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Injecting room recognises what life is like in the real world

A/Prof Yvonne Bonomo – The Age
June 2020

For the entirety of my 23 years at St Vincent's Hospital Melbourne, when a person unintentionally overdosed in the city's inner east they have generally been brought to us for emergency care and treatment.

23 years. Thousands of people. All ages, backgrounds, ethnicities. Sometimes we'd see the same faces return again and again.

We'd patch them up, try and engage them in treatment, but often the next time we'd see them was in our ED once more: another overdose, another close brush with death.

And then, suddenly, we might never see them again.

The loss of life to intravenous drug use prior to the beginning of Melbourne's Medically Supervised Injecting Room (MSIR) was a tragedy on a grand scale. Preventable tragedy.

We know these deaths were unnecessary because we now have the evidence from the independent review of the two-year MSIR trial, which has confirmed the service has been instrumental in saving lives – at least 21 – and safely managing 3,200 overdoses, 271 of them "extremely serious", and with not one fatality.

There's no question that, because of the MSIR, people who previously would have overdosed and risked losing their lives in a deserted laneway have received quick medical help – first at the injecting room, then at St Vincent's Hospital.

But for us, the MSIR has always been about far more than harm reduction.

St Vincent's Hospital Melbourne has a long and proud history in alcohol and other drug treatment. We founded Australia's first ever department of addiction medicine. Supporting people with alcohol and drug dependence is part of our DNA.

As such, we've always seen the MSIR as a potential first stop in a pathway towards treatment and hopefully rehabilitation. A vital piece of a much bigger health picture.

That's because through the MSIR we've reached a group of vulnerable patients that otherwise wouldn't normally engage with a health service.

And once a connection has been established, we've been able to work with them on a whole range of health issues – including infectious diseases such as Hepatitis C – as well as connecting them with specialist addiction treatment.

The MSIR hasn't been perfect. There remain pockets of understandable and genuine concern in the local community about its presence. That's why we welcome the Victorian government's announcement of $9 million in neighbourhood renewal and community projects for the area.

But the Victorian government deserves credit for its Damascene conversion in 2017, reversing its longstanding opposition to an MSIR to become its chief proponent.

It also hasn't let itself be sidetracked by issues that emerged over the last two years that, while a cause for concern, didn't undermine the central benefits of the service. It focused on the results and the evidence. But there is still work to do.

As a sign of our faith in the MSIR, St Vincent's Hospital Melbourne provided seed-funding for several clinical roles at the facility – in infectious diseases, mental health, and wound care – but that funding wraps up in December and so those important positions are at risk of disappearing unless sustainable backing is secured.

These are absolutely crucial health services and we encourage the government and the Health Department to support these roles beyond the end of the year.

And while it's promising to see the government's commitment to tackling drug issues by announcing a second MSIR, I'm sorry to report that on the whole the state's alcohol and other drug treatment services – as across Australia – are overwhelmed by demand and dogged by poor planning, service fragmentation, and insufficient workforce development. That must change.

Opponents of the MSIR have spent the last two years wishing it away without offering an alternative response.

But as an addiction medicine specialist, I live in the world as it is, not how others might wish it to be. People are complex. Lives are messy.

People struggling with addiction to alcohol or other drugs often continue to use and endanger their lives, even when they have lost everything: their job, their health, their families, and their freedom.

The MSIR is a service that recognises what life is like in the real world.

And as long as the MSIR is saving lives, then St Vincent's Hospital Melbourne has a chance to turn them around.

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