Supervised injecting facilities work, but is Melbourne ready for a second one?

Late last week, the Victorian state government announced that Melbourne is set to get its second safe injecting centre. This has not been without controversy.

The announcement was made by Premier Daniel Andrews, as he was releasing the results of the evaluation of Melbourne’s first medically supervised injecting centre, in North Richmond. The Richmond facility has been extended for a further three years, with plans for the second site to be established opposite the Queen Victoria Market.

City of Melbourne Lord Mayor Sally Capp isn't opposed to the idea of a second safe-injecting centre, but is concerned by the lack of consultation regarding the preferred site.

Despite the strong evidence supporting supervised injecting centres, local support is far from guaranteed.

“It would be naive to think that everybody would embrace whatever site is ultimately decided upon,” she told ABC’s Virginia Trioli.

The Richmond centre, which was opened in June 2018, has experienced a long-running campaign for it to be closed or relocated. Objections to the site have been highly publicised, and have often overshadowed the enormous public health gains made.

What is a medically-supervised injecting facility?

A medically-supervised injecting facility is a health service where people who inject drugs can come to use drugs in a clean space under the supervision of medically trained staff. Trained staff can quickly respond to prevent overdose death, as well as provide referral for other healthcare, including drug treatment.

Are supervised injecting facilities associated with more crime?

Melbourne was already experiencing an increase in heroin use and harms when the North Richmond service was established. Since then, opponents have claimed there's been an increase in heroin dealing on the streets around it, despite that trend being well-documented prior to its opening.

The area's reputation and decade-long history as one of Australia’s largest street-based heroin markets may make it difficult to link the centre directly to injecting drug use concerns and local amenity.

Further, the state government’s evaluation report shows conflict between community perceptions and crime data, with rates and types of crime in the North Richmond area appearing stable between October 2014 and September 2019.

Read more: Richmond's safe-injecting room: Controversy overshadows positive community impact

The exception was for offences related to drug use and possession. However, a concern with drug-related crime is that "the more effort police devote to drugs, the more drug offences will be detected". This makes possession offences a particularly hard measure to interpret, given the strong media and police focus on drug use in the North Richmond area.

The international evidence shows that rather than increasing drug dealing and crime, supervised injecting facilities have been associated with improvements in public order.

Multiple studies show no association between supervised injecting facilities and changes in drug trafficking. Research also reliably shows that the establishment of these services is associated with a reduction in discarded syringes in the local area – an important issue for public safety.

The Sydney medically-supervised injecting centre in Kings Cross has demonstrated local residents and business operators found clear benefits in public amenity indicators five years after it opened. Fears of increased crime and drug use appear unfounded.

Does Melbourne need to have a second site, and if so, where?

Attendance statistics suggest that the Richmond site is one of the busiest in the world, with 119,223 visits in its first 18 months. This success of the centre shows there's clear demand for services.

To be effective, supervised injecting facilities need to be located where there are established illicit drug markets, and populations of people who use drugs.

The City of Melbourne has the second-highest number of public overdose deaths in Melbourne. As with the Richmond facility, the location was chosen because there's already a considerable amount of street-based drug use and related harm.

Does the evidence show that supervised injecting facilities work?

Supervised injecting facilities have been the topic of a vast amount of research over the past 20 years.

The Sydney medically-supervised injecting centre has collated more than 220 peer-reviewed research papers that document outcomes from supervised injecting facilities.

These published studies consistently show that supervised injecting centres are associated with reduced overdoses and mortality, in addition to reduced syringe sharing and reuse, which are important in reducing spread of blood-borne viruses.

The need for these services has been highlighted recently with even greater risks for people who use drugs due to isolation during the COVID-19 pandemic. This is in addition to benefits for public amenity that are discussed above.

Was the Richmond trial a success?

The independent review into the Richmond centre found that there is clear evidence it's saving lives and contributing to other health benefits:

• In its first 18 months, more than 3200 overdoses were safely managed, including 271 overdoses classified as "extremely severe", with no overdoses deaths.
• Staff have provided a range of other important services such as referrals for mental health and addiction treatment – with more than 13,000 occasions documented during the trial.

Demand on emergency services has also decreased. Consistent with the findings from the Sydney medically-supervised injecting centre evaluation, the most recent evaluation shows a reduction in ambulance attendances due to overdoses in Richmond. This means that resources that would have been required to manage overdoses in the Richmond area were available for other medical emergencies.

Analysis of ambulance attendances for overdose requiring naloxone (an overdose antidote) showed a decline in attendances, with the largest effect seen when the centre was open (a 36 per cent reduction). As seen in the figure, while overdoses were increasing elsewhere, they've been decreasing in the MSIR area following its opening.

Good health outcomes, but more work to be done

Although the review found a reduction in reports of public injecting, it concluded that there's more work to be done to improve public amenity. Importantly, despite a reduction in public injection, local people perceived that the amount of injecting equipment discarded around the centre had not reduced, nor did they feel safer after the centre opened.

An extended trial provides an opportunity to further understand the impacts of North Richmond’s medically-supervised injecting room. Although the results so far are promising, some concerns remain regarding the high volume of attendees at the Richmond site.

The addition of a second site in Melbourne may address these concerns, in addition to recognising that there are other areas of Melbourne that experience significant drug-related harms. A $9 million commitment to improving local amenity for Richmond residents has also been made, recognising that the establishment of the MSIR alone was not sufficient to address many of the longstanding local concerns.