Review of the Medically Supervised Injecting Room Medically Supervised Injecting Room Review Panel, June 2020

Review of the Medically Supervised Injecting Room Medically Supervised Injecting Room Review Panel, June 2020 1 To receive this document in another format phone 03 9096 8452, using the National Relay Service 13 36 77 if required, or email the Centre for Evaluation and Research Evidence <[email protected]>. Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Medically Supervised Injecting Room Review Panel, June 2020. In this document, ‘Aboriginal’ refers to both Aboriginal and Torres Strait Islander people. ‘Indigenous’ or ‘Koori/Koorie’ is retained when part of the title of a report, program or quotation. ISBN 978-1-76096-010-0 (pdf/online/MS word) ii Chair’s foreword In June 2018 Minister for Mental Health Martin Foley appointed me to chair a panel to review and provide a report on the trial of Victoria’s medically supervised injecting room (MSIR). Over the almost two years of this review there have been five panel members. The establishment of the MSIR has been challenging for many: North Richmond Community Health (NRCH) (the licensee), local residents and businesses in the area, government officials responsible for implementing and overseeing the trial and other health and emergency services, and housing, legal and social support services in the area including the Yarra City Council. It has required police to adapt and attend to law enforcement in the context of a novel service. This report describes the background of the government’s decision to respond to an increasing number of heroin overdose deaths in Victoria by trialling a medically supervised injecting facility. We are aware from media and Hansard records that, prior to the trial, supporters were hopeful that the facility would save lives and reduce harms associated with overdose. We also understand there were concerns raised, largely focusing on the location of the facility adjacent to a primary school, perceived risks of allowing injection of methamphetamine in the facility and the impact of the facility on existing NRCH service users. I congratulate NRCH and others associated with establishing the MSIR on getting the facility operational in a relatively short time. Many people have taken the opportunity to tour the facility, including health and support service professionals and local residents, businesspeople and interested bystanders, and almost all have commented positively on the professionalism, care, knowledge and skill of the staff and the quality of their delivery of a safe and supportive service. People who inject drugs are typically suspicious of government service systems, so it surprised even staff that so many began attending on the first day the MSIR opened. This is likely a tribute to the relationship that the NRCH had built with the target population over many years, especially through its harm reduction services. The operations and impact of the MSIR is the principal focus of this review, but it is only one part of the response to drug use in North Richmond. My experience in the alcohol and drug sector over many years has shown me the complexity of such an endeavour and the requirement to attend to the needs and sensitivities of the local community. During this review, panel members regularly walked around North Richmond, consulted with local groups and attended and observed community gatherings of people interested in the MSIR. Reactions to its establishment have been mixed. There were high expectations that the opening of the MSIR would resolve previously identified problems linked to the sale and use of drugs in the area. Attitudes and understandings have fluctuated among local people over the time of our review, influenced by people’s direct observation and experience of living and working in the vicinity and possibly also by media reporting of activity associated with the MSIR. It is likely that this coverage has also acted as an advertisement for people seeking heroin. Local people, businesses and other services have provided valuable insights. They have presented their stories, data, experience, thoughts and suggestions. These local people care about and want the best for their locality and their community. iii Almost all the community groups that have engaged with the Panel have supported the intent to provide a safer place for people who inject drugs, even though many have expressed concerns about troubling incidents or about people congregating in the area. Some residents have proudly invited Panel members to visit the cleaned-up areas of their housing estate. Some residents have said it is worse. Sorting the different perspectives has been a challenge for the Panel. Further plans and actions of government and the local council including the precinct and social housing initiative to address amenity began in a visible way sometime after the opening of the original facility. The Department of Health and Human Services reports improvements to security, lighting, drug outreach services, cleaning, sweeps and collection of used needles, along with a more visible police presence. However, by the end of 2019 these initiatives were not especially evident. It will require more time to sort out whether the negative impacts of an active drug market in this local area can be ameliorated. As detailed in the terms of reference for this review (Appendix A), the Panel was required to develop the review scope, structure and data and evidence collection requirements with the Department of Health and Human Services and to: ▪ review data and evidence to closely monitor the objects of the Drugs, Poisons and Controlled Substances Act 1981, Part IIA ▪ provide the Secretary to the department with a draft copy of the review to inform a decision on whether the trial should be extended ▪ provide an endorsed review to the Minister for Mental Health before the end of the two-year trial. This is the report of our findings on the first 18 months of the MSIR project implementation. We have been supported in this by a team of skilled evaluators from the Centre for Evaluation, Research and Evidence in the department. I thank all who have supported the Panel’s efforts to better understand the experience of those in the area and beyond. I especially recognise and thank the staff of the MSIR for the care they provide to service users. Many service users talked with us about their positive experiences. A small number of other people who inject drugs have explained their reasons for not using the MSIR. These stories have been confronting at times for Panel members and yet important in contributing to the views of the Panel expressed in this report. It has been a privilege to work with my fellow Panel members: Associate Professor Alex Cockram, who contributed especially to the approach to our review (until her resignation early in 2019 to allow her to take up a role as Commissioner in the Royal Commission into Victoria’s Mental Health System); Mr John Ryan, with experience of drug-related harm to communities and harm reduction services that included a perspective on overseas injecting facilities; Mr Ken Lay AO, APM, the former Chief Commissioner of Police, who was an active member of the Panel from May 2019 until late January 2020, contributing his experience and insights into crime, law enforcement and emergency services relevant to the operation of the MSIR (Ken resigned to take up the Chair of Bushfire Recovery Victoria in January this year); and Associate Professor Ruth Vine, an experienced senior psychiatrist and health service leader, who joined as a member in January 2020 to provide a medical and mental health perspective. All members participated in site visits, consultations with staff, service providers, community groups and facility users. I have appreciated their engagement, wise counsel and sharing of ideas through debate and discussion. iv Professor Margaret Hamilton AO Acknowledgements Government departments and Department of Premier and Cabinet agencies Department of Health and Human Services Coroner’s Court of Victoria Victoria Police Ambulance Victoria Department of Education and Training Metropolitan Fire Brigade Crime Statistics Agency Yarra City Council Mayor, chief executive officer and staff North Richmond Community Health Management, staff and needle syringe program clients Medically Supervised Injecting Room Management, staff and service users Community members Residents Business representatives Homeless people spending time in Richmond MSIR Residents Action Committee Residents for Victoria Street Drug Solutions Victoria Street Business Association Content input Alcohol and Drug Foundation ACSO-COATS Australasian College of Emergency Medicine Australian Medical Association cohealth Fred Hollows Foundation Harm Reduction Victoria Hepatitis Victoria Fitzroy Legal Service Kirby Institute Metropolitan Fire & Emergency Services Board North Western Melbourne Primary Health Network Richmond West Primary School Royal Australian and New Zealand College of Obstetricians and Gynaecologists Royal Australasian and New Zealand College of Psychiatrists St Vincent’s Hospital Melbourne v Sydney Medically Supervised Injecting Centre Uniting NSW.ACT, Uniting Vic.Tas, and UnitingCare ReGen Victorian Drug and Alcohol Association Windana Drug & Alcohol Recovery Inc. Women’s Alcohol and Drug Service Victorian Aboriginal Health Services Victorian Aboriginal Community Controlled Health Organisation Yarra Drug and Health Forum Youth Support and Advocacy Service Technical input ANZSOG Burnet Institute Centre for Evaluation,

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