Background and Evaluation

International context

The first official supervised injecting centre (SIF) began in Switzerland in the 1980s. Now there are approximately 90 SIFs operating around the world – with most of those in the European countries of Germany, Spain, the Netherlands, Norway, Luxembourg, Switzerland and now Denmark. There are two supervised injecting centres in Vancouver, Canada, the first and largest of which opened in 2003. And there is one supervised here in Kings Cross, Sydney, NSW Australia.

This service in Sydney opened in 2001 and was the first SIF in the English speaking world. It remains the only service of its kind in the southern hemisphere.

All SIFs aim to reduce the public health and public amenity problems associated with public drug use. They are generally established in areas of concentrated and highly visible street injecting. The centres vary depending on the local context - some include facilities for inhalation or intranasal drug use, whereas others are exclusively for injecting drug use. The skills and qualifications of staff may vary too. But supervised injecting centres all have common goals: to improve the health and social welfare of their clients, to reduce deaths from overdose and to reduce public drug use.

Australian context

Kings Cross has been the epicentre of the sex and drugs industries in Australia since the 1970s, and even before this Kings Cross was host to the "Razor Gangs" involved in cocaine supply and use as early as the 1930s.

From the early 1990s an increasing number of business 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 while some of these establishments (coined “shooting galleries” by the media), were operating illegally, they provided some benefits to both drug users and the broader community from a public health and public order perspective. Specifically they moved injecting drug use from isolated back streets in Kings Cross to semi-supervised situations out of the public eye; they provided ambulance personnel with known locations to drug overdose callouts, allowing faster response times and more predictable, safer work environments; and they provided the means for disposal of injecting equipment.

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

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 [of establishing an injecting centre in a high-risk area] outweigh the policy considerations against condoning otherwise unlawful behaviour.” Further, he stated “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 to provide the same”…. “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".

This was the first recommendation to the New South Wales Government to establish a supervised injecting centre.

A Joint Select Parliamentary Committee into Safe Injecting Rooms was then established by the NSW Premier Bob Carr in 1997, to investigate this recommendation. The subcommittee visited five supervised injecting facilities in Europe, received evidence from 103 submissions and 89 witnesses, with the majority supporting the establishment of a SIF. The final report was released in February 1998, with the final vote against the establishment of a SIF, by 6 votes to 4.

Meanwhile, telephone surveys among more than 300 residents of Kings Cross, undertaken in 1997 and 1998 confirmed their experience of public drug injecting and discarded needle syringes, as well as their high and increasing support (from 69% to 76%) for the establishment of an injecting room in Kings Cross.

Nationally, the late 1990s saw the number of people dying from drug overdose increasing, and this was particularly concentrated in Kings Cross, Sydney. Around the country in 1999 more than three people a day were dying from opiates. Kings Cross was estimated to have about 10% of all drug overdose deaths at that time – the highest concentration of people dying from drug overdose in Australia. There was increasing media coverage of the issue, and the NSW Premier undertook to hold a state ‘drug summit’ if re-elected, to comprehensively review the state government’s approach to drugs and drug related harm.

A civil disobedience exercise was undertaken by the Wayside Chapel in early May 1999. A ‘mock’ injecting room operated for a small number of sessions, and placed supervised injecting centres firmly on the agenda of the upcoming NSW Drug Summit.

The New South Wales Drug Summit was then held in late May 1999.Members of Parliament met along with experts in the field, drug and alcohol clinicians, community leaders, former drug users, parents of drug users, and others. At the end 172 recommendations were endorsed by the Summit. One of these resolutions, moved by Ms Clover Moore MP for Bligh and seconded by Dr Ingrid van Beek, as Director of the Kirketon Road Centre, was that a Medically Supervised Injecting Centre (MSIC) be trialled in NSW. The resolution called for a tightly controlled trial of a medically supervised injecting centre, providing it had ‘support at the community and local government level’ and that it was ‘monitored and rigorously evaluated by an independent institution from the outset' .

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.

Rationale for location within Kings Cross

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

Location of MSIC– in summary:

The location of the MSIC was decided in consultation with the local community. It had to be physically close to where the public drug use and drug overdoses were concentrated in order to provide the most benefit. It was Kings Cross residents who did not want it located in a residential area. It was the Kings Cross Chamber of Commerce and Tourism who agreed to lift their ‘quarantine’ of sites on Darlinghurst Road. And while perhaps not perfect in every respect, it was the best of 39 sites considered over a six month period. 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 may address them.

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.

For an extended discussion regarding location of MSIC  - click here


Legislative issues

In May 2001 MSIC opened its doors for a trial period of 18 months. The trial was made possible by the amendment of the Drug Misuse and Trafficking Act 1985 (via Schedule 1 of the Drug Summit Legislative Response Act 1999). The legislation was then extended on three subsequent occasions.

MSIC operated under ‘trial’ conditions for nearly a decade. This lead to ongoing and unnecessary politicisation of the service. It lead to uncertainty around the Centre’s future, and to uncertainly for the local community and for the people who use the service.

On the 27th October 2010 the NSW Parliament passed legislation to lift MSIC’s trial status. The legislation was passed in the Legislative Assembly with a final vote of 57:29 and in the Legislative Council with a final vote of 22:15. The legislation was passed with support from Labor, Liberal and Greens MPs. With the enacting of the Drug Misuse and Trafficking Amendment (Medically Supervised Injecting Centre) Bill 2010  into law on November 1st 2010, this meant that MSIC could function as any other health service – without needing an act of Parliament every four years to continue operation.

 

Plotted history of MSIC – key dates

 

1990s

Increasing number of businesses on Darlinghurst Road illegally renting rooms for purpose of injecting drugs

1997

Royal Commission in the NSW Police Service recommended a supervised injecting centre

1998

Report from Joint Select Parliamentary Committee into Safe Injecting Rooms votes against the establishment of such a facility

1997/1998

Random telephone surveys of Kings Cross residents showed majority support for establishment of supervised injecting centre

May 1999

NSW Drug Summit held, with a recommendation that a medically supervised injecting centre be trialled

1999

Kings Cross has highest concentration of people dying from drug overdose in the country

1999

Sisters of Charity health service, originally the potential operators of supervised injecting facility, are forced to withdraw after advice from Vatican

Dec 1999

NSW Government invites Uniting Church of Australia to apply for license to operate supervised injecting facility

June 2000

Uniting Church lodges application for license to operate MSIC at 66 Darlinghurst Road, after months of community consultation

6 May 2001

MSIC opens. First supervised injecting centre in English Speaking World

June 2002

NSW Parliament votes to extend trial of MSIC

2003

First independent evaluation of MSIC published by National Drug and Alcohol Research Centre shows positive results.

Oct 2003

NSW Parliament votes again to extend trial of MSIC

2006

NSW Bureau of Crime Statistics and Research publishes report showing no adverse impact on crime in Kings Cross from operation of MSIC

2006/2007

Second independent evaluation reports published by National Centre in HIV Epidemiology and Clinical Research shows positive results.

June 2007

NSW Parliament votes again to extend trial of MSIC

2008

Independent economic analysis of MSIC shows clear benefit from service

2008/09/10

Further reports from NSW Bureau of Crime Statistics and Research show no adverse outcomes on crime from operation of MSIC

2010

Third independent evaluation report published by KPMG shows positive results

27 Oct 2010

NSW Parliament votes to overturn trial status of MSIC.

1 Nov 2010

Legislation enacted. Trial status finally officially over

May 2011

MSIC marks ten years of successful operation

 

Theological perspective

A discussion on the theological perspective of the Uniting Church’s Board for Social Responsibility was written by the Reverend Harry Herbert and W. Talbot in March 2000. It talks about the Church’s perspective, not only supporting the operation of the Sydney MSIC, but in being the license holder for the service.


Attitudes to MSIC

The local community of Kings Cross have always been supportive of the MSIC. Indeed they were supportive of the concept of a supervised injecting facility before MSIC opened, and have become increasingly supportive of MSIC specifically since the service began.

Regular random telephone surveys have been done of local residents and businesses in Kings Cross. These random surveys have been conducted by all of the independent organisations evaluating the MSIC, These have always shown that the majority of the local community support the MSIC. The latest figures come from the KPMG report which show that 78% of local residents and 70% of local businesses support the MSIC.

Australians in general have also been shown to be supportive of harm reduction measures, and of supervised injecting facilities specifically. In 2010 the National Drug Strategy Household Survey showed that the majority of Australians support supervised injecting facilities.

 A list of supporting organisation is available here along with quotes from the many people and organisations who support MSIC.

Independent evaluation of the MSIC

The Sydney MSIC was independently evaluated for nearly a decade, by a number of different organisations. There have been eleven reports released by five different agencies, all of which document that the service is meeting its aims. Specifically, these reports show that MSIC is saving lives and reducing injury from drug overdose, it is reducing public injecting and the number of syringes discarded in public, it is making contact with a vulnerable and hard-to-reach group of people who inject drugs and referring them into treatment services, and it is reducing the risk of blood borne virus transmission. In addition to meeting its aims, these evaluation reports have shown that the MSIC is cost effective, and is operating without adverse impact in the local community. Links to all of these are available below.

 

In the Eye of the Needle: Diary of a Medically Supervised Injecting Centre

In the Eye of the Needle - book cover

“In the Eye of the Needle: Diary of a Medically Supervised Injecting Centre” was written by Dr Ingrid van Beek, Foundation Medical Director of the Sydney MSIC, and published in 2004 by Allen and Unwin.

The following is an excerpt of the review of the book by Allan Clear, Executive Director of Harm Reduction Coalition, which appeared in the Harm Reduction Journal 2005.

Dr Ingrid van Beek has diarized the early history of Sydney’s center in her book, “In the Eye of the Needle”. This book is much more than the story of the medically supervised injection center. The lessons imparted here are invaluable for everyone working with drug users, and have universal application. Van Beek skilfully weaves several different strands throughout the book including the mechanics of opening and running the center; the emotional toll it takes on staff; the humanity of the drug users the center serves; the need of the clients; and the scrutiny that an institution comes under for being deemed ‘controversial’. Ultimately this book is about how compassion, healthcare, dignity and human rights can be obtained for drug users.

Subscribe Here!

Who Supports the Sydney MSIC


Supporters of the MSIC include:

Contact Us

To find out more about the MSIC or to book in for a tour please contact:

Rohan Glasgow: rohang@sydneymsic.com

Telephone: + 61 (0) 2 9360 1191

Fax: + 61 (0) 2 9360 0707

Address: 66 Darlinghurst Rd, Kings Cross NSW 2011

Postal address: PO Box 293, Kings Cross NSW 1340, Australia