Australian literature

Maureen Steele, Edmund Silins, Marianne Jauncey and al., Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work?, Drug and Alcohol Review, March 2017.

Introduction and Aims: Wheel-filtration of pharmaceutical opioid tablets is a recognised harm reduction strategy, but uptake of the practice among people who inject drugs is low. The study aimed to: (i) examine perceptions of filtration practices; (ii) provide structured education on wheel-filtration; and (iii) assess uptake of the practice. Design and Methods: Frequent opioid tablet injectors (n = 30) attending a supervised injecting facility in Sydney, Australia, received hands-on instruction on wheel-filtration based on recommended practice. Pre-education, post-education and follow-up questionnaires were administered. Results: Wheel-filtration was generally regarded as better than cotton-filtration (the typical method) in terms of perceived effects on health, ease of use and overall drug effect. Sixty-eight percent of those who said they would try wheel-filtration after the education had actually done so. Of those who usually used cotton-filtration, over half (60%) had used wheel-filtration two weeks later. Discussion and Conclusions: Uptake of safer preparation methods for pharmaceutical opioid tablets increases after structured education in wheel-filtration. Findings suggest that SIFs are an effective site for this kind of education. Supervised injecting facility workers are uniquely positioned to provide harm reduction education at the time of injection.

Can Australia respond to drugs more effectively and safely, Australia21, November 2017.

The report makes 13 recommendations, including pill testing and medically supervised injecting rooms.

Julie Latimera, Stephen Lingb, Ian Flahertya and al., Risk of fentanyl overdose among clients of the Sydney Medically Supervised Injecting Centre, International Journal of Drug Policy, Volume 37, November 2016, Pages 111–114.

Fentanyl is a powerful analgesic, the prescription of which has increased markedly in recent years. The emergence of the drug at the Sydney Medically Supervised Injecting Centre (MSIC) warranted a retrospective clinical audit to assess the risk of fentanyl overdose in comparison with other opioids, in the context of a drug consumption room.

Mark Goodhew, Allison M. Salmon, Marianne Jauncey and al., Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC), Harm Reduction Journal, (2016) 13:29.

The Sydney Medically Supervised Injecting Centre (MSIC) is a supervised injecting facility (SIF) where people who inject drugs (PWID) can do so legally, under health professional supervision. The majority of clients have low levels of education and employment, high rates of incarceration and unstable housing and poor social networks, and 70 % do not access local health services. These factors increase the risk of poor mental health, and it has been documented that PWID have elevated rates of mood, anxiety, personality and psychotic disorders; post-traumatic stress disorder (PTSD); and higher rates of trauma exposure, suicidality and self-harm. The current study is the first to investigate the mental health among clients of a SIF. Validated instruments to examine clients’ mental health, social networks and trauma histories were administered to 50 frequently attending clients by a mental health nurse. The majority of respondents were unemployed, homeless and had a history of incarceration, and 82 % report they had been diagnosed with a mental health problem, but only 24 % report they were receiving treatment. Respondents had poor social networks, had poorer mental health symptoms compared to US inpatients and had experienced multiple traumatic events, and a high number of respondents had scores indicative of PTSD. These results highlight the need for mental health clinicians to be employed in SIFs and other drug consumption rooms (DCRs) to assist clients to address their mental health and psychosocial needs, particularly in light of the fact that these services are often the only places these PWID engage with in an ongoing way. 

Medically Supervised Injecting Centre in Tom Gotsis, Chris Angus and Lenny Roth, Illegal drug use and possession: Current policy and debates, Briefing Paper No 4/2016, NSW Parliamentary Research Service, August 2016, p.47.

Robyn Dwyerab, Robert Powera, Greg Denhamc & Paul Dietzea, Public injecting and public amenity in an inner-city suburb of Melbourne, Journal of Substance Use, Volume 21, Issue 2, 2014.

Background: Public drug markets and injecting impose significant burden on individuals and the community. This study aimed to document public injecting and amenity in North Richmond, an inner-city suburb of Melbourne, Australia. Methods: A rapid assessment methodology was employed. Data comprised: secondary data on drug use indicators, structured observations and interviews with key stakeholders. Primary data were collected from May to October 2012. Quantitative data are summarised using descriptive statistics. Basic content analysis was performed on interview transcripts. Results: An average of 1843 needle–syringes (NS) were collected per month from syringe disposal bins and street-sweeps in the period January–December 2012. Discarded NS and other injecting paraphernalia were observed in a variety of locations. Stakeholder interviews indicated substantial concerns over the presence of NS and witnessing injecting and overdose. Discussion: Public injecting is widespread, frequent, and highly visible in North Richmond and has a substantial negative effect on public amenity. The research identified two main priorities: (1) enhance access to harm reduction services and materials; and (2) improve public amenity. Among other responses, the study findings support the introduction of a supervised injecting facility (SIF) as a viable component of a comprehensive harm reduction response to illicit drug use in this area.

Neil Donnelly and Nicole Mahoney, Trends in property and illicit drug crime around the Medically Supervised Injecting Centre in Kings Cross: 2012 update, NSW Bureau of Crime Statistics and Research (BOCSAR), September 2013.

Method: The volume of crime was indicated by the number of criminal incidents of robbery, theft and specific illicit drug offences recorded by NSW police between January 1999 and December 2012. We measured trends in these offences in Kings Cross LAC from May 2001 (after the MSIC was opened) to December 2012 and compared them to trends in the rest of Sydney. Spatial analyses were used to determine whether incidents of possess/deal cocaine, narcotics or amphetamines were concentrated around the MSIC. Results: With a few minor exceptions there has been a decline in the incidence of robbery and theft incidents in Kings Cross LAC since the MSIC opened. This is consistent with what occurred in the rest of Sydney. The trend in possess/deal cocaine, narcotics or amphetamines was relatively stable from May 2001 through December 2008 but then increased from January 2009 in both Kings Cross LAC and the rest of Sydney. There has been no noticeable trend in the percentage of illicit drug offences which occurred within 50 metres of the MSIC. Conclusion: The trends in property crime incidents and illicit drug crime incidents were the same in Kings Cross LAC and the rest of Sydney after the opening of the MSIC.

Dwyer, R., Power, R. & Dietze, P. (2013). North Richmond Public Injecting Impact Study. Community Report. Melbourne: Burnet Institute.

Research undertaken on the streets of Richmond and Abbotsford has revealed increasing health risks for people who inject drugs and significant community concern over the impact of injecting in public areas.

Medically Supervised Injecting Centre Position Statement 2012, The Royal Australasian College of Physicians, July 2012.

The Sydney Medically Supervised Injecting Centre (MSIC) was the first supervised injecting facility in the English speaking world, and opened in May 2001. It remains the only service of its kind in Australia, and indeed in the southern hemisphere. After nearly a decade of operation and some political sensitivity, on 1 November 2010 the trial status of Sydney's MSIC was overturned. This was done with broad support from the medical, political, scientific and academic community. In the popular media we still hear myths about supervised injecting facilities (SIFs), particularly from people or organisations whose opinions are not based on the best available scientific evidence. The Royal Australasian College of Physicians (RACP) considers it appropriate, 18 months later, to update our position on the MSIC based on the best available local and international evidence about SIFs. Here we examine what the evidence shows, specifically about the Sydney service as well as internationally.

Matthew Tieu, The Medically Supervised Injecting Centre - an Evidence Based Approach to Drug Policy?, Bioethics Research Notes, Volume 23 Issue 1, March 2011.

The main results of the reports published on the efficacy and achievements of the Medically Supervised Injecting Centre (MSIC) in Kings Cross over the last decade of its operations are discussed. The reports do not provide any substantive evidence that the MSIC has achieved its objectives.

KPMG, Further evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011). Final report, Septembre 2010.

Papanastasiou C., Kirwan A., Winter R. and Power R., The potential and viability of establishing a Supervised Injecting Facility (SIF) in Melbourne. Position Paper, Yarra Drug & Health Forum, October 2009.

SAHA, Economic Evaluation of the Medically Supervised Injection Centre at Kings Cross (MSIC), August 2008.

Allison M. Salmon and al., Impact of a medically supervised injecting centre on ambulance attendances at opioid-related overdoses, Sydney, Australia, DCRs 2008.

Dr Ingrid van Beek, MSIC, The first 7 years, Sydney, 2007.

Jo Kimber and Kate Dolan, Shooting Gallery Operation in the Context of Establishing a Medically Supervised Injecting Center. Journal of Urban Health, Bulletin of the New-York Academy of Medicine, Vol. 8, N°2, 2007.

Injecting drugs in public places is stressful and risky, and demand exists among injecting drug users (IDUs) for relatively safe and private places to use. One response to this demand is shooting galleries (SGs). These are clandestine off-street places near drug markets where IDUs go to use and sometimes access needles and syringes (hereafter collectively referred to as Bneedles). SG use has, however, been associated with increased blood-borne virus (BBV) risk behavior and transmission. The operational and environmental characteristics of SGs, mostly documented in U.S. studies, vary from being anarchic to management by operators with entry fees of cash or small quantities of drugs. The latter type of SG is the focus of this paper.

Lisa Mahers and Allison Salmon, Supervised how much evidence is enough, Drug and Alcohol Review, July 2007.

National Centre in HIV Epidemiology and Clinical Research, Sydney Medically Supervised Injecting Centre, Interim Evaluation Report n°2, Evaluation of Community Attitudes towards the Sydney MSIC, June 2006.

Dr Ingrid van Beek, MSIC The first 5 years, Sydney, 2006.

Praveena Gunaratna, Drug policy in Australia: The supervised injecting facilities debate, Asia Pacific School of Economics and Government, The Australian National University, The Policy and Governance, Paper 05-2, 2005.

Many theories have been developed to explain the influence of different groups in policy making. Some focus on public opinion, claiming that especially in issues of high salience, public opinion will play a decisive role in determining policy directions. Other theories claim interest groups (including professionals) and politicians are more critical in shaping the agenda and the solutions which are seen as viable in addressing a particular problem. The supervised injecting facilities debate in Australia, which reached its peak between 1999 and 2001 when the ACT, Victoria and NSW attempted to establish such facilities, was one characterised by a high degree of conflict between groups with differing moral and political beliefs about drug use. Case studies of each jurisdiction were assembled to delineate the impact of these different groups on the eventual failure to establish trials in ACT and Victoria, compared to success in NSW. The results indicate public opinion was sharply divided on the issue, therefore cannot be considered a major determinant of public policy in this area. Politicians however, because of their ability to block the legislation and funding needed to establish the trials, undoubtedly had the greatest influence in policy making.

National Centre in HIV Epidemiology and Clinical Research, Sydney Medically Supervised Injecting Centre, Interim Evaluation Report n°1, Operation & Service Delivery (November 2002 to December 2004), May 2005.

BC Centre for Excellence in HIV/AIDS, Evaluation of the Supervised Injection Site. Year One Summary, September 17, 2004.

Drug Free Australia,, The kings Cross InjectingRoom, The case for closure, Booklet.

Drug Free Australia, A Critical response to the Kings Cross Injecting room 2003 report. Reporting on the Report. That takes injecting addicts on a road to nowhere in The Kings Cross Injecting Room, Sept 2003.

MSIC Evaluation Committee, Final report on the evaluation of the Sydney Medically Supervised Injecting Centre, Sydney, 2003.

J. Kimber et Dr. M. MacDonald, Six Month Process Report on the Medically Supervised Injecting Centre, Sydney, January 02, 2002.

The MSIC Evaluation has three components: process, impact and economic. The impact and economic evaluations will not be reported on until after the conclusion of the 18-month trial period. This report describes the results of the process evaluation of the Medically Supervised Injecting Centre (MSIC) for the first six months of operation. Included are data relating to days and hours of MSIC operation; patterns of client attendance; client use of MSIC services; referrals to drug treatment, primary healthcare and social welfare assistance; injecting equipment supplied; clinical incidents; and enquires. A previous report provided the process evaluation at one month (Mattick et al., 2001). The data reported herein refer to calendar months from May to October 2001. As the MSIC opened for clients on 6t h May 2001, the month of May is based on 25 days of operational activity. All data that was disseminated prior to this six -month report was based on the reporting of months commencing from 6th May 2001. All subsequent reports will be based on calendar months.

The crow's eye, Safe Shooting Rooms, August 2001.

Byrne, Dr. Andrew, "Injecting Room Up and Running in Sydney." Drug Policy Alliance. July 2001.

Craig Fry and Rob Testro, "not just for us.." : safe injecting rooms : a survey of the attitudes of 215 street-based heroin users in Melbourne, Victoria, Youth Substance Abuse Service, 2000.

Dr J N Santamaria, Heroin Injecting Rooms and Catholic Health Care Services, Bioethics Research Notes 11(3): September 1999.

In July 1999, the medical director of St. Vincent's Hospital in Sydney announced that the Sisters of Charity had agreed to establish an Injection Room for Heroin Addicts as it was consistent with their philosophy of care and with Catholic teaching. Many leading Catholic spokesmen have sprung to the defence of this decision, claiming that it is not inconsistent with Catholic moral teaching and that, in the existing circumstances, it is a prudential Catholic response. In the statement given to the media, the medical director claimed that there had been wide consultation on the issue and that the decision was carefully considered before it was announced. However, on the weight of the evidence, it is difficult to believe that the consultation was wide enough.

Fry, Craig, "Establishing Safe Injecting Rooms in Australia: Attitutes of Injecting Drug Users." Australian and New Zealand Journal of Public Health. 1999; 23(5): pp.501-504.

This study has Identified a number of important issues relating to the likely demand and uptake of SIRs that should be addressed when considering the feasibility of establishing SIRs within Australia.

Parliament of New South Wales, Report on the establishment or trial of safe injecting rooms. Joint_ Select Committee into safe Injecting Rooms, February 1998.

Drugs and Crime Prevention Committee, Parlliament of Victoria. Safe Injecting Facilities, Their justification and viability in the Victorian setting, June 1996.

Eddie Micallef, Safe injection facilities : Should Victoria have a SIF Pilot-Trial, Drug Policy Alliance.