Medically Supervised Injecting Centre Research Articles

Public opinion towards supervised injecting centres and the Sydney Medically Supervised Injecting Centre

Objective: To describe public opinion towards supervised injecting centres (SICs) and the Sydney Medically Supervised Injecting Centre (MSIC) before and after the opening of the MSIC. Methods: In 2000 and 2002, telephone interviews were conducted with 515 and 540 residents and 209 and 207 businesses in Kings Cross, Australia, 7 months before and 17 months after the MSIC opened in Kings Cross. Information was obtained on respondents’ characteristics, knowledge of the MSIC, and agreement with SICs. Differences in public opinion before and after the MSIC opened were assessed using the chi-square statistical test. Results: Two-thirds of the businesses and half the residents knew the correct location of the Sydney MSIC in 2002. The level of support for establishment of a MSIC in Kings Cross (68–78%, p < 0.001) and other areas of high-drug use (71–80%, p = 0.003) increased significantly among residents between 2000 and 2002. Both groups were more likely to disagree than agree that SICs would encourage illicit drug injection. Conclusion: Public opinion towards SICs and the establishment of the MSIC generally was supportive in the short-term. Assessing whether this level of support is sustained over time will involve further research that demonstrates the benefits and effectiveness of such facilities.

The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime

The current study aimed to model the effect of Australia's first Medically Supervised Injecting Centre (MSIC) on acquisitive crime and loitering by drug users and dealers. The effect of the MSIC on drug-related property and violent crime was examined by conducting time series analysis of police-recorded trends in theft and robbery incidents, respectively. The effect of the MSIC on drug use and dealing was examined by (a) time series analysis of a special proxy measure of drug-related loitering; (b) interviewing key informants; and (c) examining trends in the proportion of Sydney drug offences that were recorded in Kings Cross. There was no evidence that the MSIC trial led to either an increase or decrease in theft or robbery incidents. There was also no evidence that the MSIC led to an increase in 'drug-related' loitering at the front of the MSIC after it opened, although there was a small increase in 'total' loitering (by 1.2 persons per occasion of observation). Trends in both 'drug-related' and 'total' loitering at the front of the MSIC steadily declined to baseline levels, or below, after it opened. There was a very small but sustained increase in 'drug-related' (0.09 persons per count) and 'total' loitering (0.37 persons per count) at the back of the MSIC after it opened. Key informant interviews noted an increase in loitering across the road from the MSIC but this was not attributed to an influx of new users and dealers to the area. There was no increase in the proportion of drug use or drug supply offences committed in Kings Cross that could be attributed to the opening of the MSIC. These results suggest that setting up an MSIC does not necessarily lead to an increase in drug-related problems of crime and public loitering.

The Sydney Medically Supervised Injecting Centre: reducing harm associated with heroin overdose

The Sydney Medically Supervised Injecting Centre (MSIC) commenced operation on a trial basis in May 2001. Operating within a clinical model, the Centre's primary objective is to reduce the morbidity and mortality associated with drug overdose. Staff include nurses authorized to administer naloxone to reverse the central nervous system depressant effects of heroin, according to clinical protocols developed and modified for the Centre's setting. Data were collected on clients’ drug overdose history, demographics, and recent drug and alcohol use at each subsequent visit. The MSIC registered 3747 injecting drug users and supervised 56 861 injecting episodes (61% to inject heroin, 30% to inject cocaine and 9% other drugs) in the first 18 months of operation. A total of 409 drug overdoses occurred (80% heroin, 15% cocaine and 5% other drugs) during this time. Among the heroin overdoses treated, 25% also required naloxone. Risk factors identified included history of heroin overdose, heroin as the main drug injected, engagement in sex work, frequent attendance at the MSIC, and otherwise injecting in a public place. Being in methadone maintenance treatment and a daily injector at registration were protective. Overall, It is likely that the early intervention provided by the supervised setting of the MSIC reduced the morbidity and mortality that would have otherwise been associated with these drug overdoses had they occurred elsewhere. Better understanding of risk factors for heroin overdose has the potential to also prevent heroin overdose in this and other settings.

The Sydney Medically Supervised Injecting Centre: A Clinical Model

The Sydney Medically Supervised Injecting Centre (MSIC) is the first supervised injecting facility (SIF) in Australia and the English-speaking world. It commenced operations in May 2001 as a trial to be independently evaluated. The MSIC was to be the only SIF in Sydney's Kings Cross, a “red-light” area where the drug-using population had previously injected in public or in illegal “shooting galleries” that had proliferated in nearby commercial sex premises since 1990. The aim of the MSIC is to reduce the public health and public order issues arising from unsupervised and public injecting at a local community level. A clinical service model was developed, which would maximize the number of injecting episodes accommodated in a professionally supervised setting and integrate with the other harm reduction services nearby. In its first two years of operation 4,719 registered IDUs made 88,324 visits to inject at the MSIC. There were 553 drug overdoses (81% heroin) managed on site, with no fatalities. Among 1,852 client referrals made for further assistance, 44% were for the treatment of drug dependence. This early experience suggests that the MSIC's clinical model has been acceptable to a significant number of the street-based drug injecting population in this setting.

The Sydney Medically Supervised Injecting Centre: a controversial public health measure.

Injecting drug use remains a major public health concern, particularly because of opiate overdose and transmission of blood-borne viruses. Sydney's Medically Supervised Injecting Centre (MSIC) opened on a trial basis in May 2001 in an effort to reduce the harms of drug use. In this report, we provide a brief overview of the reported public health impact of supervising injecting facilities (SIFs) and review the history and early process evaluations of the Sydney Centre. Medline, Internet searches and perusal of bibliographies of articles were used to identify key English language publications on SIFs. These were supplemented by interview with the Medical Director of Sydney MSIC, Dr Ingrid van Beek. It is difficult to be certain of the public health impact of SIFs but evidence from overseas and Sydney's early process evaluations provide promise that they may make a positive contribution to health.

Preference to have used a medically supervised injecting centre among injecting drug users in Kings Cross, Sydney

ObjectiveTo assess factors affecting preference to have last injected in a medically supervised injecting centre (MSIC) among injecting drug users (IDUs) attending a needle syringe program (NSP) in Kings Cross, Sydney. MethodsAll NSP attenders over a two-day period in August 1999 were asked where they last injected, whether they injected alone and if they would have preferred to use an MSIC. This was in addition to the routine data collected, which included age, gender and last drug injected. ResultsAmong the 178 respondents, 52 (29%) last injected in a public place and 77 (44%) last injected alone. Seventy-one per cent of all respondents would have preferred to use an MSIC. Of those who injected in public, 83% would have preferred to use an MSIC compared to 66% of those who injected in private, which was significant (p=0.03). Age, gender, last drug injected and having injected alone did not affect preference to use an MSIC. ConclusionsRespondents' high preference to use an MSIC suggests that it may well achieve its public order and public health objectives. ImplicationsAn MSIC may significantly shift current patterns of illicit drug use in Kings Cross, the community impact of which should be monitored and managed.