The Uniting Medically Supervised Injecting Centre Kings Cross (also known as Uniting MSIC or Sydney Medically Supervised Injecting Centre) 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.
The centre, which opened in May 2001, was the first legal injecting site in Australia with the primary purpose of preventing the risk of injuries and death resulting from unsafe and unhygienic injecting practices.[2]
As one of the first medically supervised injecting centres in the world, Uniting MSIC has received global attention for its successful reduction in drug-related emergencies.
As of 2016, the centre had successfully supervised over one million injections with no fatalities.[3]
History
From the 1970s, Sydney saw a rapid growth in the availability and consumption of heroin.[4] At the heart of the illegal drug trade scene was the inner-city suburb of Kings Cross, which was heavily affected by homelessness and the sex industry.[5]
Throughout the 1990s, King Cross became home to an increasing amount of illegally operated shooting galleries leased by sex trade businesses. For a small fee, these 24-hour rooms provided the timed use of a space for drug users to consume drugs safely, away from the threat of police detection or other drug users and with the security of clean equipment and on-site employees who could intervene in the case of an overdose.[6]
The 1997 Wood Royal Commission into police corruption in New South Wales led to a large majority of shooting galleries being closed down, having previously been operating under the blind-eye of local authorities.[7] Despite this, the uncovering of these shooting galleries gave rise to a new interest in the value of supervised injecting sites for the management of public health and order.
After a long period of public and parliamentary debate between the years of 1996 and 1999, the NSW State Parliament passed legislation permitting the 18-month trial of a supervised injecting centre in 1999.[8] Originally secured by the Sisters of Charity Health Service, who withdrew their proposal due to disapproval from the Vatican, the Government of New South Wales invited the Uniting Church of Australia to oversee the operation of such facility. With the highest number of drug overdoses in Australia and a majority support of residents and local government in favour of the establishment of a supervised injecting centre, the NSW Government recommended Kings Cross as the location for the trial centre.[9]
On 6 May 2001, the Uniting Medically Supervised Injecting Centre was opened at 66 Darlinghurst Road, Kings Cross. The site was chosen for its close vicinity popular points of sale and use of drugs in the Kings Cross area, as well as its distance from shops, clubs and pubs that could be negatively impacted by the location of the centre.[10]
The Uniting Medically Supervised Injecting Centre is permitted to operate under amendments made to Part 2A of the NSW Drug Misuse and Trafficking Act 1985 (NSW). Part 2A includes requirements stipulating the necessary level of supervision, conditions of license and the medical training of staff, as well as enforcing exemptions from criminal liability for users of the centre and police discretion not to charge users for possession when travelling to or from the centre. Any contravention of the act by the centre may result in the suspension or revocation of their license to legally operate in New South Wales.[11]
The trial period of the injecting facility was extended three times in 2002, 2003 and 2007.[5] Following clear longitudinal evidence of positive results from independent evaluation bodies such as KPMG, the NSW Parliament voted in favour of overturning the trial status of the Uniting Medically Supervised Injecting Centre.[8] Legislation was passed on 1 November 2010 to officially permit the permanent legal licence for the operation of the centre.[5]
Services
Naloxone is a commonly administered drug used at injecting centres to counteract drug overdoses.
The Uniting Medically Supervised Injecting Centre offers supervision for a number of drugs including heroin, cocaine, methamphetamines and prescription pain medications such as oxycodone and morphine.[10]
The Uniting Medically Supervised Injecting Centre is supervised by a medical director who must be qualified as a licensed doctor. At all hours of operation, four registered nurses and four counsellors are on duty, as well as one registered mental health nurse. The centre is also staffed with security guards at all times to ensure the safety of users in and around the centre as well as prevent drug dealing activity and conflict.[5]
Clients move through three separated areas when visiting the centre; the waiting room and assessment area, the injecting room and the after care area. Staff first register the patient to understand their health history, what drugs they intend on consuming and to offer counsel on the risks of injecting. Once this is completed, clients proceed to injecting booths where they are provided with clean equipment and water to inject with. In cases where overdose occurs, staff in the injecting room are trained to use oxygen masks and administer naloxone to respond to the overdose. Once a client has safely intravenously consumed the drug, they proceed to the after care room where they can stay with the support of staff until they feel ready to return to the public through the back exit.[10]
The centre provides a number of related medical services such as basic medical assessments and vein care. Health promotion in the form of both casual verbal exchanges and counselling forms a key part of the day-to-day operation of the centre and involves education around safe injecting techniques, sexual health, nutrition and liver health. On occasion, these will lead to staff issuing referrals to further services which include but are not limited to drug treatment programs, social services, housing support, mental health support, hospitals and legal centres.[10]
Since the centre's trial status was overturned, many new services have continued to be added. In 2012, the centre began employing mental health nurses who could assist clients suffering from a broad range of mental health disorders. The centre has also become a leading facility for research and medical trials directed specifically at drug users. In recent years, the centre has also begun to provide general training on harm reduction and overdose response to health professionals, students and local small businesses interested on educating themselves on how to minimise risks for themselves and others.[10]
Client characteristics
The criteria for clients is relatively broad to encourage access to all drug users who require supervision and assistance. To be eligible, clients must be
18 years or older
Have injected drugs before
Not be pregnant
Not be accompanied by a child
Not be already intoxicated
Of the registered clients of the Uniting Medically Supervised Injecting Centre, 74% are male with the average age being 32 years. 39% of clients were daily drug users while 22% were weekly users and 35% were less than weekly users. The average age that clients started consuming drugs was 18 years old, with the average length of drug use being 13 years.
39% had a history of drug overdose and 10% had a history of injecting-related injuries or diseases. 6% had shared a needle in the last month.
Under half of clients (46%) had not completed high school and for 61%, welfare payments are their main source of income. 21% were full time workers and 8% of clients had worked in sex work in the past month.
31% of clients are homeless, while 23% live locally in the 2010 postcode.
Funding and costs
The Uniting Medically Supervised Injecting Centre is funded by the Confiscated Proceeds of Crime Account which is issued to the centre by the New South Wales Treasury.[citation needed]
The initial set up costs for the Uniting Medically Supervised Injecting Centre was $1.3 million Australian dollars.[13] The annual cost of operation stands around $2.5 million Australian dollars, with costs increasing with inflation and an increasing number of services and staff provided by the centre.[14]
The average cost per client per visit to the Sydney MSIC is $34.14 and has remained relatively stable since the centre first opened.[15]
In comparison to economic assessments of a comparably sized supervised injecting facility in Vancouver, "Insite," the Sydney Medically Supervised Injecting Centre provides the same range and quality of services at a significantly smaller budget.[15]
Criticisms
The media response to the Uniting Medically Supervised Injecting Centre was initially varied and sensational. One early newspaper article received particularly widespread attention when it alleged that syringes from the centre were being negligently disposed in public bins at the rear of the facility. It was later discovered that the syringes in fact belonged to neighbouring property’s diabetic cat, which was only later corrected.[10]
The public perception was at first suspicious of the new facility, with many concerned by the fact that the centre was a drain on public resources and would attract, and retain, a community of drug users in the suburb.[10]
While independent studies have shown that the centre continues to benefit drug users and the local community, the centre has been regularly criticised by media outlets and politicians which resulted in the prolonged period for which the centre retained a trial status.[10]
The organisation Drug Free Australia has been a leading dissenter of the Uniting MSIC, regularly publishing criticisms of the centre. Drug Free Australia has continued to assert that the centre encourages drug users to experiment with higher doses of drugs than they would usually consume, thereby placing drug users at a higher risk.[16] They argue that the centre is underused and ineffective, claiming that many clients continue to inject outside of the centre and that the client characteristics represent drug users who are less likely to overdose than other groups of intravenous drug users in Sydney.[17]
In a study by the National Centre in HIV Epidemiology and Clinical Research, 49% of users stated they would have injected in public had they not used the injecting centre.[15] Against the current numbers at the time of the study, this revealed over 191 673 events of public drug consumption that had been successfully prevented.[10]
There has been a positive response in clients' willingness to rehabilitative treatments with 16% of all clients receiving referrals on average per year. For 70% of clients, the Uniting MSIC is the first health service they have ever accessed.[2]
Between 2001 and 2016, the centre had supervised over one million injections with no recorded fatalities and intervention only being required in less than 10% of interactions.[3] The centre has contributed to a significant relief on local emergency services with early studies showing an 80% reduction in ambulance call-outs to the Kings Cross area.[2]
Contrary to public concerns, the number of new diagnoses of blood borne viruses such as HIV, HBV and HCV have not shown any marked increase and remained stable, consistent with the greater Sydney region.[15]
Frequently updated research on crime in the area has continued to show no correlation between crime and the establishment of the injecting centre. In the first 6 years of operation, monthly publicly disposed needle and syringe counts revealed a 50% decrease in the Kings Cross area.[15]Theft, robbery, loitering and drug use and supply offences have seen no marked increase or decrease that can be attributed to the centre.[18]
The local community continues to support the Uniting Medically Supervised Injecting Centre with 73% of residents and business owners supporting the continued operation of the centre.[15] In a 2005 study, a significant decrease was noted in both residents and business owners who had witnessed a public injecting within the last year.[15]
Heroin, also known as diacetylmorphine and diamorphine among other names, is an opioid 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 have variable "cuts". 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.
Harm reduction, or harm minimization, refers to a range of 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.
A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It is based on the philosophy of harm reduction that attempts to reduce the risk factors for blood-borne diseases such as HIV/AIDS and hepatitis.
Supervised injection sites (SIS) are medically supervised facilities designed to provide a hygienic environment in which people are able to consume illicit recreational drugs intravenously and prevent deaths due to drug overdoses. The legality of such a facility is dependent by location and political jurisdiction. Supervised injection sites are part of a harm reduction approach towards drug problems. The facilities provide sterile injection equipment, information about drugs and basic health care, treatment referrals, access to medical staff, and, at some facilities, counseling. Most programs prohibit the sale or purchase of recreational drugs at the facility.
Needle sharing is the practice of intravenous drug-users by which a needle or syringe is shared by multiple individuals to administer intravenous drugs such as heroin, steroids, and hormones. This is a primary vector for blood-borne diseases which can be transmitted through blood. People who inject drugs (PWID) are at an increased risk for Hepatitis C (HCV) and HIV due to needle sharing practices. From 1933 to 1943, malaria was spread between users in the New York City area by this method. Afterwards, the use of quinine as a cutting agent in drug mixes became more common. Harm reduction efforts including safe disposal of needles, supervised injection sites, and public education may help bring awareness on safer needle sharing practices.
Kings Cross is an inner-city locality of Sydney, New South Wales, Australia. It is located approximately 2 kilometres east of the Sydney central business district, in the local government area of the City of Sydney. It is bounded by the suburbs of Potts Point, Elizabeth Bay, Rushcutters Bay and Darlinghurst.
The Wayside Chapel is a charity and parish mission of the Uniting Church in Australia in the Potts Point area of Sydney, Australia. Situated near Sydney's most prominent red-light district in Kings Cross, the Wayside Chapel offers programs and services which attempt to ensure access to health, welfare, social and recreation services. The centre assists homeless people and others on the margins of society.
The Royal North Shore Hospital (RNSH) is a major public teaching hospital in Sydney, Australia, located in St Leonards. It serves as a teaching hospital for Sydney Medical School at the University of Sydney and has approximately 700 beds. It is the referral hospital for Northern Sydney. Its primary referral area accommodates 5.7% of the Australian population or 17% of the NSW population.
Insite is the first legal supervised drug injection site in North America, located at 139 East Hastings Street, in the Downtown Eastside (DTES) neighbourhood of Vancouver, British Columbia. The DTES had 4700 chronic drug users in 2000 and has been considered to be the centre of an "injection drug epidemic". The site provides a supervised and health-focused location for injection drug use, primarily heroin. The clinic does not supply any drugs. Medical staff are present to provide addiction treatment, mental health assistance, and first aid in the event of an overdose or wound. In 2017, the site recorded 175,464 visits by 7,301 unique users; 2,151 overdoses occurred with no fatalities, due to intervention by medical staff. The site also offers a free checking service so clients can check their substances for fentanyl and carfentanil. Health Canada has provided $500,000 per year to operate the site, and the BC Ministry of Health contributed $1,200,000 to renovate the site and cover operating costs. Insite also serves as a resource for those seeking to use a harm reduction approach for people who inject drugs around the world. In recent months and years, delegations from a number of countries are on record touring the facility, including various U.S. states, Colombia and Brazil. 95% of drug users who use Insite also inject on the street according to a British Columbia health official.
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.
St Vincent's Hospital, Sydney is a leading tertiary referral hospital and research facility located in Darlinghurst, Sydney. Though funded and integrated into the New South Wales state public health system, it is operated by St Vincent's Health Australia. It is affiliated with the University of Tasmania College of Health and Medicine and the University of New South Wales Medical School.
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.
The Reason Party is an Australian political party founded in 2017. Its leader, Fiona Patten, describes the party as a "civil libertarian alternative". Patten was elected to the Victorian Legislative Council as at the 2018 state election in the Northern Metropolitan Region, after formerly being elected as a Sex Party member for the same seat in the 2014 state election.
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. It has also been shown to save money, as it significantly reduces costs incurred by trials, incarceration, health interventions and delinquency. It has also drastically reduced overdose deaths in the countries utilizing it, as patients take their dose in a controlled, professionally supervised setting, and Narcan (naloxone) is on hand in the case of an accidental overdose. Opiate related overdoses in the U.S. kill around 70,000 people per year.
The Ted Noffs Foundation is a charitable organisation located in Randwick, New South Wales, Australia. Since its inception in 1971, as the Wayside Foundation, in Sydney by the Reverend Ted Noffs and his wife, Margaret, it has become the leader in providing drug and alcohol services for young people in Australia.
Low-threshold treatment programs are harm reduction-based health care centers targeted towards people who use substances. "Low-threshold" programs are programs that make minimal demands on the patient, offering services without attempting to control their intake of drugs, and providing counselling only if requested. Low-threshold programs may be contrasted with "high-threshold" programs, which require the user to accept a certain level of control and which demand that the patient accept counselling and cease all drug use as a precondition of support.
Alexander David Wodak, AM is a physician and the former director of the Alcohol and Drug Service, at St Vincent's Hospital, in Sydney, Australia.
Responsible drug use maximizes the benefits and reduces the risk of negative impact psychoactive drugs cause on the lives of the user. For illegal psychoactive drugs that are not diverted prescription controlled substances, some critics believe that illegal recreational use is inherently irresponsible, due to the unpredictable and unmonitored strength and purity of the drugs and the risks of addiction, infection, and other side effects.
Heroin is classified as an opioid drug produced from the opium poppy. The illicit use of heroin in Australia emerged during the 1960s throughout the Vietnam War. 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.
The National Drug Strategy (NDS) is the national drug regulation organization which maintains drug policy of the Australian Government. It began with its first framework in 1998 and has regularly formulated the Australian approach to drug education, treatment, rehabilitation, and prevention of substance abuse. It is directed by the Ministerial Drug and Alcohol Forum (MDAF) who use the NDS to implement and monitor the effectiveness of Australian drug policy at all levels of government. The MDAF consists of various elected Commonwealth and State Ministers, as well as civil servants. The aim of the NDS is to minimise the harms associated with licit and illicit drugs by reducing demand, supply, and harm in a holistic approach to the social, individual, and economic problems created by drugs. Its main function is establishing a set of policies, implemented at state and local level, that promote research-based solutions to the complex issues presented by drug use in society. The NDS has been responsible for introduction of several harm minimisation programs specifically placed in areas with a demographic deemed high-risk. Through the various iterations of the NDS it has faced increasing scrutiny over its perceived divergence from its original purpose, as well as perpetuating policies which allocate resources inefficiently.
↑ MSIC Evaluation Committee (2003). "Final Report on the Evaluation of the Sydney Medically Supervised Injecting Centre". New South Wales Department of Health. 1: 1–176.
↑ SAHA International (2008). "Economic Evaluation of the Medically Supervised Injection Centre at Kings Cross". SAHA. 1: 2–33.
↑ Freeman, Karen; Jones, Craig; Weatherburn, Don; Rutter, Scott; Spooner, Catherine; Donnelly, Neil (1 March 2005). "The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime". Drug and Alcohol Review. Sydney, Australia. 24 (2): 173–184. doi:10.1080/09595230500167460. ISSN0959-5236. PMID16076587.
This page is based on this Wikipedia article Text is available under the CC BY-SA 4.0 license; additional terms may apply. Images, videos and audio are available under their respective licenses.
.JPG){kind=link}