On the front line of battle: What happens inside the medical injecting centres

It’s the strategy which cleaned up the streets of Kings Cross and helped more than 20,000 drug users seek treatment and this is how it operates.

Behind the frosted windows of what looks like a deserted building in Kings Cross, the lives of drug users are quietly being saved.

Opposite Kings Cross station, identifiable only by the number 66, Uniting’s Medically Supervised Injection Centre (MSIC) is where nurses make sure users don’t overdose, maintain safe needle practices and, ultimately, try to get them into treatment.

In the 20-plus years since it opened, staff have overseen more than 1.2 million drug injections – with not a single one of those resulting in an overdose-related death.

Medically supervised injections centres have faced a fierce backlash over the decades, which is often driven by the fear they act as a “honey pot” and attract drug users to an area they usually would not be.

When the centre was given the green light in the late 1990s then Prime Minister John Howard said it would make New South Wales “the drug capital of the Southern Hemisphere.”

NSW Police watching as friends try to revived two heroin drug overdose victims near Wayside Chapel in Kings Cross, Sydney

Meanwhile in Melbourne, the North Richmond centre has received fierce opposition, due to its location near a school and an increase in anti-social behaviour and discarded outside the centre.

The state’s police union has also abandoned support of a proposal to build a second medically supervised drug injecting facility in Melbourne’s CBD.

But statistics show that in Kings Cross, the injection centre has played a big role in bringing drug issues under a much greater level of control.

Discarded needles and syringes in Kings Cross almost halved when the centre opened more than 20 years ago and ambulance call-outs to overdoses in the suburb have dropped by 80 per cent.

Despite NSW being a world leader in the establishment of medically supervised injection centres, calls for more to be opened are being ignored by the state government.

Following the 2019 ice inquiry Professor Dan Howard handed down 109 recommendations, one of which was the establishment of additional medically supervised injecting centres.

Commission of Inquiry Professor Dan Howard during the 2019 ice inquiry. Picture: Joel Carrett

“The inquiry received evidence that the Uniting MSIC has been proven to be an effective harm reduction measure, delivering a range of positive public health and amenity outcomes,” the recommendation read.

“It facilitates access to social and health services, including treatment supports, for a highly marginalised population that is disengaged from mainstream services.”

Despite the centre stopping more than 10,000 overdose deaths – due to ice or heroin – the state government immediately rejected the suggestion.

Professor Howard, who led the 14-month ice inquiry, said harm minimisation was vitally important, calling it a “scandal that there has been no effort to expand the medically supervised injecting program to other locations”.

The Uniting Medically Supervised Injecting Centre in Kings Cross. Picture: Tim Hunter.

“It seems very strange the numbers are something like 15 or 16 million syringes get distributed through needle and syringe programs by the state every year and the number increases every year but there’s only one medically supervised injection centre in Kings Cross … it just doesn’t make sense,” he said.

“It’s an acknowledgment that people are going to use them to inject themselves but for some reason we haven’t moved on my recommendation that the program should be expanded to other appropriate locations.”

When the centre was opened by Uniting following a state drug summit hosted in 1999, people were using drugs intravenously on the street, discarding needles in gutters and overdosing in plain sight.

A heartbreaking photo taken in the Cross in 1998 showed a woman collapsed in a gutter after using drugs, as her four-year-old son laid in her arms waiting for her to come to. This was the norm, as Kings Cross became the epicentre of Sydney’s drug use.

The Saturday Telegraph was given an exclusive look inside the facility, which is divided into three different stages.

The reception area of the Kings Cross injecting centre. Picture: Tim Hunter.

First a client checks in at a front desk, before walking into a room with open steel cubicles that can fit two people. The cubicles are clean and bright and house a chair and small desk, where a bright yellow sharps bin sits.

Here they are watched and monitored by nurses as they inject their drugs, most commonly ice or heroin. Nurses ensure clients are using sterile needles and monitor them for signs of overdose.

Stage two is likened by staff at the centre to a job as a lifeguard on a packed beach.

“If somebody is going to collapse from an opioid overdose, it can happen very quickly,” MSIC’s operations manager Miranda St Hill said.

“You can be chatting one minute and, a few seconds later, you’re not breathing and you’re on the floor.

“It’s a bit like being a lifeguard on a busy surf beach – you just don’t take your eyes off the waves.”

Will Wood, Referral Coordinator and Nurse, and Miranda St Hill, Operations Manager at the Kings Cross clinic. Picture: Tim Hunter.

And, while working with people who are actively taking drugs sounds like a dangerous task, Ms St Hill said violent situations at the centre are less common than at an average hospital emergency department.

“One of the reasons for that is because people have chosen to come here,” he said.

“Unlike an emergency department, where perhaps you’ve collapsed in the street, someone’s called an ambulance and you wake up with all of this noise and light.”

Another interesting aspect of the centre is that if someone overdoses or becomes violent, it happens in front of other users and staff because of the open-plan set-up, which can act as a learning experience.

The injection bays at the clinic. Picture: Tim Hunter.

Tthe medical supplies given out to clients to use. Picture: Tim Hunter.

Stage three is a space with books, puzzles and a waiting cup of tea, which gives clients the time to interact with staff who can refer them on to health and treatment services.

Since the centre was opened more than 21 years ago, there have been almost 20,000 referrals to health and welfare services.

“One of our jobs in the legislation is to be a gateway for counselling and treatment,” Ms St Hill said.

“That’s the main focus for us.”

Kevin Street battled with a heroin addiction that began in the 1980s. He used the injecting room as a safe space for more than 2600 visits.

It was through the injection centre that he was finally able to seek treatment for his addiction.

“I think it’s pretty safe to say I wouldn’t be here without this centre,” he said.

“I may not be alive and I may not have ever gotten clean.”

Former client Kevin Street was able to seek treatment for his heroin addiction through the clinic. It helped him get clean. Picture: Tim Hunter.

When Mr Street first came to the injecting centre, he said it was the first time in a long time he’d been made to feel respected.

“There was no stigma associated with my drug use. l was a problematic opiate user for three decades, 35 years,” he said.

“You’re shunned by society, everybody thinks you’re a thief or a drug dealer. I was none of those things.

“I came here respected as a person, they didn’t care that I used drugs, they spoke to me, remembered my name, treated me as a person and that made me feel comfortable.”

It was that support that enabled him to finally ask for help and ultimately changed his life.

I knew I wasn’t going to get turned away,” he said.

“I knew that people would sort of go out of their way to help me. And they did.”

Staff and Mr Street at the clinic. Picture: Tim Hunter.

Uniting’s social justice lead Alice Salomon said the MSIC had been proven to save lives and questioned why it faced such severe backlash.

“The service as a stand-alone was really important for what was happening in the Cross 20-odd years ago,” she said.

“But now we know that we just need treatment services that are widely available to people – overdose prevention sites should be just a standard part of health provision located where people are using drugs.”