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Australian style harm reduction

by Antón Castellanos Usigli, December 7, 2014

According to the World Health Organization, there are more than 16 million people who inject drugs; 3 million of them live with HIV. Given that drug use is mostly penalized, the great majority of these persons can not access quality health services.


In very few countries, there are sites where medical supervision is provided for a person to inject drugs with sterile needles and syringes (preventing the contagion of diseases such as Hepatitis C or HIV), without the risk of dying from an overdose and without being judged. A month ago, I visited the only facility of this type that exists in Australia (and in the whole Southern Hemisphere): the Medically Supervised Injecting Centre (MSIC) of Sydney, located in Kings Cross.


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Antón Castellanos Usigli & Marianne Jauncey

I arrived one morning to meet Marianne Jauncey, the Medical Director of MSIC. After entering, the receptionist thought I was another client and with a big smile she asked me if it was my first time at MSIC. I explained to her that I was there to visit Marianne, we laughed and she allowed me to enter. The first thing I told Marianne was that my first impression of MSIC was that it was a very friendly place. In the walls that surrounded the administrative offices of MSIC at the top floor of the building, it is written: “As a compassionate and pragmatic harm reduction service we commit to these core values: Human Rights, Social Justice, Community, Integrity, Courage, Dignity”.


Each day, MSIC welcomes around 220 visits; most of the clients are very marginalized, such as homeless people or freelance sex workers. When the client arrives to MSIC, he has to give a unique identifier code for the receptionist to access his electronic profile, where they keep a record of the drugs that the person consumes and the frequency of consumption.


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The booths where people can inject drugs

After passing through the reception desk, the person enters to the booths where he can inject his drug. It is important to note that the client comes in with his own drug, and MSIC only provides the sterile needles and syringes that the person needs to inject in one of the booths, which are always perfectly cleaned. Two or three nurses supervise the people who inject at the booths all the time. They ask them if they are ok or if they need something. If they notice that a person is experimenting an overdose, they immediately administrate oxygen or naloxone, a medication that counters an overdose caused by opiods (like heroin or morphine). In general, the personnel from MSIC treats one overdose per day, which means many lives saved per week, month and year!


After injecting, some clients can stay for a longer period of time in a living room, where they can talk, draw, drink water or milk. For the person who needs it, an emergency psychological service is available. The MSIC also makes referrals for psychological or medical services.


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The needles and syringes provided to the clients

Apart from the friendly attitude of all the MSIC staff, they all have a great passion for providing attention to the health of the people who inject drugs. While talking with me, Marianne Jauncey referred to the chains of harms that are associated with certain behaviors, and that can be easily treatable or preventable. “In reality, it is not the actual drug what kills the person, but an overdose, which can be perfectly treatable”, said Marianne.


The obstacles to break these chains of risks are the prejudices and stigmas towards a specific population or behavior. The MSIC demonstrates that a simple friendly attitude directed to harm reduction, can have an extraordinarily positive impact in the health of an individual and society. If MSIC hadn´t been established back in the year 2001, dozens of people would still be injecting in the streets of Kings Cross and dying from overdosis in dark alleys without anyone helping them.