Volume 195 - Issue 5
Bipartisan support for Australia’s supervised injecting facility: a decade in the making
Authors: Marianne E Jauncey, Ingrid A van Beek, Allison M Salmon and Lisa Maher
Med J Aust 2011; 195 (5): 264. || doi: 10.5694/mja11.10815
Published online: 5 September 2011
Published online: 5 September 2011
To the Editor: This year marks 10 years of successful operation of the Sydney Medically Supervised Injecting Centre — Australia’s only supervised injecting facility (SIF). It is one of 90 such facilities globally, with SIFs operating in eight different countries for up to 25 years. Legislation to lift the trial status of the Sydney centre was passed in the lead-up to the recent New South Wales state election, nearly a decade after the centre opened. Despite not having explicitly supported the centre while in opposition, at the Centre’s 10-year anniversary event on 6 May 2011, the newly elected Liberal–National coalition government signalled its willingness to contribute to bipartisan support of the centre.
While the Sydney SIF has survived this transition into institutional “adulthood”, operation of the only other SIF in the English-speaking world, located in Vancouver, Canada, remains a politically sensitive issue. Indeed, the Supreme Court of Canada is currently deciding whether the right to establish and operate a SIF lies with the provincial or the federal government.
The Australian and Canadian SIFs have much in common: both have a history of politicisation, both were established under trial conditions, and both have been subject to rigorous independent scientific evaluations. They have each contributed much to the large body of evidence showing the benefits provided by SIFs to individual drug users and to surrounding communities. Specifically, SIFs have been shown to reduce numbers of deaths from drug overdose,1 reduce numbers of ambulance call-outs2 and hospital admissions, improve client outcomes,3 enhance referral to drug treatment programs,4 improve public order (eg, by reducing injecting drug use and syringe disposal in public locations),5 and be cost efficient.6 No adverse consequences have been associated with their operation.
There is widespread support for SIFs. This includes many Australasian specialist medical colleges as well as the Australian Medical Association and many scientific and research institutions. The majority of the Australian population also support SIFs, as shown in the recent National Drug Strategy Household Survey.7 Yet despite this, and the continually accumulating evidence showing the public health benefits of SIFs, the idea of establishing new facilities remains politically charged in the Australian context. In Melbourne, a local council recently urged the Victorian state government to consider establishing a SIF in an area with entrenched, street-based drug use. However, this was swiftly rejected, and calls for SIFs in other Australian states have been similarly refused by state governments. Indeed, the current legislation in NSW precludes the operation of any additional SIFs.
But for the Sydney SIF, it appears that the repeated political hurdles which characterised its first decade of operation have finally diminished. In this single instance at least, the scientific evidence on SIFs has prevailed.
Editor’s note: Ironically, after this letter was accepted for publication, the New South Wales Christian Democrat Fred Nile (Member of the Legislative Council) gave notice of intention to submit a Bill to close down the operation of the Sydney Medically Supervised Injecting Centre. No further details are available at time of going to press.
Competing interests
Lisa Maher has received funding from the National Health and Medical Research Council and the National Institutes of Health.
References
- Marshall BDL, Milloy M-J, Wood E, et al. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet 2011; 377: 1429-1437.
- Salmon AM, van Beek I, Amin J, et al. The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia. Addiction 2010; 105: 676-683. 0_pgfId-2408808
- Stoltz J, Wood E, Small W, et al. Changes in injecting practices associated with use of a medically supervised safer injection facility. J Public Health (Oxf) 2007; 29: 35-39. 0_pgfId-2408816
- Kimber J, Mattick RP, Kaldor JM, et al. Process and predictors of drug treatment referral and referral uptake at the Sydney Medically Supervised Injecting Centre. Drug Alcohol Rev 2008; 27: 602-612.e 0_pgfId-2408824
- Wood E, Kerr T, Small W, et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ 2004; 171: 731-734. 0_i1140175
- Saha International. Economic evaluation of the medically supervised injecting centre at Kings Cross 2008. http://www.druginfo.nsw.gov.au/__data/page/1189/MSIC_Final_Report_26-9-08.pdf (accessed Jul 2011).
- Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Canberra: AIHW, 2011. (AIHW Cat. No. PHE 145.) 0_pgfId-2408896