April 26, 2021

Supervised Injecting Facilities: A life saving service

Doctor explaining something to a patient

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.

More on Supervised Injecting Facilities

  1. Clark J, Torrance J. Drug Consumption Room: Could the provision of a drug consumption room bring significant benefit in reducing drug related deaths and other community harms in Bristol. Transform Drug Policy Foundation; 2018.
  2. Uniting. Uniting Medically Supervised Injecting Centre 2020 [cited 2020 June 16].
  3. Hamilton M. Review of the Medically Supervised Injecting Room. Melbourne: Medically Supervised Injecting Room Review Panel; 2020.
  4. Marshall BDL, Milloy MJ, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. The Lancet. 2011;377(9775):1429-37.
  5. Belackova V, Silins E, Salmon AM, Jauncey M, Day CA. “Beyond Safer Injecting”—Health and Social Needs and Acceptance of Support Among Clients of a Supervised Injecting Facility. International Journal of Environmental Research and Public Health,. 2019;16(11).
  6. Salmon A, Belackova V, Schwanz RS, Jauncey M, Hiley S, Demirkol A. Homelessness among clients of Sydney's supervised injecting facility. Drugs and alcohol today. 2017;17(4):258-68.
  7. Goodhew M, Salmon AM, Marel C, Mills KL, Jauncey M. Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC). Harm Reduction Journal. 2016;13(1):29.
  8. Wood E, Tyndall MW, Li K, Lloyd-Smith E, Small W, Montaner JSG, et al. Do Supervised Injecting Facilities Attract Higher-Risk Injection Drug Users? American Journal of Preventive Medicine. 2005;29(2):126-30.
  9. Kerman N, Manoni-Millar S, Cormier L, Cahill T, Sylvestre J. “It’s not just injecting drugs”: Supervised consumption sites and the social determinants of health. Drug and Alcohol Dependence. 2020;213:108078.
  10. Fairbairn N, Small W, Shannon K, Wood E, Kerr T. Seeking refuge from violence in street-based drug scenes: Women's experiences in North America's first supervised injection facility. Social Science & Medicine. 2008;67(5):817-23.
  11. Boyd J, Lavalley J, Czechaczek S, Mayer S, Kerr T, Maher L, et al. “Bed Bugs and Beyond”: An ethnographic analysis of North America's first women-only supervised drug consumption site. International Journal of Drug Policy. 2020;78:102733.
  12. Jauncey M. What goes on inside a medically supervised injection facility? : The Conversation; 2017 [cited 2021 February 12]. Available from: https://theconversation.com/what-goes-on-inside-a-medically-supervised-injection-facility-87341.
  13. Andresen MA, Boyd N. A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility. International Journal of Drug Policy. 2010;21(1):70-6.
  14. Bayoumi AM, Zaric GS. The cost-effectiveness of Vancouver's supervised injection facility. Canadian Medical Association Journal. 2008;179(11):1143.
  15. Pinkerton SD. Is Vancouver Canada's supervised injection facility cost-saving? Addiction. 2010;105(8):1429-36.
  16. KPMG. Further evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011). NSW Health; 2010.
  17. Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence. 2014;145:48-68.
  18. McKnight I, Maas B, Wood E, Tyndall MW, Small W, Lai C, et al. Factors Associated with Public Injecting Among Users of Vancouver's Supervised Injection Facility. The American Journal of Drug and Alcohol Abuse. 2007;33(2):319-25.
  19. Salmon AM, Thein H-H, Kimber J, Kaldor JM, Maher L. Five years on: What are the community perceptions of drug-related public amenity following the establishment of the Sydney Medically Supervised Injecting Centre? International Journal of Drug Policy. 2007;18(1):46-53.

20. Thein H-H, Kimber J, Maher L, MacDonald M, Kaldor JM. Public opinion towards supervised injecting centres and the Sydney Medically Supervised Injecting Centre. International Journal of Drug Policy. 2005;16(4):275-80.

21. Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JSG, et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal. 2004;171(7):731.

22. Kennedy MC, Karamouzian M, Kerr T. Public Health and Public Order Outcomes Associated with Supervised Drug Consumption Facilities: a Systematic Review. Current HIV/AIDS Reports. 2017;14(5):161-83.

23. Barry CL, Sherman SG, Stone E, Kennedy-Hendricks A, Niederdeppe J, Linden S, et al. Arguments supporting and opposing legalization of safe consumption sites in the U.S. International Journal of Drug Policy. 2019;63:18-22.

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