Should The Medically Supervised Injection Centers Be Removed

Medically supervised injection centers (MSICs) have been a controversial topic, especially in light of Prime Minister Peta Handstand’s recent call for their closure in Australia. PM Handstand claims it is due to the nature for overdoses onsite, tendency to attract addicts to the area and ‘drain on public resources’ that MSICs should be removed. However, the King’s Cross MSIC (Sydney), opened in May 2001, and the Richmond MSIC (Melbourne), opened in June 2018, have become integral parts of harm minimization in Australia and should not be shut down, as they are beneficial in their function and are essential in order to effectively deal with the national drug issue. Experience from the Sydney and Melbourne MSICs yield positive results and evidence refutes the PM’s claims which are largely inaccurate. On the other hand, I do not completely agree with the Emerald Party’s policy and believe that both parties need to reconsider a drug approach that utilizes MSICs on top of other programs. It is important to first ask what the purpose of MSICs is in the first place and how they actually function. A flawed understanding of their function is perhaps one of the reasons why there is such disjunction between public perception and what actually occurs in MSICs. MSICs function by having staff supervise drug injections which, in effect, help prevent harms which could occur, such as disease transmission or overdose, had the injection occurred elsewhere. MSICs do not provide drugs to their clients, although there is access to medical care for overdoses. In the Victorian Parliament’s 2017 inquiry for a pilot MSIC in Melbourne, the four main aims, cited from Dolan et al (2000), were to reduce public nuisance and contribute to public amenity, reduce opioid-related overdoses, decrease the transmission of viruses such as HIV and hepatitis C due to sharing of syringes and to improve access to alternative services such as medical care, drug treatment and welfare services. The International Network of Drug Consumption Rooms (2015) further adds that they aim to promote awareness and understanding in communities as well as public health knowledge.

Essentially, MSICs act as a major step for harm reduction when prevention is no longer possible and do not condone drug use nor actively promotes its usage. Contrary to what PM Handstand may believe, experience with both the King’s Cross and Richmond MSICs has demonstrated overwhelmingly positive outcomes that have benefited both clients and the local community. An evaluation report (National Centre in HIV Epidemiology and Clinical Research, 2007) indicates that there was a significant decrease in needles and syringes collected within 500 meters of the King’s Cross MSIC, dropping 48% from before its opening in 2001 to January 2007, corresponding to significant reduction in public nuisance. More than 930 000 injections and 6000 overdoses have been supervised and there have been zero fatalities on premises. In regards to the goal of connecting clients to services, more than 11, 678 referrals have been made and over 15 000 people have registered as of 2015. Most importantly, over 78% of local residents support the MSIC. The Melbourne MSIC demonstrates similar results despite having only begun as a two-year trial in 2018.In only the first 3 months of its operation, 8000 people had used the facility with staff responding to 140 overdoses. However, it is important to note, that the Richmond facility is located in a primarily residential area close to a school, while the King’s Cross MSIC is based in a more commercial area. As such, the experience of the community is based on different factors, and in Melbourne’s case, a decrease in public injections over the years has greatly benefitted the school community by ensuring the safety of students and increasing their awareness of public health, which is a benefit that was not felt as much in Sydney. The claim that there are an ‘appalling’ number of overdoses on the premises of Australian MSICs is baseless. In fact, while overdoses do occur, medical services are available to take care of clients being facilitated, and it is this visibility of overdoses that may have contributed to the perception of an overdose inflation. Of the 2106 overdoses that the Sydney facility managed in the first six years, it was estimated that about half would have occurred in public places anyway, and so it can be contended that overdoses on premise are a necessary evil in order to minimize associated risk from unsupervised drug injections where there is little to no aid from medical staff. The impressive zero fatality rate stands as evidence.

Moreover, analysis of ambulance callouts to the Sydney MSIC indicate that opioid-related overdoses actually decreased to a greater extent in King’s Cross than compared to the rest of New South Wales. There was a 68% decrease in monthly ambulance attendances from 2001 to 2007, and decrease in drug-related deaths from four to one per month, and these further highlight the effectiveness early intervention medical aid and prevent fatal overdoses. Therefore, although there is a number of overdoses that no doubt occur within the facility, the rate of these overdoses are neither ‘appalling’ nor significant and are an inevitable part of the nature of the facility itself – namely in the process of dealing with addiction. And, on the other hand, these overdoses are supervised and dealt with professionally, contributing to a downward trend of overdoses and fatality rates. Another concern mentioned was the fear of attracting drug users towards areas close to the MSICs, otherwise known as the ‘Honeypot effect’, thus creating more public disorder in King’s Cross and Richmond. Undoubtedly, there will be an increase in traffic as drug users travel to the facilities in order to access them, as evidenced by the 15 000 registered users of the facility, but this does not imply a correlation of increased drug-related activities outside the facility.

A study of the crime around the Sydney MSIC (Freeman et al, 2005) found that there was no evidence to suggest the opening of the MSIC increased levels of acquisitive crime, no significant increase in ‘drug-related’ loitering and no increase in drug use or supply offences in King’s Cross. Furthermore, the decrease in syringes collected around the MSIC suggests that there is a decrease in public injections and consequently likely suggests a decreased concentration of users in areas outside the facility. If there were a supposed ‘Honeypot effect’, it has not been expressed in empirical data suggesting ill effects so again, this may be an illusion resulting from increased visibility. Handstand’s final point is also worth addressing as it is the one that affects us the most – the funding of MSICs and whether they are worth our tax money. The annual costs of operation for the Sydney MSIC has increased yearly, from $2 420 214 (2003) to $1 995 784. Despite these costs, data suggests that the money is compensated through other means in the health system due to the prevention of HIV and hepatitis C infections, ambulance call outs, overdoses and hospital admissions; a further $658 000 is saved yearly (p. 4, SAHA International, 2008).At the same time, there is also the ‘non-financial’ cost of people’s lives, as MSICs continue to save lives from fatal overdoses and diseases, furthering Australia’s journey in harm reduction and aid. Arguably, the savior of lives in conjunction to financial benefits is all the more reason for the continuation of MSICs.

Finally, I must address the Emerald Party’s proposed policy to open more facilities due to the current MSICs having already achieved all their objectives. While I do agree that the King’s Cross and Richmond MSICs have made substantial progress towards achieving these objectives, I do not believe these achievements have been through the use of MSICs alone. While there have been astounding results towards all goals, this does not necessarily equate to a complete elimination of drug-related public injection and overdoses from the community. The facilities also only target a small proportion of drug users such as those that are logistically able to access their locations, and those that are already addicted. And so, while MSICs are quite beneficial, I admit that they should not be the only solution towards tackling the drug problem in Australia. Instead, consideration for the opening of new MSICs should be in conjunction to other policies and new measures in holistic approaches targeting different aspects of the problem. More effort needs to be taken to prevent drug addiction from occurring and tackle existing drug markets, and these issues cannot be resolved with only MSICs. Drug users who attend MSICs are usually already addicted and bring pre-purchased drugs. Ultimately, my stance on the proposed policy is to support the expansion of MSICs, but only reluctantly, as I do believe opening MSICs are beneficial, and may help if there is an increased availability to target high density drug areas. However, this cannot be the only measure to rely on, especially since realistically it may not guarantee perfect results. Ultimately, I firmly believe that current MSICs should continue to exist and there should be a tentative effort to expand the availability of these facilities to other states in Australia in order to target a greater spread of drug users. The positive outcomes of both MSICs currently existing in Australia demonstrate that there seems to be little to no adverse effects from their operation, contrary to what PM Handstand has claimed. In actuality, MSICs have provided numerous benefits economically, medically in regards to overdoses, as well as socially in a positive effect on the surrounding community. However, further effort by the government is needed to target the issue from all sectors, and not just through the opening of MSICs alone.