Following the Coroner’s inquest into the death of Ms A in Richmond, the Victorian government established an inquiry into examine the recommendation that a Supervised Injecting Facility be established in North Richmond.
cohealth’s submission strongly supports the establishment of such a facility, and argues that they should be piloted at a range of ‘hot spots’. Health and social support services should be provided at these facilities, providing an holistic approach. The evidence is clear that Supervised Injecting Facilities save lives and reduce other harms from the use of drugs. It is time that Victoria takes the steps to introduce harm reducing and life saving strategies.
Legal and Social Issues Committee
Parliament House, Spring Street
EAST MELBOURNE VIC 3002
To the Secretary
cohealth welcomes the opportunity to provide a submission to the Legal and Social Issues Committee’s Inquiry into the Drugs, Poisons and Controlled Substances Amendment (Pilot Medically Supervised Injecting Centre) Bill 2017.
Please do not hesitate to contact us should you require further information or assistance in your inquiry
Calls for the establishment of a supervised injecting facility in Victoria are not new, dating back nearly 20 years. In the intervening years, supervised injecting facilities have opened in many countries and cities around the world. With them has grown an ever-expanding evidence base regarding their effectiveness at both reducing overdose deaths and minimising a range of other health, social, justice and economic harms that can arise from injecting drug use. Victoria, however, has enjoyed none of these benefits and instead many hundreds of lives have been lost to preventable overdose deaths.
As a human rights based health organisation with a long history of delivering alcohol and drug services, cohealth is committed to drawing on the best available evidence and working directly with communities to design and deliver evidence based and effective responses to reduce individual and community harm and promote improved health and wellbeing. Applying this lens, the following submission outlines cohealth’s views on the recommendations contained in Coroner Hawkins’ Finding – Inquest into the Death of Ms A, delivered on 20 February 2017, with particular regard to the nature and extent of current, associated regulations and policing policy. In particular, and as detailed in the following document:
The first supervised injecting facility (SIF) was opened in Switzerland in the 1980s. There are now approximately 90 SIFs worldwide, the majority of which are in Europe, with two in Canada and one located in Sydney. Evaluations of Sydney’s Medically Supervised Injecting Centre (MSIC), located in Kings Cross, have found that (as of 2011) the Centre had managed more than 4400 drug overdoses without a single fatality. In addition the MSIC had:
These findings mirror those from evaluations of SIFs all over the world. There have been long standing calls, for over ten years, for a SIF to be established within the Richmond/Victoria Street Precinct in the City of Yarra in particular, with strong support from the Council, local traders association, and residents. cohealth strongly supports these calls, and recommends that a supervised injection or consumption facility be established and trialed in this key hot spot as a matter of priority. This support is based not only on conclusions drawn from abundant evidence, but also from listening to our service users who have expressed a strong desire to be able to access a supervised injecting facility and who are, in some cases, surprised to learn that such services do not already exist.
In supporting the introduction of a trial we also wish to emphasise the importance of taking a holistic approach to the operation of a SIF. Providing a space for people who use drugs to inject under supervision and receive treatment in the event of an overdose will undoubtedly save lives and improve public amenity. However a SIF also creates a point of engagement with people who use drugs, creating opportunities for ‘teachable moments’ to provide education, support and referral. Accordingly, we recommend that any facility established for the purpose of providing a supervised injecting program should take an holistic approach to service delivery, wrapping around other health and social supports.
We also note that the NSW and international experience indicates that people who inject drugs are unlikely to travel any considerable distance to access a SIF. It would therefore be beneficial to establish SIF sites at a range of potential hot-spot locations in order to deliver an overall reduction in harm.
To this end we strongly recommend that a SIF trial not be limited to one location in North Richmond, but instead urge the consideration of additional options as follows:
option 1: expand the role of existing Specialist AOD Primary Health Services (SAPHS)
A number of SAPHs currently operate throughout metropolitan Melbourne ‘hotspots’, including:
Existing SAPHS operate needle and syringe programs, provide education and health promotion services, and enable people who use drugs to access comprehensive medical services. SAPHS have established relationships with many people who inject drugs, employ experienced and qualified staff, and in many instances operate from physical premises that could be easily modified in order to accommodate supervising injecting facilities.
SAPHs staff are experienced in engaging with people who use drugs about their drug use, education about safer drug use, managing physical and mental health issues, providing brief interventions and supporting access to treatment and other support services. These services strongly respond to the need of people using drugs within the SIF environment and would provide a complementary service. Additionally, given that people who use drugs experience barriers to accessing health services, access to the SAPHs services may be increased through the SIF pathway.
Locating a supervised injecting facility within an existing SAPH or SAPHs is therefore likely to be cost effective and will ensure that clients using the service can also access and benefit from a broad range of other offerings, including potential referrals to treatment.
option 2: mobile facility/bus
A number of proposals, inclusive of design work, have been developed for a mobile supervised injecting facility, housed within a bus that has custom fit out. This approach has been utilised in Barcelona.
Advantages of a mobile service are its ability to travel to a number of different hot spot locations, and to potentially allay any community concerns about a supervised injecting facility being ‘permanently’ located in their neighbourhood. However this intermittent presence in a particular hotspot location may act as a barrier to access for people who inject drugs. In addition, the space constraints of operating the service out of a bus are likely to reduce the opportunities for longer, more meaningful engagement between health workers and clients, potentially reducing the opportunities for education and referral to treatment. We would therefore recommend that a mobile/bus-based facility only be used to fill service gaps in locations not otherwise served by an existing SAPH, and/or to provide shorter term, flexible responses in new or shifting hot-spots.
key regulatory and policing considerations
It is cohealth’s view that the current legal barriers to providing supervised injecting facilities in Victoria would be adequately addressed by the Pilot Medically Supervised Injecting Centre Bill 2017 currently under consideration. However we offer the following additional suggestions that we believe would serve to strengthen the legislation and provide the best possible operating environment for a SIF trial:
In relation to policing policy, it is self-evident that most people entering a trial SIF would be in possession of illicit substances. For the pilot to be successful, Victoria Police, including members of the Drug Squad, would need to be supportive of the model and avoid surveillance of the area, which would reduce or prevent access to the target population. This is currently the practice in the locations where several SAPHs operate, and we would expect to see this extended to apply to any location where a supervised injecting facility was operating. At the same time, and as with any community-based service, prompt response from Victoria Police when requested would be important for staff, client and community safety.
evaluating the trial
cohealth recommends that a pilot should run for a minimum of three years, with independent evaluation conducted to establish effectiveness across a range of domains, including:
cohealth strongly supports all efforts to expand the availability and use of naloxone. A safe and highly effective drug for reversing overdose from heroin and other depressants, international evaluations have shown that the widespread distribution of, and education regarding the use of, naloxone contributes to a reduction in overdose deaths. Greater resources need to be devoted to ensuring that people who use drugs, all emergency responders, and all health workers (including nurses, community health workers and needle and syringe program workers) are trained in the use of, and able to access and carry, naloxone.
To this end, we advocate that attention be given to the following three key regulatory issues:
As a provider of significant drug and alcohol services across metropolitan Melbourne, including in the City of Yarra, cohealth very much welcomes the opportunity to work closely with the Victorian Government to identify opportunities to improve injecting drug users’ access to and engagement with services. We believe there are a number of issues for consideration, and potential opportunities for greater engagement, including:
We also strongly encourage that in addition to exploring this issue with service providers, the Government actively seek the feedback and input of service users themselves. These people are the experts of their own experience and are best placed to articulate their needs, and the barriers and enablers to their accessing services.
In the late 1980’s and early 90’s Australia responded to the looming catastrophe of HIV by responding swiftly and courageously to implement evidence-based strategies to reduce the risk of transmission. As much of the rest of the world prevaricated, we introduced needle exchange programs, addressed many of the laws criminalising at risk behaviours and populations, and worked with affected communities to find solutions. Our response was world’s best, and the entire community benefitted with the HIV epidemic well contained.
Thirty years on as the overdose deaths pile up, and community concern grows about the negative health, social, and criminal consequences of drug use, it is bewildering and distressing to find that national and State governments in Australia, including here in Victoria, appear to have lost the courage and commitment to do what’s needed to prevent death and harm.
The evidence of what works is even stronger than that which we relied on to combat HIV – it is neither radical, experimental, or unclear as to the kinds of reforms that need to be introduced to drug policy to save lives and reduce harm. It is our sincere hope that this Inquiry will not only recommend that the Parliament pass the Drugs, Poisons and Controlled Substances Amendment (Pilot Medically Supervised Injecting Centre) Bill 2017, but that it will further recommend that:
 MSIC Evaluation Committee. Final Report of the Sydney Medically Supervised Injecting Centre. (2003).
 The Sydney Medically Supervised Injecting Centre: reducing harm associated with heroin overdose, Ingrid van Beek, Jo Kimber , Andy Dakin & Stuart Gilmour Pages 391-406 | Published online: 21 Oct 2010