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Experiences from the frontline

I spend 22 hours a week in one of the busiest needle exchanges in the world. Apart from the obvious statistical data informing me of this, there are two reasons why I know it to be true. Firstly, the existence of a loophole in the laws in Australia allowing us to distribute needles to the ‘general public’ and secondly, the fact that there’s a relatively large injecting culture amongst Australian drug users.

Needle and Syringe Program (NSP) stats are testimony to this. They’re also a cost saving bonanza to any health department’s budget because they stem the infection of blood borne viruses, particularly Hep C and HIV, among injecting drug users. Add to that the fact they keep people not injecting safer, and you can undoubtedly say, we have a very successful public health initiative up and running. But while we shouldn’t underestimate the benefits to all, including the clients who use the exchanges, we should equally keep in mind that this is neither an altruistic program, nor does it sit on solid ground.

Before detailing an incident that goes to the heart of our ambiguity in regard to harm reduction services such as NSP, let me point out one or two counterpoints to the program so some of the difficulties can be clearly understood.

In the NSW Users and AIDS Association discussion paper published in August 2009, there are some sobering reminders of just how fragile our NSPs are in this country. Firstly, it points out that the provision of needles and syringes for the purpose of administering illicit drugs occupies a legislative grey area. Legal provision of needles to illicit drug users is based on exempting certain people from prosecution (Drug Misuse and Trafficking Regulation 2006, 4). The report goes on to point out:

Decades after the NSP in NSW was recognised and celebrated, it is essentially still operating under an exemption to the law.

While most Australians wouldn’t be aware of the legal tenuousness underpinning their needle and syringe programs, they might try sometimes to imagine how the law at ground level – street policing, in other words – deals with opposing realities. Or, more bluntly put, how does the fact that the purpose of obtaining needles and syringes to do something highly illegal (for the most part) – which our clients do not have an exemption for – dovetail with our law enforcement agencies’ duties. The answer, from what I’ve seen lately from my spot at the front of the St Kilda Crisis Centre, is not always very well.

The Victorian police, and their counterparts in other parts of Australia, have entered into an ‘agreement’ with the respective government departments that administer funds to NSPs. While there is nothing legally binding about these agreements – they’re seen as protocols – they are vital to the viability of the programs. As you can imagine, if the police are arresting our punters after they’ve walked out of our doors, or indeed, even if their marked cars are parked outside our building, there will be clients who simply won’t access our service, increasing their risk of using unsafely.

Here in St Kilda, we’ve been talking a lot about the high incidence of police activity outside the needle exchange. We’ve been collecting dates and times of when they’re present and any reports of them harassing our clients. Unfortunately, in one month we’ve noted nineteen occurrences of client harassment or police presence or both outside the exchange. While the agreement exists in the echelons and is given official respect, in reality glitches at the bottom end occur. While it might not be straightforward in the general public’s view, it’s important that everybody understand why it’s worth protecting NSPs’ unabated access, and ultimately, building on this first step of harm reduction.

A recent incident

About a week ago, a client had been in mid-morning and I had a normal contact with him in which he picked up two needles. When he came back about three hours later, swaying around, knocking into things and telling me he’d had a few drinks on top of his suboxone (a maintenance drug similar to buprenorphine), I asked him a few questions – like where he was off to. He was, he said, on his way home, but as I was concerned about him crossing the road and getting on a tram, I talked him into sitting in the garden in our driveway until he ‘sobered’ up. He was coherent, he just wasn’t coordinated.

I’d only just settled him in a spot where I’d be able to see him from where I sit when the cops pulled up. A concerned local had rung them. I explained to the officers that we run a medical facility next door and I could take him in there. But they proceeded to handcuff him, search his pockets, from which many varied things came, and, after we’d stood on the pavement outside the exchange for thirty minutes waiting for it to show up, they threw him in a divvy van.

I felt terrible as they drove away – certain he’d be charged, plus all the other things that might happen to him once in a police station. And while I don’t want to compare what’s happening in downtown St Kilda with what’s happening to indigenous people suffering from the intervention up north, it did occur to me that to solve social problems with policing smacks of a retrograde shift, of which we can’t be sure of the outcomes. It also adds to the many reasons why we need supervised consumption rooms and chill out spaces, and was another reminder to me that much of our so-called caring is actually about control.

Mind you, to end on a positive note, there are many people who now believe we should move beyond prohibition and if you’re interested in what that might look like, visit Transform: the Drug Policy Foundation.

Overland is a not-for-profit magazine with a proud history of supporting writers, and publishing ideas and voices often excluded from other places.

If you like this piece, or support Overland’s work in general, please subscribe or donate.

SJ Finn is an Australian writer and the founder of International Overdose Awareness Day. Her novel ‘Down to the River’ was published in March 2015 (Sleepers Publishing). She can be found at www.sjfinn.com

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Comments

  1. The NSP is one of the most successful harm reduction strategies implemented in Australia, in regards to reduction in communicable diseases. I worked previously as the Hepatitis C coordinator in Qld and strategies involving User Groups and NSPs are the key planks in reducing Hep C, which is a blood-borne virus. But there is always room for improvement. There will always be a conflict between the policing role and NSP’s and the goals of the NSPs and societies expectations regarding drug use. Ideally people could get their equipment, without questions, from many outlets, including vending machines and shops. However, the community objects because they want there to be some ‘intervention’ (access to health promotion literature, referral to counselling) at the ‘exchange’ of needles. I can’t see this conflict resolving any time soon without a major shift in community attitudes regarding illicit drug use. Personally I would like equipment sold everywhere because I think the health of people should be a priority over whether they use drugs. Another quick point, I wouldn’t say that Australia has a ‘relatively large injecting culture’ – most drug users don’t inject (they snort, smoke, swallow etc). We do have thousands of injectors but in comparison to all drug users the group is small.

  2. I’m impressed with how well the NSP has done in regard to harm reduction also, very impressed. I just think it’s important not to sit on our laurels. The one injecting facility we have in Sydney is still in a ‘trial’ phase after 10 years of operation and wonderful outcomes. The point being that while it might be good to think we’re doing something for intravenous drug users with NSP, and yes, we certainly are, we shouldn’t forget the program suits our bottom lines. While other countries pull ahead with programs, and I acknowlege there are many countries that are a long way behind, we need to keep lobbying for all sorts of reform so that health and policing don’t get muddled up.

    I take the point that our number of injecting users is not very large. We have about 163,000 injecting drug users in Aust. where as China, it is estimated, has about 2,000,000 and India, 1,000,000. But per head of population and within our drug using population it is fairly high compared to The Netherlands, even the USA. But you’re right, most drug use occurs via other routes.

  3. I agree totally. We need to be doing a hell of a lot more, including safe injecting rooms, to reduce harms. The rate of infections, and other health problems, is still way to high in IDU’s. Great blog and keep up the good work at the front line.

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