Sydney supervised injecting centre (MSIC) successful at 21

Sydney’s sometimes controversial supervised injection center celebrates its 21st birthdaySt Anniversary without a single overdose death on the premises.

In 2001, the Uniting Sydney Medically Supervised Injecting Center (MSIC) opened following a request from the Royal Commission and Parliament to provide a safe and hygienic place for users to self-inject drugs – and, if they so wished, part of the health service – and health system become welfare transfer system.

Since opening, MSIC has monitored 1,232,951 drug injections and made 20,420 referrals to health and social services.

“They’re the tip of the iceberg because they’re the more formalized referrals that have been recorded,” says Associate Professor Carolyn Day, a researcher at the University of Sydney’s Faculty of Medicine and Health and lead author of a paper on the 21-year-old course of the center, published in the Medical Journal of Australia. Day has been working with the center for several years.

“There are many other informal referral activities going on.”

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The paper highlights what public health workers and researchers have learned during the center’s operation — including who should be admitted, where legal responsibility lies, and how to monitor and prevent drug sharing or sale at the facility.

“There are still all of these questions in the literature that we know have been answered by this ministry and by services elsewhere in the world,” Day says.

Both before and since its opening in 2001, MSIC has faced criticism that it may encourage more drug use or attract more users to the area.

But multiple peer-reviewed evaluations have shown that MSIC has not caused increased drug use among enrolled participants, nor has there been any change in local crime, drug-related or not – apart from a small increase in “loitering” near the site center.

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These findings were supported by research at a similar center in Vancouver, Canada.

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“I think all of those questions are settled,” says Day.

The center restricts access to those over the age of 18 and those with a history of drug injections. People who attended the center were more likely to seek treatment than drug users who did not.

MSIC has managed 10,890 overdoses since opening, with no on-site fatalities.

Because trained staff are available, most opioid overdoses are corrected with oxygen and airway management, according to the paper. About 20% needed naloxone, a drug that can mediate opioid overdose.

Of the more than 7,000 overdoses at the center between 2010 and 2020, only 1% (76) required an ambulance.

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In addition to harm reduction, the service also offers access to drug treatment, hepatitis C treatment and smoking cessation – adding to the 20,420 recommendations.

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“Each of these numbers represents an intervention that simply wouldn’t have happened otherwise,” says Day.

“These are people who didn’t seek health care – they’re going to inject drugs. But that number of people then had an interaction with a health service.”

The MSIC is one of two supervised injection facilities in Australia – the other opened in Melbourne in 2018. There are around 120 more worldwide.

Day describes the MSIC model as a “gold standard best practice”.

The researchers believe that the success of MSIC is evidence that there should be more such entities, noting that “good policy, with clear legislation and careful handling of customers within a harm reduction framework, can and does mitigate problems which may be perceived as inherent in the operation of such services.”

“It’s a damn good model,” concludes Day.

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