injecting rooms

Medically Supervised Injecting Rooms are Enslaving Lives

7 July 2023

5.6 MINS

by Dr Karen Broadley

Over the past two decades, there have been ongoing and polarising debates about medically supervised injecting rooms. Typically, in Australia, the Liberal-National Party Coalition has been opposed to injecting rooms because of the impact on the safety and wellbeing of surrounding communities.

In relation to the injecting room in North Richmond, in inner Melbourne, concerns have been raised repeatedly about the safety of children in the nearby school, people being reluctant to shop, eat and invest in the area, and impacts on local businesses. There is evidence that the opening of the injecting room in North Richmond resulted in a 5-to-7 per cent reduction in housing value in the area.

On the other side of the debate, there are claims by politicians, media and researchers that injecting rooms work because they save lives, and should be expanded.

It seems both sides of the argument are right. Or are they? The Victorian Labor Government seems to think so. It has recently been reported that it is thinking about introducing safe injecting buses into the Melbourne CBD as a type of compromise.

The ABC reports that it seems that the Government has been listening to the concerns of local traders who fear that an injecting room will harm their businesses by driving customers and tourists away. The bus proposal would enable the Government to alleviate these fears and continue with their mission to “save lives”.

But is the debate really as simple as this? Is it only about the question of whose lives matter more – drug users themselves or children, families and businesses? Indeed, do injecting rooms really save lives? Or do they enslave lives?

Let us consider a few facts.

Complex Needs

The fact is that individuals who inject drugs are among the most vulnerable in our society, with many experiencing challenges and needs in addition to their drug dependence. A recent study entitled “Experiences of participation in a longitudinal cohort study of people who inject drugs in Victoria, Australia” (also called the SuperMIX study) found that:

  • 36 per cent were homeless.
  • 86 per cent were receiving government benefits.
  • 66 per cent had a history of being in prison.
  • 45 per cent had been diagnosed with hepatitis C.
  • 52 per cent reported experiences of moderate to severe depression.
  • 17 per cent were born overseas.
  • 12 per cent identified as Aboriginal or Torres Strait Islander.

A Sydney-based study entitled “Survival, safety and belonging: An ethnographic study of experiences and perceptions of people who inject drugs accessing a supervised injecting centre” similarly found that “many participants had multiple complex challenges alongside their drug use, including mental illness, comorbidities, significant history of trauma, forensic history, and social and housing issues”.

Yet another study, entitled “Characteristics of people who used the Melbourne and Sydney medically supervised injecting facilities surveyed in the Illicit Drug Reporting System 2019”, stated that injecting rooms “are designed to benefit vulnerable and marginalised” people who inject drugs. They attract people who inject drugs who often “are unemployed, are living in unstable accommodation, have low levels of education, have a significant history of incarceration, inject in public and have a history of non-fatal overdose”.

It’s tragic, isn’t it? Is this really the best we can do? Offer vulnerable people, who are facing multiple challenges, a room or a bus where they can “safely” inject drugs that we know will harm them in ways that will continue to affect them, and those around them, throughout their lives?

Well, it seems it is the best we can do. It is well known that there is a chronic shortage of places in hospitals and residential drug-rehabilitation services. Furthermore, it is well known that our health and welfare systems and services – more generally – struggle to respond effectively to individuals who have multiple and complex challenges.

It is time our governments acted to protect and promote the human rights of people who inject drugs, who have had their lives, their health, and their family’s lives harmed by drug dependence.

It is well acknowledged by those who work within these systems that the specialist, single-issue nature of many services makes it difficult, even impossible, for people with multiple and complex challenges to access the services they need.

The problem is what is called “siloed service delivery”. For example, one service may work with people with mental-health conditions but not alcohol-or-other-drug (AOD) dependence.

Another service may work with people with AOD dependence but not if they are a perpetrator of family violence. Another may work with people with a disability but not with those with AOD dependence.

And the list goes on. Siloed services can result in multiple and repeated referrals being made. The people who are most in need of treatment and support are the very ones who do not get it. They fall between the policy and service gaps, and they do not receive the holistic care that they need.

A drug policy that focuses solely on saving lives, and an injecting-room program that focuses solely on providing drug users with a place where they can “safely” inject drugs is a simple solution to a complex problem.

Simple solutions to complex problems typically do not work. They only “work” if those who support them stay wilfully blind to logic and evidence. In the case of injecting rooms, many people (policymakers, practitioners and academics) are wilfully blind to the end results, which are isolation, depression, poor health and premature death for the people who use the injecting rooms.

Children are Collateral Damage

Another fact is that an estimated 60 to 70 per cent of children in child-protection out-of-home care have a parent with a substance-abuse disorder. There were 45,400 children and young people who were in out-of-home care as of June 30, 2022. This is a real tragedy – particularly as we know that for some children, their removal from the parental home and their placement in out-of-home care puts them at greater risk of abuse than they were before entering state care.

Some are abused in care. Many experience multiple placement changes, and are separated from siblings. Many children from culturally and linguistically diverse backgrounds are separated from culture.

It is important to note that 19,400 (42 per cent) of the 45,400 children in out-of-home care as of June 30, 2022, were Indigenous.

Again – it’s tragic, isn’t it? Is this really the best that we as a society can do? To offer vulnerable parents, who are facing multiple challenges, a room or a bus where they can “safely” inject drugs that we know will harm their lives and their children’s lives? (By the way, the SuperMix study found that 42 per cent of the individuals in the study had children).

Well, it seems it is the best we can do. Not only is there an overall shortage of drug-treatment services – on top of the problem of “siloed service delivery” – there is also a shortage of services that focus on child and family needs rather than just the adult/parent’s needs.

The authors of a 2007 study reported that, at that time, there were only a small number of alcohol-and-drug rehabilitation programs across Australia that offered women co-residency with their children. Although there is little up-to-date information, there is little reason to believe the situation has improved.

The authors noted how unfortunate this was, because of the evidence finding that women are more likely to seek residential treatment if they can be with their children, and that outcomes for the whole family are better.

Ad-hoc Solution

Interestingly, two Melbourne CBD traders interviewed for the ABC article referred to above, in a few simple words said what I have taken more than 1,000 words to say.

One said: “The State Government should fix rehab services first before even contemplating another injecting room.”

The other said: “The injecting room is just a band-aid solution.”

It isn’t rocket science, is it? Whether we are talking about injecting rooms or injecting buses, it makes no difference to people who inject drugs, whose lives are harmed, and whose children’s lives are harmed. It simply is not ethical to save lives if we are also enslaving lives – by giving drug users no other option but to stay dependent on drugs.

It is time our governments acted to protect and promote the human rights of people who inject drugs, who have had their lives, their health, and their family’s lives harmed by drug dependence. They must stop being wilfully blind to the chronic shortage of drug-treatment beds in hospitals and residential-rehabilitation services across the country.

And they must stop being wilfully blind to the lack of family-focused services for parents and children, and about the problem of siloed services as I have described.

___

Karen Broadley PhD is an executive member of DACA and has worked for years with individuals and families negatively impacted by drug use.

Originally published in News Weekly. Photo by Karolina Grabowska.

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One Comment

  1. Kaylene Emery 7 July 2023 at 11:51 am - Reply

    Such a comprehensive and trustworthy article Karen thank you. I say trustworthy because I spent twenty years as an addict. Then Twenty as a mental health professional , and like so many I am a mother.
    The stories I could tell ya.
    I was on the ground when “ safe “ drug use and injecting rooms were introduced at Eastern Syd Area Health.
    The stories I could tell ya.
    May God continue to bless and strengthen you and those you love and again , thank you.

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