Information from the Kings Cross Medically Supervised Injecting Centre

I support the Kings Cross Medically Supervised Injecting Centre (MSIC) and am on its supporters e-mail list. (The MSIC is an election issue in the upcoming NSW state election as the Opposition leader, Peter Debnam, has vowed to shut the MSIC down). I recently received the following e-mail from the MSIC, which people may be interested in reading: 

Drug Free Australia (DFA) has released the following misinformation to AAP under the title: “What’s really going on in the KINGS CROSS INJECTING ROOM?”

Please see the following corrections.

DFA INFORMATION Drug Free Australia’s “report” reveals at least 8% injectors are using ICE Drug Free Australia (DFA) has uncovered evidence that the Kings Cross Injecting Room is allowing people to shoot up ICE. This facility was put in place to supervise people injecting heroin, this taxpayer-funded trial has completely missed its target.

 FACT A range of drugs has been injected at the facility since 2001. This information is reported to the NSW Health Department on a quarterly basis. Trend data in this regard are also provided to the National Drug and Alcohol Research Centre, the Medically Supervised Injecting Centre (MSIC) contributing as a sentinel site to its national drug surveillance system. These data are also communicated to the local community through the MSIC’s regular Newsletters, which are posted on its website at <>, and have often been reported in the media. The independent evaluation team also reports on the range of drugs being used at the MSIC over time to NSW Health and in various papers published in the scientific literature. The MSIC was established to reduce all injecting-related harms – not just those associated with heroin use. Injecting as a way to self-administer drugs, is associated with significantly greater risks of harm, including drug-dependence, overdose and blood borne infections, quite regardless of the actual drug being used. While sometimes coined “the heroin injecting room” by media – the MSIC has actively discouraged this, always referring to it as the “medically supervised injecting centre”. All relevant legislation and policy documentation also use this correct terminology. The MSIC is funded through the confiscated proceeds of crime.

DFA INFORMATION Research just completed by Drug Free Australia points to numerous other irregularities and gross misinformation that demonstrates conclusively that it has consistently failed to meet the objectives upon which it was first established.

FACT MSIC Objective 1: to reduce the morbidity and mortality otherwise associated with drug overdose Results: 2,034 drug overdose cases have been successfully treated by registered nurses at the MSIC, none requiring emergency ambulance transportation to hospital; no fatalities to date; 84% decrease in ambulance callouts to overdose cases in the Kings Cross area since the MSIC was established: a 21% greater decrease than elsewhere in NSW. MSIC Objective 2: to reduce the transmission of blood borne infections including HIV and hepatitis B and C. Result: Injecting drug users (IDUs) have been provided with clean injecting equipment and specific advice to reduce injecting risk behaviour on 371,240 occasions since 2001. MSIC Objective 3: earlier and greater engagement with high-risk, street-based injecting drug users (IDUs) Result: among the 9,500 individual IDUs who have registered to use the MSIC to date most of whom had previously injected drugs in Kings Cross, the majority had never accessed any of the other health services targeting drug users in the area. Having injected in public situations is a predictor of more frequent use of the MSIC, which is in turn a predictor of successful referral from the MSIC to a drug treatment program. MSIC Objective 4: to enhance IDU access to relevant health and social welfare services including drug treatment and rehabilitation programs Result: IDUs have been referred to other relevant services on more than 6,000 occasions to date – more than 2,500 of these were to drug treatment and rehabilitation programs. MSIC Objective 5: to reduce street-based injecting and discarded injecting equipment in public places, and thereby improve public amenity Result: On average 230 injecting episodes occur at the MSIC each day – episodes that would otherwise occur in less safe, often public places. Serial random telephone surveys of local residents confirm that there has been a significant reduction in public injecting and associated injecting paraphernalia in Kings Cross since the MSIC opened.

DFA INFORMATION In 2006 only a little over a third of injections in the injecting room were heroin, with 8% of current injections being the substance Ice. Our research reveals that, in fact, only 38% of injections in the facility in 2006 were heroin injections. Other substances that make up the other 62% included methamphetamines and cocaine.

FACT While heroin remains the drug of choice for most drug users in the area and has been injected on 65% of all visits to the MSIC to date, other drugs including cocaine and methamphetamines may be substituted when heroin availability is low. “Ice”, which is the crystalline form of methamphetamine, represents a proportion of all methamphetamine-injecting episodes at the MSIC. The use of all forms of methamphetamine at the MSIC peaked in September 2003 when it reached 11% of all visits. It has gradually decreased since this time, representing 7% of all visits in the last 3 months.

DFA INFORMATION Ice, though highly destructive in the medium to long term, does not present any significant risk of overdose.

FACT There is a significant risk of methamphetamine “overdose” (more often referred to as “toxicity”) when used heavily over time. Potentially fatal manifestations of methamphetamine overdose include cardiac arrhythmias (fast and/or irregular heart beat) and cardiac arrest (“heart attack”), rapidly escalating hypertension (high blood pressure), seizures (fits) and cerebrovascular accident (“stroke”). The MSIC has developed clinical protocols to treat all of these conditions. Methamphetamine may also induce psychosis, which can be a risk to the individual and others’ safety. By relocating drug users who would otherwise inject this same drug in back streets nearby, to a clinical facility, the MSIC is uniquely positioned to identify, contain and treat those with the very early signs of methamphetamine-induced psychosis, thereby preventing its escalation and consequent public order problems when this occurs in unsupervised circumstances. The MSIC also works closely with mental health, police and other emergency services in the area to ensure a coordinated response to such problems should they arise. However, there have been no cases at the MSIC to date where emergency referral has been needed.

DFA INFORMATION With the rationale for the injecting room being supervision in the event of life-threatening heroin overdose, the injecting room is not being used for its announced purpose, says DFA spokesperson, Gary Christian.

FACT Among the 2,032 overdose cases successfully treated to date, more than 90% were heroin-related; 87 heroin-related overdose cases were treated at the MSIC in the last 3 months.

DFA INFORMATION This blatant lack of accountability, makes one wonder what else is going on in the facility. It is time to close the injecting room, said Mr Christian. It is an experiment that is in total breach of Australia’s United Nations obligations, and as a trial it should have been closed in 2003 once the negative evaluation evidence was presented.

FACT The MSIC is arguably amongst the most accountable health organisations ever established. All of its internal management protocols were carefully examined and approved by both of its licensing authorities: the Director-General of NSW Health and the NSW Police Commissioner prior to being granted a licence to operate. These cannot be changed without prior approval from these authorities. Their delegates visit the MSIC without notice on a regular basis to ensure compliance with these protocols. The service is required to report its clinical activity to NSW Health to the “Government Monitoring Committee” – made up of a range of relevant stakeholders – every 3 months. The MSIC continues to be subject to external evaluation by a team of highly respected public health researchers. All countries with supervised injecting facilities (which include Switzerland, Germany, the Netherlands, Spain, Canada, Norway and Luxembourg) are signatories to all UN drug control treaties (although some have not yet ratified the 1988 Convention). While the International Narcotics Control Board (INCB) of the United Nations Office of Drugs and Crime (UNODC) has contended that drug injection rooms contravene these treaties “by publicly inciting or inducing as well as aiding and abetting, facilitating or counselling the illicit use of drugs for personal use”, a report prepared by the UNODC’s own Legal Affairs Section for the INCB in 2002 concluded that: “It would be difficult to assert that, in establishing drug injection rooms, it is the intent of parties to actually incite or induce the illicit use of drugs, or even more so, to associated with, aid, abet or facilitate the possession of drugs. On the contrary, it seems clear that in such cases the intention of governments is to provide healthier conditions for IV drug [users], thereby reducing risk of infections with grave transmittable diseases and, at least in some cases, reaching out to them with counselling and other therapeutic options.”

DFA INFORMATION That evidence is conclusive concerning its failure, and whichever government wins the NSW election on March 24, it should divert the funds to drug prevention and effective rehabilitation, which will really save lives.

FACT The MSIC does not divert funding from drug prevention and rehabilitation programs and supports their further expansion. The MSIC urges all state politicians to approach the decision regarding its future in a non-partisan way, to consider the objective evidence and reserve their decision until the final evaluation report is tabled in NSW Parliament for consideration later this year.

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