Supervised Injecting Facilities: A life saving service

Melbourne’s Medically Supervised Injecting Room (MSIR) has recently attracted considerable media attention. This is not the first time the centre, which is located on the edge of the CBD in North Richmond, has made headlines.

Supervised Injecting Facilities (SIFs) are often subject to community debate.

What is sometimes lost in these debates is the life saving service that centres provide to some of our community’s most disadvantaged people.

The main purpose of SIFs is to prevent drug overdoses and deaths by allowing people to inject in a safer and supervised environment. Without these facilities, drug injecting often occurs in far more dangerous settings, such as on the streets or in other public spaces.

To date, there have been no reported deaths inside a SIF anywhere in the world.^1-4

However, the work of these facilities goes beyond responding to overdoses.

Helping those most in need

People who access SIFs often have complex and multiple needs, including financial difficulties, homelessness, and mental health issues, as well as histories of trauma, abuse, and neglect.^{3, 5-7}

A recent survey of people who use the North Richmond MSIR show they are more likely to:

• be unemployed
• live in unstable accommodation
• be homeless
• live by themselves
• have been in jail in the past 12 months.³

The North Richmond MSIR is Australia’s second safe injecting facility – the other opened in 2001 in Kings Cross, Sydney.

A surveyed group of regular clients to the Sydney SIF found:

• 96% had a history of trauma
• 82% had a mental health diagnosis
• 54% had attempted suicide
• 1/3 had a history of self-harm.⁷

Why are SIFs so well placed to support this population?

SIFs offer much more than a supervised space and clean injecting equipment.

They provide a gateway to other health and support services such as physical and mental health services, employment, housing and financial supports.^{1, 3-5}

SIFs can also act as a crucial first step into the treatment or rehabilitation system for many vulnerable clients.

When visiting mainstream health care services, the same people can face ‘barriers’ to accessing appropriate treatment or care, including discrimination, stigma or unsatisfactory treatment.⁸

A safe space

SIFs can be a place of refuge and shelter for clients. In these centres, clients find social acceptance rather than judgement.^9-11

There is growing evidence that Safe Injecting Facilities have a positive impact on:

• social connectedness and community
• emotional support and stress reduction
• safety and security
• current shelter status and search for housing
• health service access and use.⁹

At the Sydney facility, after clients come out of the injecting area, they move to a room known as ‘Stage 3’.

This room is a relaxed space, where activities are run to engage people in conversations about their health and wellbeing. This might involve a quiz, creative writing or art, or a demonstration of correct overdose responses, recovery positions and rescue breathing.¹²

Staff at the facility are experienced and skilled in starting conversations and creating therapeutic relationships with clients, allowing them to make effective referrals into treatment, care and other support services.¹²

Communities can benefit too

Along with saving lives and providing wrap-around supports to vulnerable people, SIFs benefit the broader community.

Health resources are saved by less ambulance call outs to public overdoses and reduced emergency department admissions. There’s also a reduction in costs associated with new HIV/Hepatitis cases, and other health conditions related to injecting drug use.^{2, 3, 13-17}

People are less likely to inject in public places where they may be seen by others. Which also means there are less syringes and needles left lying around in unsafe places.^18-21

And, despite media reports, evidence consistently shows these facilities do not increase drug consumption, drug dealing or crime in surrounding areas.^{17, 22, 23}

In fact, in some cases, SIFs can be associated with improvements in public order.²²

Supervised Injecting Facilities are not a stand-alone solution to tackling drug-related issues in the community. People who struggle with drug dependency require a wide range of affordable and accessible treatment and support services.

But, without the existence of these centres, some people may never feel encouraged to take that first step towards recovery.