Discuss the arguments for and against the availability of Safe Injecting Rooms.
The risks caused by injecting drug use pose a major public health problem both to injecting drug users and to the wider community. By looking at the arguments for and against the establishing of injecting rooms in any community, especially in Australia, issues are raised that must be considered in any effort to combat the problem of drugs in society. There is public agreement that injecting illicit drugs is a risky activity no matter where or how it is undertaken. Arguments for the availability of safe injecting rooms believe that even though these facilities may not eradicate drug taking, they can make the process less harmful to both the drug users and the public and thus can be a beneficial strategy in the war against drugs. However, the argument against considers injecting rooms as an unnecessary and potentially harmful entity by sending out a misleading message about society's tolerance of drugs, as well as continuing to expose addicts to the risk of overdose and other health problems.
Even supporters of the availability of injecting rooms to injecting drug users (IDUs) are quick to point out that the provision of these facilities are only to make it safer, because this activity can never be safe. These venues are provided and supervised by health and welfare organisations for the use of injecting illicit drugs. The main aims of injecting rooms are to reduce the harm experienced by IDUs through reducing the risk of fatal overdose and the transmission of blood borne viruses, as well as reducing the public nuisance of drug users injecting in public places. These aims are to be fulfilled through services such as the provision of sterile injecting equipment and paraphernalia and the provision of means of safe disposal of injecting equipment. The benefits of these two examples are obvious - the former aids in controlling the risk of the spread of diseases such as HIV/AIDS and Hepatitis C, both of greater prevalence among IDUs than in the non-injecting population, and the latter protects not only IDUs but also the public for which needle-stick injuries is a health scare.
Injecting rooms are attended to by trained personnel who can provide assistance in case of overdose. An 18 month Australian trial was recently opened in Kings Cross, and in the first week a young man collapsed after shooting up in the facility because he had not used heroin for a few weeks and had a low tolerance. The nurse unit manager who was able to resuscitate him with oxygen saw this as a prime example of "the sort of person we've been looking for, a person at that kind of risk" (Williams, 2001, p.9). If the condition of the IDU is more serious than the staff can handle, they can now provide ambulance officers with a known location, leading to faster response time and greater chance of survival. It also benefits the occupational safety and health for ambulance officers.
Staff at the injecting room look for opportunities to advise users on less harmful methods of drug use. IDUs account for 90% of Hepatitis C cases (Wodak, 1997) as this is contracted through blood-to-blood contact, which can happen through the sharing of infected needles. For a significant reduction in Hepatitis C cases, drug users should be encouraged to adopt non-injecting routes of administration. A counsellor working in the Australian trial sees the injecting room as a fantastic opportunity to teach drug users about the risks of blood borne viruses and assisting them into treatment (Williams, 2001) and believes that because IDUs meet these workers on territory that allows them to inject in a non-judgemental environment, they are then more likely to follow through on any treatment they agree to.
Injecting facilities are established as part of a strategy of harm minimisation and as such work to reduce the harm associated with injecting drug use, not to reduce the levels of drug use. Those who protest against the founding of these facilities believe injecting rooms do not help IDUs. They question the motives of the proponents of harm minimisation, unsure of whom the scheme really benefits: the bureaucrats who are hoping the problem of drugs might then go away, or the community who are tired of drug users who are considered public nuisances, as it appears not to benefit "the addicts where it is a case of out of sight, out of mind" (NSWCC, 1998).
Another fear that people have against the establishing of injecting rooms is that the drug trade will only benefit and increase in relation, as dealers and pushers will know where to go to target those who are looking for drugs so they can then go into an injecting facility to shoot up. This is seen as "aiding in the commission of crimes" and "facilitating illicit drug trafficking" (Riley and Humphries, 2000) and the NSW government has had to reassure the public that the trial being run in Kings Cross is not breaching any drug treaties signed by Australia (Riley et al, 2000). However, the fact remains that injecting drug use is illegal and for the trials to be run, the facility has to be protected from the law. At the same time, to be successful and keep the drug trade from booming in the areas around the facility, police would have to protect the very facility that is allowing illegal activity to continue!
One area of dispute in the argument for and against injecting rooms is the information that has been published about trials in Switzerland, Germany and the Netherlands. Those for the establishment of injecting rooms have used news such as Swiss injecting rooms not having one fatal overdose since they were established 10 years ago (Wodak, 1997) or that the rate of fatal overdoses in Frankfurt, Germany went down from 150 to 30 within four years of opening injecting rooms (ADF, 1998) as evidence that injecting rooms beneficial. Those against take care to point out that any fatal overdoses that happen to IDUs who inject their drugs in a injecting facility but do not collapse until outside the facility are not counted (Muehlenberg, 1999) and that although the rate of fatal overdoses has reduced, many users are continuing to inject drugs without any thought of quitting their habit. Also, the situation in Europe cannot be directly applied to Australia and so any evidence from the overseas trials should be approached carefully. For example, in Amsterdam certain drugs considered illicit here are legal there and are much more easily obtained and as such the injecting facilities are dealing with different conditions.
Another worry involved in the founding of injecting facilities is the mixed messages it may be sending to the youth in society (Wodak, 1997) as it seems that the existence of such a facility says that society approves of drugs by making somewhere comfortable, secure and legal for them to inject drugs; yet at the same time the government continues to pay for advertisements that tell the youth of Australia to not be involved in drug use. It sends messages to existing addicts that society feels it has failed in trying to help them quit and has given up by allowing them to have places where they can freely indulge their habit (NSWCC, 1998). Those opposing injecting rooms sees the founding of these injecting places as comparable to building more pubs for alcoholics, and serves only to create life long addicts who risk dying every time they inject illicit drugs (Muehlenberg, 1999).
Those against setting up injecting rooms believe the biggest flaw of the argument of those for injecting rooms is that they pose two alternatives only: would society want addicts injecting in dirty back alleys rather than in clean injecting rooms? (Muehlenberg, 1999) When faced with this decision, it is obvious that people would rather have injecting rooms for the health of IDUs and their own. However, those against injecting rooms believe that there is a third option - not taking drugs at all. They believe that programs of education, treatment and rehabilitation for addicts and harsher law enforcement against dealers will be adequate in combating the problem of drugs in society. Realistically it is hard for all addicts to quit and
go into rehabilitation without an intermediate step and there are those who believe that injecting rooms can fulfil this purpose.
In conclusion, it can be seen that both arguments are based in fact and have the welfare and best interest of IDUs at heart. Those for the establishment of injecting rooms are correct in stating that these facilities can help make the process of injecting illicit drugs safer and cleaner and thus better for the health of IDUs, and are a starting point for counselling and treatment of IDUs who wish to quit their habit. Those against injecting rooms are also right in noting that injecting drugs is an illegal activity and one that continues to be dangerous to addicts even when supervised in sterile conditions due to the detrimental effect of drugs on the human body. However, if the issues raised by both sides can be considered objectively with a view to helping IDUs to first lower the deaths through overdose then to gradually stop them from continuing their damaging habits, then a comprehensive solution may be found that can incorporate injecting rooms as a response against drugs in the community.
Australian Drug Foundation (ADF), ADF Position on the Provision of Injecting Facilities, 1998, http://adf.org.au/inside/position/injec.htm
Muehlenberg, B., Christian Compassion and Injecting Rooms, 1999
Mundy, J. (1996/1997) "No Place to Go" Connexions 16(6) pp. 4-8
NSW Council of Churches (NSWCC), "Heroin Shooting Galleries?", July 1998, http://www.pastornet.net.au/jmm/aasi/aasi0092.htm
Riley, M. and Humphries, D., "Injecting Rooms a Crime: UN", Sydney Morning Herald, February 24, 2000, p.1
Williams, S., "Heroes and Heroin in the Kings Cross Needle Room", The Sun-Herald, May 13, 2001, p.9
Wodak, A. (1997) "Issuing Forth" Centrelines Magazine 29 p.2