Warning: This blog deals with distressing issues such as fatal overdose and stigma around people who use drugs. These topics are sensitive. Before you get started, think about whether now is the right time for you to read it. If you need to talk about it, we’re here 24/7 — chat to us  or find support in the online community. 

August 31 is International Overdose Awareness Day, a day to remember people who have died from overdose and to raise awareness to address this preventable cause of death. As a society we can and should work together to protect people who are at risk of overdose. Unfortunately, since drug use is heavily stigmatised around the world, overdose prevention strategies can be controversial. Negative publicity means people at risk of overdose are often misunderstood or not offered the valuable support or treatment they need.

As a way of honouring and remembering loved ones who have passed we would like to look at how medically supervised injecting facilities (MSIFs) can help the Australian community by reducing harms, managing overdose, providing a gateway to health and psychosocial supports, and encouraging better health outcomes. We’ll explain why experts say they’re saving lives. 

What is a medically supervised injecting facility (MSIF)?

A MSIF is a safe, non-judgemental place to go to inject drugs under medical supervision. In the Australian context, people can access MSIFs to inject any drug, though most often this is opioids like heroin or other ‘painkillers’. The injecting room does not supply illicit drugs to people, but they do provide sterile injecting equipment, harm reduction advice and connection to health services. 

MSIFs are a form of drug consumption room (DCR). Internationally, people may visit DCR to use drugs in other forms such as smoking or snorting, but the current Australian facilities are primarily used for injecting. MSIFs are also sometimes known as medically supervised injecting centres (MSICs) or medically supervised injecting rooms (MSIRs).

One of the central aims of DCRs and MSIFs is to prevent fatal opioid overdoses by ensuring medical treatment is immediately provided if a person attending these facilities experiences an opioid overdose or experiences a drug-use related medical emergency. Treatment might include resuscitation and the administration of naloxone (also known as Prenoxad and Nyxoid), which reverses opioid overdoses. This helps to return the patient’s breathing and level of consciousness to normal. Naloxone is very effective but the person experiencing the overdose is unlikely to be able to administer it to save themselves. For this reason, it is so important that anyone at risk of experiencing an opioid overdose has an observer with access to naloxone around them, and receives follow up medical support and monitoring in the period after initial naloxone administration.

MSIF in Australia are staffed by qualified medical professionals (such as doctors and nurses) as well as harm reduction and allied health practitioners, such as social workers and peer workers. MSIF staff do not inject drugs into people attending the facility, they observe the procedure and are ready to intervene if the client experiences a medical emergency. Their role is very similar to first aid staff at music festivals — they don’t encourage festival goers to take drugs, but they are there to help if something goes wrong. At a basic level, staff at injecting rooms work on a similar principle. By reducing the risk, we can reduce the long-term harm.

Do MSIFs offer other services?

In addition to preventing fatal overdoses, MSIFs help people access essential services such as:

• Harm reduction advice (i.e. safe injecting practices, overdose awareness)
• Alcohol and other drug treatment
• Primary health care
• Oral health
• Treatment for blood-borne viruses such as hepatitis or HIV
• Mental health support
• Housing and homelessness services
• Legal support

People can also connect with peer workers on site. Peer workers are people who have lived or living experience around drugs who use their experiences to help others. We know that peer support is an important resource that helps people improve emotional and health outcomes over time. Peer workers provide crucial insight into the assistance and services that the community needs and enormously improve the quality of care available. Internationally, some DCRs are operated exclusively by peers alone.

Why do we need MSIFs?

Many people don’t realise that fatal overdoses are very common in Australia. According to the Penington Institute’s Annual Overdose Report 2021, deaths by overdose have outnumbered the road toll since 2014. There were 2227 drug deaths in 2019, and 1644 of those were unintentional. Evidence shows that injecting rooms can reduce these preventable fatalities.

Alternative access pathways to essential services also improve the general wellbeing of people who use drugs. People who use drugs may find it difficult to engage with mainstream health and social services.

What are the barriers?

• Stigma against drug use means that many health and wellbeing services may not offer alcohol and other drug services or know how to best support people who use drugs.
• Financial difficulties often prevent people from paying up-front fees.
• Insecure housing makes it difficult to build a relationship with a clinic or doctor, since you’re always moving around.
• Insecure access to a telephone or internet can make it complicated to make and keep appointments, especially now that many services are offered by telehealth.

MSIF staff can connect people with services that are better able to fill their needs and improve the general stability in their lives. That stability can be a protective factor that helps people to manage their drug use in the long term.

How long have MSIFs existed in Australia?

Injecting rooms are not a new concept. The first ‘safe consumption facility’ was set up in Switzerland in 1986. More began to pop up around the world through the 1980s and 90s in response to an international heroin crisis that necessitated that healthcare workers and policy makers to transition from a zero-tolerance viewpoint to a harm-reduction perspective. By the 2010s there were more than 90 drug consumption facilities worldwide, including 13 in Switzerland with a population of just 8.6 million. There are currently two in Australia with a population of 25.6 million.

In the late 1990s, Sydney’s Kings Cross saw an increase in heroin-related deaths and other drug-related harms. At that time, the area was associated with the highest number of deaths from drug overdose in Australia. As the crisis unfolded more people were injecting and experiencing overdoses on the streets. Despite the presence of successful sterile needle and syringe exchanges in the area, used syringes were being abandoned in public places, creating decreased public amenity. The situation led to increased pressure on the ambulance system and concern amongst the general public.

In 2001, after extensive community consultation, the Uniting Church set up the first Australian injecting facility in Kings Cross. The facility was the first in the English-speaking world. In the 20 years since the service was established, they have prevented more than 8500 overdoses and have not experienced a single fatality. They have also referred 14,500 people into support programs.

An independent review of the program by KPMG found that the Kings Cross facility had substantially achieved its goals, both in terms of preventing fatal overdose and referring clients into further treatment, and improving public order:

All key local service system representatives interviewed who were familiar with Kings Cross prior to the opening of the MSIC reported they observed less public injecting in Kings Cross since the opening of the MSIC. The proportion of the local community who have seen someone injecting in the previous month has declined substantially over time with the proportion of local residents who report having seen public injecting in the previous month halving since MSIC opened (from 55% in 2000 to 27% in 2010). The proportion of business operators who have seen public injecting in the previous month has reduced from nearly two-thirds to about one-quarter (61% in 2002 to 22% in 2010).

The Kings Cross facility was initially controversial but has since been widely accepted as a beneficial presence in the local community, and many advocatefor the expansion of the programinto other parts of NSW.  

What’s going on in Melbourne?

The success of the Kings Cross facility and similar facilities around the world inspired the establishment of an injecting room in Melbourne. North Richmond Community Health (NRCH) opened their medically supervised injecting room in June 2018 as part of a two-year trial project.

Several factors led to the selection of the North Richmond site:

• Like Kings Cross, North Richmond has a long history of drug-related problems in the community, going back decades. From 2009 to 2018, the City of Yarra experienced more heroin-related deaths than any other Victorian council area, and many occurred in public locations.
• A coronial enquiry into the North Richmond death of a 34-year-old woman (known publicly as Ms A)recommended the establishment of a pilot medically supervised injecting room (MSIR).
• A Victorian parliamentary enquiry received a number of submissions supporting expansion of harm reduction programs and the creation of a MSIR, leading to the Inquiry into the Drugs, Poisons and Controlled Substances Amendment Bill 2017 that legislated the pilot program.
• Local community and health leaders in North Richmond sent an open letter to the government requesting an injecting room due to the devastating impact of drug use in their community.
• 600 people rallied for the creation of the injection room, organised by the Residents for Victoria Street Drug Solutions (RVSDS).

So while the location of the NRCH Injecting Room has not been universally welcomed, it is important to recognise that this site was not imposed by a top-down approach from the Victorian government, but was requested by many people within the community itself, and informed by the evidence for overdose deaths in the area.

NRCH created this video tour to help the community better understand the facility and how it serves clients. 

You can also follow the NRCH Podcast to learn more about the organisation’s work and keep up to date with new developments.

Has the NRCH MSIR been effective in helping people?

The NRCH MSIR has been very effective in its mission to prevent fatal overdoses. NRCH reports the following achievements in the MSIR between 30 June 2018 and 30 September 2021:

• 4,674 overdose incidents safely managed
• 272,052 visits to the MSIR
• 80,000 health and social service support services provided
• 2,149 homelessness support services provided
• 231 clients engaged in Hepatitis C treatment on site
• 400 people began opioid agonist therapy, a form of pharmacotherapy that helps people control or decrease opioid use — you’ve most likely heard this referred to as the methadone or suboxone program
• 2,777 referrals to external support services.

An independent review panel in June 2020 also found that the injecting rooms had taken pressure off emergency services and led to a decrease in reports of public injecting in the area. A final report is due 31 December 2022.

The panel has also recommended an additional facility be opened in the City of Melbourne, where 51 Victorians died of heroin-related causes between 2015 and 2019. A site for the second facility has not yet been finalised.

A recent report by the National Drug and Alcohol Research Centre has also recommended that further injecting rooms should be opened in other areas of Melbourne to make the facilities more accessible to people in dispersed locations. 

Do MSIFs increase drug use and crime?

The evidence says no.

Other long-time residents point out that students at the school had been exposed to drug-related harms long before the injecting rooms opened.

“People don’t know that there was a huge issue with injecting and fatal overdoses in the car park next to the school for years — that’s why [the MSIR] was built there,” Victoria Street Drug Solutions founder Judy Ryan told Swinburne student newspaper The Standard. She also commented, “We rarely see someone overdosed in the streets now. You used to turn every corner and see someone overdosing… Secondly, our laneways and streets are no longer crowded with multiple emergency vehicles — we couldn’t even leave our houses. Along with that, we no longer have the constant sound of emergency sirens all the time. It was like living in a warzone.”

Judy explained her support for the MSIR: “People do not choose to have a heroin addiction. These are people with mental health issues, drug addiction issues and homelessness issues, and we should help where we can.”

Injecting facilities give people who often have limited resources and insecure housing a safe place to use drugs in a way that is less disruptive to the general community. Over time, public order begins to improve around MSIR.

The Alcohol and Drug Foundation notes that systematic reviews of safe injecting facilities around the world found that over time, the facilities are not associated with an increase in drug consumption or crime in the neighbourhood, but they are associated with long-term improvements in public order and do not increase drug-related crime. A 2006 study by the NSW Bureau of Crime Statistics and Research also found that the Kings Cross facility did not increase crime or drug dealing in the area in the five years after it opened.

Can we hear from the people who use injecting facilities?

You can read the stories of people who use the injecting rooms on the NRCH website to understand more about what draws somebody to the facility. One client spoke about how the facility helped him stop using. He said:

I was interested in the safety aspect of the injecting room because I’d overdosed numerous times. I have used the injecting room dozens of times since; it has saved my life.

This should have been done a long time ago. My brother would be alive if there was something like this back then.

But now is a good time to start changing attitudes. Not all heroin addicts are uneducated like people think. We all deserve to be helped.

It’s saving lives, it’s keeping the streets cleaner, and the police have got that area locked down airtight with security.

The addicts go to the injecting room because they think their life is worth saving. They should be treated as people who want to live their life so let’s help them. No-one is out to hurt anyone. All an addict wants to do when they go to use the injecting room is walk out alive. And by going to the injecting room, there is an avenue to get some help.

It’s ground-breaking, I would be dead without the injecting room. Or I’d probably still be using.

What can I do to help?

There are several steps you can take to help prevent fatal overdose:

• Share your support for International Overdose Awareness Day on social media. You probably know more people who have lost a loved one to overdose than you even realise.
• Write to your local council, state and federal representatives to express your support for harm reduction services for people who use drugs.
• If you believe people around you are at risk of overdose, you can learn how to use naloxone and carry it with you in case you encounter an emergency. Naloxone is now available for free without a prescription throughout Australia.Find out how you can access it.
• Find out more about the harm minimisation organisation in your state and get involved with their programs:
• CAHMA (ACT)
• NUAA (NSW)
• NTAHC (NT)
• QuIHN (QLD)
• Clean Needle Program (SA)
• Needle and Syringe Programs (TAS)
• Harm Reduction Victoria
• Harm Reduction WA

Thank you to injecting room staff

The team at Counselling Online want to extend our thanks to the people who work in injecting rooms all around the world. Thank you for helping to protect us, our friends, family and community members, and making sure people have access to the services they need. We are grateful for the lives you have saved.