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A Heroin Injecting Room Experiment

May 7, 2011

It had inauspicious beginnings, 10 years ago.

The Howard Government was opposed and may have had the power to over-rule it. A part of the United Nations attacked us. The State Opposition, having just suffered a big defeat, denounced us for taking risks with lives. The nuns of the Sisters of Charity wanted to be part of it but church conservatives ordered them away.

On the other hand South Sydney Council said they wanted it and some workers in drug rehabilitation in Kings Cross were champions of the idea.

At the end of the 1999 drug summit convened by the government in parliament house two ministers, Craig Knowles and John Della Bosca, stood in my office with a proposal for a medically supervised injecting room and persuaded me. The ultimate argument ? It might just save lives – the lives of people who are using heroin until a time ( often their late 30s ) when they get sick of it and decide to make a break with that life. We need to sustaint them till they reach that point.

The facility, as my government designed it, would be a gateway to treatment. It would mean paramedics would not be called to dark carparks or back alleys to rescue a victim of an overdose at the risk of needlestick injury to themselves. By taking injecting indoors it would mean the streets of Kings Cross would be improved.

All this has happened, as we confirmed at a gathering of 400 supporters of the centre who gathered in Sydney last night. An estimated 90 lives have been saved and Kings Cross improved. Not the Sisters of Charity but the Kirketon Centre ended up running the centre and with their professionalism answered all the critics, or almost all.

As a politician I had the job of leading public opinion to accept this measured experiment. The public responded positively even as Rightwing media thumped away in opposition and Howard denounced it. The public understood what we were doing.

It remains the only centre of its type in Australia and last year Kristina Keneally legislated to put it on a permanent statuory basis, no longer classed as an experiment. The challenge is now with Barry O’Farrell who on two occasions voted against it in the parliament but whose minister made positive comments last night.

10 Comments
  1. Sacha Blumen permalink
    May 7, 2011 11:02 am

    Bob, glad to hear the coalition minister had positive things to say about the MSIC. It’s helped both drug users and greatly improved local amenity. Only a small number of locals, some quite vocal, say it should be moved or outright oppose it.

    Your govt did good work in introducing the MSIC.

  2. Richie Gun permalink
    May 7, 2011 11:10 am

    I felt proud to be an ALP person when John della Bosca defended the injecting room on Q&A, and disgusted by Graham Morris’ visceral opposition. This measure was statesmanlike.

  3. John Ryan permalink
    May 7, 2011 1:56 pm

    The injecting room proposal was going no where, until a couple of members of the NSW Liberal Party publicly spoke in favour of it. I don’t deny that Labor Ministers carried it, but no one, not even Bob Carr said anything good about it until it had some level of bipartisan support.

    • Bob Carr permalink
      May 7, 2011 4:09 pm

      I respect your view as a former Liberal ( and liberal ) MLC but – honestly – have no recollection of your opinions weighing with me when I negotiated the terms of the motion I would accept at the Drug Summit. What counted was the desire of South Sydney Council to supped the facility instead of fiercely opposing it as almost every other council would have ; the support of health professionals ; the views of Della Bosca and Knowles ; and the simple logic of the proposition. You guys can nonetheless be satisfied with the contribution to the surrounding Zeitgeist that made it easy for me to sell when we announced the decision. But I don’t remember quoting your views, for example, when I justified the policy on the 7.30 report with Kerry o’Brien the night after the summit. And your leadership sounded like they were going to oppose it to the death. ( All more to your credit that your took the stand you did and I hope it did not cost you your preselection ).

  4. May 7, 2011 2:15 pm

    “It might just save lives – the lives of people who are using heroin until a time ( often their late 30s ) when they get sick of it and decide to make a break with that life. We need to sustaint them till they reach that point.”

    That’s the first time in 10 years that I’ve ever heard that point raised. I’m not a fan of the injecting room – it’s a sign of a muddled policy regarding drugs. However, I get the idea of it acting as a kind of “limp mode” – it allows addicts to limp through until they get to the point where they’ve had enough and want to give up. On those grounds, I can support it.

    It’s been going for 10 years – how many have limped through and given up? Are there any stats on how many regular clients are now ex-addicts?

  5. May 7, 2011 3:27 pm

    Definitely something NSW Labor can be proud of – both introducing it, *and* making it such an accepted part of healthcare services that even the Coalition isn’t seriously considering abolishing it.

  6. Judith Wheeldon permalink
    May 7, 2011 8:28 pm

    Being terrified of or bullied by polls is cowardice. Taking actions that create a new and better future that most people cannot yet imagine is leadership and courage. Well done, Bob and supporters.

  7. May 12, 2011 11:01 pm

    Bob

    According to this paper from 2000 (link below) about 5% of overdoses are fatal. Therefore, if 3500 overdoses have been managed, that would mean 140 addicts have been saved rather than 90.

    http://notes.med.unsw.edu.au/ndarcweb.nsf/resources/Mono_6/$file/Mono.46.PDF

    However, here’s some perspective. In 2002, it was estimated that there were between 17,800 and 41,900 regular heroin users in NSW. Current numbers are hard to come by.

    http://www.med.unsw.edu.au/ndarcweb.nsf/resources/TR_3/$file/TR.198.pdf

    62% of users inject once or more than once a day (mean of 2.2 injections per day).

    http://www.ndlerf.gov.au/pub/psycho-stimulant.pdf

    If we assume 30,000 users, and assume one hit per day, that adds up to 10,950,000 hits per year, or 109,500,000 hits in NSW over the lifetime of the injecting centre. 600,000 managed injections sounds like a lot, but it’s about 0.05% of all injections across the state (if you believe these numbers).

    3500 overdoses out of 600,000 injections equals an overdose rate of 0.58%. In 1998 – the peak year for heroin usage and deaths in Australia – the estimated number of non-fatal overdoses across the entire country was only 14,750. The NSW share of that would be about 7,000. 7,000 overdoses out of an estimated 11 million injections per year gives an overdose rate of 0.063%. That suggests the overdose rate at the injection centre is 9 times higher than in the outside world (or the estimated number of non-fatal overdoses was way out).

    Furthermore:

    “only 2% of heroin-related deaths in New South Wales in 1992 were in methadone maintenance (the dominant treatment modality) at the time of death, while seventy-five percent of fatalities had never been in methadone treatment. Enrolment in methadone maintenance has been found to be protective against overdose in spite of continued use of heroin, probably reflecting a combination of reduced heroin use while in treatment and/or a higher tolerance to opioids while being maintained on methadone.”

    If the centre is having a great deal of success in getting clients onto methadone, then surely this would result in a greatly decreased overdose rate?

  8. May 12, 2011 11:14 pm

    “Darke, Ross et al. (1999) noted that among the 191 fatalities in Kings Cross and immediate surrounds 47% died in home environments, 25% in hotel rooms and 19% in public places. Among the 144 cases in Cabramatta and surrounds, 65% occurred in a public place, 27% in homes and 4% in hotel rooms. It is probable that this geographic clustering of deaths in public is related to the pronounced presence of the heroin market in these two areas. The high rate of death in a public place in the Cabramatta region is likely to reflect the nature of heroin transactions in the area, in that many heroin users resident outside the area travel to the region specifically to purchase heroin, and hence consume it in public rather than waiting until they return home. By contrast, Kings Cross appears to have a resident population of heroin users, as is reflected in the proportion of overdoses that occur in private homes. A number of cheap hotels also exist in Kings Cross which offer users a private place to consume heroin purchased in the area.”

    http://notes.med.unsw.edu.au/ndarcweb.nsf/resources/Mono_6/$file/Mono.46.PDF

    Wouldn’t it have been better public policy to have opened the centre in Cabramatta rather than Kings Cross?

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  1. Sydney’s injecting room: Bob Carr’s thoughts « The Australian Drug Blog

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