Full text of DOI:10.1111/j.1467-842X.2000.tb00507.x

Brief Report
Preference to have used a medically supervised
injecting centre among injecting drug users
in Kings Cross, Sydney
Abstract
Ingrid van Beek and Stuart Gilmour
The Kirketon Road Centre, New South Wales
Objective: To assess factors affecting
preference to have last injected in a
medically supervised injecting centre
(MSIC) among injecting drug users (IDUs)
attending a needle syringe program (NSP)
in Kings Cross, Sydney.
he NSW Drug Summit, an initiative day period in August 1999 were asked by
of the NSW Government held in staff where they last injected, whether they
T
May 1999, was a landmark in injected alone or in the presence of others
public discussion of illicit drug use. One of and if they would have preferred to use an
the 172 resolutions passed by the summit MSIC. Clients were also given an opportu-
was that a medically supervised injecting nity to provide reasons for their preference,
centre (MSIC) be trialled.1 It was subse- which were also recorded.
Methods: All NSP attenders over a two-
day period in August 1999 were asked
where they last injected, whether they
injected alone and if they would have
preferred to use an MSIC. This was in
addition to the routine data collected,
which included age, gender and last drug
injected.
quently decided that this trial would be
undertaken in Kings Cross, Sydney.
Staff administering the survey described
an MSIC as being a legally sanctioned
The aims of the MSIC are to reduce fatal premises where drugs could be injected. ‘Pri-
and non-fatal drug overdose, reduce trans- vate’included home, hostel and refuge situ-
mission of blood-borne infections such as ations while ‘public’ included street, public
HIV and hepatitis B and C, increase inject- park and public toilet situations.
Results: Among the 178 respondents, 52
(29%) last injected in a public place and
77 (44%) last injected alone. Seventy-one
per cent of all respondents would have
preferred to use an MSIC. Of those who
injected in public, 83% would have
preferred to use an MSIC compared to
66% of those who injected in private,
which was significant (p=0.03). Age,
gender, last drug injected and having
injected alone did not affect preference to
use an MSIC.
ing drug users’access to drug treatment and
This information was provided in addition
other health and social welfare services, and to the routine data collected for all attend-
reduce the discarding of needle syringes in ances at K2, which included age, gender and
public places.
last drug used. A pilot survey conducted the
To inform planning of the MSIC, the previous week enabled possible ambiguities
Kirketon Road Centre (KRC) surveyed in- in the questions to be identified and
jecting drug users (IDUs) attending its sat- removed.
ellite needle syringe service, K2, located at
Data were analysed using SAS 6.12 for
the epicentre of the street-based sex work Windows. Chi-square tests were used to
and drug scene in Kings Cross, to assess fac- compare proportions.
tors affecting preference to use an MSIC. It
Conclusions: Respondents’ high
preference to use an MSIC suggests that it
may well achieve its public order and
public health objectives.
was anticipated that IDUs who usually in-
Results
jected in public places and/or alone would
most prefer to use such a service because
injecting in public and/or alone is a known
risk factor for fatal and non-fatal drug over-
dose2,3 and public injecting often occurs in
circumstances not amenable to safe inject-
ing and may also attract police and commu-
nity attention.
Over the two-day period, 198 individual
IDU clients attended K2. Of these, 178
(90%) answered the survey. There were no
significant demographic differences between
those who answered the survey and those
who didn’t.
Implications: An MSIC may significantly
shift current patterns of illicit drug use in
Kings Cross, the community impact of
which should be monitored and managed.
(Aust N Z J Public Health 2000; 24: 540-2)
Among the 178 survey respondents, 52
(29%) last injected in a public place and 77
(44%) last injected alone. IDUs’age, sex and
last drug used were not related to place of
last drug injection or whether they injected
Methods
All IDU clients attending K2 over a two-
Correspondence to:
Submitted: January 2000
Revision requested: April 2000
Accepted: August 2000
Dr Ingrid van Beek, Kirketon Road Centre, PO Box 22, Kings Cross, New South Wales 1340.
Fax: (02) 9360 5154; e-mail: VanBeekI@sesahs.nsw.gov.au
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2000 VOL. 24 NO. 5

Brief Report
Preference to have used a medically supervised injecting centre
alone. Demographic data and information about IDU clients’last
drug injecting occasion according to their preference to have used
an MSIC are reported in Table 1.
anonymity as their main reason. A significant number also ex-
pressed concern over possible police surveillance, despite spe-
cific assurance that this would not occur.
Seventy-one per cent of IDUs indicated that they would have
preferred to use an MSIC if available at their last injection. This
proportion did not change significantly for age, gender and last
drug injected. Injecting alone also did not influence preference to
use an MSIC. However, among the 77 IDUs who last injected
alone, the majority (71%) would have preferred to use an MSIC.
Preference to have used an MSIC at last injection was signifi-
cantly related to the location of last injection; 83% (n=43) of IDUs
who last injected in a public place would have preferred to use an
MSIC compared to only 66% (n=82) of the IDUs who last in-
jected in a private place (χ2=4.752, 1 df, p =0.03). The main rea-
son cited for using an MSIC by clients who last injected in a
private place was that they would prefer to use their drugs as soon
after purchase as possible, this being closer to an MSIC in Kings
Cross than their private alternative. Several also mentioned that
the private setting sometimes included their children, who they
would prefer not to inject in the presence of.
Discussion
The majority of injecting drug users attending a needle syringe
program in the heart of an open drug scene in Kings Cross, Syd-
ney, would prefer to have used an MSIC in the area for their last
drug injection, providing it was supported by the local police serv-
ice.This was similar to anotherAustralian study4 which also found
high rates of willingness to use such an injecting facility among
injecting drug users in Victoria.
A limitation to the interpretation of this high level of prefer-
ence to use an MSIC in this study is that the respondents did not
know what the nature of an MSIC in Kings Cross would be, since
it had not yet been established. It is acknowledged that there may
be a gap in expectations and the eventual reality of such a serv-
ice, which may affect current stated preference to use it. The high
profile, politically controversial nature of this initiative may also
have affected IDUs’ willingness to cite a preference to use an
MSIC in this study.
Table 2 shows the proportion of IDUs who would have pre-
ferred to use an MSIC grouped by place of last injection and
whether they injected alone. Of those who last injected in public,
82% would have preferred to use an MSIC and there was no sig-
nificant difference in this regard for those who injected alone
compared to those who injected with others. A similar pattern
was observed for those who last injected in private, which further
indicates that preference to use an MSIC was not affected by the
presence of others.
As anticipated, those IDUs who last injected in a public place
were more likely to have preferred to have used an MSIC. Since
one of the objectives of an MSIC is to address public order issues
at a community level such as public injecting drug use, this find-
ing suggests that the establishment of an MSIC is likely to reduce
this.
While the preference to use an MSIC was still very high (71%)
among IDUs who injected alone, the finding that injecting alone
was not a determinant of preference to have used an MSIC may
warrant further investigation, since this is known to be associated
with heroin overdose death.2,3 To ensure that the MSIC’s public
health objective of reducing fatal and non-fatal drug overdoses is
maximally achieved, it is important that IDUs perceive that in-
jecting alone is a risk factor for overdose death which would be
addressed by injecting in a supervised setting such as an MSIC.
Conversely, the finding that the majority of IDUs who last in-
jected in a private place with others would nonetheless prefer to
use an MSIC was somewhat surprising, given that this scenario is
generally considered to be optimal from both a public health and
Clients who reported that they would not use an MSIC gave
Table 1: Preference to have used an MSIC by age, gender
and drug-using situation.
Prefer to have
used an MSIC
Group
total
p-value
(<0.05)
Total responses
126 (71%)
178 (100%)
Age
Less than 25
25-35
35 (73%)
56 (67%)
34 (74%)
48 (27%)
83 (47%)
46 (26%)
0.7
Over 35
Gender
Male
77 (71%)
49 (70%)
108 (61%)
70 (39%)
0.9
0.9
Table 2: Preference to have used an MSIC by place of
last injection and whether injected alone.
Female
Last drug injected
Heroin
Prefer to have
used an MSIC
Group
total
p-value
(<0.05)
95 (71%)
20 (69%)
10 (67%)
133 (75%)
29 (16%)
15 (9%)
Cocaine
Other
Last injected in public
Alone
22 (81%)
20 (83%)
27 (15%)
24 (14%)
0.9
0.9
Last injected
In public
With others
43 (83%)
82 (66%)
55 (71%)
69 (70%)
52 (29%)
125 (71%)
77 (44%)
99 (56%)
0.03
0.8
In private
Alone
Last injected in private
Alone
33 (66%)
49 (65%)
50 (28%)
75 (43%)
With others
With others
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541

van Beek and Gilmour
Brief Report
public order perspective. This finding suggests that the trial es-
tablishment of an MSIC may shift current patterns of drug use
among a significant proportion of the IDU population in Kings
Cross and not just those who currently inject publicly and/or alone.
Specific consideration should be given to the possible implica-
tions at a community level of such potential shifts in where IDUs
inject and how these should be monitored and managed.
Acknowledgements
The authors gratefully acknowledge the assistance provided by
Dr John Kaldor, Deputy Director, National Centre for HIV Epi-
demiology and Clinical Research.
References
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Sydney: NSW Government; 1999.
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Research Centre; 2000. NDARC Technical Report No.: 86.
3. Zador D, Sunjic S, Darke S. Heroin-related deaths in New South Wales, 1992:
Toxicological findings and circumstances. Med J Aust 1996 Feb
19;164(4):204-7.
4. Fry C, Fox S, Rumbold G. Establishing safe injecting rooms in Australia:
Attitudes of injecting drug users. Aust N Z J Public Health 1999;23:501-4.
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2000 VOL. 24 NO. 5