Medically Supervised Injecting Centre Research Articles

Improving assessment and management of suicide risk among people who inject drugs: A mixed methods study conducted at the Medically Supervised Injecting Centre, Sydney.

People who inject drugs are 13 times more likely to die by suicide than the general population. Guidelines for responding to risk in this population are limited. Harm reduction services attended by people who inject drugs require targeted strategies to address the complexities of suicide risk among this population. Co-design, engaging health professionals and people with lived experience informed the study. Mixed methods were used to understand the experience of managing suicide risk among clients attending the Medically Supervised Injecting Centre (MSIC) in Sydney. A survey was administered to assess staff confidence in managing risk. Focus groups were conducted with health professionals and MSIC clients to explore experiences of suicide management, response and opportunities for improvement. Half (N = 17) the MSIC staff surveyed reported over 10 years' experience working with this population. Confidence in managing suicide risk was low. Three key themes emerged from focus groups (N = 17): (i) Autonomy and the need to involve clients in the assessment process; (ii) Trust between clients and health professionals, and transparency in decision-making; and (iii) System barriers, described by health professionals as inadequate referral pathways for clients in distress, and by clients as negative experiences of care, including involuntary admission and not receiving medication (e.g. methadone). Revised assessment guidelines and a tailored safety plan were developed. These resources are also suitable for other alcohol and other drug services. The challenge in managing suicide risk in harm reduction services is balancing duty of care with staff-client relationships and client engagement.

A snapshot of injecting drug consumption from the analysis of used syringes within the Medically Supervised Injecting Centre in Sydney, Australia.

The administration of illicit drugs by injection is associated with considerable harm, including an increased risk of overdose. The chemical analysis of used syringes can enhance knowledge on injecting drug consumption beyond traditional data sources (self-report surveys). This additional information may be useful during significant global events like the COVID-19 pandemic. This study aimed to examine a snapshot of the drugs injected at the Medically Supervised Injecting Centre (MSIC) in Sydney, Australia, in 2019-2020. Used syringes were collected from MSIC across three periods throughout 2019 and 2020 (February 2019, March-April 2020 and June-September 2020). Drug residues were extracted from used syringes using methanol before detection by gas chromatography-mass spectrometry and ultra-performance liquid chromatography-tandem mass spectrometry. The chemical analysis results were compared to self-report data obtained from MSIC clients. Heroin (46-53%), methamphetamine (24-34%) and pharmaceutical opioids (15-27%) were the most common drug residues detected. The chemically detected drugs had declining coherence with the drugs self-reported by MSIC clients across the time periods examined. There was no significant change in the drugs injected (heroin, methamphetamine and pharmaceutical opioids) across the three periods collected throughout varying COVID-19 lockdown restrictions. Changes in the frequency of other drugs injected and discrepancies between chemical analysis and self-report were potentially related to regulatory changes, degradation or misinformed sales. Routine chemical analysis of used syringes has provided an alternative information source to promote awareness of current drug trends and aid harm reduction.

“Overdose Has Many Faces”: The Politics of Care in Responding to Overdose at Sydney’s Medically Supervised Injecting Centre

Drug consumption room literature often presents overdose as a stable phenomenon, which can be responded to in the same way from one context to the next. The literature is dominated by a clinical paradigm that implies that consumption rooms are effective because they provide sterile spaces and medical supervision, yet this is not the only way in which such services are delivered, nor is it the only component of the care provided at centers with a clinical focus. A growing body of critically oriented social science literature has highlighted the way different socio-material relations of care produce different capacities for service delivery. In order to expand the field’s understanding of care beyond an avowed a-political approach to clinical supervision, we conducted qualitative interviews with staff at Sydney Medically Supervised Injecting Centre (MSIC) about how they respond to overdose. Drawing on feminist notions of the politics of care we argue that overdoses are ontologically multiple phenomena, which are enacted at MSIC in ways that are explicitly differentiated from how they are understood and responded to in more traditional clinical settings. This illustrates how a desirable clinical intervention (saving lives) is made possible at MSIC through a set of constitutive relations (and politics) of care that are aimed at more than simply ensuring the client’s heart keeps beating.

The Experience of Safety, Harassment and Social Exclusion Among Male Clients of Sydney’s Medically Supervised Injecting Centre

Research on drug harm reduction services has found these operate as a safe haven from health harm. Less is known about the wider sense of security experienced by clients of such services as a counterbalance to social marginality in their daily lives. As part of a larger study of the experience of violence among Australian men, the authors completed 20 qualitative semi-structured interviews with male clients of Sydney’s Medically Supervised Injecting Centre (MSIC) in 2016–2020. These were conducted anonymously in a private clinical room inside the MSIC and focused on aspects of drug use and general life experiences of violence, law enforcement, safety and security. Interviews were analysed by thematic content through a combination of preliminary and second close readings. Our analysis found that the MSIC consistently acted as a reprieve from harassment and violence from police and members of the public, conflict in drug deals, and general social exclusion.

The impact of OxyContin reformulation at the Sydney Medically Supervised Injecting Centre: Pros and cons

Abstract Background Oxycodone is implicated in a large number of overdose deaths, many involving intravenous administration of preparations designed for oral administration. International responses have included education strategies, regulatory changes, and tamper-resistant preparations to discourage injecting. Reformulated OxyContin ® was introduced in Australia in April 2014 and this study examines its impact on service utilisation, defined as visits to inject drugs at the Sydney Medically Supervised Injecting Centre (MSIC) and opioid overdoses at the MSIC. Methods Data from February 2007 to February 2016 are presented for drug type injected and onsite opioid overdose. The reformulated OxyContin ® effect was modelled using an interrupted time series approach. Results Client visits declined >1000 per month, or 18%, following reformulation, largely explained by a reduction in visits to inject oxycodone, partially offset by increased morphine or fentanyl injections. Despite this significant reduction in visits, there was no corresponding decrease in the number of overdoses managed, explained somewhat by a partial displacement from oxycodone to other opioids. Stable overdose numbers within the context of decreased visit numbers were consistent with increases in heroin and morphine overdose, with an extra 22 heroin and 12 morphine overdoses on average per month. This increase was offset by the decrease of 17 OxyContin ® , overdoses per month. Conclusions This study replicates the trend towards substitution of OxyContin ® with other opioids following the introduction of reformulated OxyContin ® in Australia and extends initial findings by showing the rate of overdose per MSIC visit increased following reformulation. These unintended consequences need to be considered when evaluating the success or otherwise of these kinds of changes in product formulation.

Homelessness among clients of Sydney’s supervised injecting facility

Purpose The Uniting Medically Supervised Injecting Centre (MSIC) opened in Sydney, Australia, in May 2001. Homelessness among people who inject drugs (PWID) in Australia has been increasing, and establishing how supervised injecting facilities (SIFs) might best support clients into housing is an important goal. The purpose of this paper is to update knowledge regarding the accommodation status of MSIC clients, thereby supporting a better understanding of the complex needs of these clients. Design/methodology/approach Client accommodation status at MSIC registration (first visit) and in a brief survey (conducted in May 2016) were compared; unstable accommodation was defined as rough sleeping, couch surfing, hostel, boarding house or crisis accommodation. The bivariate logistic regression analysis was used to explore the association between socio-demographics and accommodation status at both time points; a paired t-test was used to compare the visit records for those who reported stable and unstable accommodation in May 2016. Findings Of 232 clients who were present at MSIC during the week the Brief Survey was conducted, 107 participated. Most were male (79 per cent) with a mean age of 41.4 years. A total of 64 (60 per cent) identified as living in unstable accommodation; having increased from 40 per cent at the time of registration (first visit). There were significant positive associations between unstable accommodation status and unemployment, imprisonment and history of overdose, all measured at registration. In May 2016, unstable accommodation status was significantly associated with age of first injection and with unemployment status (as measured at registration); those living in unstable accommodation in May 2016 had a lower number of visits, a lower number of referrals to health and social services and a lower number of overdoses at MSIC than those living in a stable accommodation. Originality/value The rates of unstable accommodation among MSIC clients have been increasing. These findings highlight the importance of SIFs and drug consumption rooms as venue to address the essential needs of PWID, such as housing. The window of opportunity to support PWID who experience housing instability seems to be narrower than for those who live in stable accommodation.

Frequency and severity of non-fatal opioid overdoses among clients attending the Sydney Medically Supervised Injecting Centre

BackgroundPharmaceutical opioid overdose rates have increased in recent years. The current study aimed to compare rates per 1000 injections of non-fatal overdose after heroin or oxycodone injection, and their comparative clinical severity. MethodsAnalysis of prospectively collected data from the Sydney Medically Supervised Injecting Centre (MSIC). Severity of overdose was measured using the Glasgow Coma Scale, oxygen saturation levels, and the administration of naloxone. ResultsHeroin overdoses occurred at three times the rate of oxycodone overdoses (12.7 v 4.1 per 1000 injections). Heroin overdoses appeared to be more severe than oxycodone overdoses, with higher levels of compromised consciousness (31 v 18%) and severe respiratory depression (67 v 48%), but there were no differences in naloxone doses (20 v 17%). Concurrent use of other depressants at the time of overdose was also associated with compromised consciousness, and the need for naloxone. ConclusionsHeroin overdoses occurred at a greater rate than oxycodone overdoses, and had more severe clinical indicators.

Risk of fentanyl overdose among clients of the Sydney Medically Supervised Injecting Centre

BACKGROUND: Fentanyl is a powerful analgesic, the prescription of which has increased markedly in recent years. The emergence of the drug at the Sydney Medically Supervised Injecting Centre (MSIC) warranted a retrospective clinical audit to assess the risk of fentanyl overdose in comparison with other opioids, in the context of a drug consumption room. METHOD: Heroin, fentanyl or other prescription opioids (PO) injections resulting in overdose were audited (September 1, 2012 and August 31, 2015). Rates of overdose per 1000 injections and relative risks (RR) of overdose were calculated. RESULTS: In the audit period 189,203 injections by 4177 individuals occurred, with fentanyl injections increasing by 1000%, heroin injections increasing by 70% and, inversely, a sharp decline in other PO injections. Fentanyl injections had approximately four and half times the risk of resulting in overdose than heroin or other PO injections combined (RR=4.6); and, had two times the risk of heroin injections, and eight times the risk of resulting in overdose than other PO injections (RR=2.2 and RR=7.9). CONCLUSION: Findings from a drug consumption room, such as the Sydney MSIC can effectively inform harm reduction services and emergency services of the increased use of, and therefore risk of, fentanyl overdose relative to other opioids. The dynamic nature of drug markets mean that services such as MSIC are uniquely placed to provide not only real-time data on drug use trends, but also safer injecting advice to those engaging in new practices.Copyright © 2016. Published by Elsevier B.V. Language: en

Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC).

The Sydney Medically Supervised Injecting Centre (MSIC) is a supervised injecting facility (SIF) where people who inject drugs (PWID) can do so legally, under health professional supervision. The majority of clients have low levels of education and employment, high rates of incarceration and unstable housing and poor social networks, and 70 % do not access local health services. These factors increase the risk of poor mental health, and it has been documented that PWID have elevated rates of mood, anxiety, personality and psychotic disorders; post-traumatic stress disorder (PTSD); and higher rates of trauma exposure, suicidality and self-harm. The current study is the first to investigate the mental health among clients of a SIF. Validated instruments to examine clients’ mental health, social networks and trauma histories were administered to 50 frequently attending clients by a mental health nurse. The majority of respondents were unemployed, homeless and had a history of incarceration, and 82 % report they had been diagnosed with a mental health problem, but only 24 % report they were receiving treatment. Respondents had poor social networks, had poorer mental health symptoms compared to US inpatients and had experienced multiple traumatic events, and a high number of respondents had scores indicative of PTSD. These results highlight the need for mental health clinicians to be employed in SIFs and other drug consumption rooms (DCRs) to assist clients to address their mental health and psychosocial needs, particularly in light of the fact that these services are often the only places these PWID engage with in an ongoing way.

Shooting up illicit drugs with God and the State: the legal–spatial constitution of Sydney's Medically Supervised Injecting Centre as a sanctuary

AbstractIn 1999, the Uniting Church opened a Medically Supervised Injecting Centre (MSIC) at the Wayside Chapel in the inner Sydney suburb of Kings Cross. The Uniting Church justified this overt act of civil disobedience against the State's prohibitionist model of drug usage by invoking the ancient right of sanctuary. This invocation sought to produce a specific sort of spatialisation wherein the meaning of the line constituting sanctuary effects a protected ‘inside’ governed by God's word – civitas dei – ‘outside’ the jurisdiction of state power in civitas terrena. Sanctuary claims a territory exempt from other jurisdictions. The modern assertion of sanctuary enacts in physical space the relationship between state and religious authorities and the integration and intersections of civitas terrena and civitas dei. This article draws upon conceptions of sanctuary at the intersection of the Catholic Christianity tradition and the State since medieval times to analyse the contemporary space of sanctuary in the MSIC, exploring the shifting and ambiguous boundaries in material, legislative, and symbolic spaces. We argue that even though the MSIC has now been incorporated into civitas terrena, it remains and enacts a space of sanctuary.

The introduction of a potentially abuse deterrent oxycodone formulation: Early findings from the Australian National Opioid Medications Abuse Deterrence (NOMAD) study

There is increasing concern about tampering of pharmaceutical opioids. We describe early findings from an Australian study examining the potential impact of the April 2014 introduction of an abuse-deterrent sustained-release oxycodone formulation (Reformulated OxyContin(®)). Data on pharmaceutical opioid sales; drug use by people who inject drugs regularly (PWID); client visits to the Sydney Medically Supervised Injecting Centre (MSIC); and last drug injected by clients of inner-Sydney needle-syringe programmes (NSPs) were obtained, 2009-2014. A cohort of n=606 people tampering with pharmaceutical opioids was formed pre-April 2014, and followed up May-August 2014. There were declines in pharmacy sales of 80mg OxyContin(®) post-introduction of the reformulated product, the dose most commonly diverted and injected by PWID. Reformulated OxyContin(®) was among the least commonly used and injected drugs among PWID. This was supported by Sydney NSP data. There was a dramatic reduction in MSIC visits for injection of OxyContin(®) post-introduction of the new formulation (from 62% of monthly visits pre-introduction to 5% of visits, August 2014). The NOMAD cohort confirmed a reduction in OxyContin(®) use/injection post-introduction. Reformulated OxyContin(®) was cheaper and less attractive for tampering than Original OxyContin(®). These data suggest that, in the short term, introduction of an abuse-deterrent formulation of OxyContin(®) in Australia was associated with a reduction in injection of OxyContin(®), with no clear switch to other drugs. Reformulated OxyContin(®), in this short follow-up, does not appear to be considered as attractive for tampering.

The impact of a supervised injecting facility on ambulance call‐outs in Sydney, Australia

Supervised injecting facilities (SIFs) are effective in reducing the harms associated with injecting drug use among their clientele, but do SIFs ease the burden on ambulance services of attending to overdoses in the community? This study addresses this question, which is yet to be answered, in the growing body of international evidence supporting SIFs efficacy. Ecological study of patterns in ambulance attendances at opioid-related overdoses, before and after the opening of a SIF in Sydney, Australia. A SIF opened as a pilot in Sydney's 'red light' district with the aim of accommodating a high throughput of injecting drug users (IDUs) for supervised injecting episodes, recovery and the management of overdoses. A total of 20,409 ambulance attendances at opioid-related overdoses before and after the opening of the Sydney SIF. Average monthly ambulance attendances at suspected opioid-related overdoses, before (36 months) and after (60 months) the opening of the Sydney Medically Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the rest of New South Wales (NSW). The burden on ambulance services of attending to opioid-related overdoses declined significantly in the vicinity of the Sydney SIF after it opened, compared to the rest of NSW. This effect was greatest during operating hours and in the immediate MSIC area, suggesting that SIFs may be most effective in reducing the impact of opioid-related overdose in their immediate vicinity. By providing environments in which IDUs receive supervised injection and overdose management and education SIF can reduce the demand for ambulance services, thereby freeing them to attend other medical emergencies within the community.

High HIV testing and low HIV prevalence among injecting drug users attending the Sydney Medically Supervised Injecting Centre

Measure the self-reported prevalence of HIV, history of HIV testing and associated risk factors among injecting drug users (IDUs) attending the Sydney Medically Supervised Injecting Centre (MSIC). Cross-sectional survey of IDUs attending the Sydney MSIC (n=9,778). The majority of IDUs had been tested for HIV (94%), most within the preceding 12 months. Self-reported prevalence of HIV was only 2% (n=162) and homosexuality (AOR 20.68), bisexuality (AOR 5.30), male gender (AOR 3.33), mainly injecting psychostimulants (AOR 2.02), use of local health service (AOR 1.56) and increasing age (AOR 1.62) were independently associated. Among the 195 homosexual male sample 23% were self-reported being HIV positive. HIV positive homosexual males were more likely to report mainly psychostimulant injecting than other drugs, a finding not replicated among the heterosexual males. The associations in this sample are consistent with other data indicating Australia has successfully averted an epidemic of HIV among heterosexual IDUs. The absence of any significant associations between HIV positive sero-status and the injecting-related behaviours that increase vulnerability to BBV transmission suggests that HIV infection in this group may be related to sexual behaviours. In particular, the strong associations between homosexual males and psychostimulant injectors with HIV positive sero-status suggests that patterns of infection within this group reflect the epidemiology of HIV in Australia more generally, where men who have sex with men remain most vulnerable to infection.

Injecting-related injury and disease among clients of a supervised injecting facility

Background The process of drug injection may give rise to vascular and soft tissue injuries and infections. The social and physical environments in which drugs are injected play a significant role in these and other morbidities. Supervised injecting facilities (SIFs) seek to address such issues associated with public injecting drug use. Aims Estimate lifetime prevalence of injecting-related problems, injury and disease and explore the socio-demographic and behavioral characteristics associated with the more serious complications. Design, Setting, Participants Self-report data from 9552 injecting drug users (IDUs) registering to use the Sydney Medically Supervised Injecting Centre (MSIC). Findings Lifetime history of either injecting-related problems (IRP) or injecting-related injury and disease (IRID) was reported by 29% of the 9552 IDUs; 26% ( n = 2469) reported ever experiencing IRP and 10% ( n = 972) reported IRID. Prevalence of IRP included difficulties finding a vein (18%), prominent scarring or bruising (14%) and swelling of hands or feet (7%). Prevalence of IRID included abscesses or skin infection (6%), thrombosis (4%), septicaemia (2%) and endocarditis (1%). Females, those who mainly injected drugs other than heroin, and those who reported a history of drug treatment, drug overdose, and/or sex work, were more likely to report lifetime IRID. Frequency and duration of injecting, recent public injecting, and sharing of needles and/or syringes were also independently associated with IRID. Conclusions IRPs and IRIDs were common. Findings support the imperative for education and prevention activities to reduce the severity and burden of these preventable injecting outcomes. Through provision of hygienic environments and advice on venous access, safer injecting techniques and wound care, SIFs have the potential to address a number of risk factors for IRID.

Process and predictors of drug treatment referral and referral uptake at the Sydney Medically Supervised Injecting Centre

Low-threshold drug services such as drug consumption rooms (DCRs) have been posited as referral gateways to drug treatment for injecting drug users (IDUs). We examined the process and predictors of drug treatment referral and referral uptake at an Australian DCR. We undertook behavioural surveillance of the Sydney Medically Supervised Injecting Centre (MSIC) client cohort between May 2001 and October 2002. Data were collected for 3715 IDUs on demographics, injecting and drug use behaviours at registration and all subsequent MSIC service utilisation, including referrals. Referral uptake (defined as presentation for assessment at the relevant agency) was traced via reply-paid postcards included with written referrals. Sixteen per cent of clients who received written referrals to drug treatment had confirmed drug treatment referral uptake. Factors associated with drug treatment referral were frequent MSIC attendance [adjusted odds ratios (AOR = 9.4], receipt of written health (AOR = 4.8) or psychosocial (AOR = 4.3) referrals, heroin as main drug injected (AOR = 1.9) and completion of high school education (AOR = 1.6). Factors associated positively with drug treatment referral uptake were recent sex work (AOR = 2.6) and at least daily injection (AOR = 2.3). Previous psychiatric illness or self-harm was associated negatively with drug treatment referral uptake (AOR = 0.2). MSIC engaged IDUs successfully in drug treatment referral and this was associated with presentation for drug treatment assessment and other health and psychosocial services. To improve rates of drug treatment referral and uptake, those with a history of mental health issues may require more intensive referral and case management.

Estimating the size and dynamics of an injecting drug user population and implications for health service coverage: comparison of indirect prevalence estimation methods

(i) To compare indirect estimation methods to obtain mean injecting drug use (IDU) prevalence for a confined geographic location; and (ii) to use these estimates to calculate IDU and injection coverage of a medically supervised injecting facility. Multiple indirect prevalence estimation methods. Kings Cross, Sydney, Australia. IDUs residing in Kings Cross area postcodes recorded in surveillance data of the Sydney Medically Supervised Injecting Centre (MSIC) between November 2001 and October 2002. Two closed and one open capture-recapture (CRC) models (Poisson regression, truncated Poisson and Jolly-Seber, respectively) were fitted to the observed data. Multiplier estimates were derived from opioid overdose mortality data and a cross-sectional survey of needle and syringe programme attendees. MSIC client injection frequency and the number of needles and syringes distributed in the study area were used to estimate injection prevalence and injection coverage. From three convergent estimates, the mean estimated size of the IDU population aged 15-54 years was 1103 (range 877-1288), yielding a population prevalence of 3.6% (2.9-4.3%). Mean IDU coverage was 70.7% (range 59.1-86.7%) and the mean adjusted injection coverage was 8.8% (range 7.3-10.8%). Approximately 11.3% of the total IDU population were estimated to be new entrants to the population per month. Credible local area IDU prevalence estimates using MSIC surveillance data were obtained. MSIC appears to achieve high coverage of the local IDU population, although only an estimated one in 10 injections occurs at MSIC. Future prevalence estimation efforts should incorporate open models to capture the dynamic nature of IDU populations.

The effects of the market withdrawal of temazepam gel capsules on benzodiazepine injecting in Sydney, Australia

This study assessed the impact on benzodiazepine injection among IDU in Sydney of removing temazepam gel capsule preparations from the Australian market. Several data sources were used: (1) data from the NSW Illicit Drug Reporting System (IDRS) (an annual, cross-sectional survey of regular IDU in Sydney) for the period 1996 - 2005; (2) data from inner Sydney outreach services and the Sydney Medically Supervised Injecting Centre (MSIC) on last drug injected; and (3) national benzodiazepine prescription data, by formulation, from the Drug Utilisation Sub-Committee for the period 2001 - 06. Removal of temazepam gel capsule formulations from the Australian market in 2004 resulted in increased prescribing of tablet formulations but overall benzodiazepine prescription numbers remained stable. Injection of benzodiazepines ceased as a mode of administration of benzodiazepines among IDU in inner Sydney, but very frequent oral use of benzodiazepines remained highly prevalent. Removal of an easily injectable form of benzodiazepines appeared to halt injection of benzodiazepines among disadvantaged IDU. However, IDU continue to use the drug heavily and interventions to assist IDU with reducing dependent benzodiazepine use are warranted. There is a need for continued vigilance to emergent injecting drug use risks to implement timely harm reduction strategies.

News and Notes

News and Notes

Shooting Gallery Operation in the Context of Establishing a Medically Supervised Injecting Center: Sydney, Australia

Shooting galleries (SGs) are illicit off-street spaces close to drug markets used for drug injection. Supervised injecting facilities (SIFs) are low threshold health services where injecting drug users (IDUs) can inject pre-obtained drugs under supervision. This study describes SG use in Kings Cross, Sydney before and after the opening of the Sydney Medically Supervised Injecting Centre (MSIC), Australia's first SIF. Operational and environmental characteristics of SGs, reasons for SG use, and willingness to use MSIC were also examined. An exploratory survey of SG users (n = 31), interviews with SG users (n = 17), and drug workers (n = 8), and counts of used needles routinely collected from SGs (6 months before and after MSIC) and visits to the MSIC (6 months after MSIC) were triangulated. We found five SGs operated during the study period. Key operational characteristics were 24-h operation, AUS $10 entry fee, 30-min time limit, and dual use for sex work. Key reasons for SG use were to avoid police, a preference not to inject in public, and assistance from SG operators in case of overdose. SG users reported high levels of willingness to use the MSIC. The number of used needles collected from SGs decreased by 69% (41,819 vs. 12,935) in the 6 months after MSIC opened, while MSIC visits increased incrementally. We conclude that injections were transferred from SGs to the MSIC, but SGs continued to accommodate injections and harm reduction outreach should be maintained.

Five years on: What are the community perceptions of drug-related public amenity following the establishment of the Sydney Medically Supervised Injecting Centre?

Background and Objectives There is currently limited evidence on medium to long term community perceptions of public amenity where supervised injecting centres operate (SIC). Our objective was to investigate if community perceptions of public amenity have changed over time, comparing data collected prior to the establishment of the Sydney Medically Supervised Injecting Centre (MSIC), after 18 months and then following four and a half years of operation. Methods Telephone surveys were conducted among random samples of local residents and business operators in the vicinity of the MSIC at baseline, in the short term (following 18 months of operation) and in the medium term (following four and a half years of operation). Respondents were asked about their perceptions of drug use and its consequences in their neighbourhood, and to describe what they saw as advantages and disadvantages of the Sydney MSIC. Responses were compared over time and according to demographic characteristics of the survey participants. Results The survey was completed by 515, 540 and 316 residents and 269, 207 and 210 businesses in the 3 years respectively, with response rates generally above 75%. There was a significant decrease in the proportion of residents and business operators who reported having witnessed public injecting and publicly discarded injecting equipment, in the last month, with no significant change in proportions offered drugs for purchase. Residents were less likely to have seen public injecting in the last month if they were female, retired, lived over 500 m from the MSIC or participated in the survey in 2005. Business operators who had witnessed public injecting or discarded needles and syringes in the last month were less likely to report either if located over 500 m from the MSIC. Those businesses operating for over 5 years were more likely to have seen publicly discarded needles and syringes than those who had opened within the last year. Approximately 90% of both samples reported at least one advantage of the MSIC located in their area, citing the control of HIV/AIDS and hepatitis C and reduced overdose risk for injecting drug users among potential advantages. Conclusion While the Sydney MSIC continues to attract political controversy, local residents and business operators perceived significant improvements in public amenity indicators since the opening of the service. Community members appear to be cognizant of both public health (potential reduction in blood borne virus transmission and overdose among injecting drug users) and public amenity benefits of the service.