Breaking News
May 25, 2018 - Origami inspires researchers to develop new solution for tissue regeneration
May 25, 2018 - Melorheostosis – Genetics Home Reference
May 25, 2018 - Non-addictive pain medication changing therapy for substance use disorders
May 25, 2018 - Delayed lactate measurements in sepsis patients increase risk of in-hospital death
May 25, 2018 - Researchers identify novel epigenetic mutations as cause of neurodevelopmental, congenital disorders
May 25, 2018 - UD researchers examine connection between DNA replication in HPV and cancer
May 25, 2018 - Researchers identify neurons that play key role in aggressive behavior
May 25, 2018 - Researchers discover unexpected chemosensor pathway for predator odor-evoked innate fear behaviors
May 25, 2018 - Nearly one in three people know someone addicted to opioids
May 25, 2018 - New findings could help fine-tune treatment for cancer patients
May 25, 2018 - New cancer treatment approach targets specific sugar receptors
May 25, 2018 - Skin responsible for uptake of cancer-causing compounds during barbecuing than lungs
May 25, 2018 - Early-onset cannabis use linked to further drug abuse problems
May 25, 2018 - Covered California takes aim at hospital C-section rates
May 25, 2018 - FDA Approves Palynziq (pegvaliase-pqpz) for the Treatment of Adults with Phenylketonuria
May 25, 2018 - Arthritis Glossary
May 25, 2018 - Study links breast cancer to the body’s internal clock
May 25, 2018 - Strenuous exercise in teenage years may protect against height loss later in life
May 25, 2018 - FDA approves novel enzyme therapy for adults with rare and serious genetic disease
May 25, 2018 - New research project aims at developing effective interventions for kids with DLD
May 25, 2018 - Middlemen who save $$ on medicines — but maybe not for you
May 25, 2018 - Study sheds new light on sharp rise in fatal drug overdoses in recent years
May 25, 2018 - Students propose revision of listeriosis guidelines for safer pregnancy
May 25, 2018 - TNFi Exposure In Utero Does Not Up Serious Infection Risk
May 25, 2018 - Organization of cells in the inner ear enables the sense and sensitivity of hearing
May 25, 2018 - Yoga May Be Right Move Against Urinary Incontinence
May 25, 2018 - Drinking recommended amount of milk could protect obese children against metabolic syndrome
May 25, 2018 - New cytokine network can repair tissue damage in the intestine, study finds
May 25, 2018 - Lyme disease researcher dispels misconceptions about ticks and provides prevention tips
May 25, 2018 - Penn researchers find link between social media usage and underage drinking
May 25, 2018 - Unique nanotechnology method to simplify skin disease diagnosis
May 25, 2018 - Study reveals new protective mechanism for tumor cells in breast cancer
May 25, 2018 - FRAME Alternatives Laboratory chosen for major European liver research collaboration
May 25, 2018 - Study shows yogurt may dampen chronic inflammation linked to multiple diseases
May 25, 2018 - Invasive cancers that are born to be bad show detectable differences from harmless tumors
May 25, 2018 - Study identifies new mechanism involved in development of Lou Gehrig’s disease
May 25, 2018 - UAB professor receives award for malaria prevention study in pregnant women in Cameroon
May 25, 2018 - Study provides blueprint of how fruit flies can be used to screen potentially pathogenic human genes
May 25, 2018 - New drug-delivering nanoparticle could offer better way to treat brain tumors
May 25, 2018 - Kessler Foundation scientists compare two tests for assessing learning in individuals with MS
May 25, 2018 - Stroke Symptoms and Diagnosis (Beyond the Basics)
May 25, 2018 - Protein goes against the family to prevent cancer
May 25, 2018 - Drugmakers blamed for blocking generics have milked prices and cost U.S. billions
May 25, 2018 - Speakers announced for National Medicines Symposium 2018
May 25, 2018 - GSK Receives FDA Approval of Arnuity Ellipta for Asthma in Children From 5 Years of Age
May 25, 2018 - Pfizer settles kickback case related to copay assistance for $24m
May 25, 2018 - Nuclear pore functions are essential for T cell survival
May 25, 2018 - Study defines molecular basis to explain connection between mother’s nutrition and infant growth
May 24, 2018 - IHI hosts representatives to develop a national action plan for patient safety
May 24, 2018 - Zika detection breakthrough by University of Queensland
May 24, 2018 - FDA Alert: 95% Ethyl Alcohol Product by Ethanol Extraction: Recall
May 24, 2018 - New method allows scientists to study how HIV persists
May 24, 2018 - Study reveals rate of vertebral and non-vertebral fractures in children with leukemia
May 24, 2018 - Whey protein supplementation and physical activity aid women in improving body composition
May 24, 2018 - Seniors’ air pollution exposure linked to hospitalization for ARDS
May 24, 2018 - Home-based telehealth therapy program effective for stroke rehabilitation, shows study
May 24, 2018 - Addressing Parents’ HPV Vaccine Hesitancy Ups Vaccination Rates
May 24, 2018 - Opioid addiction treatment drug helps suppress HIV in former prisoners
May 24, 2018 - FDA warns against using teething remedies for babies
May 24, 2018 - Healthy lifestyle counseling program linked to reduced risk of developing cancers
May 24, 2018 - CU research sheds light on liver disease caused by intravenous nutrition
May 24, 2018 - Skin cream containing rapamycin reduces TSC-related facial tumors
May 24, 2018 - Suicide rates twice as high among black children finds new study
May 24, 2018 - Researchers find new method to treat severe asthma
May 24, 2018 - Scientists report new strategy for fighting bacteria
May 24, 2018 - South Asians living in the United States more likely to die of heart disease and stroke
May 24, 2018 - Health Tip: Why Get a Biopsy
May 24, 2018 - Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012
May 24, 2018 - Motivation to move may start with being mindful
May 24, 2018 - Advanced genetics study of TB bacteria uncovers virulent ‘Beijing lineage’ strain among young adults
May 24, 2018 - Friends tend to have similar pain tolerance levels, study reveals
May 24, 2018 - International researchers succeed in stopping growth of mesothelioma in model animals
May 24, 2018 - Inactive people find high-intensity interval training to be as enjoyable as traditional exercise
May 24, 2018 - Now more of us can count on more time dodging the dementia bullet
May 24, 2018 - Scientists develop new test to predict woman’s risk of preterm birth
May 24, 2018 - Global healthcare access and quality improved from 2000-2016
May 24, 2018 - Virtual follow-up visits for hypertension care just as effective as in-person office visits
May 24, 2018 - New research reveals links between type 1 diabetes and mental health
May 24, 2018 - Antioxidant-enriched multivitamin may decrease respiratory illnesses in CF patients, finds study
May 24, 2018 - Antidepressant treatments increase risk of weight gain, study finds
What goes on inside a medically supervised injection facility?

What goes on inside a medically supervised injection facility?

image_pdfDownload PDFimage_print
The reception is just like a typical health service. Credit: Uniting Medically Supervised Injecting

The Victorian government recently announced a medically-supervised injecting centre for North Richmond, an inner-city area plagued by drug overdoses. While some may argue the establishment of such facilities normalises drug use, the centres offer an essential service to keep people who use drugs and the community safe.

A medically-supervised injecting centre is a physical space where it’s legal for people who inject drugs to come with pre-obtained substances and inject themselves. The key point is that rather than just being supplied with clean injecting equipment and then sent away to inject elsewhere (as is the case with needle syringe programs across Australia for the last 30 years), people are also provided with a safe space to inject.

How does the service work?

Stage 1

Walking in the front door, visitors probably feel they’re in the reception area of a typical health service. There are paintings on the wall, and someone smiling from behind a reception desk asking how they can help. A first time visitor will be taken aside to register with the service, which involves a conversation with one of our trained nursing or counselling staff, and a brief medical history being taken. Most of our clients have been injecting drugs for over a decade, and have complex histories, with mental health and childhood trauma both common features.

People are not required to leave either their full name or their real name, nor give us their Medicare details. Instead, they give us a password and we provide them with a unique number used for any subsequent visits. This option for anonymity is to encourage people who might be unsure about using our service.

Most health professionals in the drug field have never been present for the injection of drugs. Credit: Uniting Medically Supervised Injecting

Once registered, people are asked what drug they’re seeking to use, as well as what other drugs they’ve used recently. This gives staff a sense of what to expect in stage two, where supervised drug injection takes place. Testing of the drugs is not part of what an injecting centre traditionally does, due to the time and expense associated with it. The aim of an injecting centre is to physically accommodate the injection of drugs that would normally occur somewhere inherently more dangerous, and often public.

Stage 2

In stage two, staff provide clean injecting equipment. Typically this takes the form of small 1ml syringes, swabs to clean the skin, a tourniquet, water, filters and a spoon. Clients sit at one of eight stainless steel booths, then use this equipment to inject themselves. Staff are not legally able to inject a client, but their role as clinicians trained in harm reduction is to reduce the risks associated with that injection.

This may involve talking to someone about where and how they inject, encouraging them to wash their hands and use swabs, ensuring they don’t share any equipment, and other techniques aimed at ensuring they understand the risks of blood-borne virus transmission. Because there is no quality control for illicitly sourced drugs, part of the harm comes from simply not knowing what may or may not be in the mixture, so staff are always on the look-out for unexpected reactions.

This area can be really quite confronting. For health professionals working in the field of drugs, we have never been present for the actual injection of any drug. Why? Because this is illegal. So despite handing out injecting equipment to drug users over many years for the specific purpose of injecting drugs, we’ve never been able to provide additional care when it’s really needed. Instead, we’ve been forced to tell people to go elsewhere.

An injecting centre provides the setting and the possibility for a new type of connection with our clients. The power of suspending judgement for those who are the most judged and vilified in our society can be transformative.

Clients are able to access counselling and referral services. Credit: Uniting Medically Supervised Injecting

Stage 3

After the injection, clients safely dispose of their used equipment, and move to the next room, known as stage three. This is a more relaxed space, where we run all sorts of activities to engage people in conversations about their health and wellbeing. It may be a quiz, creative writing or art, or instructing people on appropriate overdose responses and showing them the recovery position and rescue breathing.

All staff have relevant experience and additional training to ensure they’re skilled in opening up conversations with the people they see. This therapeutic relationship is essential to make effective referrals into other treatment, care and support services.

Referrals may be for specialised treatment for addiction (from detoxification services and rehabilitation, to methadone and buprenorphine – slow-release oral opioids), or to relapse prevention and other types of counselling. It may be for a range of other medical services such as mental health treatment, dental services, hepatitis C treatment, or wound care.

Preventing overdose

In all stages of the service, there is always a risk of overdose, and staff are trained to intervene immediately. Crucially, no one has ever died from a drug overdose in any such facility anywhere in the world (there are now more than 110 services internationally).

No one has ever died from a drug overdose in an injecting facility. Credit: Uniting Medically Supervised Injecting

Whether it’s illicit heroin or pharmaceutical morphine, all opiate drugs switch off the part of the brain that reminds you to breathe. If no one intervenes in an opiate overdose, oxygen will be depleted and eventually the heart will stop, causing death. But if someone is present, recognises what is happening and intervenes appropriately, the person can be saved.

Our staff protect a person’s airway, provide supplemental oxygen, even artificially breathe for them via bag/valve/mask resuscitation. Nursing staff can also administer naloxone (narcan), which is an opiate antidote. This drug reverses the effect of any opiate drug, and the brain is reminded to breathe again.

An injecting centre is very much a practical and evidence-based response, effective in areas with highly concentrated public drug use and overdose. It has been shown that an injecting centre does not create a honeypot for more drug use, rather it assists in addressing existing problems. They are well supported by police, as well as their local communities.

But it won’t make the problem vanish, nor get everyone instantly off drugs. Drug addiction is a chronic relapsing health problem that needs long-term commitment and encouragement in order to see change.

We need a wide range of affordable treatment and support services for people with problematic drug use, and treatment needs to be available and accessible to people when they need it. An injecting centre is only ever going to be one part of the larger jigsaw puzzle – but without it, people may die before they get the help they need.


Explore further:
Australian injecting room upholds fight against AIDS epidemic

Provided by:
The Conversation

Tagged with:

About author

Related Articles