By The Joint Select Committee into Safe Injecting Rooms, Parliament of New South Wales

Executive Summary

This Inquiry has its genesis in a recommendation made by Commissioner Wood in the Final Report on the Royal Commission into the New South Wales Police Service. Evidence had been presented to the Royal Commission that illegal shooting galleries, that is, places where drug users go to buy injecting equipment and rent a room for a short period of time to inject drugs, were operating in Kings Cross often with the approval of the police. Given that such a situation could give rise to corrupt practices, and that illegal drug use is an ongoing phenomenon in our society, Commissioner Wood recommended that consideration be given to the establishment of safe, sanitary injecting rooms under the licence or supervision of the Department of Health, and to amendment of the Drug Misuse and Trafficking Act 1985 accordingly (Final Report,. Vol I/: Reform, p226). The New South Wales Parliament acted in response to Commissioner Wood's recommendation and the establishment of a Joint Select Committee Upon Injecting Rooms was agreed to in June 1997.

A Subcommittee of the Joint Select Committee visited five injecting rooms and held discussion with key stakeholders in Europe. The Committee also visited several Sydney suburbs, Wollongong, Newcastle, and a number of rural areas in New South Wales in order to speak to concerned members of the community, health workers, and drug users. In addition to its own research, the Committee received 103 submissions and took formal evidence from 89 witnesses.

Chapter Two attempts to canvas a number of aspects related to the injecting drug problem despite well acknowledged difficulties associated with the presentation of an accurate profile of injecting drug use. It would appear from various studies that: injecting drug use appears to be undertaken by a very small percentage of the Australian community (1% - 2%), but approximately half the injecting drug user population is located in New South Wales. Injecting drug users are not a homogeneous group: they use drugs for different reasons; they do not all use the same drugs, they do not all have the same level of drug use; the vast majority do not inject their drugs in a public place; there is no certain way to determine who will and who will not become an injecting drug user; they can be found all over the State although there is a greater prevalence in certain areas such as Sydney than others; and approximately 66% have had at least one (non-fatal) heroin-related overdose, and 90% have been present when someone else has overdosed.

The overall health of regular injecting drug users is often compromised, particularly in relation to the presence of blood-borne viral infections contracted through the injecting drug process. While the rate of HIV amongst injecting drug users has remained relatively low since the introduction of harm reduction measures such as the Needle and Syringe Exchange Programs, hepatitis B and hepatitis C infection have not been able to be contained in the same way. Both these diseases pose significant concerns not only for the individual but also for the community at large, given the ease with which they can be transmitted.

While it is understood that for many people injecting drug use is experimental, there are a number of people who become dependent, and as such a number and range of services and treatment programs should continue to be provided as a positive public policy response to injecting drug use. Not all options will be of equal benefit to each drug user. When considering illicit drug use, it should always be kept in mind that any one injection could be fatal, and therefore the question of harm reduction is ever present. The recommendation of Commissioner Wood to consider the establishment of safe, sanitary injecting rooms was made in the context of the harm reduction approach, specifically as an extension of the Needle and Syringe Exchange Program. He said:

At present, publicly funded programs operate to provide syringes and needles to injecting drug users with the clear understanding 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 For these reasons the Commission favours the establishment of premises approved for this purpose and invites consideration of an amendment of the Drug Misuse and Trafficking Act 1985 to provide for the same (Final Report, Vol II: Reform, p226).

Chapter Three contains details of a number of overseas injecting rooms visited by the Subcommittee to gain a first hand impression of how these facilities were run. These centres were located in Rotterdam and Arnhem, the Netherlands; in Berne and in Basel, Switzerland; and in Frankfurt, Germany.

The overseas experience of injecting rooms provided the Committee with important data on the possible costs and benefits of legal injecting rooms, as well as the problems encountered in establishing and operating them. While the philosophies of the injecting rooms varied in the detail, the commonality in approaching the injecting drug problem from a harm reduction perspective was evident in all the European centres visited. The Committee is cognisant of the fact that the establishment of injecting rooms in particular cities in the Netherlands, Switzerland and Germany, needs to be viewed in terms of their specific cultural and legal context, and that this feature needs to be taken into account when considering whether such facilities would translate to an Australian setting.

The question of costs and benefits associated with the establishment or trial of injecting rooms is examined in Chapter Four. It should be stated at the outset that while the general costs and benefits of establishing or trialing injecting rooms can be identified, a mathematically precise cost-benefit analysis cannot be provided. Those accustomed to working in the area of costing aspects of the illicit drug problem list a number of reasons, most of which are linked to limitations of, and gaps in, data collection for why this is the case. With this in mind, the Committee has looked at the arguments for and against the establishment or trial under the broad headings of health implications; social implications; economic implications and legal implications. At the end of the day which arguments are seen as compelling, are to a certain extent, a matter of individual value judgement. As was articulated in one submission to the Committee:

There is no simple or objective basis on which to decide whether legal injecting rooms should be established. Considerable uncertainty exists in predicting what their effects would ultimately be, and there is significant concern about potential and perceived problems, while at the same time a decision not to establish or allow them would be equally difficult because it would leave unaddressed the serious problems associated with public injecting (Reid, Submission 101).

The arguments for the establishment or trial of injecting rooms from a health perspective are: the potential to reduce fatal overdoses and to reduce the transmission of blood-borne viral infections; such facilities may provide injecting drug users with better access to primary medical care and improve the likelihood of them accessing drug treatment programs; and injecting rooms may improve the occupational health and safety conditions of health workers and emergency service personnel. The arguments against are that injecting rooms could lead to an increase in drug use or in the number of injecting drug users; they may delay injecting drug users from seeking rehabilitation; and there are potential health and safety implications for both those using and those working in the injecting room.

The arguments for the establishment or trial of injecting rooms from a social perspective are that they may: lead to a reduction in the public nuisance aspects of injecting drug use; reduce the opportunities for police corruption; reduce the incidence of certain criminal activities; improve the likelihood of re-integration of injecting drug users into mainstream society; and they may provide a valuable point of contact with the most marginalised of injecting drug users. The arguments against are that injecting rooms may: lead to the assumption that drug use is condoned; lead to the congregation of injecting drug users; cause areas where injecting rooms are located to become labelled as drug centres or to feel as if they are 'social experiments'; and lead to an increase in drug dealing and in opportunistic street and property crime; Some rely on moral grounds to object to the establishment or trial of injecting rooms.

The arguments for the establishment or trial of injecting rooms from an economic perspective are that they may: reduce the cost to the community associated with the treatment of overdoses and the treatment of people who contract blood-borne viral infections; modelled along the lines of a more general health facility, reduce the social and economic costs to the community of injecting drug use; mean less time and consequently less money will need to be spent by councils on removing discarded syringes from public areas; and the return for money spent on increased law enforcement does not appear to date to have been cost effective. The arguments against are that: spending money on injecting drug users is a waste of money; injecting rooms would have a negative impact on businesses and on property values in the nearby vicinity; and money spent on injecting rooms would be better spent on alternative drug treatment and rehabilitation programs or law enforcement.

The arguments for the establishment or trial of injecting rooms from a legal perspective are: that it would clarify the role to be adopted by police in relation to both those using and those running such establishments; and eliminating the need to pursue self-administration offences in the courts would save police and court time. The arguments against are that: making a distinction between behaviour which is legal in an approved injecting room but illegal elsewhere will lead to the creation of 'fuzzy' law; and there are a number of potential issues surrounding incidents occurring in an injecting room.

Chapter Five examines the current legal position in New South Wales in relation to injecting rooms and presents a number of options, both legislative and non-legislative, for reform if the establishment or trial of injecting rooms is recommended. While it would appear technically feasible to achieve the establishment and/or trial of injecting rooms through administrative means such as the amendment of the Police Commissioner's Instructions, or possibly through amendment to the Drug Misuse and Trafficking Regulation 1994, the Committee is of the view if this were to go ahead, legislative amendment to the Drug Misuse and Trafficking Act 1985 would be more appropriate. While the form of amendment would ultimately be a question for the Parliamentary Counsel's Office, the insertion of a new Part into the Drug Misuse and Trafficking Act 1985, exempting those activities taking place in an injecting room which would otherwise be an offence, would be a useful way to proceed. If a trial, as opposed to establishment of injecting rooms were recommended, these exemptions would only apply for the time specified for the trial. It would remain the case that all other drug-related activities occurring in a non-injecting room context would remain offences, and would be vigorously pursued by law enforcement officials. Legal issues of a general nature, particularly those related to liability, would also need to be addressed. It would appear that while Australia's international treaty obligations do not prevent the trial of injecting rooms, the position as regards their actual establishment is less clear, with expert opinion divided as to the possibility.

Chapter Six examines many of the operational aspects which would be involved in the establishment or trial of an injecting room, and those assessed as being minimum mandatory requirements are outlined. In deliberating on the issues surrounding the establishment or trial of such facilities, the Committee was mindful of the fact that it must consider both the needs of the potential user group and those who may be affected by the operation of the injecting room.

The minimum mandatory requirements identified are:

• only those over the age of 18 with a history of injecting drug use would be able to gain access to the injecting room;
• the full range of sterile injecting equipment should be available in the injecting room as should a means to ensure appropriate and safe disposal of used equipment;
• the injecting room should be adequately staffed by trained health workers;
• a registration system and strict entry criteria should be in place;
• an injecting room should be located in an area where public injecting is currently
  a problem, and the area chosen must be on an accessible public transport route;
• the hours of operation of the injecting room need to have minimal impact on the local community;
• all services offered by an injecting room need to be provided free of charge;
  
• an expert advisory group consisting of key stakeholders needs to be set up to oversee the establishment and running of any injecting room. The Committee is of the opinion that the success of any innovative program in injecting drug use is reliant on the co-operation and support of police, health workers and the community;
  

Three possible injecting room models are presented, and their advantages and disadvantages discussed. The first model is a new service or facility managed by the NSW Health Department or contracted out by the Department to a suitable non-government organisation; the second model is an injecting room incorporated into an existing health or drug treatment service; and the third model is the licensing and regulating of an existing commercial premises.

If the trial or establishment of injecting rooms is to proceed, the expert advisory group would be best placed to determine on a case by case basis the operating details of any particular injecting room which may be created. This would be done in close consultation with the local community.

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