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Supervised injection site

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The Guidelines for the operation and use of consumption rooms define Injecting rooms as "legally sanctioned and supervised facilities designed to reduce the health and public order problems associated with illegal ... drug use" [1] It describes various facilities where the consumption of illicit substances is legally permitted. The main focus for these facilities is reducing the harm associated with injecting drug use. There are very few in existence, mostly in Europe, with one in Australia and another in Canada. The European rooms operate as drug consumption rooms, which means that they are simply spaces where consumption of illicit substances is legal. The Australian and Canadian facilities were set up later, and operate as supervised injecting facility in Canada, and medically supervised injecting centre in Australia. In these facilities illicit drug use is permitted, but there is a more clinical approach to the service delivery, with a large staff of nurses overseeing proceedings, and basic life support equipment is available if needed. There are none in the United States.

European drug consumption rooms

As of 2000, there were 16 legal drug consumption rooms in the Netherlands, the first being set up in the 1970s,[2] 17 in Switzerland, the first in 1985,[2] and 13 in Germany, the first in 1994[2], in Oslo, Norway, opened in 2005 and Copenhagen, Denmark 2007. These centres are usually located in urban areas, with the primary aims to reduce negative health effects and minimise the public disturbance arising from street-based drug use.

Australian and Canadian supervised injecting centres

The Sydney Medically Supervised Injecting Centre (MSIC) opened in May, 2001, in Kings Cross, Sydney.[3] It was set up as a recommendation of the Wood Royal Commission to combat street crime in the area and reduce police corruption.[4] The Canadian Insite commenced operation in 2003. As well as public order and improving health, the major difference between the supervised injecting centres and the unsupervised European model is the more clinical nature of the service. Oxygen and Naloxone are administered in the case of opioid and heroin overdose.[3]

Opposition

Injecting rooms are controversial because they are an attempt to decrease the negative consequences of existing drug abuse, rather than punish drug users through law enforcement. Critics of the practice say that they encourage drug abuse. A common approach to drug policy is to have three layers:

  • Harm prevention - to prevent people first using drugs
  • Supply reduction - to prevent drugs from reaching the population
  • Harm reduction - to prevent harm to people who use drugs despite the attempts of the previous two policy focuses. Injecting centres fall under this approach.

Much of the controversy over injecting centres is about the distribution of resources between the three approaches. For example the conservative Australian politicians Gordon Moyes and Fred Nile say that little to no money should be spent on harm minimisation strategies, and instead redirect funds to preventative measures. Opponents argue that the sites send a message that the government supports illegal drug use, and that the sites themselves are unnecessary, costly, and contribute to crime in the area which they are situated. Many of the assessments carried out on the Canadian and Australian projects have found no evidence to back this last claim.[5][6]

Where safer injection sites are used to alleviate the harms of illegal practices or behaviours, critics of the approach, such as the United Nations International Narcotics Control Board,[7] cite concerns about its strategies sending a message of sanctioned acceptance of the very behaviours which the community, through its legislators, do not accept.[8][verification needed] Critics[who?] of this intervention point to evaluations of safe injection sites. For example, the 2003 evaluation of the Sydney Medically Supervised Injecting Centre[9] found that that there was no evidence that the injecting room reduced the number of overdose deaths in the area, no improvement in ambulance overdose attendances in the area, no improvement in ambulance overdose attendance during hours the injecting room was open, no improvement in overdose presentations at hospital emergency wards (p. 60). Later research balanced these initial findings, noting that "the Sydney MSIC reduced the demand for ambulance services, freeing them to attend other medical emergencies within the community" (but it is also noted that data from this later study uses the data for the same ambulance services as the 2003 evaluation, but with obviously conflicting data for the years 2001 and 2002) .[10][11][12]

The 2003 evaluation further indicated no improvement re HIV infections (p. 71) no improvement in Hep B infections (p. 72) either worse or no improvement (depending on the suburb studied) in new Hep C notifications (p. 80) discarded syringe counts on street reduced only in line with reductions in numbers handed out due to heroin drought (p. 123) and drug-related loitering and drug dealing worsened at the station entrance immediately opposite the centre (p. 147).

An analysis of this evaluation by an epidemiologist, addiction medicine practitioner, and social researchers and practitioners found overdose levels in the MSIC 36 times higher than on the surrounding streets of Kings Cross, with clients averaging only one in every of their 35 injections in the room, evidencing low utilization rates in light of the ever-present risk of fatal overdose to each heroin user.[13] Testimony of ex-clients of the MSIC reported to the NSW Legislative Council[14] alleged that the extremely high overdose rates were due to clients experimenting with poly-drug cocktails and higher doses of heroin in the knowledge that staff were present to ensure their safety. The 2003 evaluation noted that, “In this study of the Sydney injecting room there were 9.2 heroin overdoses per 1000 heroin injections in the centre. This rate of overdose is higher than amongst heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room.[15] It is this injecting room effect of increasing the trade for local drug dealers that has been condemned by critics.

See also

References

  1. ^ Schneider W, St¨over H (eds). Guidelines for the operation and use of consumption rooms. Developed at the conference: consumption rooms as a professional service in addictions– health. M¨unster: akzept Bundesverband 2000, trans J. Kimber.
  2. ^ a b c Dolan, Kate; Kimber, Jo; Fry, Craig; Fitzgerald, John; Mcdonald, David; Trautman, Franz (2000). "Drug consumption facilities in Europe and the establishment of supervised injection centres in Australia". Drug and Alcohol Review. 19: 337–346. doi:10.1080/713659379.
  3. ^ a b Van Beek, Ingrid (2004). In the eye of the needle: Diary of medically supervised injecting centre. Crows Nest: Allen & Unwin. ISBN 9781741143812. OCLC 57515258.
  4. ^ "Report on the Establishment or Trial of Safe Injecting Rooms, Executive Summary". The Joint Select Committee into Safe Injecting Rooms, Parliament of New South Wales. Retrieved 2010-03-30.
  5. ^ "Research Results." Vancouver Coastal Health: Insite. Retrieved August 1, 2006.
  6. ^ Donnelly, Neil; Snowball, Lucy (2006). "Recent trends in property and drug-related crime in Kings Cross" (PDF). Contemporary Issues in Crime and Justice. 105: 1–7. {{cite journal}}: Unknown parameter |month= ignored (help)
  7. ^ "Analysis of the World Situation". Report of the International Narcotics Control Board For 2001 (PDF). International Narcotics Control Board. 2001. p. 80. ISBN 9211481457. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  8. ^ 2007 National Drug Strategy Household Survey: first results. Australian Institute of Health and Welfare. 27 April 2008. pp. 10–11. ISBN 9781740247740.
  9. ^ 2003 MSIC Evaluation Committee "Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre" (PDF). Retrieved 2010-01-09. 2003
  10. ^ Salmon, Allison; Van Beek, Ingrid; Amin, Janaki; Kaldor, John; Maher, Lisa (2010). "The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia". Addiction. 105 (4): 676–683. doi:10.1111/j.1360-0443.2009.02837.x. PMID 20148794. {{cite journal}}: More than one of |author= and |last1= specified (help); Unknown parameter |month= ignored (help)
  11. ^ Beletsky, Leo; Davis, Corey S; Anderson, Evan; Burris, Scott (2008). "The law (and politics) of safe injection facilities in the United States". American Journal of Public Health. 98 (2): 231–7. doi:10.2105/AJPH.2006.103747. PMC 2376869. PMID 18172151. {{cite journal}}: Unknown parameter |month= ignored (help)
  12. ^ Kerr, Thomas; Kimber, Jo; Rhodes, Tim (2007). "Drug use settings: an emerging focus for research and intervention". The International Journal on Drug Policy. 18 (1): 1–4. doi:10.1016/j.drugpo.2006.12.016. PMID 17689337. {{cite journal}}: Unknown parameter |month= ignored (help)
  13. ^ "The Case for Closure" (PDF). Drug Free Australia. 2008. Retrieved 2010-01-09. More detail at http://www.drugfree.org.au/fileadmin/Media/Reference/DFA_Injecting_Room_Detailed_Research.pdf
  14. ^ NSW Parliament Hansard "Rev Dr Gordon Moyes Injecting Room Hansard". Retrieved 2010-01-09. 26 June 2007
  15. ^ 2003 MSIC Evaluation Committee "Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre" (PDF). Retrieved 2010-01-09. 2003 p p 62,63
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