Heroin in Australia

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Chemical structure profile of heroin Heroin.png
Chemical structure profile of heroin

Heroin is classified as an opioid drug produced from the opium poppy. [1] The illicit use of heroin in Australia emerged during the 1960s. [2] Its origins have been linked to American troops stationed in major cities such as Melbourne and Sydney, who introduced the drug to the red-light districts whilst on their recreational leave. [2]

Contents

Since then, the use of heroin amongst the general Australian population has fluctuated, with reports of a shortage occurring at the turn of the century. [2] It is now believed to be the fourth most common principle drug of concern in Australia, [3] with reports noting a decline in the use of the drug since the early 2000s. [4] : 51 

Currently, the illegal use of heroin in Australia is low, despite the market being highly stable. [3]

The use of heroin in Australia saw a sharp increase during the 1990s, which is now known as the Australian heroin epidemic. [2] This epidemic was accompanied by a surge of new heroin users, specifically in NSW and Victoria, [5] as well as a rise in its purity, which was easily accessible. [6] However, this changed at the start of 2001, when Australia saw a rapid decline in the availability of heroin. [3] This is commonly referred to as the 'heroin drought' or 'shortage'. [3] This is reconfirmed against statistics that show a sharp drop in heroin users who reported the illicit substance as their 'first drug of choice' throughout this period. [5]

This heroin shortage was confirmed by the National Alcohol and Drug Research Centre, with key informants reporting that in comparison to the 15 minutes it took to locate heroin prior to December 2000, it took up to 4 hours in January 2001. [7] The causes of the heroin shortage have been disputed; however, the general consensus is that it was the result of three main factors: the increase in heroin seizures by law enforcement throughout late 1990s, the arrest of several key figures in the heroin markets, and the severe droughts that were affecting the opium poppy regions in Myanmar. [7]

Since 2002, the heroin market has seen an upturn, with the supply and use of the illicit drug increasing. [5] As of 2018, the heroin market is considered 'highly stable', despite the low percentage of the general population recorded actually consuming heroin. [3] There has been a 25% drop in recent heroin use in Australia, from 79% in 2000, to 54% in 2018. [8]

Supply and distribution

From its expansion during the Vietnam war to the 1990s, heroin importation was majorly controlled by various organised 'white' crime groups throughout Australia. [9] The heroin market and its drug trafficking groups were able to flourish during this time due to the prevailing police corruption, especially in NSW. [9] However, the heroin market was gradually overtaken during the 1990s by Southeast Asian syndicate groups. [9] Australia's heroin predominately originates from the Golden Triangle, specifically Myanmar, although there have been seizures of South American heroin too. [9]

Historically, Sydney has been the largest point of distribution for imported heroin; in particular, the suburbs of Kings Cross, Redfern and Cabramatta became hotspots for large open-air markets. [10] However, throughout the drought, the expected patterns of heroin distribution changed. [10] The market became more discreet, and there was a shift to deal more available drugs such as cocaine and methamphetamine. [10] This is also confirmed by a sharp drop in the number of arrests for heroin street dealers, which halved in 2001. [10]

During the height of Australia's epidemic, users were buying relatively cheap but pure heroin. [6] From 1996 to 2000, the amount for a gram halved from $400 to $220 and the amount for a 'cap' was $25. [6] This changed however at the turn of the century, with a gram of heroin selling for $450 during the drought [4] : 57–58  and 'caps' were selling double what they were previously. [6] However, the price of a 'cap' has stabilised at this price, over the past decade, with no reports of increases since 2000. [4] : 57–58 

Route of administration

In Australia, the injection has been the predominant route of administration, unlike Europe, where smoking heroin is more prevalent. [5] This is due to the type of heroin that is available in Australia's markets, which lends itself to injecting rather than smoking. [5] Throughout the drought, as the supply of heroin decreased, so did the level of injecting. [11] This decrease in injecting also saw a reduction in the amount of infections associated with needles, such as hepatitis C. [11] Since the end of the shortage, smoking heroin is on the rise in Australia, in particular, the method of 'chasing'. [5]

However, injecting heroin maintains the most popular route of administration in Australia, with the National Drug and Alcohol Research Centre reporting 100% of reported heroin users injecting in 2018, compared to the 6% who smoke. [8] It is common for heroin users in Australia to transition to smoking to injecting heroin throughout their heroin careers. [5]

Fatalities and health risks

Heroin-induced deaths in the Australian population are significantly less than when compared to Asia, Europe and North America. [12] However, of the nearly 2000 drug-related deaths in Australia in 2016, 20% of these were caused by heroin. [3] The rate of mortality amongst the Australian population who use heroin has fluctuated over time, however, opioids, both illicit (heroin) and licit, have remained the substance most prominently found in drug-related fatalities. [3]

From the 1960s onwards, the toll of heroin-induced deaths in Australia kept rising until it peaked during the 1990s heroin epidemic, [5] gaining widespread attention from both the Australian public and media, [6] At the start of 2001, there was a 40% drop in heroin overdoses across the nation within the space of four weeks. [6] This dramatic reduction is often used to confirm the shortage of heroin. [6] Since the drought, the rate of mortality has not returned to its height from the late 1990s, but has risen again recently, as well as a 25% increase in hospitalisations for opioid poisoning, which is thought to be the result of the aging population of users from the 1990s developing medical conditions from sustained drug use. [3] Mortality rates in Australia differ based on the age cohort. From 2001 onwards, there has been larger increases of heroin overdoses amongst those within the 35-44 and 45-54 year age brackets, [4] : 53–54  but these rates have noticeably declined amongst those who are 15–24 years old. [2] The rate of heroin deaths for male heroin users are much higher than for females, and have been since 2001, with the rate of deaths for males in 2012 4.6 times higher than female users. [4]

The leading cause of death amongst Australian heroin users is accidental overdose, with a rate of 30-45%. [5] Of the near 9,000 opioid deaths that occurred in Australia from 2001 to 2012, one-third of these were due to accidental overdose. [2] However, these numbers may be far lower than what is accurate, due to the high metabolism rate of heroin, meaning toxicology reports may not always depict levels of the illicit substance. [3] The Australian Treatment Outcome Study (ATOS), found that the cohort they interviewed who were regular heroin users, were four and a half times more likely to die than the expected general population rate. [12] Fatalities resulting from medical conditions attributed to long term drug use is the second highest way heroin users in Australia die, accounting for 20-35% of total fatality rates. [5] As opioids are the drug most commonly injected in Australia, [2] heroin users are prone to diseases, such as blood-borne viruses, like Hepatitis C and HIV, [3] due to unhygienic practices of sharing needles. [5] Australian heroin users who are seeking treatment, or are registered at methadone maintenance programs, were four times less likely to die than those who weren't. [5] Enrolment in medically supervised injecting centres reduces the risk of overdose by nearly 75%. [5]

Characteristics

There has been limited and reliable research done into the characteristic of typical Australian heroin users. [5] However, studies do show that in Australia, the illicit use of heroin is predominantly done by men, with two male heroin users for every one female user. [5] The cohort of Australian female heroin users also typically are a lot younger than the Australian male users, and female users are more often in a heterosexual relationship with a partner who also injects illicit substances. [5] There is a wide age range of heroin users in Australia, with a heroin user expected to fall between the late teens to the late forties, with the average age approximated to be 30 years old. [5] The physical health of heroin users in Australia is poor due to the prominence of infectious blood-borne diseases spread through needle-sharing amongst heroin users. [5]

Data has also shown that the heroin shortage of 2001 has also changed who in Australia is using heroin, [4] with a decline in younger first-time heroin users injecting the drug, [4] which is consistent with studies that show that the use of heroin amongst the general population is low and has plateaued since 2001. [3] Despite this, heroin users in Australia are more likely to fail in their attempts to quit abusing the substance than any other illicit drug. [3]

The employment status for heroin users is significantly low, confirmed by the findings that the majority of fatalities who died of heroin-related causes were unemployed. [5] Indigenous Australians are considered an "at risk" cohort, with research undertaken by the Australian Institute of Health and Welfare revealing that 11% of clients in treatment services were Indigenous Australians. [3]

Shooting galleries

'Shooting galleries' are illegal and covert spots near popular drug markets where injecting drug users, predominantly those using heroin, go to consume illicit substances. [13] Described as 'businesses', these galleries are found operating with budget hotels, often linked with the sex industry. [13] Rooms are rented out to heroin users for a fee, with extra benefits including, but not limited to, 24-hour use or an ambulance being called in the case of an overdose. [13] These galleries were particularly prominent in Sydney, associated with its 'red light district' Kings Cross during the 1990s. [13] There is some evidence that supports the assertion that corrupt police officers were knowingly ignoring these places, which allowed them to develop. [14] : 78  There were at least 10 shooting galleries known to be operating during the peak of the heroin epidemic, in 1994, and they were highly popular for heroin users until 1995, when a majority of them were closed down after a Royal commission into police corruption. [13]

Supervised Injecting Rooms

Supervised injecting rooms, also known as Medically Supervised Injecting Centres (MSIC's) or safe injecting facilities (SIF's), are legal areas set up to provide drug-takers a safe environment to inject in, under the supervision of trained medical personal. [15] The first official legal recommendation for a Medical Supervised Injecting Centre in Australia originated from the 1997 Wood Royal Commission into NSW's police corruption; [14] : 80  however, the trial for one was denied the following year. [14] : 83  A second campaign for a Sydney-based MSIC occurred after the Sun Herald, a Sydney-based newspaper, ran a story that featured a photo of a young teenager injecting heroin on its front page. [14] : 80  After he was re-elected, Premier of NSW Bob Carr, summoned a drug summit which took place in 1999. [14] : 80  The summit approved of a trial MSIC in Kings Cross for 18 months, [14] : 80  which opened in May 2001. [14] : 80  The MSIC was the first supervised injecting room outside of Europe, [16] and it received public backlash from Australia's own Prime Minister at the time John Howard, [17] as well as the Vatican. [17] In 2010, the status of the Sydney MSIC was promoted from trial to a permanent health service. [15] Heroin was the most predominant drug injected on site from 2001 to 2007, but more than half the overdoses that occurred from 2014 to 2017 were heroin-induced. [18]

Until 2018, the Sydney Medically Supervised Injecting Centre was the only of its kind in Australia. [19] Despite attempts by various organisations to propose an SIF in Melbourne, the Victorian State Government throughout the 2000s refused to support a trial. [14] : 87  In 2017, in response to a woman overdosing in a fast-food chain in Melbourne's suburb of North Richmond the previous year, a trial for a supervised injecting room was suggested. [15] The centre launched in July 2018, and received 20,000 visits after the first 4 months. [19] The trial is running for 2 years; however, due to the demand for the centre, a new, larger facility is currently being built. [20]

Related Research Articles

<span class="mw-page-title-main">Heroin</span> Opioid used as an analgesic and a recreational drug for its euphoric effects

Heroin, also known as diacetylmorphine and diamorphine among other names, is a morphinan opioid substance synthesized from the dried latex of the Papaver somniferum plant; it is mainly used as a recreational drug for its euphoric effects. Medical-grade diamorphine is used as a pure hydrochloride salt. Various white and brown powders sold illegally around the world as heroin are routinely diluted with cutting agents. Black tar heroin is a variable admixture of morphine derivatives—predominantly 6-MAM (6-monoacetylmorphine), which is the result of crude acetylation during clandestine production of street heroin. Heroin is used medically in several countries to relieve pain, such as during childbirth or a heart attack, as well as in opioid replacement therapy.

<span class="mw-page-title-main">Methadone</span> Opioid medication

Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid agonist used for chronic pain and also for opioid use disorder. It is used to treat chronic pain, and it is also used to treat addiction to heroin or other opioids. Prescribed for daily use, the medicine relieves cravings and removes withdrawal symptoms. Withdrawal management using methadone can be accomplished in less than a month, or it may be done gradually over a longer period of time, or simply maintained for the rest of the patient's life. While a single dose has a rapid effect, maximum effect can take up to five days of use. After long-term use, in people with normal liver function, effects last 8 to 36 hours. Methadone is usually taken by mouth and rarely by injection into a muscle or vein.

<span class="mw-page-title-main">Harm reduction</span> Public health policies which lessen negative aspects of problematic activities

Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.

<span class="mw-page-title-main">Fentanyl</span> Opioid medication

Fentanyl is a potent synthetic piperidine opioid primarily used as an analgesic. It is 50 times more potent than heroin and 100 times more potent than morphine; its primary clinical utility is in pain management for cancer patients and those recovering from painful surgeries. Fentanyl is also used as a sedative. Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose. Fentanyl works by activating μ-opioid receptors. Fentanyl is sold under the brand names Actiq, Duragesic and Sublimaze, among others.

<span class="mw-page-title-main">Drug overdose</span> Use of an excessive amount of a drug

A drug overdose is the ingestion or application of a drug or other substance in quantities much greater than are recommended. Typically it is used for cases when a risk to health will potentially result. An overdose may result in a toxic state or death.

<span class="mw-page-title-main">Supervised injection site</span> Medical facility

Supervised injection sites (SIS) or drug consumption rooms (DCRs) are a health and social response to drug-related problems. They are fixed or mobile spaces where people who use drugs are provided with sterile drug use equipment and can use illicit drugs under the supervision of trained staff. They are usually located in areas where there is an open drug scene and where injecting in public places is common. The primary target group for DCR services are people who engage in risky drug use.

<span class="mw-page-title-main">Opioid use disorder</span> Medical condition

Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.

<span class="mw-page-title-main">Drug injection</span> Method of introducing a drug

Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body. Intravenous therapy, a form of drug injection, is universally practiced in modernized medical care. As of 2004, there were 13.2 million people worldwide who self-administered injection drugs outside of medical supervision, of which 22% are from developed countries.

Illicit drug use in Australia is the recreational use of prohibited drugs in Australia. Illicit drugs include illegal drugs, pharmaceutical drugs when used for non-medical purposes, and other substances used inappropriately. According to government and community organisations, the use and abuse, and the illegality, of illicit drugs is a social, health and legal issue that creates an annual illegal market estimated to be worth A$6.7 billion. Estimates made in 2022 place the figure at A$11.3 billion per year.

<span class="mw-page-title-main">Benzodiazepine use disorder</span> Medical condition

Benzodiazepine use disorder (BUD), also called misuse or abuse, is the use of benzodiazepines without a prescription and/or for recreational purposes, which poses risks of dependence, withdrawal and other long-term effects. Benzodiazepines are one of the more common prescription drugs used recreationally. When used recreationally benzodiazepines are usually administered orally but sometimes they are taken intranasally or intravenously. Recreational use produces effects similar to alcohol intoxication.

Heroin-assisted treatment (HAT), or diamorphine-assisted treatment, refers to a type of Medication-Assisted Treatment (MAT) where semi-synthetic heroin is prescribed to opiate addicts who do not benefit from, or cannot tolerate, treatment with one of the established drugs used in opiate replacement therapy such as methadone or buprenorphine. For this group of patients, heroin-assisted treatment has proven superior in improving their social and health situation. Heroin-assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Canada, and Denmark. Additional trials are being carried out in the United Kingdom, Norway, and Belgium.

<span class="mw-page-title-main">Substance use disorder</span> Continual use of drugs (including alcohol) despite detrimental consequences

Substance use disorder (SUD) is the persistent use of drugs despite the substantial harm and adverse consequences to one's own self and others, as a result of their use. In perspective, the effects of the wrong use of substances that are capable of causing harm to the user or others, have been extensively described in different studies using a variety of terms such as substance use problems, problematic drugs or alcohol use, and substance use disorder. The National Institute of Mental Health (NIMH) states that "Substance use disorder (SUD) is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD". Substance use disorders (SUD) are considered to be a serious mental illness that fluctuates with the age that symptoms first start appearing in an individual, the time during which it exists and the type of substance that is used. It is not uncommon for those who have SUD to also have other mental health disorders. Substance use disorders are characterized by an array of mental/emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance(s) despite repeated attempts; operating vehicles while intoxicated; and physiological withdrawal symptoms. Drug classes that are commonly involved in SUD include: alcohol (alcoholism); cannabis; opioids; stimulants such as nicotine, cocaine and amphetamines; benzodiazepines; barbiturates; and other substances.

<span class="mw-page-title-main">Acetylfentanyl</span> Opioid analgesic

Acetylfentanyl is an opioid analgesic drug that is an analog of fentanyl. Studies have estimated acetylfentanyl to be 15 times more potent than morphine, which would mean that despite being somewhat weaker than fentanyl, it is nevertheless still several times stronger than pure heroin. It has never been licensed for medical use and instead has only been sold on the illicit drug market. Acetylfentanyl was discovered at the same time as fentanyl itself and had only rarely been encountered on the illicit market in the late 1980s. However, in 2013, Canadian police seized 3 kilograms of acetylfentanyl. As a μ-opioid receptor agonist, acetylfentanyl may serve as a direct substitute for oxycodone, heroin or other opioids. Common side effects of fentanyl analogs are similar to those of fentanyl itself, which include itching, nausea and potentially fatal respiratory depression. Fentanyl analogs have killed hundreds of people throughout Europe and the former Soviet republics since the most recent resurgence in use began in Estonia in the early 2000s, and novel derivatives continue to appear.

<span class="mw-page-title-main">Methamphetamine use in Australia</span>

Under Australia's law, methamphetamine is a Schedule 8 drug, available for medical use but restricted in manufacture, supply, and possession. The drug is sought after to give oneself a ‘high’ or a ‘rush’ in their body. Users of this drug often feel senses of exhilaration and arousal as the brain is flooded with monoamines. Methamphetamine has many names not only in Australia, but also around the world. These include chalk, crypto, gear, getgo, tweak, and cristy, although the two most common ones in Australia today are ice and shard. Speed refers to the powder form of the drug, while ice refers to the highly purified, crystalline form. The powder form is often diluted with adulterants including glucose and sucrose.

<span class="mw-page-title-main">Opioid epidemic in the United States</span> Ongoing overuse of opioid medication in the US

There is an ongoing opioid epidemic in the United States, originating out of both medical prescriptions and illegal sources. The epidemic began in the United States in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years.

Discrimination against drug addicts is a form of discrimination against people who suffer from a drug addiction.

A take-home naloxone program is a governmental program that provides naloxone drug kits to those that are at risk of an opioid overdose. Naloxone is a medication that was created to reverse opioid overdoses. As an opioid antagonist, it binds to the μ-opioid receptors blocking the opioid's effects. Naloxone quickly restores normal respiration. The ongoing opioid epidemic has caused many public health authorities to expand access to naloxone.

<span class="mw-page-title-main">Uniting Medically Supervised Injecting Centre</span> Hospital in New South Wales, Australia

The Uniting Medically Supervised Injecting Centre Kings Cross is a state government-supported facility in Kings Cross, New South Wales that provides safe injecting rooms, sterile equipment and medical supervision for individuals who wish to administer an illicit drug intravenously.

Opioid agonist therapy (OAT) is a treatment in which prescribed opioid agonists are given to patients who live with Opioid use disorder (OUD). In the case of methadone maintenance treatment (MMT), methadone is used to treat dependence on heroin or other opioids, and is administered on an ongoing basis.

Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.

References

  1. ↑ National Institute on Drug Abuse. "Heroin". www.drugabuse.gov. Retrieved 2019-05-13.
  2. 1 2 3 4 5 6 7 Hall, Wayne; Degenhardt, Louisa (2009-09-01). "The Australian Illicit Drug Reporting System: Monitoring Trends in Illicit Drug Availability, Use and Drug-Related Harm in Australia 1996–2006". Contemporary Drug Problems. 36 (3–4): 646. doi:10.1177/009145090903600317.
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  4. 1 2 3 4 5 6 7 Roxburgh, Amanda; Ritter, Alison; Slade, Tim; Burns, Lucy (2013). "Trends in Drug Use and Related Harms in Australia, 2001 to 2013" (PDF). Drug Trends.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Henderson, Nicky; Ross, Joanne; Dakre, Shane; Teesson, Maree; Lynskey, Michael (2002). "Longitudinal studies of dependent heroin users in Australia: Feasibility and benefits" (PDF). National Drug and Alcohol Research Centre. Retrieved 2019-05-13.
  6. 1 2 3 4 5 6 7 Darke, Shane; Topp, Ibby; Kaye, Harlene; Hall, Wayne (2002). "Heroin use in New South Wales, Australia, 1996–2000: 5 year monitoring of trends in price, purity, availability and use from the Illicit Drug Reporting System (IDRS)". Addiction. 97 (2): 179–186. doi:10.1046/j.1360-0443.2002.00032.x. ISSN   1360-0443.
  7. 1 2 Weatherburn, Don; Jones, Craig; Freeman, Karen; Makkai, Toni (October 2001). "The Australian Heroin Drought and its Implications for Drug Policy". Contemporary Issues in Crime and Justice. 59: 2.
  8. 1 2 Peacock Gibbs1 Sutherland Uporova1 Karlsson Bruno Dietze Lenton Alati Degenhardt Farrell1, Amy Daisy Rachel Julia Antonia Raimondo Paul Simon Rosa Louisa Michael (2018). "KEY FINDINGS FROM THE NATIONAL ILLICIT DRUG REPORTING SYSTEM (IDRS) INTERVIEWS" (PDF). Australian Drug Trends 2018. Retrieved 2019-05-13.{{cite web}}: CS1 maint: numeric names: authors list (link)
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  11. 1 2 Day, Carolyn; Degenhardt, Louisa; Gilmour, Stuart; Hall, Wayne (August 2004). "Effects of Reduction in Heroin Supply On Injecting Drug Use: Analysis Of Data From Needle And Syringe Programmes". British Medical Journal. 329 (7463): 428–429. doi:10.1136/bmj.38201.410255.55. PMC   514203 . PMID   15292056.
  12. 1 2 Darke, Shane; Mills, Katherine L.; Ross, Joanne; Teesson, Maree (2011-06-01). "Rates and correlates of mortality amongst heroin users: Findings from the Australian Treatment Outcome Study (ATOS), 2001–2009". Drug and Alcohol Dependence. 115 (3): 190–195. doi:10.1016/j.drugalcdep.2010.10.021. ISSN   0376-8716. PMID   21130585.
  13. 1 2 3 4 5 Kimber, Jo; Dolan, Kate (2007). "Shooting Gallery Operation in the Context of Establishing a Medically Supervised Injecting Center: Sydney, Australia". Journal of Urban Health. 84 (2): 255–266. doi:10.1007/s11524-006-9145-3. PMC   2231637 . PMID   17273925.
  14. 1 2 3 4 5 6 7 8 Fitzgerald, John. L (2013). "Supervised injecting facilities: a case study of contrasting narratives in a contested health policy arena". Critical Public Health. 23. doi:10.1080/09581596.2012.735360.
  15. 1 2 3 "Medically supervised injecting centres". ADF - Alcohol & Drug Foundation. 2017. Retrieved 2019-05-28.
  16. ↑ Salmon, Allison; Thein, Hla-Hla; Kimber, Jo; Kaldor, John. M; Maher, Lisa (July 2006). "Five years on: What are the community perceptions of drug-related public amenity following the establishment of the Sydney Medically Supervised Injecting Centre?". International Journal of Drug Policy. 18 (1): 46–53. doi:10.1016/j.drugpo.2006.11.010. PMID   17689343.
  17. 1 2 Yamey, Gavin (11 March 2000). "UN condemns Australian plans for "safe injecting rooms"". BMJ.
  18. ↑ Roxburgh, Amanda; Darke, Shane; Salmon, Allison. M; Dobbins, Timothy; Jauncey, Marianne (2017). "Frequency and severity of non-fatal opioid overdoses among clients attending the Sydney Medically Supervised Injecting Centre". Drug and Alcohol Dependence. 176: 128.
  19. 1 2 Lyons, Amanda (30 January 2019). "Inside North Richmond's safe injecting room". The Royal Australian College of General Practitioners.
  20. ↑ "Melbourne's safe injecting room trial saving lives but upsetting locals". ABC News. 20 April 2019.
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