ON THE RIGHT TRACK?

Safe Injecting Rooms For Drug Users Are Successful In Europe. Sian
Powell Looks At How The Idea Could Work Here.

EARLY in the frosty winter morning a crowd begins to gather outside Niddestr
49, an anonymous building in downtown Frankfurt. Stamping their feet on the
freezing pavement and exhaling white clouds of warm air, they're waiting to
do something that is as yet unknown in Australia: to walk in, sign on with a
nickname or initials, receive a new needle and syringe and an alcohol swab,
and await their turn to shoot up in peaceful and hygienic surroundings.

When Jo Kimber visited six government-run safe injecting rooms in
Germany late last year, she was impressed by how friendly relations
were between the staff and the drug users, and how smoothly everything
functioned.

"The feeling in most places was positive rather than negative," says
the National Drug and Alcohol Research Centre researcher.

"They are more than just places to take drugs -- they provide all sorts
of services and support, such as a cafe with cost-price food and
drinks, needle and syringe exchanges, counselling, primary medical
care, washing machines and dryers, showers, and clothing pools."

Many Australians would recoil at some of the mechanics of injecting
centres: the screened-off corner in the injecting room itself which
allows women particularly, to inject in the groin; the mirrors hung in
strategic places to assist those who want to inject into their necks;
the sheer number of drug users who need medical care for abscesses and
collapsed veins. But Germans generally have a far more pragmatic view,
and have long recognised the twin benefits of getting addicts off the
streets and keeping them as healthy as possible.

Now, with today's Uniting Church announcement that a site has been
chosen for the 18-month injecting centre trial approved by the NSW
parliament, it looks as though Australia will soon take its place
alongside the three nations that have sanctioned injecting rooms:
Switzerland, Germany and The Netherlands. Spain, too, late last year
announced it would open an official injeeting room in the near future,
and the idea has been mooted in Austria.

In 1998, 737 Australians died of heroin overdoses -- injecting room
advocates are hoping for a reduction in those numbers; even though
only one injecting room will be open in Sydney, and for only seven
hours a day.

Certainly, the Australian public seems doubtful about the benefits of
safe injecting rooms: the 1998 Drug Household Survey of more than
10,000 people found only one in three Australians supported the idea.
A more finely focused survey of 300 residents in Kings Cross in 1997
and 1998 found about seven in 10 were in favour (with a slight
increase in 1998).

The first injecting rooms in Germany, which opened in 1994, also met
with some opposition, but the significant decrease in fatal overdoses
and the noticeable decline of the "open" drug scene on the streets -
addicts publicly injecting heroin - swung public opinion around.

There are now 13 official injecting centres, or Gesundheltrsraume
(health rooms), in Germany, and more are in the pipeline. All are
funded, at least in part, by local authorities and run by
non-government organisations in consultation with the community and
the police, and none has ever had a fatal overdose on the premises.

Statistics complied by the George Soros-funded Lindesmith Centre in
the US paint a clear picture of the German success. Fatal overdoses in
Frankfurt declined from 147 in 1991 to 26 in 1997.

Switzerland introduced injecting rooms when it became clear in the
1980s that the drug-using population was being ravaged by HIV.
Established in the German-speaking cities of Zurich, Bern and Basel,
the injecting rooms have improved the health of drug users, according
to a paper by Wouter de Jong and Urban Weber published in the
International Drug Journal last year,

These experts concluded that the Swiss safe injecting rooms were good
for the health of drug users, reduced the presence of syringes on the
streets and decreased the prevalence of unsafe sex. Much the same
benefits occurred in Germany, they found, with a reduction in fatal
overdoses.

It is the irrefutable benefits illustrated by statistics such as these
that have persuaded the religious establishment to take part in the
safe injecting room projects both in Victoria and NSW.

When the Vatican forced the Sisters of Charity to pull out of running
the Sydney injecting room last year, the Uniting Church stepped into
the breach. The Uniting Church's Rev Harry Herbert said details of
exactly how the premises in Kings Cross would be laid out and the
services that would be offered had yet to be finalised.

Herbert recently visited Melbourne, where the Wesley Mission has an
inner-city safe injecting facility just about ready to go. The Mission
is waiting for the go-ahead from the Bracks Government, which in turn
has asked an expert committee to look at ways of setting up the safe
injecting rooms project. Once the nuts and bolts are sorted out it
seems likely the Government will ask the Wesley Mission to take on one
of the five proposed injecting centres.

Wesley Mission Victoria managing director Judy Leitch says the church
has been working on the Melbourne project for 12 months now, and is
committed to alleviating the plight of drug users: "Last year there
were 350 fatal overdoses in Victoria," she says. "It's escalating -
every year there's more."

The Wesley Mission centre will have enough space for six addicts at
once to be injecting in the injecting room; Herbert thinks places for
10 would be more suitable in Kings Cross. Niedestr 49, by way of
comparison, has places for 12, and accommodates more than 400 visits a
day.

Despite the Wesley Mlssion's head start, Australia's first injecting
centre might open in Canberra. In the ACT, the injecting centre
legislation has been passed and a committee recently appointed to
investigate ways and means. Many in Government circles expect an
injecting centre to be operational in the nation's capital by mid year.

For the Sydney injecting centre, Herbert envisaged a workstation type
of arrangement, with hygienic stainless steel surfaces and hard
flooring. "The injecting room would be like an operating theatre, with
easy clean surfaces and no edges," he says. A cafe would probably be
part of the centre, and rules would be developed.

Professor Ian Webster, chair of the Alcohol and Other Drugs Council of
Australia, says agencies have to provide a service drug users found
acceptable. "You might build the most pristine place, but unless it's
something they accept, they won't use it."

The important thing is to keep the users alive: many drug users grow
out of the habit, he says. The paradigm has remained much the same for
years: one-third of heroin users die, one-third grow out of it, and
one-third remain dependent on one substance or another. It is hoped
the introduction of an injection room will change those fractions,
keeping, addicts alive by preventing fatal overdoses.

Most heroin overdose deaths in NSW over a five-year-period occurred in
Sydney, and 20 per cent of all deaths occurred in or near Kings Gross,
with 15 per cent, in or near Cabramatta. Well over half of the
Cabramatta and Kings Cross overdose deaths were in a public place. The
provision of a safe injecting room, then, should drag the numbers of
fatal overdoses down, at least in Kings Cross.

A SURVEY by the National Drug and Alcohol Research Centre of 200
injecting drug users found that addicts who frequently injected in
public places were more likely to have overdosed in the preceding six
months.

Australian drug users are likely to use safe injecting rooms providing
their anonymity can be guaranteed and the level of intervention
remains low.

Another recent survey, conducted by Turning Point Alcohol and Drug
Centre in Victoria, found that nine in 10 injecting drug users knew
about safe injecting rooms, knew they would be safe and secure, knew
there would be no police present, and that medical staff would be on
hand. Almost eight in 10 said they would be willing to use a safe
injecting room.

The addicts are in favour, much of the medical establishment is in
favour, the Uniting Church is willing to take on the project: all that
is now required is an unhindered trial. Australia led the world in the
provision of needle and syringe exchanges, and as a result the
incidence of HIV among injecting drug users here is remarkably low in
comparison with the rest of the world.

Webster believes that there is a critical mass of researchers doctors
and activists involved in the drugs problem in Australia, and as long
as the project proceeds as planned. It is possible that Australia
could again lead the world -- at least the English-speaking world -- in
the development of pragmatic and humane drugs policies, which includes
the provision of injecting rooms.