Sydney’s Medically Supervised Injecting Centre (MSIC) turned 21, on Friday 6 May 2022, with the landmark achievement being recognised by Lord Mayor of Sydney Clover Moore, who handed over the key to the city to commemorate 21 years of service in saving lives.
The landmark achievement also received praise from many who have been involved in alcohol and other drugs (AOD) health service spaces or engaged with MSIC. Such as, long-standing advocate and President of the Australian Drug Law Reform Foundation Dr Alex Wodak, (Wodak was also a key figure in helping open Australia’s first needle exchange program and the MSIC at Kings Cross), singer/songwriter Steven Kilby whose heroin use and beliefs about the problematic nature of drug prohibition have been well documented and businessman/entrepreneur/philanthropist/commissioner for The Global Commission on drug policy, Sir Richard Branson.
MSIC has supervised more than 1.2 million injections during this time and managed over 10,000 overdoses, without any deaths occurring. There’s no doubt that this service has saved thousands and thousands of lives during this time. MSIC was the first supervised injecting facility in the English-speaking world and opened in May 2001. It remains one of only two services of its kind in Australia, and indeed in the southern hemisphere. Worldwide, Sydney, Melbourne (Australia), New York (USA) and Ontario, British Columbia, Alberta, and Québec (Canada), are the only English-speaking regions with safe injecting facilities and centres.
Historically, The first professionally staffed service for people who inject drugs (PWID) emerged in Rotterdam, Netherlands during the early 1970s as part of the "alternative youth service" provided by St. Paul’s Church. Its purpose was to improve the psychosocial function and health of its clients, though inadvertently became a pioneer in providing the blueprints for future needle exchange programs (NSPs).
The first modern supervised injecting facility site opened in Bern, Switzerland in 1986. Part of a project combatting HIV, the general concept was for the service to operate as a drop-in centre, where hot meals and counselling would be provided along with health promotion incentives on safe sex, BBVs and STIs Although sterile needles were distributed at the site, supervised injecting was never intended to be part of the service, though the church centre inevitably became a safe haven for people to inject drugs. The church centre later turned into the world’s first legally sanctioned drug consumption facility, after discussions with police and legislature who mutually decided that the service can operate provided no minors be admitted. (Dolan et al. 2000)
Fast forward to the 1990s, Sydney’s Kings Cross was a notorious setting during a heroin boom, claiming countless lives through overdose, a mass of drug-related harms and increases in BBVs such as HIV and Hepatitis C through the sharing of needles. Kings Cross had the highest concentration of people dying of drug overdose in Australia. The confronting scenes of public injection and overdose as well as discarded injecting equipment in Kings Cross inspired Reverend Ray Richmond to conduct an act of civil disobedience by establishing a safe injecting room inside Kings Cross’ Wayside Chapel which became known as ‘The Tolerance Room.’ It was this bold act amongst others of rebellion that paved the way for radical changes in state drug reform legislation.
Under the leadership of then NSW Premier Bob Carr, the 1999 drug summit coupled with the drug reform advocacy of then director of St. Vincent’s Hospital Alcohol and Drug service Dr Alex Wodak and colleagues, set the foundation for the introduction of Australia’s first medically supervised injecting centre, to be run by the charitable arm of the Uniting Church.
It was also during this time period that drug user organisations and peers were at the forefront of initiating harm reduction strategies for PWID and pushing for NSPs to be established. In 1989 these peers mobilised to form the New South Wales Users and AIDS Association (NUAA) the peak drug user organisation for NSW. Today, NUAA along with AIVL and other state and territory peer-based organisations, continue to provide invaluable harm reduction services, health promotion, support and advocacy for PWID. The AIVL national network of peer-based organisations is run, staffed and led by people with lived experience of injecting drug use who understand the intricate needs of a community that continues to be highly stigmatised and marginalised. At the time, the announcement from Carr that the centre would go ahead faced considerable opposition, particularly from Prime Minister John Howard who feared it had the potential to green-light injecting drug use and “make NSW the drug capital of the Southern Hemisphere.”
Present attitudes towards MSIC from Kings Cross residents and the general Australian public have continued to show increases in support throughout the decades, demonstrated in regular random surveys and independent evaluations. These documents indicated that the vast majority of residents and local businesses, communities, medical quarters, counsellors, families, and those most affected by drug related harms, support MSIC. Additionally, the most recent National Drug Strategy Household Survey reports that nationally attitudes are shifting towards greater acceptance of drug harm reduction measures with almost 3 in 5 Australians (57%) supporting pill testing as well as education rather than law enforcement as the preferred strategy to reduce the use of illicit drugs (AIHW 2019).
Speaking on MSIC turning 21, Dr Marianne Jauncey, the medical director of MSIC stated on ABC radio that “there’s nobody sensible left that doesn’t acknowledge that medically supervised injection centres save lives, makes a difference, takes injecting off the street…Yet the question remains why is there only one?” (in NSW). Dr Jauncey further stated that it remained wrong that health workers anywhere else in the state can provide sterile needles but then legally must turn the person away to inject elsewhere, despite the risk of overdose, arguing that there should be the capacity for supervision wherever sterile injecting equipment is distributed.
At the passing over of the keys to the city ceremony for MSIC, The Uniting Church’s moderator for NSW and the ACT Reverend Simon Hansford praised MSIC for all the work it has done in saving lives, though was concerned that MSIC has largely been the last bold act of revolution in drug reform for NSW, pointing out the drastic lack of services in regional areas where illicit drug use, particularly injecting drug use is deeply impacting a vast array of communities.
The principles of harm reduction are deeply embedded in the work that takes place at MSIC. These principles have been shown to reduce costs of ambulance call-outs for overdose and drug-related harms and significantly lower rates of HIV. Australia is one of only a handful of countries globally to achieve the 2020 HIV elimination targets set by the United Nations, to have 90% of all people living with HIV know their HIV status, 90% of all people diagnosed with HIV taking antiretroviral therapy, and 90% of all people receiving antiretroviral therapy to have achieved viral suppression (meaning that their treatment is working and effectively prevents the transmission of the virus to other people). Needle Syringe Programs (NSPs) and Medically Safe Injecting Centres like MSIC have contributed to an overall HIV prevalence rate of less than 1% amongst PWID, and reduced rates of syringe sharing from 70-90% to around 17%. (AIHW 2019).
AIVL Board President and Executive Director CAHMA Chris Gough who previously worked at MSIC congratulated MSIC on 21 years of service to the community of people who inject drugs in Inner Sydney. Chris noted that MSIC works with some of the most marginalised people in society, many of whom have ongoing issues of homelessness, social isolation, unemployment, and mental health issues. One aspect that stood out to Chris when he worked at MSIC was the significant trauma that was pervasive within MSIC’s client base as well as the multiple layers of stigma and discrimination that the community faces.
“Congratulations to Marianne Jauncey and the wonderful staff at MSIC for serving our community in such a caring and supportive way. As well as the bread and butter of overdose prevention and reversal, which has saved countless lives, one of the best aspects of MSIC is its journey to build people’s self-respect and social inclusion, with the MSIC Art From the Heart of Kings Cross health promotion and the Consumer Action Group (CAG) being some excellent examples. The AIVL community wishes MSIC a very happy 21st Birthday and many happy returns. We can’t thank the staff of MSIC enough for their caring, compassionate work to some of our most marginalised community members, as well as their ongoing work in creating a world that is free of stigma and discrimination.”
Happy 21st MSIC from all the team at AIVL, long may the impact of your work be recognised as a vital stalwart in the public health response to injecting drug use in Australia and the advocacy, support, and human rights for PWID.
AIVL remains hopeful that more medically supervised injecting centres will open across the country in areas that are in desperate need of such services.
Adrian Gorringe - Project Officer AIVL
Chris Gough - AIVL Board President & Executive Director CAHMA
Charlie Lay - Project Officer, AIVL
Australian Institute of Health and Welfare 2019, ‘Australian National Drug Strategy Household Survey 2019’ Australian Government. Canberra.
Dolan K, Kimber J, Fry C, Fitzgerald J, McDonald D and Trautman F 2000, ‘Drug consumption facilities in Europe and the establishment of supervised injection centres in Australia’ Drug and Alcohol Review vol.19 no.3 pp.337-346.
AIVL is the national organisation representing people who use/have used illicit drugs and is the peak body for the state and territory peer-based drug user organisations.
Jake Docker, CEO, AIVL – email firstname.lastname@example.org