It is also a location in which the use and dealing of heroin has been concentrated for more than 2 decades, littered with syringes, dealers brazenly hawking their poison around the bustling food and grocery precinct, locals are out of patience.
However, those trying to cope with the ongoing drug epidemic are on the verge of seeking the State Governments go ahead for Melbourne’s first SIS, Safe Injecting Site.
In 2013, researchers from the respected Burnet Institute completed a study that pointed to an SIS as a relevant resolution to this appalling situation. The ‘North Richmond Public Injecting Impact Study’ was undertaken in collaboration with the Yarra Drug and Health Forum, City of Yarra and North Richmond Community Health Centre. The research suggested that setting up a facility offering 24-hour access to sterile injecting equipment would be one of the areas only hopes of quelling the ongoing “widespread, frequent and highly visible” illicit drug use.
Greg Denham, the Executive Officer for The Yarra Drug and Health Forum, who commissioned Burnet’s first feasibility study, says that in his experience, most of the community supports the introduction of an injecting facility.
“I have spoken to numerous people living and working in the Richmond area and haven’t met one person opposed to the idea, Mr Denham said. “The majority of people in the community want to try something that reduces the visible impact of injecting drug use, and I believe that the evidence in Sydney shows that an injecting facility will help. We anticipate that such a facility will reduce visible public injecting and ‘nuisance’ type behaviour and improve significantly the public amenity. No one wants to see people shooting up and needles and syringes left in parks and streets.”
During the period that the Burnet Institute’s research was undertaken – 2010-2012 – the area witnessed a 400 percent increase in the number of needles collected from disposal units and street-sweep operations. In the local government area the City of Yarra, of which Richmond is part, 1550 syringes were collected each month from public syringe disposal bins.
With ambulance callouts for heroin overdoses more than 1.5 times higher than for other Melbourne areas in the period between 2011 and 2012 – a total of 336 overdoses – drug-related arrests in Richmond were 3 times higher than the state average, it’s clear something needs to be done.
In its latest push to set up an SIS, Yarra Council is according to some ‘angering local traders and residents.” According to News Corp staffer Andrew Jefferson, “they are tired of junkies littering Richmond’s streets with discarded syringes.”
Yarra Council, the Yarra Drug and Health Forum, the Greens, the Australian Sex Party, and the Australian Medical Association are keen for the State Government to follow NSW’s lead by sanctioning a six-month trial of an SIS.
The head of Burnet Institute’s Alcohol and Drugs group Professor Paul Dietze says there is clear evidence worldwide that SISs are effective in reducing drug related harms. What we now need to ascertain is the benefit (or otherwise) in locating a facility in Richmond, determining how to successfully implement the program in this community.
“It might not be the case that a supervised injecting facility is required, but we do know these facilities are valuable in high drug use areas. We just need to find out the needs of the various people involved, the people using drugs, retailers, police and the wider community in the area so clear recommendations can be made to council or State Government to make a response,” Professor Dietze said. “If this needs analysis recommends that a supervised injecting facility is the way forward, we then need to determine what that facility might look like, how it will operate. Research indicates that, overall, the community is supportive of harm reduction interventions of this sort,” he added. Harm reduction is based on a hierarchy of needs that equally well supports efforts towards abstinence alongside other public health goals. But for those who continue to use drugs, for whatever reason, we need to offer comprehensive harm reduction services to keep them healthy and protect society from drug-related harm.
Local police fear the arrival of the state’s first injecting room might attract more dealers to the area, keen to feed the habit of desperate addicts, leading to an increase in crime. Police say more than half of the dealers caught in Richmond come from outside the area.
A local business representative has likened the problem to a zombie plague. “It’s getting worse, not better,” Meca Ho said. “People are too scared to walk down Victoria St because they don’t feel safe, we don’t need a shop attracting more.”
“An injecting room will just encourage more drug use, not less,” Mr Ho said.
A long serving police inspector concedes that containing the drug problem in Richmond is an uphill-battle, but one police remain committed to winning. Drug addicts have turned sections of Melbourne’s biggest public housing estate into makeshift shooting galleries.
Inspector Bernie Edwards says the drug problem is an ongoing fight.
“People talk about adopting a zero-tolerance approach, but that just doesn’t work,” Inspector Edwards said. “You can’t win by just locking people up. We need to try and break that cycle of use.”
There is no simple answer to the drug use problem in the area, Inspector Edwards says a written protocol prevents police from taking a direct approach to addicts using the North Richmond Community Health Centre.
Drug users access the facility for clean needles, however many of them shoot up heroin in nearby car parks and lanes.
“The Community Centre is a no-go zone for police.” Inspector Edwards said. “For police it’s all about preventing the spread of blood-borne viruses. I could put a circle of police around the Community Centre tomorrow but that defeats the purpose of what it’s there for.”
He said police conducted regular operations in Richmond to detect illegal drug activity and associated crime, and admitted it was not ideal having people shooting up in streets.
“Would I want an injecting room next to my house? I wouldn’t,” he said. “Supervised injecting rooms breach the law, so any move to establish one will need to be government policy.”
This isn’t the first time an SIS has been proposed for the area, the Victorian parliament rejected the idea in 2011. In a bid to control its heroin problem, the Yarra Council put forward the idea of a Kings Cross style SIS, voting in favour of an injecting room. Supporters suggested the injecting room in Sydney’s Kings Cross was successfully managing drug use, taking the problem of the streets.
The council’s proposal needed the support of the State Government, which quickly vetoed the plan.
Then Victorian Premier , Ted Baillieu said “We’ve got to get the message through to young people that dabbling in drugs is dangerous and can and does ruin lives, and we’re not going to give up.”
UPDATE! Victoria’s premier Daniel Andrews has dismissed calls for the Richmond trial of an SIS, saying that his government wouldn’t break an election promise by changing drug laws. However Mr Andres conceded that there was a desperate need for ‘new thinking’ on the problem of drug use in the state.
“We think there are further supports, funding and a greater focus on the problem,” Mr Andrews said. “There are other things we can do without taking that very big step of providing supervised injecting sites.”
Doctors Call For Supervised Injecting Site
The Victorian branch of the Australian Medical Association – AMA – wants a trial of safe injecting rooms in Melbourne. AMA Victoria’s president Stephen Parnis says they would save lives by reducing the number of drug overdoses and cut the number of ambulance call-outs and hospital admissions.
“Measures like this can prevent overdose and help control the spread of Hepatitis C, which is of increasingly high prevalence amongst Victorian drug-users,” Dr Parnis said. “Supervised injecting facilities have worked to reduce harm in Sydney’s Kings Cross and we’re hopeful they can do the same in Melbourne’s drug hotspots.”
Under a trial, drug-users would get sterile injecting equipment and a way to safely dispose of it, help in case of an overdose, and medical, rehabilitation and counselling services.
“Our harm reduction priorities are focussed in other areas, including the significant expansion of pharmacotherapy services, with the doubling of the budget and expanding needle syringe programs in areas of particular need,” a Victorian Government spokesperson said.
The Victorian Alcohol and Drug Association’s Sam Biondo says that governments are risk-averse.
“They feel that if the community doesn’t support it, then they will wear the backlash,” Mr Biondo said. “But what we’re seeing in many places in Victoria is there’s great support for these sorts of initiatives and the Government really does need to get real and start to reflect some of the sentiment on the ground. Certain governments have certain views about getting hard on drugs and getting hard on people that are breaking the law, but that approach has been well and truly shown to be a failure.”
Argument Still Stands
Four years on since its first attempt at securing an SIS for the area Melbourne’s Yarra City Council still firmly believes the proposition has merit. The motion, aimed at cutting the amount of drug use – and the number of drug overdoses – along the suburb’s main shopping strip of Victoria Street has once again been relegated to the too-hard-basket.
With local Victoria St traders coming out against the proposal, saying they would prefer street cameras to deal with the problem.
So do safe injecting rooms work, and who do they work for?
Paster Graham Long is from Wayside Chapel, who provide meals, changes of clothing and counselling services for homeless and disadvantaged people in Kings Cross. He says the Sydney Medically Supervised Injecting Centre has made a huge impact.
“We know that we were picking up in the order of 130 needles a day at the front of the chapel – these days if we pick up two or three we think we’re having a very bad day,” Mr Long said.
Paster Long says the injecting room looks like any other shopfront or medical centre.
“It just doesn’t stand out,” he said.
A trader directly opposite the Sydney MSIC disagreed, saying “there are always ‘people you don’t want’ hanging around outside, you have a huge honeybee effect.”
The trader – who wished to remain unnamed – claims his business has suffered 50 per cent losses since the Sydney SIS opened.
“A lot of the locals don’t like coming through here now because of the injection centre and the people it attracts.” The trader said.
Others who live and work in the area agreed, with one man saying that he saw drug deals being done nearby to the centre all the time.
However, Family Drug Support’s Tony Trimingham says the centre has made Kings Cross a more pleasant place.
“10 years ago any time of day you would have been confronted – you couldn’t sit down and have a pleasant cup of coffee without seeing somthing that would offend you,” Mr Trimingham said. “The Cross is definitely cleaner.”
Mr Trimingham says there was initially resistance from traders in Vancouver when he went over in 2000 to help set up a similar centre there. He says these same traders are now the injecting centre’s biggest supporters. Mr Trimingham started Family Drug Support after his son died of an overdose.
“Drug overdose deaths are preventable,” Mr Trimingham said.
The owner of the business opposite, though, said Richmond’s traders should do ‘everything they could do’ to fight any proposed injection centre.
Syringe Vending Machine Proposal
If history is anything to go by, the next step for those working on a solution to the inner-urban drug problem is syringe vending machines – SVMs – not quite as ostentatious as an SIS, but far less labor intensive than a manned needle exchange program.
History repeating, because this proposal – SVMs – has also been put forward before, by the same group as the Richmond SIS. The Yarra Drug and Health Forum wanted to trial the machines so people can get clean syringes as an alternative to needle exchange programs or supervised injecting rooms, the proposal was refused last year.
SVMs have been used in New South Wales since 1992 and are also being used in Queensland, the ACT, Western Australia and Tasmania, leaving Victoria as the standalone state on prohibition on the harm minimisation front.
The Salvation Army says “SVMs are a considered a key part of the public health responses in nearly all Australian jurisdictions, reducing blood borne virus transmission associated with injecting drug use. They do this by increasing access to sterile injecting equipment. They may be installed in areas where:
It is not possible to establish a staffed Needle and Syringe Program, or it’s been identified that some current injecting drug users may not otherwise access staffed needle exchange programs.
Victoria is one of the few Australian states and territories that do not utilise SVM’s within the suite of harm reduction approaches to reduce BBV transmission. Consequently there is limited access to sterile injecting equipment 24/7 across Victoria and in rural areas.”
Read more at: www.salvationarmy.org.au
The Burnet Institute report, ”North Richmond Public Injecting Impact Study” by Dr Robyn Dwyer, Professor Robert Power and Professor Paul Dietze
During the 1990s, Australia experienced a heroin “epidemic”, in which high quality, low priced heroin, imported from South East Asia, was readily available in many metropolitan, suburban and rural areas. However, since 2001, Australia has been experiencing what is being referred to as a “heroin drought”, with high grade heroin being much more difficult to access.
As a result of this, many other illicit drugs have risen and fallen in popularity to fill this void, with prescription temazepam, morphine, oxycodone, methamphetamine and cocaine all being used as a substitute. 2008 has seen a reversal of this trend, with the arrival of Afghan heroin being seen in Sydney for the first time ever. Although anecdotal evidence from illicit drug users reject the claim, some researchers assert that the potency of heroin has since been on the rise, and is nearly comparable to the purity of heroin prior to 2000.
In 2001, the Sydney Medically Supervised Injecting Centre opened in Kings Cross. It was opened on the recommendation of the Wood Royal Commission. Prior to this, several venues such as strip clubs or brothels in Kings Cross rented out rooms to injecting drug users so that they could have a private and safe place to inject. This practice went on with unofficial approval by the police, as it kept injecting drug use off the streets and in the one area. This further allowed criminal activity to profit off illicit drug use, as many venue owners would sell rooms and drugs. The Wood Royal Commission identified that while there were benefits to these illegal shooting galleries, allowing police to cooperate with illegal activities could encourage corruption, it suggested an independent medical facility to continue providing safety for the users, and safety for the public by lessening the impact of drug use on the streets, such as discarded needles or drug related deaths.
The Australian Crime Commission’s illicit drug data report for 2011–2012 was released in western Sydney on 20 May 2013 and revealed that the seizures of illegal substances during the reporting period were the largest in a decade due to record interceptions of amphetamines, cocaine and steroids. The report also stated that average strength of crystal methamphetamine doubled in most jurisdictions within a 12-month period and the majority of laboratory closures involved small “addict-based” operations ::::
The Melbourne inner-city suburbs of Richmond and Abbotsford are locations in which the use and dealing of heroin has been concentrated for a protracted time period. Research organisation the Burnet Institute completed the 2013 ‘North Richmond Public Injecting Impact Study’ in collaboration with the Yarra Drug and Health Forum, City of Yarra and North Richmond Community Health Centre and recommended 24-hour access to sterile injecting equipment due to the ongoing “widespread, frequent and highly visible” nature of illicit drug use in the areas. During the period between 2010 and 2012 a four-fold increase in the levels of needles and syringes collected from disposal units and street-sweep operations was documented for the two suburbs. In the local government area the City of Yarra, of which Richmond and Abbotsford are parts, 1550 syringes were collected each month from public syringe disposal bins in 2012. Furthermore, ambulance callouts for heroin overdoses were 1.5 times higher than for other Melbourne areas in the period between 2011 and 2012 (a total of 336 overdoses), and drug-related arrests in North Richmond were also three times higher than the state average. The Burnet Institute’s researchers interviewed health workers, residents and local traders, in addition to observing the drug scene in the most frequented North Richmond public injecting locations.
On 28 May 2013, the Burnet Institute stated in the media that it recommends 24-hour access to sterile injecting equipment in the Melbourne suburb of Footscray after the area’s drug culture continues to grow after more than ten years of intense law enforcement efforts. The Institute’s research concluded that public injecting behaviour is frequent in the area and inappropriately discarding injecting paraphernalia has been found in carparks, parks, footpaths and drives. Furthermore, people who inject drugs have broken open syringe disposal bins to reuse discarded injecting equipment.
A study (part of the Global Burden of Disease Study 2010 published in The Lancet), led by Professor Louisa Degenhardt from the National Drug and Alcohol Research Centre, reported in late August 2013 that Australia has one of the world’s most serious drug problems, caused by amphetamines, cocaine, cannabis and opioids. Co-author Professor Harvey Whiteford, from the University of Queensland, stated: “There is no doubt Australia has a culture, especially among our young people, which does not see the taking of illicit substances or binge drinking as particularly detrimental to the health. Our study suggests otherwise.”
In mid-September 2013, research by the Australian Bureau of Statistics valued the contribution of the illicit drugs market to the Australian economy at A$6 billion, while tax avoidance is responsible for an additional A$20 billion. The same research also recorded a fall of 19 per cent between 2008 and 2013 due to a reduction in the sales of heroin and cannabis.
An Australian study released on September 16, 2013 showed that ambulance callouts for meth and amphetamine-related issues rose from 445 to 880 cases in Melbourne, the capital city of Victoria—this rise is attributed mainly to crystal methamphetamine, as attendance figures rose from 136 to 592 cases. The list of reasons for the callouts included anxiety, paranoia, palpitations, gastrointestinal symptoms, and self-harm.
Figures obtained by the Australian Bureau of Statistics (ABS) on drug overdose were released in August 2014. The data revealed that the 1,427 overdose deaths recorded nationally in 2012 by the ABS outnumbered the road toll for the second year in a row, as well as a 65-per cent increase in accidental overdose deaths among females over the previous decade. Many of the recorded deaths were the result of prescription drug use.
Supervised Injection Sites
Supervised injection sites (SIS) (also known as supervised injection facilities, safe injection site safer injection facility (SIF), drug consumption facility (DCF) or medically supervised injection center (MSIC) are legally sanctioned and medically supervised facilities designed to reduce nuisance from public drug use and provide a hygienic and stress-free environment for illicit drug users when consuming drugs, mostly injecting drug use.
They are part of a harm reduction approach towards drug problems. The facilities provide sterile injection equipment, information about drugs and basic health care, treatment referrals, and access to medical staff. Some offer counseling, hygienic and other services of use to itinerant and impoverished individuals. Most programs prohibit the sale or purchase of recreational drugs. Many require identification cards. Some restrict access to local residents and apply other admission criteria, such as only allowing injection drug users, but generally in Europe they do not exclude addicts who consume by other means.
What disparagingly is called “shooting galleries” have existed for a long time; there were illicit for-profit facilities in New York during the 1980s and in Sydney during the 1990s. What differs these from the legally sanctioned is the care they provide. While the operators of the facilities in New York and Sydney had little regard for the health of their clients, modern supervised injection facilities are a professionally staffed health and welfare service.
The first professionally staffed service where drug injection was accepted emerged in the Netherlands during the early 1970s as part of the “alternative youth service” provided by the St. Paul’s church in Rotterdam. At its peak it had two centers that combined an informal meeting place with a drop-in center providing basic health care, food and a laundering service. One of the centers was also a pioneer in providing needle-exchange. Its purpose was to improve the psychosocial function and health of its clients. The centers received some support from law enforcement and local government officials, although they were not officially sanctioned until 1996.
In 1986 a café was set up in Berne for injecting drug users who were unwanted at other cafés. Part of a project combatting HIV, the general concept of the café was a place where simple meals and beverages would be served, and information on safe sex, safe drug use, condoms and clean needles provided. Social workers providing counselling and referrals were also present. An injection room was not originally conceived, however, drug users began to use the facility for this purpose, and this soon became the most attractive aspect of the café. After discussions with the police and legislature, the café was turned into the first legally sanctioned drug consumption facility provided that no one under the age of 18 was admitted.
During the 1990s additional legal facilities emerged in other cities in Switzerland, Germany and the Netherlands. In the first decade of 2000, facilities opened in Spain, Luxembourg, Norway, Canada and Australia.
Police corruption and street crime in the Kings Cross district of Sydney, prompted the Wood Royal Commission to recommend the opening of an injection facility in the area, with the Sydney Medically Supervised Injecting Centre (MSIC) opening in May, 2001. In Canada: problems with drug use, discarded needles and crime made Downtown Eastside of Vancouver the location for the first facility, when Insite commenced operation in 2003.
Whereas injection facilities in Europe often evolved from something else, such as different social and medical out-reaches or perhaps a homeless shelter, the degree and quality of actual supervision varies. As many European centers also allow clients to consume drugs by other means then by injecting it on its premises, EMCDDA prefers call them “drug consumption facilities” instead of anything alluding to “injection”. The history of the European centers also mean that there have been no or little systematic collection of data needed to do a proper evaluation of effectiveness of the scheme.
However, some of the very rationale for the projects in Sydney and Vancouver are specifically to gather data, as they are created as scientific pilot projects. The approach at the centers is also more clinical in nature, as they provide true supervision with a staff that is equipped and trained to administer Oxygen or Naloxone in the case of a heroin or other opioid overdose.
At the beginning of 2009 there were 92 facilities operating in 61 cities, including 30 cities in the Netherlands, 16 cities in Germany and 8 cities in Switzerland.
In the late 1990s there were a number of studies available on consumption rooms in Germany, Switzerland and the Netherlands. “The reviews concluded that the rooms contributed to improved public and client health and reductions in public nuisance but stressed the limitations of the evidence and called for further and more comprehensive evaluation studies into the impact of such services.” To that end, the two non-European injecting facilities, Australia’s Sydney Medically Supervised Injecting Centre (MSIC) and Canada’s Vancouver Insite Supervised Injection Site have had more rigorous research designs as a part of their mandate to operate.
The NSW Government has provided extensive funding for ongoing evaluations of the Sydney MSIC, with a formal comprehensive evaluation produced in 2003, 18 months after the centre was opened. Other later evaluations studied various aspects of the operation – service provision (2005), community attitudes (2006), referral and client health (2007) and a fourth (2007) service operation and overdose related events. Other evaluations of drug-related crime in the area were completed in 2006, 2008 and 2010, the SAHA International cost-effectiveness evaluation in 2008 and a final independent KPMG evaluation in 2010.
In 2003, 2006 and 2010 a drug prevention advocacy group, Drug Free Australia, completed analyses of evaluations up to these dates. The reports of these analyses, distributed to the media and to politicians were informed by teams of published experts, researchers and professionals which in the 2010 analysis included Dr Robert DuPont, first President of the United States National Institute of Drug Abuse (NIDA).
These analyses have led to a robust debate about the effectiveness of the Sydney MSIC in Australia. In the NSW parliament, some politicians from the Labor Party which installed the injecting room referred to Drug Free Australia as “peddling misinformation”, claiming that MSIC staff members of the facility had refuted their analysis, referring other members back to the official evaluations.
In turn, Drug Free Australia has documented its allegation that the Sydney injecting room’s evaluations were demonstrably the production of partisan sympathizers and colleagues of injecting room staff, responsible for “often providing misleading or totally erroneous conclusions or otherwise failing to make the necessary conclusions from negative data.” Drug Free Australia has likened the extant criticisms of climate science, where science is alleged to have been manipulated to fit ideological and political ends, to that of its criticisms of the injecting room’s scientific evaluations.
The Vancouver Insite facility was evaluated during the first three years of its operation by researchers from the BC Center for Excellence in HIV/AIDS with published and some unpublished reports available. In March 2008 a Final Report of the Expert Advisory Committee appointed by the Canadian Ministry of Health was released, evaluating the performance of the Vancouver Insite against its stated objectives.
Harm Reduction via Needle Exchange Programs
Client Characteristics and Utilization
The 2010 KPMG evaluation of the Sydney MSIC found that it had made service contact with its target population, with 12,050 visitors to the Centre for a total of 604,022 injections between May 2001 and April 2010, where clients averaged 14 years of illicit drug use and where 39 – 51 percent across the various years were heroin injectors and 35 percent in 2007 had experienced an overdose previously.
The Drug Free Australia 2010 analysis found that the 7 percent of clients who attended the centre more than 98 times in a year were still injecting 80 percent of the time outside the centre, while the 26% who visited 10-98 times per year injected 95 percent of the time on the street, in a car, a toilet, at home or someone else’s home. With injector safety the most prominent rationale for the establishment of injecting rooms, the analysis questioned such low utilization rates in light of the room’s capacity for 330 injections per day, but where between 2001 and 2010 it had averaged just 185 injections per day.
The Expert Advisory Committee for Insite cited 8,000 people who had visited INSITE, with 18 percent accounting for 80 percent of all visits to INSITE, less than 10 percent using the site for all injections, a median number of 8 visits across all clientele, and 600 visits per day, of which 80 percent were to inject, showing that the facility was near capacity. Drug Free Australia has noted that for the 1,506 injectors who most regularly use the centre, who would cumulatively inject somewhere between 6,000 and 9,000 times daily, the less than 500 injections in Insite daily represents at best one injection in every 12 by its highest utilizers inside the facility.
Two surveys of approximately 1,000 users established some key user characteristics – clients averaged 15 years of drug use, 51 percent injected heroin and 32 percent cocaine, 87 percent were infected with Hepatitis C virus and 17 percent with HIV, 20 percent were homeless with numerous others living in single resident rooms, 80 percent had been incarcerated, 21 percent were using methadone and 59 percent reported a non-fatal overdose during their lifetime.
European consumption rooms cater more so to users older than 30 years, mainly with problematic heroin and cocaine habits. Various studies have documented an ageing population of clients over time. Whereas in 1990, in one study, 50 percent of clients were 25 years or younger, by 2001 the percentage was 15 percent. Clients across European consumption rooms are characterized by heavy injecting drug use, a continuous use of illicit drugs and deriving from a poorer demographic. German studies found that between 19 and 27 percent of clients were from unstable accommodation. In the injecting rooms near Madrid 42 percent of the marginalized target group were homeless, while the number was 60 percent for the Can Tunis area of Barcelona. In a German study 15 percent of clients had never accessed addiction treatment of any kind.
Client utilization in the European situation is more difficult to analyze. Studies on sites in Frankfurt and Zurich found that clients used facilities 5 times a week and in Rotterdam 6 times a week and twice in the previous 24 hours. A study of clients in Frankfurt in 1997 found that 63 percent claimed to be daily visitors, while in another surveyed non-random sample from 18 German consumption rooms, 84 percent claimed use of the facility at least once weekly, with 51 percent claiming at least once per day utilization.
Evaluators of the Sydney MSIC found that over an 8-year period staff provided 47,396 other occasions of service (94.6 per 1,000 visits) including advice on drug and alcohol treatment on 7,856 occasions, 22,531 occasions where staff had provided vein care and safer injecting advice, with a total of 8,508 referrals to other services where 3,871of referrals were to treatment. Of the 3,871 referrals to treatment 1,292 were to detox and 434 to abstinence-based rehabilitation or therapy. The evaluators asserted that the MSIC was thereby evidenced as a gateway for treatment.
Drug Free Australia has heavily criticized the MSIC referral rates to treatment as abnormally and unjustifiably low. They note that the 2010 MSIC evaluation does not give the percentage of clients referred to drug treatment, but that the 2007 evaluation records just 11 percent of clients over 6 years referred to treatment. They further cite the 2010 evaluation’s appeal to smoking cessation surveys which demonstrate that 20 percent of all tobacco smokers, using the most addictive of all commonly used drugs, are currently ready to quit at any point in time. Alternatively, the MSIC has had opportunity to continuously assist their clients over a period of many years and not just at a single point of time.
The Expert Advisory Committee found that Insite had referred clients such that it had contributed to an increased use of detoxification services and increased engagement in treatment. Insite had encouraged users to seek counseling. Funding has been supplied by the Canadian government for detoxification rooms above Insite.
Impact on Public Nuisance
“The Sydney MSIC client survey conducted in 2005, found that public injecting (defined as injecting in a street, park, public toilet or car), which is a high risk practice with both health and public amenity impacts, was reported as the main alternative to injecting at the MSIC by 78 percent of clients. 49 percent of clients indicated resort to public injection if the MSIC was not available on the day of registration with the MSIC. From this, the evaluators calculated a total 191,673 public injections averted by the centre.
Public amenity can be further improved by reduced numbers of publicly disposed needles and syringes. Data from the Sydney MSIC’s 2003 report indicated reductions in needles and syringe counts and resident and business-operator sightings of injections in public places decreased marginally but could not be certain that there was any effect by the MSIC beyond the heroin drought which had commenced some months prior to the opening of the MSIC. The Drug Free Australia analysis pointed to the needle, syringe and public sighting decreases being almost exactly equivalent to the 20 percent decreases in the number of needles distributed from local pharmacies, needle exchanges and the MSIC, thereby indicating no clear impact by the MSIC.
Observations before and after the opening of Insite indicated a reduction in public injecting.
Impact on Blood-borne Viruses
The 2003 evaluators of the Sydney MSIC found that it “had not increased blood-borne virus transmission” with the data more specifically showing no improvement re HIV infection incidence, no improvement in Hep B infections, either worse or no improvement (depending on the suburb studied) in new Hep C notifications, no improvement in reuse of others’ syringes and injecting equipment, no improvement in tests taken for HIV and Hep C and initial improvement in tests taken for Hep B but worsening again in 2002. The 2010 evaluation found no measurable impact on blood-borne diseases.
The Expert Advisory Committee for Vancouver’s Insite found that journal studies with mathematical modeling by researchers from self-reports of users generated a wide range of estimates for HIV cases averted, but they were not convinced that the assumptions were valid.
Impact on Community Levels of Overdose
Over a nine-year period the Sydney MSIC managed 3,426 overdose-related events with not one fatality while Vancouver’s Insite had managed 336 overdose events in 2007 with not a single fatality.
The 2010 MSIC evaluators found that over 9 years of operation it had made no discernable impact on heroin overdoses at the community level with no improvement in overdose presentations at hospital emergency wards.
Research by injecting room evaluators in 2007 presented statistical evidence that there had been later reductions in ambulance callouts during injecting room hours, but failed to make any mention of the introduction of sniffer dog policing, introduced to the drug hot-spots around the injecting room a year after it opened.
Site Experience of Overdose
While overdoses are managed on-site at Vancouver, Sydney and the facility near Madrid, German consumption rooms are forced to call an ambulance due to naloxone being administered only by doctors. A study of German consumption rooms indicated that an ambulance was called in 71 percent of emergencies and naloxone administered in 59 percent of cases. The facilities in Sydney and Frankfurt indicate 2.2-8.4 percent of emergencies resulting in hospitalization.
Vancouver’s Insite yielded 13 overdoses per 10,000 injections shortly after commencement, but in 2009 had more than doubled to 27 per 10,000. The Sydney MSIC recorded 96 overdoses per 10,000 injections for those using heroin. Commenting on the high overdose rates in the Sydney MSIC, the evaluators suggested that;
“In this study of the Sydney injecting room there were 9.2 (sic) heroin overdoses per 1000 heroin injections in the centre. This rate of overdose is higher than amongst heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room.”
The Drug Free Australia 2010 analysis of the Sydney MSIC evaluations found overdose levels in the MSIC 32 times higher than clients’ own recorded histories of overdose prior to registering to use the facility. The Drug Free Australia calculations compared the registration data for overdose histories published in the MSIC’s 2003 evaluation document, which allowed comparison rates of overdose from a period before a heroin drought reduced overdoses Australia-wide, with rates of overdose drawn from data in the 2010 evaluation. Drug Free Australia has expressed concern that the evaluators, in using injecting room overdose data to calculate quite incorrect ‘lives saved’ estimates, failed to examine the extent to which overdoses were over-represented in the injecting room against data they had available to them on clients’ prior histories of overdose.
Against other measures the Sydney MSIC’s overdose rate is highly disproportionate. Estimates of the number of dependent heroin users in Australia completed for the year 1997, compared with estimates of the number of total non-fatal and fatal overdoses in Australia for 1997/98 yields a rate of 2 overdoses for every 10,000 injections against the MSIC’s rate of 96 overdoses for every 10,000 injections in the 2003 evaluation and rates as high as 146 overdoses per 10,000 injections in the year 2009/10.
A review of the MSIC registration surveys recording each client’s previous overdose histories reveals that MSIC clients’ previous overdose history were less prone to overdose than various other previously studied heroin injector cohorts in Australia.
People Living with HIV/AIDS
The results of a research project undertaken at the Dr. Peter Centre (DPC), a 24-bed residential HIV/AIDS care facility located in Vancouver, were published in the Journal of the International AIDS Society in March 2014, stating that the provision of supervised injection services at the facility improved health outcomes for DPC residents. The DPC considers the incorporation of such services as central to a “comprehensive harm reduction strategy” and the research team concluded, through interviews with 13 residents, that “the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services”, in addition to creating a setting in which drug use could be discussed honestly. Highly active antiretroviral therapy (HAART) medication adherence and survival are cited as two improved health outcomes.
Calculations of Lives Saved
The European Monitoring Centre (EMCDDA) 2004 Review of Drug Consumption Rooms calculated the number of lives saved for all 25 drug consumption rooms across Germany. It calculated from known overdose mortality rates per 100 dependent heroin users (2 percent) and the number of injections per 100 person years per dependent heroin user (1,000 injections per year per user). Their calculation indicated that 100 dependent heroin users, cumulatively injecting 100,000 times a year, would statistically have 2 overdose fatalities annually. Thus 500,000 injections results in 10 expected fatalities averted by the entirety of injecting facilities across Germany.
Drug Free Australia has noted that the EMCDDA review’s 2 percent overdose fatality rate appears excessive in light of mortality studies done by the EMCDDA for 5 European countries, (Germany was not included, but Spain, with the highest heroin overdose mortality, was still well below 2 percent). The percentages by country were Barcelona, Spain 1.4 percent; Rome, Italy 0.2 percent; Sweden 0.7 percent; Amsterdam, Netherlands unknown; Vienna, Austria 0.2 percent.
The Canadian Expert Advisory Committee 2008 review of Insite did not declare the method by which it concluded that 1.08 lives are saved by the facility each year, but Drug Free Australia claims that the EMCDDA method, used with Canadian data and assumptions, yields the same result. Canadian heroin mortality in 2002/3 was roughly the same as Australia’s at 1 percent (958 deaths from more than 80,000 dependent heroin users) and mortality percentages for 2006 or 2007, Drug Free Australia claims, might well be expected to be little changed. Further, the Expert Advisory Committee clearly state their assumption that a typical Canadian heroin user injects 4 times daily.
Consequently 100 Canadian heroin users would cumulatively inject 146,000 times annually, and the 144,000 opiate injections in Vancouver’s Insite would avert the death of the one injection in 146,000 which would likely have been fatal.
The conclusion of the 2003 Sydney MSIC evaluators was that “a small number of opioid overdoses managed at the MSIC might have been fatal had they occurred elsewhere”, calculating that the centre had saved 4 lives per annum during the evaluation period. Estimates were directly calculated from the 329 heroin overdose interventions in the centre. A later SAHA International evaluation of the MSIC calculated 25 lives saved by the facility in a single year.
Drug Free Australia cites two statistics together which demonstrate that the Sydney MSIC cannot statistically claim to save even one life per year. The first is that 1% of dependent heroin users die from fatal overdose each year in Australia. The second is that a dependent heroin user averages ‘at least’ three injections per day according to the MSIC 2003 evaluation’s researchers. Taking these two statistics together, it is clear that the injecting room would need to host 300 injections per day (ie enough heroin injections for 100 heroin addicts injecting 3 times daily) before they could claim they had saved the life of the one (1 percent) of those 100 who would have died annually. But the injecting room averages just half that number with less than 150 opiate injections per day. Drug Free Australia has shown that the 2003 and 2008 MSIC evaluators indefensibly failed to factor the vastly elevated number of overdoses in the centre into their calculations of lives saved.
The Sydney MSIC was judged by its evaluators to have caused no increase in crime[ and not to have caused a ‘honey-pot effect’ of drawing users and drug dealers to the Kings Cross area. The Drug Free Australia analysis pointed to data within the report clearly demonstrating that drug-related loitering and drug dealing worsened at the station entrance 25 metres opposite the MSIC and at the rear door of the centre. A later 2010 evaluation of crime in Kings Cross claimed that drug-related crime had decreased at the same rate as the rest of Sydney after a heroin shortage intervened 6 months before the MSIC opened, but Drug Free Australia has asserted that the evaluators failed to make any mention or assessment of the impact of police sniffer dogs introduced 12 months after the MSIC opened to deter drug dealers and users from the back lanes of Kings Cross, which might well be expected to have decreased drug-related crime more than areas of Sydney not policed by sniffer dogs.
Testimony of ex-clients reported to the NSW Legislative Council alleged that the extremely high overdose rates were due to clients experimenting with poly-drug cocktails and higher doses of heroin in the knowledge that staff were present to ensure their safety. The 2003 evaluation explanation for high overdose rates citing greater amounts of heroin used has been cited by Drug Free Australia as cause for concern. NSW Member of Parliament, Andrew Fraser, made the same allegation regarding the MSIC as a site for experimentation, citing testimony of another ex-client in a Parliamentary speech in 2010.
Observations before and after the opening of Insite indicated no increases in drug dealing or petty crime in the area. There was no evidence that the facility influenced drug use in the community, but concerns that Insite ‘sends the wrong message’ to non-users could not be addressed from existing data. The European experience has been mixed.
The Sydney MSIC has enjoyed the support of the surrounding Kings Cross community, with the 2010 evaluation indicating 78 percent of residents supportive of its presence and 70 percent of business operators. Contesting the reliability of these evaluation surveys is a 2010 petition to the NSW Parliament by 63 business owners immediately surrounding the MSIC to move the facility elsewhere because it has adversely affected their businesses.
The Expert Advisory Committee for Vancouver’s Insite found that health professionals, local police, the local community and the general public have positive or neutral views of the service, with opposition decreasing over time.
Drug Free Australia has expressed concern that supporters, staff and various NSW politicians continually has represented each overdose intervention in the centre to the Australian media as a life saved, when such an equation was clearly false.
The cost of running Insite per annum is $3 million Canadian. Mathematical modeling showed cost to benefit ratios of one dollar spent ranging from 1.5 to 4.02 in benefit. However, the Expert Advisory Committee expressed reservation about the certainty of Insite’s cost effectiveness until proper longitudinal studies had been undertaken. Mathematical models for HIV transmissions foregone had not been locally validated and mathematical modeling from lives saved by the facility had not been validated. The Sydney MSIC cost upwards of $2.7 million Australian per annum in 2007. Drug Free Australia has asserted that in 2003 the cost of running the Sydney MSIC equated to 400 NSW government-funded rehabilitation places while the Health Minister for the Canadian Government, Tony Clements, has stated that the money for Insite would be better spent on treatment for clients.
2013 documentary film Making a Place Called Safe: A Public Health Case for a Safer Injection Facility in San Francisco interviews people on the need for a safer drug injection facility in San Francisco.
2012 United Nations World Drug Report
The 2012 United Nations World Drug Report published data that indicated that Australia has one of the highest global prevalence of cannabis use. The report also stated that cocaine use had increased over the four years leading up to 2012. The use of 3,4-methylenedioxy-N-methylamphetamine (MDMA), more commonly known as “Ecstasy”, declined from 3.7 percent to 3.0 percent between 2007 and 2010; however, the highest number of manufacturing laboratory interceptions occurred in Australia during this period.
The Australian government enacted numerous policies in response to illicit drug use. During the 1980s, it was one of the first countries to enact the policy of “harm minimisation”, which consists of three pillars: “demand reduction”, “supply reduction” and “harm reduction”. This policy is still in effect as of 2012 and the following outlines are contained in the The National Drug Strategy: Australia’s integrated framework document:
Supply reduction strategies to disrupt the production and supply of illicit drugs, and the control and regulation of licit substances. It involves border security, Customs and prosecuting people involved in the trafficking of illicit substances.
Demand reduction strategies to prevent the uptake of harmful drug use, including abstinence orientated strategies and treatment to reduce drug use; This involves programs promoting abstinence or treating existing users.
Harm reduction strategies to reduce drug-related harm to individuals and communities. It is a policy that is a “safety net” to the preceding two policies. The threefold model accepts that demand prevention and supply prevention will never be completely effective, and if people are involved in risky activities, the damage they cause to themselves and society at large should be minimised. It involves programs like needle & syringe programs and safe injecting sites, which aim to prevent the spread of disease or deaths from overdoses, while providing users with support to reduce or stop using drugs.
In 2007 Bronwyn Bishop headed a federal parliamentary committee reported that the Government’s harm reduction policy is not effective enough. It recommended re-evaluating harm reduction and a zero-tolerance approach for drug education in schools. The committee also wanted the law changed so children can be put into mandatory care if parents were found to be using drugs. It suggested “establish[ing] adoption as the ‘default’ care option for children aged 0–5 years where the child protection notification involved illicit drug use by the parent/s”. The report says federal, state and territory governments should only fund treatment services that are trying to make people permanently drug-free and priority should go to those that are more successful.
The report was criticised by a range of organisations such as Family Drug Support, the Australian Democrats and the Australian Drug Foundation for lacking evidence, being ideologically driven and having the potential to do harm to Australia. The Labor Party authors also released a dissenting report. The report and its recommendations have been shelved since the election of the Rudd Government in 2007 (Rudd was prime minister until 2010).
A report authored by Professor Alison Ritter, the director of the drug policy modelling program at the University of NSW (UNSW), was released in June 2013 calculated that the Australian Government continues to spend A$1.7 billion dollars on its annual illicit drug response. Entitled “Government Drug Policy Expenditure in Australia”, the report also concluded that the harm reduction arm of the government’s policy, with 2.1 per cent of the drugs budget, or A$36 million, devoted to harm reduction in the 2009-10 financial year. During the same time period, A$361 million, or 21 per cent, was directed towards treatment and A$1.1 billion was expended on law enforcement. The report identifies a significant decrease in the proportion of funds allocated to harm reduction over time and Ritter expressed her concern in an interview with the Sydney Morning Herald newspaper:
It’s a shift in policy that hasn’t been formally acknowledged. There is absolutely no reason that investment should have decreased. We don’t have good evidence that law enforcement works, and we have anecdotal evidence I suppose that it might not work as a policy. We continue to arrest people and drugs keep coming into Australia … and profits continue to be made.
Drug Law Reform
A number of Australian and international groups have promoted reform in regard to 21st-century Australian drug policy. Organisations such as Australian Parliamentary Group on Drug Law Reform, Responsible Choice, the Australian Drug Law Reform Foundation, Norml Australia, Law Enforcement Against Prohibition (LEAP) Australia and Drug Law Reform Australia advocate for drug law reform without the benefit of government funding. The membership of some of these organisations is diverse and consists of the general public, social workers, lawyers and doctors, and the Global Commission on Drug Policy has been a formative influence on a number of these organisations.
Australian Parliamentary Group on Drug Law Reform
The Australian Parliamentary Group on Drug Law Reform consists of politicians from state and federal governments. Upon joining the group, all members sign a charter that states:
This Charter seeks to encourage a more rational, tolerant, non-judgmental, humanitarian and understanding approach to people who currently use illicit drugs in our community. The aims of the Australian Parliamentary Group for Drug Law Reform are to minimise the adverse health, social and economic consequences of Australia’s policies and laws controlling drug use and supply.
As of 1998, short-term goals of the Group include:
an increasing focus on the reduction of harm associated with drug use
abolition of criminal sanctions for the personal use of drugs
the adoption on a national basis of the South Australian and Australian Capital Territory expiation notice model for the reform of laws regarding the personal use of marijuana
the adoption of a process including consultation and prescription by medical practitioners for selected illicit drugs
Long-term goals include “the reform of drug laws in planned stages with detailed evaluation of such laws at all stages and the minimisation of the harmful use of drugs”.
According to its website, Responsible Choice is an organisation that was initiated in response to the criminalisation of cannabis in Australia, specifically in terms of the legalisation of alcohol, another drug that the organisation describes as “our ONLY legal similarly categorised substance”. The organisation explains that its mission is to “enliven the debate as to whether or not cannabis should enjoy regulation within Australian society comparable to alcohol. It is also our intention to provide recent, relevant and factual information regarding both cannabis and alcohol” and Responsible Choice’s “resident writer”, Tim, further explains that:
As a parent I have come to realise that I no longer believe alcohol is a recreational drug I would encourage my children to use. Knowing full well that when the time comes the choice will not be mine to make, I have made it a goal of mine to investigate, research and comment on current drug policy juxtaposed with the negative effects alcohol, with a view towards providing researched based information to those who are seeking it. This has allowed me to see the place that cannabis should rightly have in our society, specifically in its capacity to reduce the harmful effects of alcohol.
As of February 2013, Responsible Choice provides support to the Australian Drug Law Reform political party.
Australian Drug Law Reform Foundation
The Charter of the Australian Drug Law Reform Foundation is “endorsed by the Australian Parliamentary Group for Drug Law Reform, seeks to encourage a more rational, tolerant and humanitarian approach to the problems created by drugs and drug use in Australia.” Supporters of the organisation can provide financial donations, join the organisation as a member and review the website for its information resources. The website also lists numerous Australian supporters of drug law reform:
Nicholas Cowdery AM QC Former NSW Director of Public Prosecutions
Ken Crispin QC (retired) Supreme Court Judge
Professor Peter Baume AC Former Senator for New South Wales
Geoff Gallop Former Premier of Western Australia
Dr. Wendell J. Rosevear OAM
The Hon. Amanda Ruth Fazio Member of the NSW Legislative Council
The Hon. Richard Stanley Leigh Jones Former Member of the NSW Legislative Council
Dr Mal Washer MP Federal Liberal Member for Moore
Kate Carnell AO Former Chief Minister of the ACT
Michael Moore CEO Public Health Association of Australia and Former Minister for Health and Community Care
Mick Palmer AO APM Former Commissioner, Australian Federal Police
Dr Michael Wooldridge Former Commonwealth Minister for Health
Professor David Penington AC Former dean of medicine and vice-chancellor at Melbourne University
The Hon. Cate Faehrmann Member of the NSW Legislative Council
The Hon. John Della Bosca Former member of the NSW Legislative Council
The Hon. Stanley Lee Jones states on the website of the Foundation:
If heroin were legal today, as it was in 1953, society would not have a drug problem. I talked to a former member for Monaro who was a chemist and who dispensed heroin in the 1950s. He said he had no problems with his customers when heroin was legal. In those days 70 percent of crime was not associated with drug prohibition: It did not exist because heroin was legal. The problems began only when heroin became illegal and a criminal fraternity developed around its sale, as occurred during the prohibition era of the 1930s when criminals made money by selling illegal alcohol. When there is a profit motive involved people will push any illegal substance. That is the key problem: If there were no profit motive there would be no incentive to push drugs on the streets of Cabramatta or anywhere else. When people finally realise that they will find a solution to the drug problem.
The Foundation features numerous reports that are available for download on its website, such as the Australia21 reports “Alternatives to Prohibition” and “The Prohibition of Ilicit Drugs: Killing and Criminalising Our Children”, “A Balancing Act” from the Open Society Foundation, Release’s “A Quiet Revolution: Drug Decriminalisation Policies in Practice Across the Globe”, and “Children of the Drug War”, edited by Damon Barrett and produced by Harm Reduction International.
NORM Australia is based in Kotara, New South Wales, produces a quarterly magazine (the first edition of the NORML Australia Magazine can be viewed online) and “supports the right of adults to use marijuana responsibly, whether for medical or personal purposes.” The organisation “also supports the legalization of hemp (non-psychoactive marijuana) for industrial use.” The organisation’s website’s membership list consists of 17 individuals, while the representatives of the organisation of the organisation are also listed on the website: Sean Sylvester (President), David Perkins (Vice President) and Vickie Blay (Treasury).
Law Enforcement Against Prohibition Australia (LEAP)
As of February 2013, Paul Cubitt, a former correctional officer who was originally based at Long Bay prison in New South Wales, Australia, is the President of Law Enforcement Against Prohibition (LEAP) Australia. Cubitt has revealed that successive employment positions within the Australian correctional and justice system, including a period at the Alexander Maconochie correctional centre in Canberra, Australia, and a vocational course led him to an understanding of “the harm that society is doing to people who are afflicted by drug abuse”. As of February 2013, the website of the organisation is not functional.
Greg Denham, a former police officer who served in the Australian states of Queensland and Victoria, has conducted work on behalf of LEAP Australia in the Victorian capital city of Melbourne—as the executive officer of the Yarra Drug and Health Forum, Denham has also been a vocal supporter of a proposal to establish a supervised injecting facility in the Melbourne suburb of North Richmond.
Drug Law Reform Australia
The organisation, under the leadership of Greg Chipp, emerged prominently in 2013, and is a political outflow of non-political parents’ and friends’ groups for drug law reform. The organisation achieved the status of a political party in early 2013 by attracting in excess of 500 members, and fielded candidates in the 2013 Australian election. The goals of the Drug Law Reform Party are:
Stop the senseless harm caused by the failed prohibition policies, which criminalize ordinary Australians for personal drug use.
Advocate for conscience votes on single issues where legislation does not match the lived reality of large proportions of the Australian public.
To encourage political and community debate of alternatives to the current drug laws.
Call for a royal commission into organized crime and corruption associated with the drug trade.
Through parliament representation, use the senate committees, and productivity commission to examine the current drug laws.
Global Commission on Drugs
In its 2011 report, the Global Commission on Drugs found that the “global war on drugs has failed.” The Commission, headed by several former heads of state, a former UN Secretary General and others, observed that governments around the world must begin introducing “models of legal regulation of drugs to undermine the power of organised crime and safeguard the health and safety of their citizens.” With this in mind, the organisation, Australia 21, began researching drug policy in the Australian context.
In response to an 2011 international report by the Global Commission on Drugs, the organisation, Australia21 appointed a steering committee to evaluate Australia’s current illicit drug policy. The report found that Australia’s current drug policy, focused as it is, on criminalisation of supply and use of drugs, has driven the production and use of drugs underground and has “fostered the development of a criminal industry that is corrupting civil society and government and killing our children.” They also noted that “by defining the personal use and possession of certain psychoactive drugs as criminal acts, governments have also avoided any responsibility to regulate and control the quality of substances that are in widespread use.” The report also highlighed the fact that, just as alcohol and tobacco are regulated for quality assurance, distribution, marketing and taxation, so should currently, unregulated, illicit drugs.
The independent organisation has also released the following reports: “Alternatives to Prohibition” and “The Prohibition of Ilicit Drugs: Killing and Criminalising Our Children”.
Australian Illicit Drug User Organisations
In response to the emergence of HIV/AIDS in the mid-1980s, Australian drug users began to self-organize into community, peer-driven state and national drug user organisations. The aim of these organisations was to give voice to the experiences of Australian drug users and to advocate for drug-related policy reform, the provision of harm reduction prophylactics, the expansion of opioid substitution programs, to highlight the health issues affecting illicit drug users and to reduce the stigma and discrimination many illicit drug users experience. Drug user organisations have been recognized by state and federal governments as an effective strategy to educate illicit drug users in relation to techniques for avoiding blood-borne virus transmission, responding to drug overdose, safer injecting techniques, safer sex and legal issues. Australian drug user organisations use a peer education and community development approach to health promotion, with the aim of empowering illicit drug users by providing them with the skills they need to effect change in their own communities.
As of November 2012, every Australian State and Territory, with the exception of Tasmania, has a state-funded drug user organisation. A number of health services also employ illicit drug users to provide peer education in relation to specific issues affecting illicit drug users. Australia’s peer-based drug user organisations are members of the Australian Injecting and Illicit Drug Users League (AIVL), a national drug user organisation, which advocates for changes to current illicit drug policy at a national level. As a member-based organisation, AIVL also supports State and Territory peer-based organisations to strengthen their internal governance structures, their capacity to provide services to illicit drug users and assists member-based organisations to develop advocacy strategies for engaging in localized drug-related policy issues.
AIVL is a member of the International Network of People who Use Drugs (INPUD), an international network of drug user organisations and drug user activists, that advocate for the health and human rights of illicit drug users. INPUD facilitates representation by illicit drug users to lobby international policy-making bodies such as the United Nations Office on Drugs and Crime, the World Health Organization, UNAIDS, Harm Reduction International, the Commission on Narcotic Drugs and the International AIDS Society.
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