A clean, well-lighted place for junkies

Posted: Aug 23, 2001 12:00 AM
SYDNEY -- "The English-speaking world's first injection centre" for heroin and other users -- as its spokesman Pat Kennedy called it -- lies across Darlinghurst Road from King's Cross Station. It has no sign. A security guard flanks one side of the unadorned storefront nestled in Sydney's notorious red-light district. A man and a woman carrying a big Coke bottle walk through the door on the side of the building. When they enter the reception area, polite staffers ask them if they've ever visited the centre before. "I'm a newbie," the man happily announces. Before he has time to fill out a form that asks him what "drug/s" he will be injecting -- "heroin, cocaine, speed, benzos, methadone, other (specify) -- and where he spent last night, he is whisked into another room. Earlier in the week, I had heard the centre's director, Dr. Ingrid van Beek, discuss what led the New South Wales government to fund an 18-month trial of "safe, sanitary premises where users can safely shoot up." Her goals, she told those attending a drug conference in Perth, are to reduce overdoses, cut down on the number of HIV and hepatitis infections, increase users' access to health care and other services and reduce the public nuisance problems associated with injecting. Her goals fit with Australia's "harm-minimization" movement. Van Beek argues that the clinic didn't bring junkies to the area because the district had already attracted a thriving drug trade. There were an estimated 100 drug overdose deaths a year there. There have been 36 overdose incidents reported at the Medically Supervised Injection Centre since it opened in May. So you can say the centre has saved lives. (Drug overdoses also are down in the area, although a heroin drought in Australia might take much of the credit for that statistic. The Sydney Morning Herald reported that area needle exchanges had fallen from more than 50,000 in October 2000 to 15,767 in May.) The centre boasts that it has referred more than 100 of its 831 clients to drug treatment and rehabilitation. Thus, the centre offers more than a safe place to shoot up. The bad news is that the premise is BYO (bring your own). Users buy from dealers, and thus continue to subsidize organized crime. You have to ask yourself if it is dangerous to make injecting drugs seem "safe." On the drug-talk circuit, clinics already have an acronym: SIRs, for "safe injecting rooms." Kennedy is adamant, however: "No one has ever said that injecting any drug is safe. We never call it a safe injecting room, but it is safer than shooting up in a dark alley in King's Cross all by yourself." University of Melbourne economist Harry Clarke said at the Perth drug conference that by reducing the risk of shooting up to "zero," SIRs are likely to reduce abstinence. That makes perfect sense. In the drug world, there has long been a line that users have hesitated to cross -- that of using needles. But with the message that needle use can be "safe," that line could dissolve. The centre has been open mere months and already advocates are talking about having the government allow "heroin trials" -- that is, allowing doctors to prescribe heroin. Early this month, Australia's top law-enforcement agency, the National Crime Authority, released a report that said, "Among the many measures worthy of consideration is to control the market for addicts by treating the supply of addictive drugs to them as a medical and treatment matter subject to supervision of a treating doctor and supplied from a repository that is government controlled." That's something you won't hear in the States from the FBI. The National Crime Authority also warned that "law enforcement alone" can't win the drug war. If there weren't a heroin drought in Australia, you'd want to stand up and cheer. But the timing is off. There is a drought, and it too has saved lives. The generals are winning the war and conceding defeat. The worst part about the drug war is that every excuse for a solution has its casualties: Criminalizing drugs wrongly puts productive people behind bars; decriminalizing drugs increases use. "Harm minimization" -- when not thought out carefully -- can turn into a harm bonanza.