From 2003

Some facts about the Sydney Medically Supervised Injecting Centre

Kings Cross has been the epicentre of the sex and drugs industries in Australia for the past 3 decades, and as a result, there is a population of drug users who consider Kings Cross their base. Even long before, Kings Cross was host to the "Razor Gangs" involved in cocaine supply and use as early as the 1930s, and Woolloomooloo and East Sydney were the first home of Australia's sex industry from about 2 centuries ago!

From the early 1990s an increasing number of commercial sex establishments on Darlinghurst Road in Kings Cross, started to rent rooms otherwise used for commercial sex, on a 15 to 30 minute basis for the purpose of injecting illicit drugs. In 1997 the Royal Commission into the NSW Police Service found that some of these establishments (coined “shooting galleries” by the media), were also involved in the supply of illicit drugs.

While operating illegally, these shooting galleries provided some benefits to both drug users and the broader community from a public health and public order perspective in that they:

• moved injecting drug use from isolated back streets and parks in Kings Cross, to semi-supervised situations out of the public eye,
• in the situation of drug overdose, provided ambulance personnel with a finite number of known locations allowing faster response times and more predictable, safer work environments and
• provided the means for disposal of injecting equipment.

But they:

• were operating in contravention of the Drug Misuse and Trafficking Act (making them illegal),
• provided limited if any education and referral to drug users regarding health and social welfare services and in some instances did not supervise activities adequately resulting in ongoing drug overdose deaths,
• sold the injecting equipment and/or rented the rooms to inject for commercial gain only, turning away those unable to pay (often those most “at risk”) and
• in some instances were associated with other criminal activities, in particular drug supply.

Several very significant operators supplying drugs from these shooting galleries were incarcerated as a result of the Wood Royal Commission, reducing the number and scale of these establishments, but lower level, street-based dealers from other areas filled the void almost overnight. This was in keeping with the world experience that where there is a demand for drugs and someone willing to commit crime for lots of fast money, there will be a supply of drugs. At the same time much of the injecting drug use which had occurred in these shooting galleries also returned to the streets, parks and other public places.

Appreciating the public health and public order problems arising from public drug injecting, Justice James Wood recommended the following in the Royal Commission's final report.

“At present, publicly funded programs operate to provide syringes and needles to injecting drug users with the clear understanding that they will be used to administer prohibited drugs. In these circumstances to shrink from the provision of safe, sanitary premises where users can safely inject is somewhat short sighted. The health and public safety benefits outweigh the policy considerations against condoning otherwise unlawful behaviour. Consideration should be given to the establishment of safe, sanitary injecting rooms under the licence or supervision of the Department of Health, and the amendment of the Drug Misuse and Trafficking Act 1985 accordingly".

In 1997 the NSW Government established a Joint Select Parliamentary Committee into Safe Injecting Rooms to investigate this recommendation. The Committee received 103 submissions and took formal evidence from 89 witnesses. In particular, most key witnesses representing the various sectors in Kings Cross testified in support of the idea. However, the majority of the Committee (6 of the 10 members) didn't recommend the establishment such premises in NSW.

Meanwhile, telephone surveys among more than 300 residents of Kings Cross, undertaken in 1997 and 1998 confirmed the increase in their experience of public drug injecting and discarded needle syringes. At the same time, high and increasing support from 69% to 76% for the establishment of an injecting room in Kings Cross was also registered among those polled.

A civil disobedience exercise in early May 1999, wherein a mock injecting room operated for a number of sessions at the Wayside Chapel, placed supervised injecting centres firmly on the agenda of the NSW Drug Summit, an initiative of the NSW Government held later that month. One of the 172 resolutions moved by Ms Clover Moore MP for Bligh, seconded by Dr Ingrid van Beek (as Director of Kirketon Road Centre) and passed resoundingly by the Drug Summit was that a Medically Supervised Injecting Centre (MSIC) be trialed in NSW. It was subsequently proposed that this trial be undertaken in Kings Cross and legislation was passed later that year to enable its establishment for a period of 18 months. (This was later extended to 30 months ending 31 October 2003, to enable the completion of the Final Evaluation Report, which was released in July 2003).

Kings Cross was considered most appropriate because it had the highest prevalence of drug overdose deaths in the state (and Australia) and the local community had already demonstrated its support to trial such an initiative.

But where to locate an injecting facility in Kings Cross?

In December 1999, following the withdrawal of the Sisters of Charity Health Service upon advice from the Vatican, the NSW Government invited the Uniting Church of Australia to apply for a licence to establish and operate the facility.

A few weeks later 2 potential sites, which had been identified by the Sisters of Charity group, were presented to a community meeting held at St John’s Church in Darlinghurst. One was in Orwell Street and the other on the corner of Hughes and Macleay Streets, Potts Point. Local residents reacted angrily, saying that these sites were too close to the more residential part of Kings Cross. They argued that the MSIC should be located in the more commercial part on Darlinghurst Road, where the shooting galleries had always operated and where there was most to be gained in terms of public amenity. Other advantages identified were that the main street was better lit and more policed than the residential areas.

While the Sisters of Charity Health Service had originally agreed not to consider sites on the main street at the urging of the Kings Cross Chamber of Commerce and Tourism, their representative at this community meeting, Mr Malcolm Duncan agreed to lift this quarantine. People got together after the meeting and formed a new residents group called the Potts Point Community Action Group, to advocate that the MSIC be sited away from the more residential area of Kings Cross.

The Uniting Church then invited various relevant community stakeholders to join a Community Consultation Committee to restart the process of site selection to now also include sites on Darlinghurst Road. This Committee included representatives of local residents, drug users, their families, the Chamber of Commerce and Tourism, other local health and social welfare services, police, local and state government. This Committee accepted with only minor changes the guiding principles for site selection previously established by the Sisters of Charity. These included the following.

• Floor space area of 150 – 200 square metres
• Useable space to allow sub-division as required
• Easy ambulance access
• Within 300 metres of Springfield Mall
• Ground level access front and back
• Acceptable to target population and other key stakeholders
• Positive ambience, natural light.

So why a central location?

During the 12 months to end 1999, there were 677 ambulance call-outs to the Kings Cross/Woolloomooloo/Darlinghurst/East Sydney area to heroin overdose cases. More than 90% (621) of these call-outs were to places within 300 metres of the proposed site at 66 Darlinghurst Road, Kings Cross; 54% (335) of ambulance call-outs were to drug users who had overdosed on the street outside or in premises on Darlinghurst Road, Kings Cross.

The reason for this concentration of drug overdose cases in central Kings Cross was that this was where drug supply had always been most concentrated. It is well established that drug dependent drug users inject as soon as possible after they have procured the drug of addiction, mostly to overcome physical symptoms of drug withdrawal (“hanging out”), but also to avoid police apprehension for drug possession. Hence proximity to the street-based drug scene (focused around Springfield Mall at this time) was considered to be of paramount importance in site selection, just as it had been for the 60 or so other injecting centres established in other cities in the world.

These ambulance overdose call-out data showed that locating the MSIC elsewhere (away from Darlinghurst Road) would have significantly lessened its ability to meet its stated primary aim: to reduce the morbidity and mortality associated with drug overdoses when they occur in un-supervised, back street situations. Furthermore, if a significant proportion of the street-based drug users in the area didn’t use the MSIC, it would also limit its ability to improve public amenity, another aim of the MSIC.

In late January 2000 the then President of the Chamber of Commerce and Tourism informed the Uniting Church about the availability of premises at 66 Darlinghurst Road (owned by another then member of the Chamber). Of the 39 sites assessed across a 6-month period, this site best met the guiding principles and a lease was signed in February 2000.

Mr Duncan formed a new group to oppose this site, which called itself the Kings Cross Community Coalition. It suggested several other locations. These included a site in Earl Place but Potts Point residents strongly opposed this. Another was on the ground floor of the recently constructed Elan apartment building but the owners refused to lease to the MSIC. And the third was the Kirketon Road Centre above the Darlinghurst Fire Station, but it had no available space and the need for fire truck access would potentially interfere with ambulance access.

Why not put it in the hospital?

The St Vincent’s Hospital campus has also been suggested despite the much publicised need for the Sisters of Charity Health Service to withdraw from its involvement in the MSIC initiative 4 years ago. However when still involved, it had excluded operating the MSIC from its hospital site, because of the distance from the heart of Kings Cross. Even in the unlikely event that drug users would walk there each time to inject, this would create an “ant trail” from central Kings Cross across the overpass down Victoria Street, Darlinghurst to the hospital with attendant issues along the way. It would also pose safety and security issues at the hospital given its particularly vulnerable community of mainly elderly, infirm people in open ward situations with stocks of pharmaceutical drugs of great interest to drug users.

In June 2000 the Uniting Church lodged its application for a licence to operate the MSIC. One of the requirements was that “sufficient community acceptance” of the chosen location be demonstrated. A further telephone poll at that time commissioned by the Uniting Church showed that a majority of local residents and businesses supported the MSIC being located at 66 Darlingurst Road. The licence was granted in October 2000.

The licensing authorities’ (being the Director General of the NSW Health Department and the NSW Police Commissioner) decision in this regard was unsuccessfully challenged by the Kings Cross Chamber of Commerce and Tourism in the NSW Supreme Court in March 2001. The licence was upheld and the MSIC commenced operations in May 2001.

Further telephone polls undertaken by the independent evaluation team before and after the first 18 months of operation also registered high and increasing levels of support for the MSIC at 66 Darlinghurst Road, among more than 500 local residents (68% to 78%) and 200 local businesses (58% to 63%). In particular both local residents and businesses cited that “location of the MSIC in high drug use areas” was the most important consideration in deciding where it should be located. Only 1% of businesses cited that the MSIC had “affected business”.

The report also found that there was little evidence that the MSIC had a “honey pot” effect. In fact the number of drug users in the area had decreased, along with drug-related crime, in line with the rest of NSW.

I hope that this brief background to the establishment of the MSIC in Kings Cross will add to your understanding of the rationale for its current location. While perhaps not perfect in every respect, it was the best of 39 sites considered over a six month period. Although not supported by everyone, there were no other sites that gained greater support and none that pleased everyone. The MSIC continues to host the Community Consultation Committee, so if you have concerns about any aspect of its operation, please contact us at the MSIC so that we can address them.

Yours sincerely,

Dr Ingrid van Beek
Former Medical Director

(Archived from 2003)