Drug consumption rooms (DCR)
Drug Consumption Rooms are also known as 'medically supervised injecting centres', ‘safe injecting facilities’, ‘safe injecting sites’ or 'drug injection rooms', or ‘drug fixing rooms’. Some provide space for safe injection only, while majority of DCRs also provide places to smoke or snort drugs. There are even 'smoking only' consumption rooms.
Project Solidify – Supervised Drug Consumption Facilities to Instill Harm Reduction and Social Cohesion at Local Levels
The project will focus on the implementation and sustainability of the Drug Consumption Rooms in several European cities and assess their impacts on the territory. EN FR DE ES PT
Accidental Intimacy: Transformative Emotion and the Sydney Medically Supervised Injecting Centre
This article widens the debate surrounding supervised injecting facilities (SIFs) by exploring an aspect of SIFs yet to be examined in the scholarly literature: the relationships created between staff and clients within these settings. By analyzing entries made in the Sydney Medically Supervised Injecting Centre's (MSIC) client comment books we explore the centrality of emotional connection to clients' experiences of the service. We argue that the everyday contact between staff and clients—including the “accidental intimacy” that develops when clients inject in the presence of staff —counters the sensations of shame identified by many in the comment books, creating new relations, and new performative possibilities for the production of self, belonging and citizenship for clients of the service. In exploring the role of emotions in the operation of the MSIC we also aim to highlight the political, policy, and clinical value of qualitative forms of inquiry for the harm-reduction field.
Beyond failure: The generative effects of unsuccessful proposals for Supervised Drug Consumption Sites (SCS) in Melbourne, Australia
Focusing on the 20-year history of unsuccessful proposals for Supervised Drug Consumption Sites in Melbourne, Australia, this paper highlights the generative effects of apparent ‘failure’ in policy-making and policy mobilization. Rather than framing thwarted proposals as categorical failures, we show how they altered parameters of policy acceptability, invigorated policy and practitioner networks, facilitated the development of allied programs, and, recently, inspired a successful SCS proposal. The paper argues that apparent policy failure and the potential for policy change must be evaluated and conceptualised in terms of variously long historical timeframes. In doing so, the paper contributes to ongoing debate over the conceptual and empirical status of failure in policy mobilities literature.
“Beyond Safer Injecting”—Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility
Health and social issues in aging populations of people who inject drugs (PWID) tend to aggregate, despite risky injecting practices decreasing with age. Identifying needs and avenues of support is becoming increasingly important. We described the health and social situation among clients of a long-running supervised injecting facility (SIF) in Sydney, Australia. An interviewer-administered survey (n = 182) assessed current housing status, employment, physical and mental health, incarceration history, drug use, engagement in drug treatment, health service utilization, and willingness to accept support. Results were compared to the information provided at initial visit. Up to half of the participants transitioned between lower- and higher-risk health and social indicators over time. Willingness to accept support was greatest amongst those with higher self-perceived need. Support for mental health was a low priority, despite the high self-reporting of mental health issues. SIF clients are open to support for health and social issues, despite ongoing active drug use. Lower-threshold services such as SIFs are well-positioned to recognize and respond to deteriorating health and social issues for PWID. Facilitating care and treatment remains a challenge when the services to which people are being referred are higher-threshold with a more rigid approach.
Creating and sustaining cooperative relationships between supervised injection services and police: A qualitative interview study of international stakeholders
BACKGROUND: Supervised injection services (SIS) operate with special exemptions from drug law enforcement. Given the expansion of SIS and the opioid overdose crisis in numerous jurisdictions, now is a critical time to examine factors that contribute to cooperative SIS-police relationships. We sought to learn about SIS-police relationships from international jurisdictions with well-established as well as newer SIS.
METHODS: We conducted 16 semi-structured telephone interviews with SIS managers (n = 10) and police liaisons (n = 6) from 10 cities in seven different countries (Australia, Canada, Denmark, France, Germany, Netherlands, and Spain). All participants provided informed consent. We focused our coding and analysis on themes that emerged from the data.
RESULTS: Five key contributors to cooperative SIS-police relationships emerged from the data: early engagement and dialogues; supportive police chiefs; dedicated police liaisons; negotiated boundary agreements; and regular face-to-face contact. Most participants perceived the less formalised, on-the-ground approach to relationship-building between police and SIS adopted in their city to be working well in general. SIS managers and police participants reported a lack of formal police training on harm reduction, and some thought that training was unnecessary given the relatively positive local SIS-police relationships they reported.
CONCLUSION: Our qualitative study provides new, in-depth empirical examples of how police in varied international jurisdictions can come to accept and work cooperatively with, not against, SIS staff and clients. Investing ongoing effort in SIS-police relationships, in a manner that best suits local needs, may hold greater and more sustainable public health value than delivering specific curricula to police.
Enhancing consumer participation in a medically supervised injecting centre through participatory action research
Consumer participation in health care refers to consumer involvement in decisions regarding the planning, delivery and evaluation of services. Consumer participation has been occurring in drug treatment services for over a decade, but progress has been slow due to poor organisational commitment, negative attitudes and power imbalances between consumers and providers. There are no reported consumer participation studies in harm reduction settings. This study investigated how the process of forming a consumer action group (CAG) influenced consumer participation at the Uniting Sydney Medically Supervised Injecting Centre (MSIC), a service designed to reduce the negative impacts of injecting drug use.
The aim of this study was to investigate how the process of forming a consumer group influenced consumer participation at MSIC. A participatory action research method was employed. The first stage investigated current levels of consumer participation at MSIC and motivation to form a CAG. Data for this stage included a consumer satisfaction survey (n=100), a staff brainstorming exercise (n=36) and structured interviews with consumers (n=12) and providers (n=7). In the second stage, MSIC consumers (n=11) and staff (n=5) developed a CAG. The third stage involved the implementation of the CAG’s goals to enhance consumer participation. The fourth stage comprised an evaluation using a consumer satisfaction survey (n=100) and structured interviews with CAG members (n=13) and MSIC staff (n=10), and the process of the author’s withdrawal from the study.
There were considerable challenges in establishing a CAG. These included: consumers’ marginalised lifestyles, MSIC’s biomedical model and negative attitudes of staff. Despite these constraints, there was active interest in developing the CAG. The group successfully implemented strategies to enhance MSIC’s consumer participation. The consumer CAG members reported that the group helped them to improve their relationships with each other and staff, reduce drug use, address health problems and consider employment in the drug treatment services. A key factor that facilitated the group’s success was the support the consumer members received from MSIC staff.
In line with previous research findings from drug treatment services, this study revealed that consumers’ drug use and lifestyles can constrain consumer participation. However, the results also demonstrated that these factors were mediated by the staff’s efforts to focus on the consumers’ strengths. Participation not only empowered consumers, but also increased their social capital and prompted them to make positive lifestyle changes. Overall, this study provides evidence that highly marginalised consumers can successfully contribute to service delivery when a strength-based approach is adopted.
Establishing Supervised Injecting Facilities: A Responsible Way to Help Minimise Harm
The trial of supervised injecting facilities is one of a number of strategies that should be employed to address the problems associated with street-based injection drug use in Australia. In this article, it is proposed that these facilities should be trialled in view of their success overseas in lowering the incidence of drug overdose, in preventing the transmission of blood-borne diseases and in reducing public nuisance. It is argued that Australia’s health-related human rights obligations under international law require the trial of supervised injecting facilities. Contrary to the arguments of some, the various drug-related treaties to which Australia is a party accommodate the establishment of supervised injecting facilities. The early success of a supervised injecting facility in New South Wales augurs well for the prospects of decreasing the incidence of overdose and blood-borne disease among street-based injecting drug-users by adopting an approach to drug policy that is based on principles of harm minimisation.
Establishing the Melbourne injecting drug user cohort study (MIX): rationale, methods, and baseline and twelve-month follow-up results
BACKGROUND: Cohort studies provide an excellent opportunity to monitor changes in behaviour and disease transmission over time. In Australia, cohort studies of people who inject drugs (PWID) have generally focused on older, in-treatment injectors, with only limited outcome measure data collected. In this study we specifically sought to recruit a sample of younger, largely out-of-treatment PWID, in order to study the trajectories of their drug use over time.
METHODS: Respondent driven sampling, traditional snowball sampling and street outreach methods were used to recruit heroin and amphetamine injectors from one outer-urban and two inner-urban regions of Melbourne, Australia. Information was collected on participants’ demographic and social characteristics, drug use characteristics, drug market access patterns, health and social functioning, and health service utilisation. Participants are followed-up on an annual basis.
RESULTS: 688 PWID were recruited into the study. At baseline, the median age of participants was 27.6 years (IQR: 24.4 years – 29.6 years) and two-thirds (67%) were male. Participants reported injecting for a median of 10.2 years (range: 1.5 months – 21.2 years), with 11% having injected for three years or less. Limited education, unemployment and previous incarceration were common. The majority of participants (82%) reported recent heroin injection, and one third reported being enrolled in Opioid Substitution Therapy (OST) at recruitment. At 12 months follow-up 458 participants (71% of eligible participants) were retained in the study. There were few differences in demographic and drug-use characteristics of those lost to follow-up compared with those retained in the study, with attrition significantly associated with recruitment at an inner-urban location, male gender, and providing incomplete contact information at baseline.
CONCLUSIONS: Our efforts to recruit a sample of largely out-of-treatment PWID were limited by drug market characteristics at the time, where fluctuating heroin availability has led to large numbers of PWID accessing low-threshold OST. Nevertheless, this study of Australian injectors will provide valuable data on the natural history of drug use, along with risk and protective factors for adverse health outcomes associated with injecting drug use. Comprehensive follow-up procedures have led to good participant retention and limited attrition bias.
High HIV testing and low HIV prevalence among injecting drug users attending the Sydney Medically Supervised Injecting Centre
OBJECTIVE: 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).
METHODS: Cross-sectional survey of IDUs attending the Sydney MSIC (n=9,778).
RESULTS: 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.
CONCLUSIONS: 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.
