Injecting some reality
Anita Quigley
July 04, 2007 12:00am
ON a tour last week of the controversial Kings Cross injecting room, I discovered three interesting pieces of information - aside from the surprise that such a centre runs excursions for the general public.
While users are allowed to stick a heroin-filled syringe into any part of their body except their neck, smoking is banned (on health grounds), as is being intoxicated. Suspected drunks are breathalysed.
And users are permitted to maintain anonymity.
The Sydney Medically Supervised Injecting Centre (MSIC) prides itself as a vital provider of public health.
Yet if intravenous drug users are not required to give their real name, how effective can it honestly be in assessing, verifying and monitoring a person's health? Particularly someone as unhealthy (and unreliable) as an addict.
Meanwhile, fewer chemists in Sydney these days sell Sudafed, a cold medicine containing pseudoephedrine. Those that do require photo ID and your signature on a registry. All this for a legal off-the-shelf drug. In this sense, it's more strictly policed than is the injecting room.
Last Wednesday, as I was touring the MSIC, the Upper House of the NSW parliament was passing legislation authorising the centre's operation for another four years. It now sits on Governor Marie Bashir's desk awaiting her signature to make it law.
I am not sure how many MPs who voted in support of the MSIC have toured the injecting room, but I would hope all of them. Especially before voting on such an important issue.
Tours are held on the third Wednesday of the month and take about an hour, during which time the centre is closed to users.
It is fair to say the MSIC was reluctant to allow a Daily Telegraph journalist to join the public tour. I was told they considered this newspaper's view on the injecting room as negative.
I was also told that anything said by our guide, clinical services manager Colette McGrath, or any members of the public be off the record, so everyone could speak freely and the usefulness of the tour not be compromised. Most of my group were health students from Wisconsin in the US.
It is also fair to say the tour is favourable to the MSIC, which is not unexpected given it is run by its own staff.
Behind the frosted glass entrance is a waiting room. Users - who only have to give a first name and the first three letters of a surname - move from there to one of eight injecting booths, each able to seat two people.
On average the MSIC sees 230 people a day.
It's a fairly soulless place, despite users being required to share each booth with someone else (a friend or a fellow injector). That aspect makes it seem like a social exercise, as does the "after care" area of lounge chairs where addicts can "relax, have a coffee and a chat, whatever," according to a centre leaflet.
When addicts enter the injecting room they receive a syringe, spoon, tube of saline water and tourniquet if required. While staff cannot administer the drug, they can help look for a vein if the user is having difficulty.
It is interesting that users only attend the injecting room for about nine per cent of all their injecting episodes – so for more than 90 per cent of their injections they are doing so elsewhere.
The "after care" area is where staff can help with referrals to rehabilitation – but the MSIC has a low rate of referrals. Since 2001, the centre has had well over 300,000 injection episodes yet it records only a few thousand referrals to drug treatment and rehabilitation services; less than one per cent of injections.
Medical director Dr Ingrid van Beek is quick to point out the MSIC's primary role is to reduce fatal drug overdoses. "Drug users attend the MSIC to inject drugs in relative safety and are not necessarily at the stage of being able or willing to cease their use," she says.
Is there ever a good time?
Injecting rooms (of which there are now 70-odd around the world) need to be far more proactive in lowering drug use and fighting addiction. Otherwise the addict will continue with his/her habit, secure in the knowledge that he will not die, even if the system has failed to cure him.
It is also important to remember there is a causative connection between addiction and criminality - and the fact users have an injecting room does not lessen that. They still need the money to buy the drugs to inject there.
In 2003 the Drug Free Australia committee analysing injecting room data found that clients of the MSIC were recording a prior history of one overdose for every 4380 injections on average in their intake questionnaire.
But inside the injecting room, there was an extraordinary one overdose for every 106 injections, 42 times higher than than those clients' previous history.
In a transcript read last week to parliament, a former injecting room client told how addicts are taking higher-than-usual doses of heroin and mix dangerous drug cocktails at the MSIC.
The man claims that many users are mixing heroin and pills including Benzodiazepines, Normison, Oxycodone and Xanax.
"I have seen that they are going in for one thing but really they are going in for two (or three), with the heroin on top of the pills, but they won't (tell anybody that)," he said.
"They feel a lot more safer, definitely because they know they can be brought back to life straight away.
"So in a way they feel it is a comfort zone, and no matter how much they use if they drop (die) they (might) be brought back."
He said the dangerous experimentation was done behind workers' backs.
By its own admission the MSIC, which boasts of no fatal overdoses thus far, says only 62 per cent of all injections over the past six years have been heroin.
If such risk-taking behaviour as mixing cocktails of drugs is prevalent, then for how much longer will the injecting room be able to boast of its "clean record"?
And what can it do to prevent such behaviour from addicts who by their very nature are "sneaky people" as the ex-addict so readily admitted.
The MSIC has been running as a pilot since May 2001 and the program was recently extended again on a temporary basis.
It is imperative the MSIC continue to defend its legitimacy with more independent research needed and strict analysis of the way data is collated.
