Medically Supervised Injecting Service / Opioid Replacement Therapy
Richelle Hunt and Brett Worthington
10 July 2023
Recent data shows that Victoria has the higher rates of heroin consumption than other Australian states. In this edition of The Conversation Hour the team explores how to remedy better access to treatment and how much the issue of stigma underpins the issue.
1 May 2023
Exclusive: Proposed amendment would make North Richmond facility permanent and widen eligibility criteria
The Victorian Greens will introduce changes to a government bill in a push to make it easier to open more safe injecting rooms and allow greater access for the “most vulnerable and marginalised” drug users.
The government’s drugs, poisons and controlled substances amendment (medically supervised injecting centre) bill 2023, which will make the currently facility in North Richmond permanent, will be debated and voted on in the upper house when parliament resumes this week.
A trial at the North Richmond facility has saved an estimated 63 lives and safely managed 6,000 overdoses since it opened in 2018.
The Greens say the amendments to the bill are based on the recommendations of an independent review into the facility by the public health researcher John Ryan, which the government relied on when making its decision to make it permanent.
They include changing the wording to allow for more than one medically supervised injecting room to be licensed at the same time.
The Greens upper house MP Aiv Puglielli pointed to a long-awaited report of the former police commissioner Ken Lay, due to be released next month, into the possible location for a second facility in Melbourne’s CBD and said the amendments could prevent the government stalling on opening another facility.
“We’re concerned that if we don’t take this opportunity now with this legislation to get safe injecting right in Victoria, that we will see the government walk away from future rooms in our state,” Puglielli said.
The Greens are also seeking to adjust the eligibility criteria for using the North Richmond safe injecting room, which currently locks out pregnant women, people under the age of 18 and those subject to court orders. People who need assistance injecting drugs would also be granted access to the facility under the change.
The Ryan review – as well as a 2020 review chaired by Prof Margaret Hamilton – recommended expanding eligibility criteria, but the government has emphatically ruled this out.
The Victorian Alcohol and Drug Association’s executive officer, Sam Biondo, said those currently excluded from using the North Richmond facility were some of the “most vulnerable and marginalised individuals in the community”.
“For the life of me I can’t understand why they want to place people at high danger. Through denying these genuinely isolated, marginalised individuals [access], we’re actually losing the opportunity to refer them to other support,” he said.
“Whether that’s treatment, housing, mental health, dental – it’s all the things that make a positive difference to their life and we could find a pivot point for them through that service.”
Biondo said people exiting the criminal justice system were also particularly at risk of overdose.
“Their tolerance level is low, there’s the shock to their system of venturing back into the community and the potential to use in quantities they were previously using which would be sufficient to kill them,” he said.
In 2021 a Victorian coroner recommended the government overhaul the way it supports people who use drugs when they are imprisoned and after their release, following the 2014 overdose death of a man a day after he left the prison system.
The coroner said in the year the man died, there were 220 heroin-involved overdose deaths recorded in Victoria. Of these, more than 40% had spent time in prison and 10 died within seven days of release.
Meanwhile, the opposition and the Liberal Democrats (LDP) are also seeking changes to the bill.
The LDP wants the facility to be able to prescribe the opioid hydromorphone, or Dilaudid, to drug users who haven’t had success with existing treatments such as methadone.
The opposition, meanwhile, wants to ensure safe injecting rooms are located at least 250m from any education or care services. It follows complaints by some community members that the North Richmond facility is currently located next door to a primary school.
The Coalition’s amendments would also seek to boost transparency by requiring regular external reviews every four years, and the release of annual reports.
The opposition is also expected to use question time in parliament this week to grill the government after the release of an anti-corruption watchdog investigation during the Easter break.
The investigation into a $1.4m grant awarded to a union, dubbed Operation Daintree, cleared Andrews and his ministers of corruption but criticised the “increasing influence” of advisers and the centralisation of power in the premier’s office.
Drug Checking (a.k.a. Pill Testing)
17th July 2023
Authorities are being called on to open testing services urgently with a rise in more harmful synthetic – but cheaper – drugs on the market.
The state government should establish drug checking facilities to counter a steep rise in drugs circulating in the community that contain potentially deadly synthetic substances, experts say.
RMIT senior research fellow Monica Barratt said adulterated drugs cooked up in labs were often cheaper to make than the drugs they mimicked.
“Fentanyl and fentanyl analogs have been added to opioids, and are often added to or sold as heroin with devastating death tolls in North America,” Dr Barratt said.
“The reality of supply and demand for drugs means these adulterations and substitutions are going to continue to happen, especially as novel substances are typically more profitable.”
In 2021, the coroner recommended the state government adopt a checking system to tell users what substances their recreational drugs contained.
Dr Barratt, who gave evidence at the coronial inquest that led to the recommendation, said tests could quickly assess the content of drugs.
“Knowing whether drug samples contain unexpected novel synthetic substances gives the community and the government vital information it currently lacks,” she said.
“Drug checking services never tell someone that drugs are safe, they do the opposite. They demonstrate the variable quality across our drug markets and show people that they cannot simply trust claims made by sellers.”
Victorian Alcohol and Drug Association chief executive Sam Biondo said drug checking facilities were needed urgently to forewarn users.
The facilities, if established, would be different to proposals for pill testing at festivals.
Mr Biondo said reporting in the Herald Sun’s recent Narcos series on the global drug trade had highlighted that dangerous synthetic drugs were increasingly common.
Analysis by the coroners court showed 47 people died from overdoses of novel psychoactive drugs in 2021-22, rising from just three in 2017-18.
“As it stands in Victoria, we discover hazardous substances when people overdose, at morgues, or police seizures,” Mr Biondo said. “When we heard about a large fentanyl seizure last year, it had taken six months before the public was informed of this risk. We need something in real time, not six months down the track.
“We need to know about new hazardous substances hitting our shores before people have taken them.”
A spokeswoman said the state government took a health-led approach to alcohol and drug use and its $372m for alcohol and drug services in 2023-24 funded two initiatives that functioned as an “early warning system” to identify emerging harms.
17 July 2023
The Andrews government is being urged to follow the lead of New Zealand and open up drug testing services to combat potentially deadly synthetic substances.
The Victorian government needs to launch its own drug checking services, with experts warning the state is “lagging behind” other jurisdictions.
The calls come as a new report – released on Monday – found the trial of Australia’s first drug checking service, CanTEST in Canberra, helped 437 people reduce their risk of an overdose or poisoning through drug tests.
Of the more than 600 samples examined, just over half were actually found to be the drug that service users had expected.
The Herald Sun last month revealed experts had called for a Victorian-based service to counter a steep rise in drugs circulating in the community that contain potentially deadly synthetic substances.
In 2021, the coroner recommended the Victorian government adopt a checking system to tell users what substances their recreational drugs contained.
RMIT senior research fellow Monica Barratt, who gave evidence at the coronial inquest that led to the recommendation, said Victoria is “beginning to lag behind other jurisdictions”.
“Canberra, and our near neighbours, New Zealand, have successful drug checking services, and Queensland has announced it will support and fund drug checking in the near future,” she said.
“Instead, we find out about local drug trends after the harms have occurred: through analysis of overdose presentations at hospitals, at the morgue or through police seizures.”
RMIT senior lecturer in criminology and justice studies Peta Malins said the report highlighted Australia’s “unpredictable and unregulated” illicit drug markets.
“Victorian Coronial data released last month shows we now have the highest tally of deaths involving novel psychoactive substances on record,” Dr Malins said.
“How high does this number have to be before the government takes action?”
Acting Victorian Alcohol and Drug Association chief Scott Drummond said the services facilitate brief interventions and information to people who may regularly use drugs on how to reduce associated harm.
“These services not only provide the life saving benefit of providing individuals and the community information about hazardous substances, but by changing substance use behaviour they reduce the demand on our overburdened and stretched acute health services such as emergency departments,” he said.