It was with some disappointment but mostly a sense of achievement that I recently finished my eight-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 very privileged to have been part of the team of health professionals that was charged with establishing this ground-breaking public health initiative. There was a time in the very beginning when the MSIC was embroiled in various legal and political challenges featuring in the media on an almost daily basis, that we started to think the MSIC would never open its doors.
But eventually these were overcome; the MSIC has now been providing a vital health care service in Kings Cross for just over seven years, mostly without attracting unwanted public attention, although one notable exception was when dumped needle syringes out the back alleged to have emanated from the MSIC instead turned out to have come from a diabetic cat “Trotsky”, a feline resident in the area.
There is no doubt that the MSIC has improved the health of the most marginalised injecting drug users who are often not in contact with any health services. Over 10,000 injecting drug users (IDUs) have registered to use the facility to date; more than 200 injecting episodes occur there every day.
This means that instead of injecting in unsupervised, often public and squalid circumstances, they are injecting in a clinical setting where, in the event of a medical emergency, such as an overdose, specially trained registered nurses provide prompt and effective resuscitation. The Centre also enables counsellors to engage people in help for the often desperate personal circumstances that led to their socially isolated lives.
The MSIC successfully treated 2,458 drug overdoses on-site in the past seven years, while ambulance callouts to heroin overdoses in the area decreased by 80%, thereby freeing these up to attend other medical emergencies. Drug users have been referred to other relevant services including drug treatment and rehabilitation on more than 7,000 occasions to date.
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. Drug-related crime is down 40% from what is once was. 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 — on 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 eight different countries today.
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So why I am disappointed? 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 four-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.
I understood why the NSW Government held back last year – mostly because they wanted to avoid a potentially lengthy and costly Federal Court challenge from the erstwhile Howard Government in the run-up to the Federal election on the basis that such facilities contravene the UN International Drug Conventions.
This was despite the UN’s own legal advice suggesting that it would be hard to argue that supervised injecting facilities, just like needle syringe programs that now exist in virtually every country in the world, contravene these conventions. It’s noteworthy that such facilities remain as trials only in Australia and Canada, despite the other countries with such facilities being signatories to the same UN conventions.
The NSW Government must revisit 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.