ILLICIT DRUGS: by Tim CannonNews Weekly
Kings Cross safe injecting rooms fail to reduce drug overdose deaths
, September 19, 2009
Sydney's Medically Supervised Injecting Centre (MSIC) has failed to meet its key objective of reducing drug overdose deaths in the Kings Cross area, according to social researcher Dr Lucy Sullivan.
Dr Sullivan recently conducted an analysis of four official reports tracking the operation of the MSIC from its opening in 2001, through to April 2007. In that time, the number of drug overdose deaths fluctuated uniformly across the state of NSW, including the area serviced by the MSIC. These fluctuations reflected changes in the availability of heroin, such that any reduction in the number of drug overdose deaths during that period can be attributed to a reduction in the supply of heroin.Transient use
According to Dr Sullivan, the ineffectiveness of the MSIC is largely attributable to the fact that drug-users were likely to use the MSIC only as a matter of convenience, while continuing to undertake the greater part of their drug use elsewhere. For example, in the period between 2001 and 2004, drug-users visited the MSIC an average of once every 44 days, even though 99 per cent of clients reported injecting drugs at least weekly. Such transient use is unlikely to significantly reduce the risk of drug-related death.Prevention of death
The MSIC reports do reveal a dramatic decline in the number of drug-related deaths in the Kings Cross area following the opening of the MSIC, with deaths falling from an average of four per month, to an average of one per month. However, this decline was not significantly greater than the decline in drug-related deaths in the rest of the state, where the average fell from 27 per month to 8 per month over the same period.
Dr Sullivan suggests that the drop in drug-related deaths in that time was the product of a "heroin drought" experienced across NSW, with a significant reduction in the overall availability of heroin from the year 2000. In light of these observations, Dr Sullivan contends that the operation of the MSIC showed no demonstrable impact on the number of drug-related deaths in the Kings Cross area.
A similar picture emerged for opioid-related ambulance attendances and emergency department presentations, with similar reductions in both the Kings Cross area and in the rest of NSW. In particular, Dr Sullivan noted that the availability of on-hand assistance at the MSIC was no more effective than ambulance attendance in reducing drug-related fatalities.Reports misleading
Although the information contained in the MSIC reports clearly demonstrates the ineffectiveness of the MSIC in reducing drug-related deaths, Dr Sullivan criticised one of the reports for failing to include this vital information in its executive summary.
According to Dr Sullivan, "The Executive Summary
misleadingly reports only the finding of a slightly greater fall in ambulance call-outs to overdose events in the MSIC area than in the rest of New South Wales, with the implication that rapid treatment on site in the MSIC would be more effective in preventing deaths than when treatment is delayed till an ambulance arrives (or till transport by whatever means to an Emergency Department). As the actual death rate figures reveal, this is not the case."
The executive summary goes on to hypothesise: "it is likely that substantial proportions of overdoses managed at the site would have resulted in significant morbidity had they occurred elsewhere, and that half would have otherwise occurred in public places." As Dr Sullivan rightly points out, the inclusion of speculated outcomes have no place in the executive summary of an official report, particularly when they are not supported by the data contained in the report itself.Curbing supply is the answer
For Dr Sullivan, the conclusion to be drawn from the MSIC reports is "absolutely clear": overdose deaths fall when there is a fall in heroin use, not
as a result of the occasional use of safe injecting centres. Furthermore, the "heroin drought" can be seen to have had a significant impact in reducing heroin-related deaths both immediately and in the long term. Accordingly, Dr Sullivan concludes that the MSIC reports offer sound support "for the common-sense view that restriction of access to drugs, in which illegality plays a major role, is crucial to the prevention of drug overdose deaths."