Medically supervised injecting rooms and politics of illicit drug policy

Monash Lens

It’s often presumed that centre-left political parties and governments favour a public health-based approach to illicit drug use designed mainly to save lives and reduce harm to individuals and the community, even if it results in an overall increase in drug use (what is called harm reduction).

  • Philip Mendes

    Professor, Department of Social Work, Faculty of Medicine, Nursing and Health Sciences

In contrast, centre-right political counterparts prefer a law enforcement-based approach that prioritises a reduction in drug use irrespective of whether it results in higher levels of mortality for existing drug users (what is called zero tolerance).

Superficially, this distinction seems to be borne out by the Australian debate concerning the introduction of medically supervised injecting rooms (MSIR), which is a major harm reduction initiative intended to save the lives of existing users.

It was a Labor Party government in NSW led by then premier Bob Carr that introduced the only MSIR in that state, based in Kings Cross, despite initial opposition from the conservative parties.

In Victoria, two state Labor governments led respectively by premiers Steve Bracks (in 2000) and Daniel Andrews sought to introduce an MSIR. The Andrews government finally passed legislation for a trial MSIR in late 2017.

Conversely, the Victorian centre-right parties (the Liberal Party and National Party) have consistently opposed an MSIR throughout those two decades, principally on philosophical grounds.

In the case study that follows, I demonstrate, however, that the Victorian Labor Party’s position on an MSIR has not been linear or consistent, and has in fact veered from support to long-term opposition, and then back to support.

Its perspective has been informed by a number of factors, including harm reduction philosophy and an associated belief in the value of research evidence, a mixture of political expediency and principled politics, and the influence of local community advocacy campaigns.

In the beginning, there was support

The Victorian Labor Party first proposed the introduction of MSIRs in five Melbourne municipalities during the 1999 state election campaign. Its campaign promise was influenced by the large increase in heroin-related deaths in Victoria at that time, rising from 49 in 1991 to 359 in 1999, and projected to increase to nearly 500 by 2005.

On securing government, Labor endorsed a proposal from a drug policy expert committee headed by academic Professor David Penington to introduce an 18-month trial of MSIRs in the municipalities of Melbourne, Yarra, Maribyrnong, Port Phillip and Greater Dandenong.

Speaking in Parliament in support of the proposal, the then premier Steve Bracks argued that MSIRs would be effective in saving lives:

“Overseas evidence is overwhelming. Anyone who has had the opportunity to travel and see some of the facilities and talk to municipal officials, police and other organisations would bear that out…There are 15 supervised injecting facilities in Switzerland, and seven in Frankfurt, Germany. I saw some of the facilities in Switzerland, and to date no deaths have occurred in injecting facilities there. In Frankfurt the number of deaths from overdoses has reduced from 147 in 1991 to 26 in 1997. That is a startling decrease, and on any evidence is a remarkable achievement – an important one for saving lives. In the Frankfurt facilities also, there have been no fatal overdoses to date.”

In a further statement, Bracks reiterated the government’s harm reduction philosophy, emphasising that MSIRs were:

“… all about saving lives. What is happening now is not working in Victoria – we have more than 80 deaths from heroin already this year, and it is escalating … We must do something different.”

In October 2000, following the parliamentary vote to reject the proposed trial, he again insisted that MSIRs were necessary “to reduce deaths, to minimise harm and to restore people’s lives”. As late as March 2001, the government restated its support for MSIRs.

The premier argued that this was a principled, rather than populist position, insisting that the government would continue to support MSIRs even if the proposal cost them electoral support. But the increasingly polarised debate took its toll, as the opposition parties and the Herald Sun newspaper mobilised opposition to any MSIR proposals.

In October 2002, the Labor government formally announced it had dropped the MSIR proposal.

One of the key factors influencing Labor’s policy shift was a sharp decline in the number of heroin-related deaths as a result of a heroin production drought – there were only 11 deaths between January-May 2001, compared to 85 for the corresponding period in 2000.

This decline arguably removed the rationale for radical measures such as an MSIR. But political expediency also played a part. This became evident during the June 2008 byelection in the state seat of Kororoit, when the Labor government employed political scare tactics against the prominent independent candidate Les Twentyman, who was a vocal public advocate of an MSIR.

An ALP election brochure accused Twentyman of seeking to establish an MSIR near local schools, train stations and churches. The brochure read:

“Les Twentyman wants to build heroin injection rooms in your suburb, placing your kids at risk.”

In June 2010, new Labor premier John Brumby reaffirmed the government’s opposition to an MSIR. Further statements both in opposition and again in government from 2011-2016 reaffirmed that position.

However, in October 2017, the Labor government, headed by Daniel Andrews, suddenly announced a plan to establish an MSIR in North Richmond, within the City of Yarra. A pro-MSIR advocate later described this shift from opposition to strong support as a “Damascene conversion“.

Why did the Labor government change its mind?

A number of factors appear to have influenced the government’s policy reversal. Foremost was a renewed rise in heroin-related deaths from 107 in 2012 to 172 in 2015, 190 deaths in 2016, and peaking at 220 deaths in 2017.

The City of Yarra had the highest frequency and average annual rate of heroin-related overdose deaths from 2009-17, including 91 deaths from 2014-18.

A further factor was the recommendation of the inquest by coroner Jacqui Hawkins for creation of an MSIR in North Richmond to reduce the risk of fatal overdoses.

That recommendation explicitly informed the establishment in February 2017 of an inquiry by the Legislative Council into a Pilot Medically Supervised Injecting Centre Bill.

The parliamentary inquiry report, presented in September 2017, reported evidence from Australian (including evaluations of the Kings Cross MSIR), and international research based in Canada and Europe, that MSIRs reduced the rate of drug-related overdoses, moderate risky forms of behaviour such as needle-sharing, and generally enhanced the health of injecting drug users.

An additional factor was the public advocacy campaign conducted by a coalition of organisations and individuals, including the influential Yarra Drug and Health Forum, North Richmond residents led by Judy Ryan from the Residents for Victoria Street Drug Solutions group, the Reason Party’s Fiona Patten, local traders, families of those who had lost close relatives to overdoses, and health and welfare professionals.

That campaign may have persuaded the government that public opinion was now favouring the introduction of an MSIR.

Nevertheless, the principal factor seems to have been political expediency connected to the state Labor Party’s byelection battle with the Greens (who were strong supporters of an MSIR) in the seat of Northcote.

Indeed, the conservative opposition parties (who strongly opposed an MSIR) accused the government of changing its policy solely for political reasons connected to poor polling in the seat of Northcote. This assertion was supported by Herald Sun state political editor Matt Johnston, who argued that there had been dozens of deaths in Richmond for a number of years, but it was only the political threat from the Greens in a number of inner-city seats that persuaded the government to change its mind.

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