Description of the Present Policy
The first part of this essay is a description of the present policy – the supervised injection facility (SIF) policy. The policy facilitated the establishment of a medically supervised injection centre (MISC) in North Richmond where users visit and inject drugs under the supervision of clinical officers to ensure safety and hygiene among substance users. North Richmond has a history of major drug abuse problems, which led the locals to protest and lobby for the establishment of a SIF as a way of reducing harm and fatalities in the area. North Richmond is a leading heroin distribution centre because people from all over the state pass through the region due to its central location with two tramlines and eight train lines.
Locals have been witnessing increased instances of drug overdose cases in their neighbourhoods together with ambulance sirens as emergency teams rush to assist the affected individuals. Besides, due to the ever-rising cases of drug abuse in North Richmond, the area is littered with syringes and other unhygienic items, which pose health risks to the locals, especially children. These issues contributed largely to the need to have the SIF facility established in North Richmond.
Under supervised injection policy, drug users can walk into the injection rooms with their drugs of choice and receive clean equipment from the staff members before proceeding stainless booths where they inject themselves safely (Parliament of Victoria 2017b). The involved clinicians are not legally authorised to inject drugs to users. The SIF is not designed to encourage people to start or stop using drugs. On the contrary, the policy has clearly stated objective to reduce harm to drug users and communities where they live in by providing safe places for drug injection and use.
The impacts of this policy on the community include reducing the number of syringes and needles on the streets and traumatic cases of seeing overdosed people lying around. In addition, the policy would cut down the number of ambulance call-outs to attend to overdose cases, thus allowing such public resources to be used in emergency cases, which ultimately improves their utility (Parliament of Victoria 2017b). Similarly, police officers in the region would be available to deal with matters related to law and order as opposed to going after drug users. To the individual users, the policy ensures that the health risks related to drug use are minimised.
For instance, sharing syringes increases the risk of blood transmitted health conditions, such as HIV and AIDS (Rowe & Mendes 2004). Additionally, the policy deals with the problem of overdose, which might lead to fatalities if not addressed in time. Such approaches to drug use have worked successfully in Australia and around the world. For instance, Sydney has one operational SIF. Fitzgerald (2013) argues that SIFs have been successful in countries where they have been implemented and supervised according to the set guidelines.
The injection room policy elicited different opinions from diverse societal quarters with proponents and opponents airing their views concerning the issue. Different government bodies, lobby groups, and individuals have been involved in the debate on the viability and feasibility of this policy as discussed in this next sections of this paper.
Critical Assessment of the Policy Process
The second section of this essay is a critical assessment of the process that was involved in the development of the SIFs policy in North Richmond. Policy development goes through defined processes to ensure that all stakeholders are involved before reaching the final decision on whether to accept or reject the underlying issues. Palmer and Short (2014) indicate that the policy-making process involves different stages, such as the request to address certain problems together with expressions of support.
In the conversion stage, the inputs from the different stakeholders are transformed into decisions and actions, which ultimately lead to specific outcomes (Palmer & Short 2014). The achieved outcomes, in turn, influence the inputs and the policymaking process, thus creating an on-going feedback cycle for measurement and evaluation of any given policy.
The process of this policy started on February 7, 2017, when the Drugs, Poisons, and Controlled Substances Amendment (Pilot Medically Supervised Injecting Centre) Bill 2017 was introduced to the Legislative Council (Parliament of Victoria 2017b). The introduction of this bill was instigated by a coronial investigation into a case involving Ms A, who overdosed and died in a fast-food restaurant. On February 22, 2017, the Legislative Council agreed to refer the Bill to the Legal and Social Issues Committee, which was supposed to report its findings before September 5, 2017 (Parliament of Victoria 2017b).
The committee was expected to consider recommendations made by Coroner Hawkins after investigating the overdose case of Ms A, the nature and extent of the available regulations, and the associated policing policies. After reviewing the bill, on September 7, 2017, the committee released a report detailing its findings (Parliament of Victoria 2017c). The bill proposed the establishment of a SIF at an unnamed location in North Richmond, which would run for 18 months on a trial basis. After the 18 months, the program would be evaluated to establish if the set objectives were met.
The committee gathered evidence from the involved stakeholders, such as medical specialists, organisations, local residents, and outsiders. In addition, the committee reviewed the existing literature on SIFs and visited sites where such programs are carried out. Ultimately, the committee released its report with 11 findings and concluded that the majority of stakeholders supported the establishment of a SIF in North Richmond, even though most of the supporters were organisations based outside the area (Parliament of Victoria 2017b). The concerns of the committee were taken on board when the Victorian government finally approved the establishment of a SIF in North Richmond on a trial basis for 2 years.
A range of arguments and views were raised from both the opposing and supporting sides of this debate. The proponents pointed to the pressing need to establish a SIF in North Richmond as a way of reducing harm to both drug users and the community (Parliament of Victoria 2017b). Key advocacy and lobby groups were involved, and the majority of them supported the proposed policy. Some of the advocacy groups that submitted their opinions included the Yarra Drug and Health Forum, Harm Reduction Victoria, Living Positive Victoria, Victorian Alcohol and Drug Association, Australian Drug Association, among others.
According to Harm Reduction Victoria, “Harm reduction focuses on the safety of the individual, the family, and the community, and in so doing, provides agency to the individual, to families and the community to protect the health and wellbeing of all Victorians” (2017, p. 5). As such, proponents argued that the establishment of a SIF would not promote or reduce the overall drug usage in the area, but it would diminish the detrimental effects associated with drug use. For instance, the streets would eventually become clean because drug users would not litter them with used syringes and other dangerous materials.
The Victorian community had suffered from traumatic scenes of people using drugs openly with others lying unconscious on the streets after overdosing on hard drugs, such as heroin. The proponents also cited that public resources, such as emergency and police services, were being diverted to dealing with drug users instead of focusing on delivering quality and timely services to the community.
Therefore, by establishing a SIF in the area, the police and emergency services would be freed to deal with their core activities for the community to derive maximum utility. On the other hand, substance users would be in a position to inject drugs safely, thus avoiding health risks associated with consuming drugs in dangerous environments, such as street alleys (Parliament of Victoria 2017b). Additionally, such individuals would ultimately get help from the facilities on ways to manage their drug use habits and overcome perhaps overcome such tendencies.
The national, state and local governments supported the establishment of a SIF in the area given the numerous cases of deaths in North Richmond. For instance, in 2016, the area recorded 190 and 116 deaths associated with heroin and ice use, respectively (Parliament of Victoria 2017b). However, the opponents of the policy argued that the demerits of establishing a SIF centre in North Richmond outweighed the merits. The key opponents of the policy included local traders, organisations, and the opposition. According to the policy’s opponents, the establishment of a SIF in North Richmond would facilitate an unparalleled increase of drug users in the area, thus forcing businesses to close down as customers choose to stay away (Victoria Street Business Forum 2017).
Another criticism of the policy was that the proposed location of the facility was close to a school, and thus children would be exposed to drug dealing and consumption. The opposition parties also noted that the proposed policy had many unanswered questions, and thus they opposed it. Some of the contentious issues that opposition parties raised included whether ice users would be accepted into the facility (Parliament of Victoria 2017a).
While the police claimed that ice users would be barred from the SIF, the bill stated that the secretary would decide. The opposition also cited the undefined role of police in the implementation of the policy, limited resources, and unclear program monitoring and assessment guidelines together with incomplete information on the available clinical support (Parliament of Victoria 2017a). Therefore, the Liberals-Nationals in both the upper and lower houses opposed the bill. However, the advocacy and lobby groups influenced the policy debate positively, which led to the approval of the policy and the establishment of a SIF in North Richmond for a 2-year trial period. These groups presented their detailed reasons for supporting the proposed policy by highlighting the benefits of such a SIF in the area.
Critical Assessment of the Policy
This section gives a critical assessment of the policy by discussing the associated positive and negative aspects.
Advantages
One of the main strengths of this policy seeking the establishment of a SIF in North Richmond is the hundreds of lives that would be saved. The Legal and Social Issues Committee established that the area was experiencing high cases of drug-related deaths. For instance, the number of heroin-related deaths had risen by 49.6 per cent from 127 cases in 2009 to 190 in 2016 (Parliament of Victoria 2017b).
Therefore, the presence of a SIF in the area would reduce this number of deaths significantly because substance users would have the opportunity to inject drugs safely. Immediate deaths occur due to overdosing, which is common in North Richmond. The establishment of SIFs in other areas has yielded positive results. For instance, according to Ng, Sutherland, and Kolber (2017), a study carried out in Canada showed that a SIF centre decreased overdose deaths from 253 to 165 per 100,000 persons annually.
Additionally, intravenous drug users admitted to hospital with skin infections reduced from 35 per cent to 9 per cent in 3 years (Ng, Sutherland & Kolber 2017). Similar results were observed at King Cross SIF centre in Sydney. Therefore, North Richmond would benefit from this policy by having lower mortality and morbidity rates related to drug use.
Another advantage of this policy would be the removal of used syringes and other dangerous materials from the streets of North Richmond (Denham 2015). During its review, the Legal and Social Issues Committee established that the streets were littered with materials related to drug use, and they were a health risk, especially to children. The committee members spent 90 minutes walking through the streets of North Richmond, and they came across numerous paraphernalia associated with drug use (Parliament of Victoria 2017b).
However, with the introduction of a SIF in the area, drug users would walk into the facility, get clean syringes and inject themselves with drugs before disposing of the used materials hygienically. Consequently, the streets would become cleaner and safer for the residents (Denham 2015). Children would be in a position to play safely without the fear of encountering used drug-related materials. Similarly, parents would be at peace by knowing that their children are safe on the streets.
The third advantage associated with the introduction of a SIF in the area is the improvement of the welfare of the community. During the policy debate in parliament, Ms Hartland (Western Metropolitan) talked passionately about how people in North Richmond were traumatised due to scenes of people using drugs openly and having to call emergency services for help after encountering an overdose victim (Parliament of Victoria 2017a).
Other residents reported shocking incidents where they found dead bodies on their backyards caused by drug overdose. Emergency health workers decried the high cases where they would be required to resuscitate people in car parks. Therefore, a SIF centre in the area would play a critical role in ensuring the welfare of the community by reducing the harm that non-users face due to the presence of substance abuse in the neighbourhood (Rowe & Mendes 2004).
Additionally, the families of drug users would be saved the agony of having to lose their loved ones to substance abuse. Moreover, public resources would be used in areas where they are needed most. For instance, instead of going after drug users, police officers would concentrate on maintaining law and order for the benefit of the residents. Similarly, emergency ambulance services would be used in other instances where such services would offer the highest returns for the people of North Richmond.
One of the most effective components of this policy is the provision of a gateway through which drug users could access health and social assistance, including treatment, care, and counselling. While the SIF centre does not primarily seek to reduce the overall drug usage in the area, users have an opportunity to get professional assistance as a way of overcoming their addiction problem.
According to Haber and Day (2014), the National Drug Strategy in Australia uses three pillars – demand, supply, and harm reduction to address the problem of drug use and abuse in the country. Drug users would go through three stages after arriving at the SIF centre. In the last stage, users would get an opportunity to interact with other users and healthcare professionals. During these sessions, substance users may be persuaded to reconsider their life choices and seek help to overcome their problems.
Disadvantages
One of the major weaknesses of the SIF program in North Richmond is the fear that it would promote drug usage among the residents. Speaking for the Liberals-Nationals during the debate on the issue in parliament, Ms Wooldridge (Eastern Metropolitan) expressed concerns that by accessing safe injection environments, people would not be compelled to seek help and discontinue the use of drugs (Parliament of Victoria 2017a).
Another key problem with this policy is the lack of a clear definition of the drugs that would be used in the program. Ms Wooldridge noted the controversy on whether ice users would be allowed to visit the facility because the police and the bill gave contradicting information (Parliament of Victoria 2017a). Additionally, the bill contravenes the Australian law concerning the possession and use of drugs. As such, the role of police officers in the implementation of the policy is not well defined, which may cause controversies in the long-term.
While the policy has numerous merits, one of the problems is with the location of the SIF in North Richmond. The proposed location is only a few meters from Richmond West Primary School, and thus parents and other stakeholders are concerned with the possibility of children being exposed to drug use. According to Smith (2016), parents are considering the possibility of moving their children from the school after the opening of the SIF centre in the area.
Another weakness associated with this policy is the closure of businesses in the region with the expected influx of drug users into the area. According to the Victoria Street Business Association (2017), most business owners would consider moving their premises to other parts because the opening of the SIF in the area would affect their operations negatively. The Vietnamese Community in Victoria informed the Legal and Social Issues Committee of the same concerns (Parliament of Victoria 2017b). This community noted that the opening of the facility in the region would entrench a culture of drug use and force family-owned businesses to close their shops on the Victoria Street, which underscores a weakness of this policy.
Change Recommendations
I would recommend several changes to the policy to ensure that all stakeholders support it in a bid to achieve its objectives within the 2-year trial period. The first change is based on the SFI’s proximity to Richmond West Primary School. Children should be protected from exposure to drug dealing and use. Therefore, the policy should address security measures, such as increasing the number of police officers guarding the school for the children’s safety.
In addition, policing along Victoria Street should be improved to ensure that business premises are protected from drug users visiting the SFI. This aspect would ensure that business owners continue with their operations uninterrupted and serve their customers accordingly. I would also support the calls by the Victoria Street Business Association (2017) to have more CCTV cameras installed along the Victoria Street to ensure that lawbreakers are identified and held to account for the safety of everyone visiting or working in the area.
Ms Wooldridge and the opposition raised critical issues that should be addressed through policy changes. One of the concerns was the issue of limited resources to support such programs. As such, I would recommend the government to come up with clear funding strategies and indicate how and where the allocated resources would be used for transparency and accountability. The involved minister should indicate how much the project would cost together by highlighting the source of funding. Ms Wooldridge also questioned the objective of the policy because it does not state the proposed strategy categorically to ensure that users get the needed professional help. It would be counterproductive to provide a safe place for drug injections, without creating a feasible strategy on how to help the addicts to overcome their detrimental habits.
The police also raised concerns on their role in the implementation of the policy. According to Royall, Alison, and Minear (2018), the police questioned how they would be expected to enforce the law on drug possession and usage. For instance, the pertinent issue arising from this statement is whether the police would arrest and charge users for possession of drugs on their way to the SIF. Therefore, I would recommend the inclusion of a clause in the policy to ensure that drug users visiting the facility have some form of identification so that the police can know how to apply the law.
The policy should have a clause recognising drug users as patients that require medical attention. Additionally, the community should be sensitised on this approach of categorising drug users as patients. Consequently, the relationship between police officers/community and the drug users visiting the centre would improve tremendously as the majority of people would be concerned about the welfare of the addicts together with how they can be assisted. I would also recommend a framework to allow on-going discussions with all the involved stakeholders, including government agencies, researchers, health professionals, the community, and the business sector. This approach would create an enabling environment for the adoption of an appropriate and holistic solution that could be used in the long-term to address the problem.
Reference List
Denham, G 2015, ‘Case study of the community campaign to introduce supervised injecting facilities in the City of Yarra’, In Yarra Drug and Health Forum, Criterion, Sydney. Web.
Fitzgerald, J 2013, ‘Supervised injecting facilities: a case study of contrasting narratives in a contested health policy arena’, Critical Public Health, vol. 23, no. 1, pp. 77-94.
Haber, P & Day, C 2014, ‘Overview of substance use and treatment from Australia’, Substance Abuse, vol. 35, no.3, pp. 304-308.
Harm Reduction Victoria 2017, Submission to the Legal and Social Issues Committee Parliament of Victoria. Web.
Ng, J, Sutherland, C & Kolber, M 2017, ‘Does evidence support supervised injection sites?’, Canadian Family Physician, vol. 63, no. 11, pp. 866.
Palmer, G & Short, S 2014, Health care and public policy: an Australian analysis, 5th edn, Palgrave Macmillan, South Yarra, Vic.
Parliament of Victoria 2017a, Legislative Council fifty-eighth parliament first session. Web.
Parliament of Victoria 2017b, Legislative Council – Legal and Social Issues Committee. Web.
Parliament of Victoria 2017c, Medically supervised injecting centre Bill report tabled. Web.
Royall, I, Alison, G & Minear, T 2018, ‘Police raise concerns about role in Richmond heroin safe injection room’, Herald Sun. Web.
Rowe, J & Mendes, P 2004, ‘The politics of illicit drugs’, in J Rowe & P Mendes (eds), Harm minimisation, zero tolerance and beyond: the politics of illicit drugs in Australia, Pearson Education, Frenchs Forest, NSW, pp. 17-23.
Smith, R 2018, ‘North Richmond safe injecting centre opens after mass overdose deaths’, News.Com. Web.
Victoria Street Business Association 2017, Standing committee on legal and social issues. Web.