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MSIR doing what it was designed for

April 17 2019 by Nicolas Clark

Inside the Medically Supervised Injecting Room

Last week more than a hundred people gathered for a meeting in North Richmond at a pub across from the medically supervised injecting room.

A mix of media, politicians, local residents and people working in the alcohol and drug sector attended. It was a spirited discussion about the issues associated with drug use and antisocial behaviour negatively affecting local residents.

North Richmond has been a hot spot for drug use for two decades. The City of Yarra had the highest frequency of heroin-related deaths in Victoria between 2009 and 2016 – one of the reasons North Richmond was chosen as the location for Victoria’s only injecting room.

The injecting room opened on June 30 last year for the start of a two-year trial. The expectation for some was that it would solve the drug problems in the area and an inability to achieve this might be perceived as a failure of the injecting room itself. The issue is more complex.

After nine months, it is doing exactly what it was designed to do – save lives. More than 650 overdoses have been successfully reversed in the injecting room, all of which would have occurred in public and which may have otherwise been fatal.
The injecting room has an average of about 200 visits a day. Most of the time we are close to or at capacity, and sometimes people might have a short wait to use the room. More than 2200 individuals have registered to use the facility.
Some residents voiced concerns that the injecting room has created a “honeypot” effect, attracting more drug use to the area. Indeed, many residents said the situation had improved in their area, but their voices are rarely aired.
Early data shows that ambulance callouts for drug overdoses in the North Richmond community have reduced, essentially reversing the trend in recent years. The proportion of overdoses that occur when the room is open has also fallen. This means that we are freeing up our paramedics to attend other emergencies.

At last week’s meeting, residents said the injecting room was not near enough to a hospital to help assist those with drug dependencies. However, the injecting room sits adjacent to the North Richmond Community Health Centre and provides visitors with a wide range of dental, medical, social, legal and mental health services on site.

This is unique to North Richmond. No other injecting room in the world, to our knowledge, has this one-stop facility.

We have seen many of our clients start to take better care of themselves, in some cases stop using drugs, gain employment, reunite with their families, and escape situations of domestic violence.

Our clients have multiple and complex health needs that are not being met in traditional care. More than a third of clients request hepatitis C testing and treatment and a quarter want our help accessing alcohol and other drug treatments.

Clients are screened for blood-borne viruses and treated for hepatitis C on site, as well as treatment for drug dependence.

We are in the process of scaling up our responses to these issues but so far we have tested more than 150 people and treated 40 for hepatitis. We estimate we can treat 250 people a year, making a substantial contribution to ending the hepatitis epidemic in Australia.

We estimate that more than 100 people have entered different forms of drug treatment via the injecting room already. As we move to the larger facility, we will have the capacity to ensure more people get the treatment they need.

We continue to work with the local school and law enforcement to improve the safety of all residents. A sign that some residents are encouraged by our progress is evidenced by a significant increase in school enrolments at the local primary school this year.

It is imperative that a society takes care of its most vulnerable individuals and that is why we extend compassion, care and resources to this stigmatised group, but we also recognise that it is not done to the exclusion of community concerns.

It is important to note that we are still in the early stages of a two-year trial, but I am extremely proud of what our staff have achieved so far. An independent evaluation will determine whether the injecting room is meeting its aims of preventing overdose deaths, improving access to healthcare and improving community amenity.

In the meantime, we will continue this vital and necessary work.


Associate Professor Nicolas Clark is the medical director of the North Richmond medically supervised injecting room.

Dr Nico Clark Medically Supervised Injecting Room Update

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