Maggio 2001

Australia: harm reduction policies in New South Wales. The case of the Kings Cross injecting facility

Simon Lenton
PERTH

The most newsworthy recent development in Australian drug policy has been the establishment of a trial of a supervised injecting facility in Kings Cross. This Sydney suburb is well known for sex work and drug dealing. What makes the story even more interesting is that there is a Vatican connection.

Supervised injecting facilities (SIFs) are legally sanctioned and supervised facilities designed to reduce some of the health and public order problems associated with street-based injecting drug use. Such facilities allow for the consumption of drugs, obtained elsewhere, under hygienic, low risk, and low stress conditions. They should be distinguished from 'shooting galleries', unsanctioned injecting places, which reached notoriety in some larger US cities and are characterised by unsanitary injecting and multiple needle sharing. Most SIFs have been instituted in response to concentrated drug markets characterised by 'public nuisance' (very visible drug dealing and consumption), and poor health conditions for drug users. Over 45 SIFs operate in Europe and although the research is limited, what information is available suggests SIFs have: extremely low rates of overdose or other complications; decreased needle sharing among participants; reduced drug use and discarded injecting equipment in public places; and improved general health and social functioning among participants.

State Governments in three Australian jurisdictions had indicated a preparedness to trial SIFs. A proposed trial in the Australian Capital Territory (ACT) was put on hold in June 2000 after two non-aligned members of parliament combined with the Labor opposition to threaten passage of the government's budget if it included funds for conducting such a trial. In Victoria, prior to the September 1999 election, the opposition Labor Party announced it would conduct a controlled trial of SIF at a number of sites in Melbourne. Following an unexpected win by Labor, a community consultation revealed considerable criticism, particularly from residents and business groups near proposed sites. In August 2000, the now opposition party voted the proposal down. These examples demonstrate the immense difficulties in implementing even modest, carefully controlled trials of SIFs in the Australian political environment. In both the scientific and public health policy issues appear to have been sidelined in favour of political opportunism. However, in NSW, the Kings Cross trial is still alive, despite substantial threats to its survival since it was announced.

A trial of a SIF was first publicly mooted in NSW in 1997 by Commissioner James Wood, who conducted a Royal Commission into corruption in that state's Police service. Illegal 'shooting galleries' had operated in some Sydney sex shops since the early 1990's, with rooms hired for $A6 for 10 minutes. A parliamentary committee, established after the Royal Commission, recommended SIFs not be trialed, but specified mandatory minimum requirements should such facilities ever operate in Australia. In 1998, frustrated health and welfare professionals opened an unsanctioned injecting facility in the Uniting Church's Wayside Chapel in Kings Cross. This created much media interest, saw the centre closed within 2 weeks and the Reverend arrested, although the chargesagainst him were later withdrawn. This civil disobedience exercise also placed SIFs firmly on the agenda of the NSW Drug Summit, held 2 weeks later.

One recommendation of a 1999 NSW Parliamentary Drug Summit was that the government should not veto proposals for an appropriately run SIF where community support existed. Random surveys of the local community in Kings Cross found increasing community support for establishing a SIF in the area, rising from 70% in 1997 to 76% 1998. The Sisters of Charity, an order of nuns who operate a public hospital near Kings Cross, volunteered to run a SIF. However, this offer was withdrawn in October 1999 on orders from the Vatican. According to media reports, Sydney's Catholic Archbishop, Cardinal Edward Clancy, received the instruction in a letter from Cardinal Joseph Ratzinger after the Archbishop had asked the Congregation for the Doctrine of the Faith for a determination on the issue. Meanwhile, legislation was passed by the NSW Parliament enabling an 18-month trial of a SIF. The University of NSW offered to run the centre, but later withdrew this offer as it was to be involved in the SIF's planned evaluation. The Federal Health Minister had also warned the University that federal funds, provided to the university, could not be spent on this service. In December, Australian Prime Minister, John Howard, made public statements saying that he did not support SIF proposals and sought to stop states running trials. This followed the International Narcotics Control Board allegedly advising the NSW government that the proposed trials were contrary to UN Drug conventions and would send the wrong signal in the lead up to the Sydney Olympics. This is despite the fact that, just a year earlier, representatives of the governments considering such trials had apparently argued successfully they were consistent with the conventions under a clause allowing strictly controlled 'medical or clinical trials' of new drug treatments or reforms.

However, in December 1999 the Uniting Church was nominated by the government to operate the 18-month SIF trial, and was granted a license to do so by the NSW Police Commissioner and the Director-Genral of Health in October 2000. While a site was found in an old pinball parlour and extensively re-fitted for its new purpose, the fight was not yet over. The Kings Cross Chamber of Commerce, a local business association, lodged a legal challenge in the NSW Supreme Court questioning the validity of the Church's licence on the grounds that it had not demonstrated 'sufficient community acceptance' of the proposed site. This was despite evidence from an independently conducted random telephone poll of residents and, a host of letters, demonstrating majority community support. On April 5, 2001 Justice Brian Sully of the NSW Supreme Court dismissed the action, finding that there was no current legal impediment to the Church operating the SIF. Although on May 2 the Supreme Court received an application from the Chamber that it will be seeking to appeal the decision.

Staff recruitment has begun for the Kings Cross 'Medically Supervised Injecting Centre' (MSIC), as it is known. The MSIC has a waiting room, the injecting room itself (with booths where people can sit in pairs and inject together), and an after care area where tea and coffee, health information, counselling and social welfare assistance will be available. Those who use the facility must be 18 years or above and must register for an admission card. Once in the injecting room users will be asked to wash their hands, given a sterile injecting kit, and shown to an empty cubicle. Two staff will monitor this room at all times. In the recovery area, counsellors will be available to offer help with accommodation and treatment. Drug dealing, smoking, and re-entering the injecting room are forbidden.

When it finally opens for business the MSIC will be subject to an extensive independent evaluation by a committee of drug, research, and law enforcement experts. The evaluation aims to assess: its operational feasibility; the public health impact with regard to drug overdoses and blood-borne virus transmission; the impact on the health and wellbeing of clients and their use of other drug treatment services; criminal activity in the area around the service; the public injecting of drugs and the discarding of used injecting equipment in the local area; the local and state-wide community attitudes to illicit drug users and to the MSIC; and an economic cost analysis of the SIF. The evaluation will be eagerly awaited by those in Australia and elsewhere who would like to see the trial of supervised injecting facilities in other locations.

Post script:
The Kings Cross MSIC opened for business on Sunday 6/5/01. Despite a large media stake out, small numbers of injectors have been using the service and many more have said they will use it once the media frenzy calms down. On day two of opening one client sought referral for drug treatment.

NB: The story printed here borrows heavily from a paper by Dolan and colleagues published in the professional journal Drug and Alcohol Review.

* Research Fellow presso il National Centre for Research into the Prevention of Drug Abuse, Curtin University, Perth.