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C18. Medically supervised injecting rooms: the Melbourne experience

C17. Medically supervised injecting rooms: the Melbourne experience

Learner category:

  • Novice Level

Learning objectives:

  • Participants will explore the challenges faced in the trial of Melbourne’s medically supervised injecting room
  • Participants will explore harm reduction from the perspective of nurses working in medically supervised injecting rooms
  • Participants will be introduced to the role of the nurse in similar facilities worldwide.

Abstract

In 2018, a medically supervised injecting room opened in North Richmond, Victoria, Australia. This is the second Australian injecting room, and was opened subject to a trial period. This presentation will examine the changing media and public perception of the medically supervised injecting room, including the groundswell of support that led to the opening of the room and how this rapidly changed once the room was operational. We will also explore the demographics of the North Richmond area, Melbourne’s largest concentration of injecting drug users. Challenges to the ongoing success of the room will be discussed, with a particular focus on the nursing role in supervised injecting facilities. Finally, we will attempt to address the question: is Melbourne ready for the ongoing operation of a medically supervised injecting room?

Authors

Adam Searby
RN, PhD, Deakin University/Drug and Alcohol Nurses of Australasia

Dr Searby is a registered nurse who has worked across mental health, community and addictions nursing. He is currently a lecturer at Deakin University, Melbourne, Australia and has research interests in addiction nursing workforce development and older adult addiction issues. Dr Searby is the president of the Drug and Alcohol Nurses of Australasia, the peak professional body for addictions nursing in Australasia.

https://youtu.be/oDRn9lThA4w 

Comments (31)

  1. Joycelyn Iheanacho

    Thank you for your presentation. Do you have any data or studies that show the reduction rate of Hepatitis C and/or other infectious disease in the area where the injecting site is? Also do you know how many people seek treatment for substance use after being exposed to the services available in the injecting site? Lastly, did your group encounter any ethical issues such as these sites encourage or enable drug use more than possible treatment and recovery? Thanks so much?

    1. Adam Searby

      Hi Jocelyn,
      Thanks for watching and for your comment. There is some very good evaluation data covering these issues – for the Sydney injecting room (the first in Australia): https://www.health.nsw.gov.au/aod/resources/Documents/msic-kpmg.pdf
      And for the Melbourne room, which was the focus of this session: https://www2.health.vic.gov.au/about/publications/researchandreports/review-med-supervised-injecting-room-report
      Both of these reports answer these questions quite well. Adam.

  2. Dennis Hagarty

    Thank you Adam. Interesting about the difficulties to get patients to use there and not in the street within sight of the facility. Good community support from first line workers and public service representatives. Do you have anyone in the media that can show some of the positive results you spoke of?

    1. Adam Searby

      Thanks for your comment Dennis. We have a media outlet called The Conversation, which is written by academics but often used to inform some of our mainstream media. There have been several articles published which might be of interest to you: https://theconversation.com/au/topics/safe-injecting-rooms-4127. Adam.

  3. Addy Adwell

    Thank you for this presentation- was helpful to hear about how the media played a role in both supporting the effort and undermining it. Would be curious to learn more about how you improved your hiring procedures for employment for people with lived experience?

    1. Lauren Carpenter, RN, CARN

      I am also quite interested to learn more about this. The facility I work at also hires people with lived experience as opposed to education or other requirements. Are there specific guidelines you follow? A certain amount of time without using drugs or alcohol? Thanks!

      1. Adam Searby

        Hi Addy and Lauren,
        The issues with staffing were obviously quite contentious at the time and raised a lot of questions around recruitment. I cannot comment on guidelines for the organization as I do not work for them, however this incident resulted in the resignation of senior staff and a review into hiring practices (https://nrch.com.au/wp-content/uploads/2019/12/North-Richmond-Community-Health-AOD-Program-Review.pdf). Staffing recommendations are also covered in the trial report I posted above. Adam.

  4. Lauren Carpenter, RN, CARN

    Good evening! Thank you so much for this presentation. I am located in MA, United States and there has been discussion regarding MSIR, however, I have not learned the ins and outs of such rooms as you have presented. I was very interested in learning about your response to overdose, especially using supportive measures/oxygen instead of using naloxone as first line. Is this consistent in regards to most overdoses in Australia? As far as I am aware, naloxone is generally used without much thought with overdoses in my region. Thanks again!

    1. Adam Searby

      Hi Lauren,
      There has been a lot of work done on naloxone in supported enviroments, i.e. injecting rooms, and the recommendation is for high flow oxygen via bag or mask for five minutes prior to naloxone. Again, this is outlined in the report posted above, however COVID-19 has changed this somewhat. We have just completed some qualitative work with addiction nurses in Australia and those working in injecting rooms reported using naloxone immediately due to concerns with ventilation and the spread of COVID. So this has certainly changed procedure from what we are hearing. Adam.

    2. Addy Adwell

      I am also very interested in the answer to this question.

      1. Adam Searby

        Hi Addy,
        I did try to find these guidelines but as they are from the centre itself I cannot post them here. I believe that the five minutes oxygenation prior to naloxone came from studies with paramedics responding to overdose in Melbourne – pre-oxygenation was shown to reduce agitation after naloxone administration. I should also point out that oxygen is used in many cases beyond the respiratory arrest type overdose we immediately think of when discussing opiates. For instance, consumers who are ‘on the nod’ have their oxygen saturation (Spo2) monitored. Many of these people drop their SpO2 or respiration rate significantly, which is thought to be a key driver for repeated hypoxic brain injury. In this instance oxygen is used, or even simply keeping people alert and getting them to deep breathe and increase their respiration rate. Adam.

  5. Colleen Blums

    Thank you Adam. Really interesting presentation.Looking foward to the live workshop.

    1. Adam Searby

      Thanks for watching Colleen! I am told there will be plenty of time for discussion during the live workshop – I am looking forward to hearing the perspectives of harm reduction approaches like this from other nurses around the world. Adam.

  6. Enriqueta Rivas

    Very interested research, how they manage adverse efects related to inyected medication, does there permanently a doctor in the area, does any of the drug are experimental drugs? please explain.

    1. Adam Searby

      Thanks for your comment Enriqueta,
      There is a medical doctor who oversees the centre, and there is always a doctor on call – but this is largely a nurse-supervised injecting room. Nurses run the response to overdose by supplying oxygen, ventilation and naloxone where required. In fact, the report I posted above talks about the value of the nurse in the facility so is worth a read.
      In regard to experimental substances, as I mentioned in the presentation the vast majority of injections are heroin, or to a lesser extent a combination of heroin and diphenhydramine hydrochloride (this phenomenon has been observed in Melbourne for some time: https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/VIC_IDRS_2011.pdf). Although this is based on self report – people using the room need to declare what they plan to inject when they enter the facility. Of course, there are protocols for adverse reactions that cannot be managed in the room.
      Adam.

  7. Niall Tamayo

    Ty for that presentation! I wonder how politics, the public, or even the legal system influenced the addition or deterrence of supervised consumption sites? Maybe at your sites or at other sites. In Canada, some sites have lost funding and have had to put up “illegal” sites to counter these actions.
    Second question: Is there a plan to add other ways the substances will be consumed?

    1. Adam Searby

      Hi Niall,
      Thanks for watching! The original injecting room in Sydney did start as an illegal site I believe, in a place called Kings Cross which like Richmond in Melbourne was considered a ‘hot spot’ for heroin use. Public and political pressure saw the room trialed there, much like what happened in Melbourne. Prior to the room opening, the government had declared they had no interest in opening the room, viewing it as a politically unpopular decision. Continued campaigning from the community group, coupled with the campaigning of an independent politician and the coroner’s report shifted this stance. A former colleague of mine, Dr Stephen Bright, has a lot of great commentary on the media coverage on his site http://www.aodmediawatch.com.au.
      To the second question: I don’t believe there are plans to offer other consumption alternatives, simply because statistics and surveillance on the target group for the room don’t show smoking as a common way of consumption. Our group mostly inject heroin.
      Adam.

  8. Trish HAFFORD

    Excellent presentation Adam, this is a hot topic in Glasgow, I learned a lot. Trish

    1. Adam Searby

      Thanks for watching Trish. Definitely a hot topic, I am looking forward to hearing more about other regions and their perceptions of facilities like this in our live workshop at the end of the conference. Of course, in Melbourne we have been through the full spectrum of comments about how the room enables drug use, how it encourages drug use, how drugs are illegal and it is not fair on hardworking, law abiding taxpayers, etc. I have always viewed the room as a healthcare facility that provides ‘wraparound’ services to marginalised people where they present, rather than some sort of party house where people inject drugs (some media paint it like this). I think we need to be better at educating the public in that respect.
      PS – really looking forward to your keynote on older people and substance use. Adam.

  9. Rachel Shuster

    Excellent presentation, Adam! Thank you for presenting on such an important topic. It is my hope that the US will model programs like this from other countries where it’s been implemented. Currently, I know of one facility in Boston where individuals can be monitored after substance use, but they aren’t able to use on-site (though it occurs, just not under medical supervision which leaves unmet needs with high risks).

    1. Adam Searby

      Thanks for watching Rachel! As I mentioned somewhere above, there seems to be raging debate on what actually happens in these facilities. I have had many people in Melbourne become quite animated when I tell them I’ve worked in the room, telling me I’m enabling drug use and the like. However, when you tell them about marginalized people getting access to healthcare and services, actually describe what the room is like (a spotlessly clean healthcare facility) and the public health dollars saved by these initiatives they tend to end up agreeing that the room is a good idea. So, I think we have some work to do on educating the general public. As I said in Baltimore last year, I’ve never seen anyone walk into this facility saying “injecting heroin looks cool, can I have a go?” The cohort that use the room carry a heavy burden in respect of mental and physical health co-morbidities and trauma. They tend not to fit with traditional models of healthcare delivery, hence why I think this facility is so important. Adam.

  10. Nkosinomusa Napier

    Thanks for such an amazing and informative presentation Adam.

    1. Adam Searby

      Thanks for watching Nkosinomusa!

  11. Oluremi Adejumo

    Yes, I agree with your view that the war on drugs has failed. Substance Use Disorder is now a global, public health concern that requires a revision of policies.

    1. Adam Searby

      Thank you Oluremi,
      You are correct – harm reduction is a policy revision. It accepts that people will take drugs despite laws prohibiting this, and works with people to make this as safe as possible. Of course, you can never make illicit drug use 100% safe, but the facility does also provide wrap around healthcare for people who would not otherwise be able to access it.
      Adam.

  12. Bari Platter

    Thanks for the great presentation! In Denver, we passed legislation for Denver county for safe injecting sites but it hasn’t gotten off the ground because of the publics resistance. I hope that we are able to move forward with this initiative in Colorado.

    1. Adam Searby

      Thanks Bari,
      I’d love to hear more about the barriers other jurisdictions are facing. I suspect there would be similar public arguments to what we heard in Melbourne.
      Adam.

  13. Michelle Labossiere-Tekpoh

    Thank you for the very informative presentation!

    1. Adam Searby

      Thanks for watching Michelle.

  14. Cheneen Austin

    Thank you for this presentation. There has been significant pushback in the United States regarding medically supervised injection sites. If I might ask, how did you engage with the key stakeholders? I understand from your presentation that the overdose rate was a significant factor. What other interventions did you implement to help get the community onboard? And how have you addressed the negative media coverage surrounding the MSIS? Have you launched any sort of public awareness campaign in the community? Again, thank you for your presentation.

    1. Adam Searby

      Hi Cheneen,
      It was an interesting lead up to the acceptance of the room – our government at the time came out and pretty much ruled out the opening of the room. It really was the coroner’s case that led the change. There is some excellent analysis of the media leading up to the room at http://www.aodmediawatch.com.au.
      There was also significant work done by a community group, Residents for Victoria Street Drug Solutions (www.vicstreetdrugsolutions.org) who advocated for the room alongside a state politician.
      Since the room opened, there hasn’t really been a campaign to address negative media coverage. Given the room was opened on a trial basis, this was largely done in the report I cited above. There is some effort to address the misunderstanding, such as holding tours of the room for the public when it is closed, and information on the community health service’s site including a video ‘explainer’ (https://nrch.com.au/services/medically-supervised-injecting-room/).
      Adam.

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