Australia: A safe needle can save lives

Nabeela Khan in Sydney

Published on August 2, 2017

Located in the heart of Sydney, Kings Cross is vibrant and famous red light area of Australia. From sophisticated and artistic society beginnings, the area has transformed itself to become the vibrant and controversial hot spot.

On a recent evening, I found the Cross full of trendy bars, restaurants and energy. At United Medically Supervised Injecting Centre (MSIC), I saw a young man in his early 20’s. He was impatiently knocking on the door parallel opposite the reception desk. He looked at the receptionist. The receptionist responded saying he was supposed to wait.

The Sydney’s MSIC is a special place.

It is not just a rehabilitation centre for drug users. It is a centre which provides a roof to drug users to inject drugs and discourage them from injecting in open. It has been a resounding success.

In the last 16 years, the MSIC has made over 15, 000 referrals into treatment and support services, which includes mental health services, as well as drug treatment services.

When it was opened in 2001 the surrounding area, Kings Cross, had the highest concentration of drug overdoses in Australia. But 16 years later, today ambulance call-outs to the Cross has fallen by 80 per cent. The reports of public injecting and the amount of publicly discarded needles have reduced considerably.  The centre has also saved countless lives by helping many onto the path of recovery and rehabilitation.

Medical director of the Uniting Sydney MSIC, Dr Marianne Jauncey said that MSIC aims to provide public health and public amenity by reducing drug use in public places.

 “One key measure of what an MSIC can do, apart from the obvious reduction in injury and death from intervening in overdose to keep people alive is connecting with people,” said Jauncey. “Once they are here we can refer them for treatment and care services.”

The Uniting Sydney MSIC is the only supervised injecting facility in Australia. Globally the first official supervised drug injecting facility began in Switzerland in 1986. Now there are nearly 100 supervised injecting facilities operating in nine countries, including in Germany, Spain, Norway, Denmark and Canada. At these facilities, people can use drugs under the supervision of medical staff and health professionals.

Why was Kings Cross selected for Uniting Sydney MSIC?

Kings Cross was chosen as the location for the Uniting MSIC because it had the highest frequency of drug overdose deaths in Australia. Officials at Uniting Sydney MSIC said the place was also chosen because the local community was very supportive of trialling the initiative in their area.

A visit to MSIC reveals the benefits for the local Kings Cross community are obvious.  At one time the whole place used to remain occupied with people injecting drugs, openly.

Today the place is clean and calm. In 1990’s there were increasing number of businesses in Kings Cross illegally renting rooms for purpose of injecting illicit drugs. In 1999, it reported the highest concentration of people dying from drug overdose in Australia.

After recommendations and surveys, New South Wales Government invited Uniting Church in Australia to apply for licence to operate supervised injecting centre. There was an agreement that everyone has the inherent right to dignity and respect.

That is how MSIC was opened in 2011.

These centres acknowledge that injecting drugs is not safe but allow for a safer environment to those who inject drugs. It ensures that they access emergency care if required and obtain clean injecting equipment.

“We never force people to seek support or provide rehabilitation,” said Januncey. “It is a matter of their choice”.

Although, the centre keeps a close watch on people who walk in to the centre and provide them with medical aids in case they collapse or lose control.  According to a study by MSIC, majority of respondents were unemployed, homeless and had a history of incarceration, and 82 % report they had been diagnosed with a mental health problem. One of the major benefits of drug consumption rooms is that it also helps in providing details to authorities with rapid feedback about the drugs currently used in the street.

People attending the MSIC often have multiple issues, ranging from mental illness to homelessness. Some are often victims of violence. At the University of Melbourne, Prof. Gregory Armstrong is looking at relationship between suicidal thoughts and drug abuse. He says the problem needs a holistic approach.

“We cannot just take a crime and punishment approach to drug use,” said Prof Armstrong. “It is much deeper. We have to look holistically at the drivers of suicidal thoughts.”

Can India learn from this?

The first HIV case was found in India in 1986 in the southern state of Tamil Nadu. Today India has the third largest HIV epidemic in the world with 2.1 million people living with HIV at the end of 2016, according to the latest data of UNAIDS. Infection rates are high in injecting drug users. Syringe sharing and unprotected sex are very common and suicidal thoughts are strongly associated with increased injecting and sexual risk behaviours.

“When someone is in a suicidal headspace, they may become more reckless in their behaviour” said Professor Armstrong’s “If you’re not sure you want to live today, then it is hard to be concerned about things like HIV that may kill you in the future”.

India runs a needle exchange program whch primarily provides new needles/syringes. It has helped India to some extent overcome its problem of HepC and HIV. New infections from HIV, the virus that causes AIDS, have almost halved in India over the past decade, but decline has to be greater to end AIDS by 2030.

The biggest lesson from the Australian experience is that it can help in monitoring health-risk behaviours including suicides and blood-borne viruses. However, India’s program is mostly aimed to deal with communicable diseases. There is a need to widen the scope of program to combat of suicides, depression.  In 2014 alone, there were 3,647 suicides cases due to drug abuse in India, according to the India’s National Crime Records Bureau.

“India has done some terrific work to set up harm reduction interventions, with a lot of work being led from successful interventions in northeast India”, points out Prof. Gregory. “This work needs to be continued, rather than seeing them as criminal outcasts.”