Text Print Send

Should the Kings Cross injecting room be made permanent?

Monday, 7 July 2008

Dr Ingrid Van Beek writes:

Share / Save Article

It was with some disappointment but mostly a sense of achievement that I recently finished my 8-year tenure as the Medical Director of Australia’s first Medically Supervised Injecting Centre (MSIC).

I was appointed to this position in February 2000 on a half-time basis while also continuing on as the Director of the Kirketon Road Centre – a primary health care facility of the South Eastern Sydney and Illawarra Area Health Service located in Kings Cross, which I had directed since 1989 and now return to full time.

I am proud of the MSIC’s achievements – the staff have successfully treated 2,458 drug overdoses onsite in the past 7 years, while ambulance callouts to heroin overdoses in the area decreased by 80%, thereby freeing these up to attend other medical emergencies.

The MSIC continues to enjoy broad-based support from the local community; notably 68% of local business managers and 80% of local residents who were resident in the area before the MSIC supported its establishment when last surveyed. The Kings Cross Business Partnership (which replaced the Chamber of Commerce post-bankruptcy) has credited the MSIC for helping business recovery in Kings Cross for having reduced street-based drug injecting.

The jury is well and truly in as far as the international research community is concerned so far as the merits of supervised injecting facilities. They are now well recognised as effective in reducing drug-related harm associated with street-based injecting to both individual drug user and greater community. The Sydney centre is considered to be exemplary of the 76 or so such facilities operating in 8 different countries today.

So why I am disappointed? The reason is that the MSIC continues to operate on a trial basis, rather than as the accepted and much-needed legitimate health care facility that it is. The most recent 4-year extension to the trial - making it a record-breaking 10 and a half year scientific trial with little end in sight - was passed by the NSW Government in June last year.

It’s now time the NSW Government revisited the trial status of the MSIC. I whole-heartedly support the ongoing rigorous evaluation and monitoring of health services to ensure their effectiveness, particularly in the illicit drugs area as needs can change over time, but the MSIC’s apparently endless trial status is a barrier to its integration with the rest of the public health system. This affects continuity of care, workforce development and staff morale, especially as the end of each trial period draws near.

It’s time the trial was declared a success, and we moved on. What might help the NSW Government to move in this direction?

Already a Crikey Member? Login below to comment or click here to start a Free Membership now.

Your Email Password
Remember Me

Need your password?

susan Monday, 7 July 2008 2:32:22 PM: Dr van Beek has been commended and rightly so. Not just for her unwavering commitment to harm minimisation and the centres compassionate and professional aim to save and improve the lives of many marginalised people, but her wider aim to also protect and educate the wider public (even those detractors) regarding the public health benefits In a global environment where Hepatitis C and HIV are a stark health and economic reality.
An exemplary doctor and human being has a message for those in government, "Let common sense prevail and MAKE THE CENTRE PERMANENT!!!!!!"
ian mead Monday, 7 July 2008 2:51:45 PM: The injecting centre has been a huge success as many of those who have lived in Kings Cross will attest to. Not only does it save lives but takes it off the streets. It should be given permanent status. At the end of the day if there are no drug users usin it it will be close anyway. The NSW Government needs to stand behind the evidence.
It should no longer be a trial and be made permanent
Ian Sydney
steve robinson Monday, 7 July 2008 3:06:27 PM: Dr Van Beek should be Australian of the Year for the work she has done in this very difficult arena - the Alcohol and Drug sector has an enormously high burn-out rate amongst workers and Dr Van Beek has thrived where others have fallen by the wayside. She has consistently advanced the pragmatic cause of harm reduction -seeking to lessen the inherit dangers faced by injecting drug users not the least of which being public apathy.

It goes without saying that the MSIC should remain open as long as there are people who inject drugs - and that is likely to be a very long time yet. Quite rightly those most affected by the drug using community in Kings Cross - police, residents and business owners - overwhelmingly support the MSIC. They are the ones who have seen a drastic reduction in people overdosing on street corners, front gardens and public parks. The MSIC has saved lives and will continue to do so. Additionally it provides injecting drug users with a valuable point of contact with a range of treatment services which, in many cases, provides them with an opportunity to reduce or eliminate their drug use.

It would seem that the only people that seriously oppose the MSIC are hardline Christian minority groups led by the likes of Fred Nile and groups like Drug Free Australia - and here's me thinking that Jesus had compassion for socities most marginalised. It must be a different Jesus that I'm thinking of.

Thank you Dr. Van Beek for all your hard work, determination, compassion and courage. You are a truly heroic individual - I understand that you will remain in the AOD sector and this comes as a tremendous relief to me - you'd be impossible to replace.
Richard (yes, i used to work there) Monday, 7 July 2008 3:20:22 PM: It’s interesting that the State Health Minister’s recent comment about the issue of permanency for the Injecting Centre was to say there is a “need to build ongoing … evidence about the Centre’s effectiveness, particularly regarding its capacity to get clients into treatment”. The Minister is taking a politically popular line here. It’s the sort of unfortunate political equivocation that disingenuous Governments peddle on complex and potentially divisive social issues.

The imperative of getting addicts into treatment was never a key criteria of success for the Centre. From the time of the T-Room at the Wayside Chapel to the 1999 Drug Summit and then the drafting of the proposal for the MSIC the designers and authors of the MSIC were clear about where the Centre should sit in the continuum of drug services; it was to be a low threshold service attracting the most disadvantaged and vulnerable people. The ideal outcome for the Centre would be to prevent immediate harms like overdose and Hep C and HIV transmission.

The Centre has clearly met and exceeded expectations in terms of it’s pre stated objectives. What has also been demonstrated is that the Centre does act as an important and unique gateway to treatment for many people who would not otherwise come into contact drug services. But it does this by focusing of the immediate needs of people, the engagement and rapport gained through this can be built upon to address secondary needs. Coercing or pressuring clients into treatment would be counterproductive because it would alienate them.

The Minister continued with the oxymoron; “ the Government is committed to the continuation of the trial”. It’s hard to completely comprehend the Government’s position on the Centre. If ever there was a clear winner in terms of policy, an arrow they could paint the bulls eye around then this is it. It’s hard to answer Ingrid van Beek’s question, it seems modern politics discourages vision, conviction and a willingness to lead community debates.
Anne Woods Monday, 7 July 2008 4:08:32 PM: I can understand equivocation when the effectiveness of a plan is unproven. But here we have a government with a chance to do somethng useful, that may REALLY help people an still they equivocate. I have to question this governments ability to make any sensible decisions if even the 'bleeding obvious' ones are avoided
scot Monday, 7 July 2008 6:47:43 PM: I was a long time (since childhood) resident of Woolloomooloo, then Darlinghurst and lastly Potts Point for not quite 30 years until just three years ago. The improvement that was visible in the Kings Cross area ever since the injecting centre opened was quite remarkable. Kudos for all involved, but it is time to make it permanent and extend to new centres in other areas where needed.
Paul H Tuesday, 8 July 2008 10:05:35 AM: I remember the old days (early 80s) of trying to buy fits. You'd have to travel around to just a handful of chemists and hope the staff on duty would say yes. I used to share with a limited number of people - most now have hep C and one has HIV as well. I guess it is just by chance that I didn't get HIV.

I SAY KEEP THE MSIC GOING AND GIVE IT SECURE ONGOING FUNDING. It is initiatives like it (and NSP in general) that have enabled me to make it through my younger adventurous stage of life comparatively safely.

My daughter has just started at Syd university and would echo my view. My bet is she'd much rather me help look after future grandkids than her have to nurse me through HIV illness.
David Carey Tuesday, 8 July 2008 11:53:08 AM: Having lived in Brougham St. Woolloomooloo and currently Elizabeth Bay, and being a daily visitor to the Kings Cross going to work, shopping, my local club and my local branch of my community group, since 1985, I have seen the years that preceded the MSIC and I've seen the last eight years. Street injecting was a nightmare, for the users and the people who live in this area. I'd walk down Butler Stairs each morning on the way to work, crunching underfoot, literally 50 or more syringes. The Council workers were petrified of needle-stick as they swept up the leaves in Victoria St. Only yards from the Police Station in Fitzroy Gardens I've seen people injecting. On the way home at night? Well, that's when you saw the Ambo's parked in the side streets, and even Darlinghurst Road, carting the O D's in to the back of the van, or trying to zap them with Narcan.

Does this happen any more? I don't think so. I haven't seen it for years. The statistics, of thousands of overdoses saved through the MSIC, back-up my local knowledge. Ask the locals in this 2011 postcode area. Of course it has worked.
Continuing the "Trial" status is nonsense. Just get it made "permanent" and review its performance regularly, like every other health service.

David Carey
Elizabeth Bay Rd
Carl Tuesday, 8 July 2008 12:21:15 PM: How much evidence do the prohibisionists in Australian society need before they realise that their Hobbesian ideal of absolute control and constraint should be committed to history with all the other failures to attempt to force people to conform.

What place does such facile appeal to popularist "law & order" politics have in a compassionate civil society?

Based on the mortuary fees alone the MSIC pays for itself! Isn't a life saved a life gained?

By institutionalising the MSIC and acknowledging the mis-fortune that some distressed folk - our fellow citizens - suffer in our society as a health issue of our society we go a long way towards remediating that illhealth and strengthening our social capital.

Fund the MSIC now, open as many such centres as are needed across the entire country and observe the reduction of suffering and the removal of the incideous black market in opiates, and stop pretending that punishment results in anything but social disintegration.
A local resident Wednesday, 9 July 2008 10:02:04 AM: Apart from the fact the MSIC keeps people alive, the residents of Kings Cross enjoy the long term benefits everyday:
• Less sirens as ambulances scream around the streets every night picking up overdosed people from dark and dangerous alleys and doorways.
• Less syringes dumped in public toilets and parks.
• Less aggression from people injecting in public places.
I would hate to think what Kings Cross would be like if the centre hadn't opened all those years ago and I can't help but think those complaining now are new to the area and don't actually remember what it was like.
I find it odd that they don't complain about the gangs of drunken young men and women who are far more frightening to me when they roam the streets in the early hours of the morning.
We also can't ignore the fact that some people will become addicted to drugs no matter what we do and will only seek help when they are ready. Forced drug rehabilitation does not work and leads to death from overdose when they return to the streets and their tolerance has dropped.
The MSIC provides a safe clean supportive environment where users have the confidence to confide in staff when they are ready to change their lives.
For most of the users, the MSIC would be their ONLY contact with a health professional. Without MSIC they would be back on the street, injecting in dark and dangerous areas - and dead far more quickly.
Dr Alex Wodak Wednesday, 9 July 2008 10:49:24 AM: There is no available public health or policy explanation for the reluctance to accept the MSIC after 7 years of operation. The initial classification as a research project was quite legitimate at the time. But the quality and quantity of evidence of this and comparable international facilities demonstrating evidence of considerable benefit without significant unitended negative consequences requires revision of this classification. The most parsimonious explanation for the current classification is that political factors have been regarded as more important than public health or policy considerations.
Clearly, the continued survival of this important facility cannot be assumed. Kings Cross has been the major drug market in Australia for more than four decades. One in every ten fatal drug overdoses in the country occurs within 2 km of this MSIC. Therefore, the MSIC plays an important role in reducing the health, social and economic costs of illicit drug use in Australia.
The longer the MSIC has survived, the clearer it has become that the MSIC has major benefits for injecting drug users and the community. It has also become clear that the MSIC is not associated with any important adverse consequences. If politics and especially if drug policy was a more rational process, then this facility would be recognised as a legitimate health service.

Budget countdown: Tax revenue, recession, deficit, oops

Rundle: UK cops take a (deserved) media beating

New York Post circulation down 20%

Germany: worst banking system ever

First homebuyer grant was nothing but a gift to vendors

To read these stories take a free trial now.

Please login to continue

Should the Kings Cross injecting room be made permanent?

Share / Save Article