AUSTRALIAN SAFE-INJECTION SITE A SUCCESS

When the doors of the English-speaking world's first-ever legal
injection site for drug users opened two years and four months ago in
Sydney, Australia, no one could believe it was real -- least of all
its medical director, Dr. Ingrid van Beek.

And many were uncertain about its future.

But van Beek got a couple of encouraging signs in the first weeks of
operation that gave her faith that it would actually work in the way
that people had hoped.

One was the young man who was the first drug user to come to the site
the day it opened.

He'd never had any contact with health services at all. He just
injected and left the first night, but came back the next day for
referral to treatment.

"He's still there. We had a curious success with that very first
client," said van Beek in an interview from the site this week.

The other small but telling incident happened with
police.

Staff saw two people appear in the site's doorway one night and then
saw them slowly get dragged back by police.

A few minutes later, the two users were back.

Local police, not familiar with the location of the newly opened
injection site, had nabbed the two after seeing them buy drugs nearby.
But when the men turned over their small stash of heroin caps and
explained they were on their way to inject at the site, police handed
the caps back and sent them inside.

"That went around the community pretty fast," said van Beek. And,
after that, there were no more questions about whether the injection
site was really just a trap so police could watch who was going in and
arrest people.

The more concrete signs of success came this spring, after a positive
report from the site's scientific evaluation committee.

Their conclusions:

- - The site was bringing in the kind of street-injecting users it had
been set up to attract.

- - It had likely prevented a small number of overdose deaths, although
the committee emphasized that the main reason for a noticeable decline
in overdose deaths in the previous three years was due to a decline in
the heroin supply.

- - Crime had decreased in the area, although that was also largely
attributed to the downturn in heroin use.

- - Public injections in the area had decreased, as had loitering in the
vicinity of the site. Numbers of discarded syringes also decreased.

- - Drug users who came to the site were more likely to start treatment
for drug dependence than those who didn't.

- - Almost 80 per cent of local residents and 63 per cent of local
businesses supported the establishment of the injection site, while
the proportion of those outright opposed had dropped noticeably in the
18 months of the site's operation.

- - Half of the residents and a third of the businesses didn't even know
where the site was.

Of course, that doesn't mean there is no opposition at all. Just over
50 per cent of people the evaluation team surveyed in 2002 said they
believe the major disadvantage of the site is that it encourages drug
use -- that was an increase from the 45 per cent who said that before
the site opened.

And there has been sharp criticism from some public commentators and
opposition politicians that the amount of money spent to run the site
for the first 18 months -- $4.3 million Australian, including the
costs of legal bills -- is a criminal amount of money to throw away
for so few benefits.

But the New South Wales government had decided, in spite of that, to
extend the trial for another four years. After all, controversy is
nothing new surrounding the site.

There had been years of public debate over setting up a site at
all.

The idea got started in the 1990s after investigations into
drug-related criminal activity and police corruption showed that there
were many illegal shooting galleries operating in the Kings Cross area
of Sydney.

Kings Cross, like Vancouver's Downtown Eastside, has been the
epicentre of the city's largest illicit drug market since the 1960s,
along with prostitution and gambling. Although only five per cent of
the city's residents were located there, it generated 20 per cent of
the ambulance calls for drug overdoses.

The New South Wales government started talking about a trial injection
site in 1997, but it wasn't until 1999 that politicians decided they
would support giving it a try -- despite the opposition of the federal
government. Then there was more than a year of legal battles when the
Kings Cross Chamber of Commerce went to court to stop it from opening.
And the group that had originally planned to manage the site, the
Sisters of Charity, were forced to withdraw under pressure from the
Vatican.

"The whole thing was a saga. By the time we finally opened, we didn't
believe it was going to happen," said van Beek.

In May 2001, shortly after a Supreme Court judge had ruled against the
Chamber of Commerce, van Beek and her staff, now operating under the
sponsorship of Australia's Uniting Church, one of the country's
largest Protestant denominations, were facing a whole new set of problems.

The by-then gigantic entourage of media were so hungry to report on
the opening that one newspaper crew even rented a hotel room across
from the site, which sits among the area's sex-toy shops and strip
clubs, to do round-the-clock surveillance.

Local businesses who had been involved in the court case were still
adamantly opposed and were preparing to set up teams to stand outside
the site and watch who went in and out. A photography business next
door even set up a camera trained on the door.

Drug users in the area had said they were dubious about using the site
because they thought it might just provide a way for the police to spy
on people and then arrest them.

And a change in the local drug scene had resulted in a shortage of
heroin and a move to cocaine, which forced van Beek to change the
rules for the injection site, stipulating that people only be allowed
to inject once per visit.

While she felt obligated to protect both staff and clients from the
consequences of someone on a protracted cocaine binge, she worried
that the rule would drive users away.

In spite of all that, almost 4,000 users visited the site, which is
now open 12 hours a day, for a total of 56,000 visits in the 18-month
trial.

"Most of what we did seemed to work out," said van
Beek.

The media disappeared after the first couple of weeks and, once the
public attention was gone, users started appearing in numbers.

Police, who were one of the licensing authorities for the site, were
cooperative.

"They were a little anxious, but by and large they were willing to
give it a go. The reality was it took the pressure off them and
allowed them to focus on drug supply," she said.

The cocaine users adapted to the new rule, circulating out of the
building and back in again if they wanted to inject. And it actually
ended up benefitting everyone, because forcing them to walk around the
building allowed them to slow down their intake and allowed staff to
monitor them for signs of drug-induced psychosis.

"The policy I thought would drive cocaine users away ended up becoming
a therapeutic intervention."

And, says van Beek, even though it's not her main priority, the site
actually contributed to public order.

"If anything, we cleaned up that place."

SYDNEY INJECTION SITE USERS

Total number of clients 3,782

Average age 31 years old

Average age started injection 19 years old