The Melbourne supervised injecting room (MSIR) has hit the headlines again after reports that two individuals linked to the North Richmond Community Health centre — which houses the service — had been arrested.
One person was reportedly charged with drug offences and later released on bail, while a second was released without charge.
Unfortunately, some initial reporting was inaccurate. The Age first reported that the staff worked at MSIR, before issuing a correction. By then, however, concerns about the long-term viability of the service had begun to be raised.
Reporting of the arrests resulted in calls to close the service, suggestions it should be moved and a claim by City of Yarra councillor Stephen Jolly that the site had become "toxic".
It is important to note that, in response, many have spoken out in support of the service, including Dr Hester Wilson, chair of the specific interests addiction medicine network at the Royal Australian College of General Practitioners, and a local residents group that has maintained a longstanding support for the service.
Of course, people who use the service are members of the community, too, but we do not get to hear from them. This is likely due to a combination of factors, including the criminalisation of drugs and the persistence of stigma associated with drug use.
Without these vital personal perspectives, it is easy to lose sight about who the service is designed for and what it means for them. This may even create an impression that the interests of some citizens matter more than others.
The results
The MSIR opened in July last year and is only the second supervised injecting facility in Australia. The other is located in King’s Cross, Sydney, and is known as the Medically Supervised Injecting Centre. There are more than 100 such facilities around the world.
The legislation establishing the MSIR requires it to be evaluated after its first two years. Highly respected drug expert Professor Margaret Hamilton is overseeing the evaluation and its results are expected to be made public in late 2020.
Importantly, the law establishing MSIR outlines several objectives for the service. They include reducing the number of avoidable deaths and harms caused by overdoses and providing a gateway into other forms of health and social assistance.
This might include drug treatment for those who want it, but also other social supports such as access to housing and employment services, healthcare and mental health treatment.
The legislation also aims to improve the amenity of the neighbourhood.
Some of those who have raised concerns about the service are worried about an apparent rise in visibility of public injecting in the area. They may argue that the service is not yet meeting one of the stated objectives.
Emerging evidence on the other objectives, however, show the clear benefits of the service.
Last month, data detailing the first year of operations at MSIR was released. This data received far less media attention than the arrests, but paints a picture of the service fulfilling its legislative obligations.
In its first year of operation, there were:
* 2908 registered clients using the service;
* 61,823 visits including a supervised injection; and
* 1232 overdoses safely managed by staff inside the MSIR.
The North Richmond Community Health service also reported that it had offered 5082 on-site services to registered clients. These included health promotion services and various forms of health and social support.
There were also 1393 referrals to co-located services and clinics and external services. This provides a gateway to supports including alcohol and other drug treatment, primary care, oral health, blood-borne virus treatment, mental health support, housing and homelessness services and legal support.
There is no reason to expect that these trends will not continue into the second year of the trial.
These results should not surprise us. They correspond with international evidence that consistently shows supervised injecting rooms generate significant health, social and economic benefits.
We also know, perhaps most importantly, that these facilities save lives.
Although we might have hoped for the prevention of overdoses, these early results are a genuine testament to the work of all those at the MSIR.
Critical time
The work of the service also comes at a critical time.
Canada and the United States are undergoing an almost unprecedented drug overdose crisis. In 2017, more than 70,000 Americans died of overdose and 12,800 Canadians have died in the past three years.
In part, this is because fentanyl — a synthetic pain medicine approximately 100 times more potent than heroin — has entered the illicit drug market.
The scale of the overdose crisis in those countries is so severe that it has contributed to an overall reduction in life expectancy — a phenomenon normally only seen during times of war.
Although Australia has so far managed to avoid a similar overdose crisis, experts have warned against becoming complacent. Recent data shows there were 1795 “drug-induced deaths” in 2017 — up from 1045 people the year before.
It bears repeating in this context that MSIR alone safely managed 1232 overdoses in its first year. This gives us a sense of just one of the ways the service is making a vital contribution to the community.
Any suggestion that the viability of MSIR has been thrown into question is thus premature, and represents a fundamental misunderstanding of the nature and work of this vital, life-saving service.
[Kate Seear is an Australian Research Council DECRA Fellow, an associate professor in Law and the Academic Director of the Springvale Monash Legal Service. Reprinted and abridged from Monash Lens.]