Supervised injecting facilities (SIFs) are services where people who are at risk of drug-related overdose can safely use drugs knowing a trained worker will respond if needed. Thousands and thousands of people have safely used the more than two hundred drug consumption services in the world and the evidence showing the benefits for the community is well-established [1].Yet, because of stigma about drug use, for many people they remain controversial.
On 23 April 2024, the Victorian Premier revealed that plans for Australia’s third SIF, Melbourne’s second, had been abandoned because of their difficulty “finding a location that strikes that balance between supporting people who use drugs with the needs of the broader community”[2].
Australia has a long and proud history of supporting harm reduction services for people who inject drugs. Needle and syringe programs (NSPs) were introduced in 1986 and soon after had been established throughout the country. Many community pharmacies and other health services also provide this essential service. This wide implementation is now rightly recognised and celebrated for preventing an HIV epidemic among the community of people who inject drugs, as well as preventing HIV transmissions in the general community.
SIFs, however, have had far less support. The first SIF in Australia was opened in King’s Cross, Sydney, in 2001. It wasn’t until almost twenty years later, in 2018, that another SIF, the second in Australia, was established in Richmond, Melbourne. There were many similarities between the service in Sydney and the new service in Melbourne. They followed the same medical model and had many of the same rules and regulations about who could access them. There were also some big differences. Sydney’s service operated on a main street surrounded by shops and traders, whereas Melbourne’s service was opened at a community health centre that had a long history of operating a busy needle syringe program. Although both services were opened in areas where the local people lived with a daily reality of public injecting and overdose, the Melbourne facility was in a more gentrified, suburban location, and there was a primary school next door. These factors were highlighted and used by those who were opposed to the service being established.
The planned second SIF for Melbourne was announced in 2020 in response to the backlash that had come from the local homeowners around Richmond. The idea was to take pressure off the busy Richmond location by having an alternative option in the CBD. This area also has documented public injecting, significant numbers of ambulance callouts for drug-related overdose, and high rates of overdose deaths. The people opposing the SIFs aren’t the people who experience these impacts, but they might sometimes see them happen. Having a SIF in the area would make that less likely, but stigma isn’t logical. For the four years following the announcement for a SIF in the CBD, there were coordinated campaigns and protests both for and against opening the service. The government commissioned a review, and the report was released at the same time as the announcement of the new SIF not proceeding. Although this review recommended providing a small facility in the CBD, this evidence-supported plan was not implemented. A more expensive plan including several different programs was announced instead.
What is most disappointing for people who believe an injecting facility in Melbourne’s city centre is needed is the messages this sends: the lives of people who inject drugs don’t matter, the care of people who love people who inject drugs doesn’t matter. The initiatives announced by the government will have far less of an impact on overdose than a small injecting facility would have had. A person who injects drugs dies every month in Melbourne’s CBD. Rates of overdose are rising every year in Australia currently at five deaths a day, and Victoria has some of the highest rates of heroin use in the country. Each day we don’t have somewhere safe for people to go is another day where people’s lives and health are at risk.
The SIF in Sydney, meanwhile, has been very successful. After a rocky start, including with some parts of the media, Sydney’s service, has a lot of local support in comparison to Melbourne’s. Even the local police seem supportive of the service. Both existing SIFs have also been evaluated, possibly more than any other health service in the country and have been found to be extremely successful in reducing the amount of public injecting that occurs in their areas, reducing the number of ambulance callouts and successfully managing hundreds of overdoses without a single overdose death.
These kinds of services are particularly beneficial for people who already live in unsafe circumstances, such as people who are homeless and people who normally use drugs alone.
What these facilities don’t do:
- They don’t act as a “honeypot”, bringing drug users from far and wide to the area.
- They don’t increase the amount of young people who use drugs by making it seem like a good thing to do.
- They don’t create more violence and crime in the areas where they are opened.
Despite the overwhelming evidence for their benefits, the controversy surrounding them usually seems to come from a place of misinformation and stigma “not in my backyard”, “they should all be punished, not allowed to use drugs”, or “what about the children?” Some media is happy to amplify these negative perceptions such as this article from the Age in 2023, quoting local community members in Richmond, Melbourne: “Get rid of it. Problems are 10 times worse since it opened with junkies shooting up outside my garage and more.”[3]
It is true there is still some public injecting in local areas near the SIFs, and elsewhere. Overdoses also continue to happen in the Australian cities that have SIFs. There are many reasons these things continue to happen, even where SIFs exist:
- Each city only has one SIF with limitations on how many people can use it.
- People who are nowhere near where the SIF is located, and people who have somewhere else they feel safe injecting will likely not go to the SIF.
- There are regulations and rules governing who can and can’t use the services.
This last point is an extremely important one. The SIFs we have in Australia were developed mainly by politicians and policymakers, largely without input from people who might use them. The restrictions and regulations about who can use the SIFs can make some of our communities’ most marginalised and vulnerable even more so.
People who can’t access the SIFs include pregnant people, people under the age of 18, and people who need help to inject. That means pregnant people who would like to use the SIF are not able to be connected to information and services for support. They and their unborn babies are more at risk of blood borne virus transmissions like HIV or hepatitis C. It also means young people are less likely to learn about how to protect their health and less likely to be referred to services that could support them, while people with disabilities are more likely to experience violence from having to use drugs in unsafe places, and in some cases, having to ask someone they don’t know to help them inject. All these people and more could benefit from having somewhere safe to inject.
One of the major differences between Australia’s provision of SIFs and many of the facilities in other countries is the “medical model” used here. Many other countries have peer-led facilities with clinical support available within them, when it is needed or wanted. This tends to make them welcoming environments and cheaper to run.
People who use drugs have been working with our friends and loved ones, managing overdoses, providing support, peer education and safer using advice, and responding to trauma and mental health for decades. We know the services to refer our community to when and if they decide they want support as we know how to be there for each other. Peer workers with lived and living experience are also able to provide practical advice about things that are important to their peers, like how to look after veins and prevent hepatitis C and HIV transmissions.
With resourcing and support from legislators, clinicians, community leaders, and the broader community, these services could be provided in Australia, similar to countries where peer-led drug consumption rooms have been successfully operating for years. Supervised injecting facilities and drug consumption rooms aren’t the answer to every overdose or every other issue faced by people who inject drugs, but they are a good option for those people who would otherwise be injecting in public or injecting alone.
It is time Australia’s politicians listen to us, follow the evidence, and be braver when it comes to protecting the lives of people who use drugs. We deserve inclusive measures, supportive services and the same respect, health and human rights as the rest of the community. Isn’t equality and caring for mates the essence of being Australian?