At some level I’m used to it, because I’ve seen it all before – but I haven’t seen it for so many years. It’s almost like going back in time.
— THE DOCTOR WHO runs Sydney’s supervised injecting centre was taken aback by the scenes she witnessed in the back lanes of Dublin city centre this week.
Dr Marianne Jauncey, who was in the city to meet with campaigners lobbying for similar services to be allowed in Ireland, said public injecting in the Australian city had decreased markedly in the decade-and-a-half since the centre was set up.
There had also been an 80% reduction in the number of ambulances being called to the King’s Cross area of Sydney, where the facility is located, Jauncey said.
That’s because these services do what the ambulances do – we have nurses on duty, we have oxygen there.
In addition to the obvious medical advantages, the decrease in ambulance call-outs has also eased pressure on the public purse and cut down on noise and hassle for locals and business-owners in the area, according to Jauncey.
Legislation on the way
Ireland’s first such centre could be up and running by the end of 2017, after the Fine Gael-Labour Cabinet approved amendments to Misuse of Drugs legislation at the end of last year.
The new minority coalition committed itself those law changes in the Programme for Government back in May. This week a spokesperson for the Department of Health confirmed “work is continuing on the drafting of this legislation” and that a Bill is expected to be published in the coming months.
“A health-led rather than criminal justice approach” to the issue of drugs is now being pursued – and proponents of injecting facilities argue that they help stem the spread of diseases like HIV, cut down on overdose deaths and reduce anti-social behaviour, amongst other benefits.
Backers of the idea, however, are still expecting some opposition to the first centre, as the planning and set-up process gets under way.
Dr Jauncey, who sat down for an interview with TheJournal.ie after her guided walkabout of Dublin’s drug black spots, has experienced that set-up process first-hand. She took the time to answer some of the questions and discuss some of the issues that are likely to crop up as politicians debate the planned legislation.
Australia
Sydney’s Medically Supervised Injecting Centre wasn’t set up overnight by any means, Jauncey explained.
An increasing number of businesses in the King’s Cross area of the city, throughout the 1990s, complained of people illegally renting rooms for the purposes of injecting; the inception of the idea for a supervised injecting centre can be traced to the finding of a judge who headed up a commission into the New South Wales Police Service in 1997, who said:
To shrink from the provision of safe, sanitary premises where users can safely inject is somewhat short sighted.
Still, it would be another four years before the centre opened. Run by the Uniting Church, and initially established on a strictly trial basis, the facility marked its 15th anniversary in May of this year.
It was set up in King’s Cross as the district had the highest concentration of people dying from drug overdose in Australia, Jauncey explained.
“The people that lived and worked there were the ones who were walking over dead bodies and calling the ambulances themselves. They were constantly witnessing people using, people intoxicated and slumped in back doorways and in alleyways.
In the years before the centre opened there were two ambulances being called every single day within a 300 or 400 metre radius at the epicentre of King’s Cross so the issue of drugs was really on everyone’s mind.
A random phone survey showed there was majority support for an injecting facility in the area – and Jauncey said that subsequent polls found that support only increased over time.
It’s imperative that such centres are set up in areas where people are coming to buy drugs, she stressed. The evidence has shown that locating them out in the suburbs simply wouldn’t work.
“What we now understand really well is that people will come to an area to buy the drugs. If they buy the drugs in a different area they will not then jump on a train and spend time travelling and then get off and go somewhere else to use the drugs.
There are a number of reasons for that. One, it takes time. Two, it takes money. All of that time is time when they may have the drugs stolen from them – or be arrested. A lot of the time people we see who are in withdrawal are desperate to use those drugs too.
The New South Wales Parliament voted several times to extend the centre’s trial period, after independent evaluations showed it was having clear benefits. Legislation was passed to allow the facility to run on an ongoing basis, after those trial periods came to an end, in November of 2010.
What’s the centre like?
6,000 overdoses have been successfully treated at the King’s Cross centre in the last 15 years – and no-one has died.
The centre itself is tucked away in a nondescript building between a hostel and a Chinese restaurant on the Sydney district’s main street.
So what happens when a drug user arrives at the facility?
According to Jauncey:
People come in a very nondescript front door and there’s a reception area that looks the same as any reception area, if you went into a travel agency for example. There will be somebody who smiles at them and says ‘hello how can I help?’ when they come in.
If it’s a person’s first time to use the service a staff member will sit down for a five to ten minute chat about the service, and to assess their condition. They don’t record identities, but drug users will be asked to provide a first name – any first name – and the first three letters of a surname, so a record can be kept of the times they use the facility.
“The only exception to that is if there is someone underage,” she explained. The centre’s staff are legally required to verify the identity of people they suspect to be under 18, and to turn them away.
When regulars call in, they’re asked what drugs they’ve brought with them and what they may have taken in the last 24 hours, so they can be properly assessed.
Upstairs, the person will sit down at one of the stainless steel injecting booths that line the walls of the centre – after being given clean injecting equipment by another staff member.
They’ll be encouraged to wash their hands before injecting – a simple act that, in itself, can have huge benefits.
Physically, just getting somebody to wash their hands is actually incredibly effective at reducing the rate of abscesses and skin infections.
A yellow sharps bin is provided for people to dispose of the injecting equipment, and a nurse is always on duty and on the look-out for potential overdose cases.
Of the overdoses that occur probably most of them occur within that room where all the booths are. We’ve got oxygen available there. We might see somebody slump, we might see somebody stand up and look like they’re going to fall over, we might see somebody start to fall out of a chair.
If that overdose was taking place down an alleyway somewhere, the person could die. Jauncey stressed:
It’s supervising activity that was already going to occur – but it’s inherently more safe.
Aftercare
Once the drugs have been injected, the person moves into a third room for aftercare.
“It’s important we don’t just send them out onto the street.
Again they can spend as long as they wish there. They’ve got tea and coffee, they’ve counsellors. We still have oxygen and a nurse available because a number of overdoses don’t actually occur on the tip of a needle – they can occur five or ten minutes later.
There’s a private counselling room available to the service user in that area too, where staff focus on “meeting that person where they’re at”. A person may be looking for information on treatment options at that stage – or the centre might be able to help with more short-term needs, like finding a bed for the night.
And while it may, at first, appear a little unusual to be offering this extra help after the drug-using experience, said Jauncey:
“There is a sense that we have to do everything before they use – and I think that’s a really common misperception.
What we know after 15 years of working is that your chances of really effective engagement in stage one, in the reception area, are vastly reduced because by definition they are there to take drugs and they’re intent on using. They may be in withdrawal, they may be hurting, they may be in pain – so our job is respectfully, carefully to assess what they are using and get them in.
And what if someone who’s not a habitual drug user happens to show up in the reception area, asking to use the service?
Somebody comes in and wants to experiment and is not an injecting drug user? Then, as a health professional, my job is to make sure I don’t start someone on a career of being an injecting drug user.
The Sydney doctor has been Medical Director of the King’s Cross centre since 2008. She’s well used to making her case for the project, she said – as there are still occasional protests against its existence (a fresh public debate over its policies has been taking place in Australian media outlets this summer).
Even so, support in the local area has only grown since the facility’s founding, she said – as the benefits to the district become clearer over the years.
Global experience
There are over 100 such clinics around the world as of 2016 (the first ‘official’ one was opened in Switzerland in 1986) and most are located in European countries.
The Ana Liffey Drug Project’s Tony Duffin, who has been campaigning for an Irish centre, said it was imperative the legislation is changed in the next Dáil term so services can get up and running here.
“It’s not a silver bullet, nothing is,” Duffin added, stressing that such centres would form just one part of a wider service landscape.
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