (MJA) say the Kings Cross supervised injection site established 21 years ago proves the effectiveness of the approach.

The authors, led by University of Sydney Associate Professor Carolyn Day, who was previously Director of Addiction Medicine Education at Sydney Medical School, highlight the scale of the work being undertaken at the Medically Supervised Injecting Center (MSIC).

Since launch through the end of April this year, MSIC has recorded a total of 1,232,951 injections at the facility with no deaths, the researchers said.

They also write that nearly 11,000 overdoses have been successfully treated, while 20,420 referrals to health and social services have been made.

The authors say that the MSIC allows for a significant reduction in harm to participants, with adverse events occurring in less than 1% of all injections.

“Put simply, when a safe place to inject drugs is provided, the short-term harms associated are greatly reduced,” the statement reads.

“The longer-term harms will also be reduced with improved access to services, including drug treatment, hepatitis C treatment and smoking cessation.”

dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine, agrees.

She got to know the facility firsthand, having worked there as acting medical director in 2009-2010, and said it’s a working system.

“It’s a successful and humane model,” said Dr. Wilson NewsGP. “Even if we don’t condone drug use, the fact is that it happens.”

She says the service reaches out to people at high risk, who often don’t receive treatment, and supports them in seeking help.

“This is a group who find it difficult to access treatment and have had significant negative experiences of stigma and discrimination in accessing health care,” she said.

“For most who have access to the MSIC, their drug use has had a serious impact on their lives and the MSIC supports them in changing their lives for the better.

“It was set up to prevent overdoses and it is important to remember that you cannot treat someone who has died from an overdose.

‘The referral rate is wonderful and the result of a lot of work and engagement with MSIC staff, sometimes over a long period of time.’

Despite the strong opposition the center’s supporters encountered before it began its work, Dr. Wilson that it now has broad support.

“When it opened there was some concern from the local community but it is now part of the landscape and local amenities have improved with fewer needles in the community and locals no longer being woken up by ambulances passing through the street.” racing down the street after overdoses,” she said.

The researchers also say there is now a “substantial body of evidence” for the impact of the monitored injection facilities (SIFs), and again suggest that the concerns initially raised were unfounded.

“Early research found that MSIC did not result in a honeypot effect [ie, attract new users to the area]but resulted in improved and sustained public convenience,” they wrote.

They also point out that only about 120 supervised injection facilities operate around the plant, including two in Australia, and point to legal obstacles preventing more centers from opening – including a law that would require the state to change Legislation is required to allow more than one facility in NSW.

“The key themes that emerge are that good policy with clear legislation and careful customer management within a harm reduction framework can and does mitigate problems that might be perceived as inherent with the operation of such services,” the article reads.

“Given the solid evidence, current governments in Australia and elsewhere should scale up SIF services without unnecessarily lengthy trial periods.”

In 2018, another safe injection site was opened in North Richmond in Melbourne, a move that again met with significant local opposition.

Since it opened, data suggests the center is also preventing deaths.

For the authors of MJA Perspective piece, the arguments are already won – especially against the background of the increasing deaths from opioid overdoses and the recommendations of coroners for more SIFs.

‘Questions about the scientific and operational value of SIFs have been answered,’ they conclude.

‘After 21 successful years it is time to implement solid support for more services to be implemented both in Australia and internationally.’

dr Wilson also believes the case has now been successfully brought forward.

“We have to be able to respond to the needs of people where they live,” she said. “MSIC has shown that this can be done safely and with good results.”

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