April 22, 2018

Medically supervised injecting centres: dispelling the myths

MSIC: dispelling the myths

The primary aim of a medically supervised injecting centre (MSIC) is to tackle health risks associated with using drugs on the streets as well as introducing drug users to services and support.  Evidence to support the existence of centres is overwhelming yet a lack of understanding of the purpose is easily lost amidst misinformation in the media.

Medically supervised injecting centres have three clear goals;

  1. To provide an environment for safer drug use
  2. To improve the health of drug users
  3. To reduce public disorder

A supervised injecting centre does exactly as the name suggests.  The staff in the centre ‘supervise’ episodes of injecting drug use that would otherwise happen somewhere else – often in public, laneways, public toilets or next to schools.  The absence of a designated place to inject will not stop someone from injecting, regardless of drug type.

All MSICs acknowledge that injecting any drug is inherently ‘unsafe’ however the practice can be made ‘safer’ if supervised by a trained professional in a controlled environment.

MSICs do not supply drugs. Clients arrive at the centre with pre-purchased drugs. MSICs do not support drug dealing – selling, buying or sharing drugs is prohibited within a centre.  Staff do not assist a client to inject their drug of choice. Instead staff are present to supervise the injection of the drug and to ensure that there is immediate access to emergency medical care in the event of an overdose and to support the drug user after injection has taken place.

The Medically supervised injecting centre in Kings Cross, Sydney report a mix of drug types used in the facility.  In 2015, heroin only made up 41% of all injectionsAmphetamines, which includes methamphetamines or ICE, made up 18% of all injections.  As more than one million injections have taken place since the MSIC in Sydney opened its door, a conservative estimate would suggest that may have included more than one hundred thousand injections of amphetamines.  The Australian newspaper reports that despite injections of methamphetamine increasing from 268 in January 2012 to 1212 in June 2017 rates of abuse and aggression are decreasing.

The very nature of the centre allows for the drug user to remain in the centre in a calm, safe space post injection.  There is no evidence, anecdotal or otherwise, that use of methamphetamine under the supervision of trained professional health workers aligns with the concerns being addressed in the local media.

In October 2017, the Victorian government passed legislation to open a MSIC in North Richmond, a suburb that has a high level of drug use and tragically high numbers of overdose deaths.  Many concerns have been expressed regarding the location of the centre being close to a primary school.  These are legitimate concerns and worthy of being expressed.  Children should not be exposed to trauma on their daily walk to school.  However, the current situation in Richmond sees primary school children, kindergarten children and families being exposed to an open drug using scene daily.  Many families and children in the area have already been exposed to drug use, discarded injecting equipment and many have borne witness to tragedy.   Discarded injecting equipment is regularly found in the playground of the primary school.  This is unacceptable and must be addressed.  And now it finally is.  By the establishment of a medically supervised injecting centre.  The establishment of the centre is not the only solution to solve the drug problem but it is a significant step as part of an overall approach.

The supervised injecting centre will reduce the discarded needles in the playground, it will reduce the likelihood of primary school children being exposed to drug using, it will reduce the open drug using scene.  This is based on fact.  There are over 220 peer reviews papers that show facilities like this work.

Media reports early in 2018 that all drugs of dependence will be allowed in the centre, including methamphetamines, generated a great deal of noise and misinformation.  The drug of choice used within the centre does not change the purpose of, or the impact that the centre will have on the lives of drug users or the wellbeing of the community. Feeding the hysteria surrounding crystal methamphetamine only contributes to further stigmatisation of the people who are using it – and we know that stigma is a major reason people don’t seek help.

Opposition to the centre and moves to stop the trial well before any impact can be measured will only increase the harms (including stigmatisation) associated with injecting drug use in Richmond and will result in more deaths and greater harms in the Richmond area.

The Medically supervised injecting centre is good public health policy and deserves bipartisan support.

If we don’t have a centre in Richmond people will continue to die. And they will die in public places for school children to witness.  People will still inject a variety of substances. Injecting equipment will continue to be found in the playground of the local school. Residents will still witness overdoses and have to provide emergency first aid to people on their doorstep.   And school children will continue to witness the tragedy that is severe drug dependence.

This life saving, public health intervention should not be at risk due to misinformation and moral panic whipped up by incorrect reporting and a lack of basic understanding of what the centre exists for in the first place.