Breaking News
February 20, 2018 - Booze Beats Pot at Being Unhealthy: Oregon Poll
February 20, 2018 - Morning Break: ’20 Years Late’; Drugs in the Dirt; Catching Flu in the Dorm
February 20, 2018 - Another piece to the puzzle in naked mole rats’ long, cancer-free life
February 20, 2018 - Scientists identify four viruses that can produce insulin-like hormones
February 20, 2018 - New e-Health solution developed to prevent cardiovascular disease, dementia in senior citizens
February 20, 2018 - New genetic risk score could help guide screening decisions for prostate cancer
February 20, 2018 - Study finds higher risk of stroke among blacks with atrial fibrillation than whites
February 20, 2018 - Physical activity could be used as strategy for diabetes prevention
February 20, 2018 - Researchers develop sensing method for early detection of cancer and diabetes
February 20, 2018 - New wearable electronics could be game-changer for stroke rehabilitation
February 20, 2018 - Immune history influences person’s response to flu vaccine
February 20, 2018 - Serenity Now! Learn to Have Patience with Patients
February 20, 2018 - Computer simulation addresses the problem of blood clotting
February 20, 2018 - Persistent bloating can be a sign of ovarian cancer, warns charity
February 20, 2018 - Key protein involved in epigenetic regulation of gene expression guides skin cell renewal
February 20, 2018 - Heart attack symptoms often missed in women
February 20, 2018 - Diagnosis of celiac disease takes 3.5 years for patients who do not report GI symptoms
February 20, 2018 - Study reveals functional dynamics of ion channels
February 20, 2018 - Study explores link between mortality risk and combustible tobacco use
February 20, 2018 - ‘She Trusted Me, and I’d Turned Her Away’
February 20, 2018 - AbbVie and Voyager Therapeutics collaborate to develop new treatments for tauopathies
February 20, 2018 - Fast food makes the immune system more aggressive in the long term
February 20, 2018 - Therapeutic target for glaucoma could have treatment ramifications for Alzheimer’s and Parkinson’s
February 20, 2018 - Overcoming Negative Reviews | Medpage Today
February 20, 2018 - MyD88—villain of allergies and asthma
February 20, 2018 - Food scientists develop rapid screening technique to detect pesticide residue in vegetables
February 20, 2018 - Lab-grown cerebellar cells may help explain how ASD develops at molecular level
February 20, 2018 - Scientists explore connection between bad sleep habits and stiff blood vessels
February 20, 2018 - New Treatment Apalutamide (Erleada) Approved for Prostate Cancer That Resists Hormone Therapy
February 20, 2018 - Do You Really Need My Signature on That?
February 20, 2018 - HIV-1 genetic diversity is higher in vaginal tract than in blood during early infection
February 20, 2018 - Diabetes does not increase work-loss years due to early retirement
February 20, 2018 - Researchers aim to find out how PTSD affects decisions of police
February 20, 2018 - UH Cleveland Medical Center explores novel treatments for uterine fibroids
February 20, 2018 - Flu Vax Efficacy 25% Against Predominant H3N2 Strain So Far
February 20, 2018 - HIV screening most optimal at 25 years of age if no risk factors
February 20, 2018 - Loyola Medicine primary care physician offers advice to minimize risk of flu
February 20, 2018 - Safe sleep recommendations for parents that may help reduce child’s risk of SUID
February 20, 2018 - Why Do So Few Docs Have Buprenorphine Waivers?
February 20, 2018 - Low levels of alcohol good for the brain
February 20, 2018 - Experimental treatment improves invisible symptoms of a man with spinal cord injury
February 20, 2018 - Myriad’s EndoPredict offers better prediction of breast cancer recurrence, analysis shows
February 20, 2018 - Researchers identify fifteen genes that determine our facial features
February 20, 2018 - Morning Break: New Health IT Player; Luxturna No Bargain; Nuclear Freakout
February 20, 2018 - How does it compare? Hospice care at home, at assisted living facility, at nursing home
February 19, 2018 - Scientists develop water-soluble warped nanographene for bioimaging
February 19, 2018 - It’s Not Your Imagination: You’re Hungrier After Losing Weight
February 19, 2018 - Antihypertensive Use At Delivery Rising in Preeclampsia
February 19, 2018 - A centuries-old math equation used to solve a modern-day genetics challenge
February 19, 2018 - Liquid biopsies could be used as new predictive marker for metastatic TNBC
February 19, 2018 - Russian researchers develop new multi-layered biodegradable scaffolds
February 19, 2018 - Are ‘Vaccine Skeptics’ Responsible for Flu Deaths?
February 19, 2018 - Hidden genetic effects behind immune diseases may be missed, study suggests
February 19, 2018 - Emergency nurses experience regular verbal and physical abuse
February 19, 2018 - Study sheds light on biology that guides behavior across different stages of life
February 19, 2018 - Morning Break: Transgender Breast Feeding; Brazilian ‘Pro-Vaxxers’; Post-Stroke Exercise
February 19, 2018 - Meningitis vaccination strategy in Africa found to be effective, economical
February 19, 2018 - Researchers uncover how excess calcium may influence development of Parkinson’s disease
February 19, 2018 - Psoriasis drug also effective at reducing aortic inflammation
February 19, 2018 - Excess emissions can make serious contributions to air pollution, study shows
February 19, 2018 - Researchers reveal potential biological roots behind individuality
February 19, 2018 - Diabetes Drugs Differ on HF; School-Based Obesity Program Flop; Plaque Type in ACS
February 19, 2018 - Surgical infections linked to drug-resistant bugs, study suggests
February 19, 2018 - Poor awareness may hinder a child’s early dental care
February 19, 2018 - Research finds rising trend in incidence of merkel cell carcinoma
February 19, 2018 - Researchers uncover Ras protein’s role in uncontrolled cancer growth
February 19, 2018 - FDA Approves Apalutamide (Erleada) to Help Curb a Tough-to-Treat Prostate Cancer
February 19, 2018 - Educational Tool Boosts Cervical Length Screening
February 19, 2018 - Spider’s web inspires removable implant that may control type 1 diabetes
February 19, 2018 - Scientists develop fluorescent probe to identify cancer stem cells
February 19, 2018 - University Hospital of Santiago de Compostela participates in large pancreatic cancer study
February 19, 2018 - New blood test shows promise to revolutionize diagnosis of tick-borne diseases
February 19, 2018 - Report: Use, Not Price, Drives State Health Costs
February 19, 2018 - Emergency services crews often unprepared for diabetic crises
February 19, 2018 - Scientists in Sweden create DNA nanowires that offer hope for treatment of diseases
February 19, 2018 - ID Break: Clean Hands, Fewer Abx; $11 Million HIV Cure?; MenB Vax for Kids
February 19, 2018 - Patient exposure to X-rays depends on how dentists are paid
February 19, 2018 - Study reveals parents’ views toward children’s tanning bed use
February 19, 2018 - Shot may help reduce risk of shingles
February 19, 2018 - FDA approves first treatment to reduce risk of NSCLC progression
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