Can ‘safe injecting sites’ help Australia’s homeless?

Melbourne, Australia – Forty-year-old Scottie, who asks that we only use his first name, has been homeless for most of his life.

“I took off when I was 13,” he says.

Tall and lanky, he exudes a positivity that seems at odds with his harrowing story.

“I had a really, really bad family life – straight up. There was nothing good about it,” he explains. “I grew up in the bikie [motorcycle gangs] world, right? So it’s a lot different to most of the world people think.”

He describes a home life of alcohol and drug use.

“I’d wake up in the morning for primary school, and I’d have to step over bodies on the ground – not dead ones! – just passed out, drunken bodies,” he says. “I used to go around and I used to pick up all the spare change as a kid and used to have a bit of a drink, have a bit of a nip on all the old drinks sitting around and I’d go to school half tanked and with a lot of money.”

Scottie had access to drugs at a young age, and began dealing when he was about 10 years old.

“That’s all I knew,” says. “I’d wake up in the morning, same thing every day – jump over all the people, take my weed to school, sold it off.”

But he soon became hooked on heroin, and his home life started to deteriorate.

He ran away when he was 13, began living on the streets of Melbourne and tried to take his own life.

The drug use and homelessness continued into adulthood, and he ended up going in and out of prison for petty crimes and drug-related offences.

“Basically, you’re sleeping on the streets, right?” Scottie says, describing his life then.

“So you get up in the morning, and you’re in front of the shops on the main street. You fold up your blankets, you lay them out in a square and then you sit down there and you beg. That’s pretty much all you can do.”

Scottie says sleeping rough brings a particular set of dangers.

“It’s dangerous on the streets – there’s competition for [begging] spots, people will just take your shoes if they feel like it,” he says.

“If you get a bad group of blokes, and they’re coming out from a nightclub and you ask them for a bit of change or something they will bash me, just for asking for a bit of change.”

Homelessness and drug use – not the whole story

A 2006 report found that more than 90 percent of Australians believed that homelessness is a result of drug use.

Yet recent research from homelessness services in Melbourne demonstrated that while 43 percent of the homeless population reported having issues with alcohol and other drug use, only one-third reported that they had these problems before becoming homeless.

The remaining two-thirds had, instead, developed risky and adverse drug and alcohol use after they became homeless.

While a recent Victorian government inquiry into homelessness in the state found that the underlying causes of homelessness are varied and complex – and not simply due to drug habits, as many Australians believe – untreated drug use can compound experiences of homelessness.

‘Safe injecting sites’

In the last two years, Scottie has begun to tackle his heroin addiction by attending the Medically Supervised Injecting Room (MSIR) in North Richmond.

The MSIR opened in 2018, and is akin to a medical centre, in which intravenous drug users can check in, access clean syringes and inject in a safe environment.

Staffed by nurses and doctors, who oversee the centre, users can also access methadone programmes, housing and other social services.

Scottie has signed onto a methadone programme at the MSIR, and is in frequent contact with the staff, who he describes as “the most brilliant people in the world. They were the ones that got us doctors’ appointments and got us on the programme.”

The methadone helps Scottie to wean himself off heroin, a preferable alternative to going “cold turkey”.

“Going cold turkey is bad,” he says. “It’s that overwhelming your body starts convulsing. So you spend like three or four days in the shower, you can’t go anywhere else. It’s the worst. Your body is just craving [and] you can’t sleep, you are literally awake three or four days. It’s horrible.”

As well as providing access to methadone, the MSIR also provides a safe space for intravenous drug use, keeping people off the streets and helping to avoid overdoses.

Trish Collocott is the CEO of North Richmond Community Health, which oversees the MSIR.

She described it as a “gateway service” which aims to connect vulnerable people with services that can assist them.

“[The MSIR is] a health response to a health issue. We are talking about very vulnerable people,” said Trish.

She said that rather than clients utilising alleyways and vacant car lots to use intravenous drugs, having a space to inject in a controlled, supervised and clean environment reduced overdose rates.

That the service provided new needles also means that there was a reduction in blood-borne viruses.

MSIR and homelessness

The MSIR is currently in a two-year trial, with a recent review demonstrating its success: In the first 18 months of the trial, 4,350 people registered to use the service.

Trish said that, like Scottie, a third of clients were homeless or in insecure accommodation, and one of the benefits was the ability for clients to be connected with homelessness services.

Yet the MSIR has come under scrutiny and criticism from the public for drawing too many drug users into one place. There have been many reports made by local residents about anti-social behaviour by the service’s users.

That the MSIR was built close to a primary school has also drawn much criticism, and plans to build another MSIR in Melbourne’s CBD were recently voted down by the local council.

Trish acknowledged that there are often negative views of the service because of the association with heroin use and stated that much of this rests on a lack of wider education about what the MSIR actually does.

“The service doesn’t promote dealing, it doesn’t promote the use of drugs in any other way other than giving people who are already injecting users a safe place to inject that’s medically supervised,” she said.

Trish explained that when someone comes in to use the service they don’t walk in, inject and then walk out again – they need to register and engage, have a conversation with workers and be linked up to the other services.

Yet she also acknowledged that having just one service that draws large numbers of drug users to one location can be off-putting for local residents.

“Talking to a number of the [surrounding] community, I hear the same thing – they all see the need for the injecting service but it’s the location that worries them,” she said. “And I think that’s probably true wherever you put these services.”

She said it was her personal view that such injecting services should be integrated into a larger number of primary care medical centres throughout Melbourne.

A larger number of smaller services would be able to help more clients without having so many congregating in one location.

“My opinion would be don’t have large facilities. Have smaller facilities integrated into mainstream services,” she said.

‘It’s a lifestyle, heroin’

Despite the criticism, for Scottie and his partner, the MSIR was the starting point from which to turn their lives around.

He says that they decided to quit heroin because they were “sick of the lifestyle”.

“It’s not a thing you can do easy, it’s a lifestyle, heroin,” he explains. “We were sitting out on the street from six o’clock in the morning till eight o’clock at night coal biting (begging). Once we’d get the hundred up, we’d run down to Richmond and score, and come back, and do it again. Sit there for another hit. We used to do that three times a day. It was just enough. Sick of every day having to get up and do the same thing.”

“The injecting rooms are a positive thing,” he says. “Ninety percent of the people would just shoot up in the car park. But once they put the injecting rooms there, you didn’t have to do that no more. It’s a controlled environment, it’s all clean. And they’ve got doctors next door. That’s what ended up happening to me, they referred me to the doctors.”

For Scottie and his partner, their efforts to quit heroin have been underscored by finally finding permanent housing.

They now live in social housing in the suburb of Fitzroy, and Scottie says that now that he is off heroin, the next step is to get off the methadone programme completely.

“We want to reduce the methadone, reduce it slowly, get off that,” he says. “Because I’m sick of the liquid handcuffs, I call it. I’m sick of being handcuffed to the chemist. So that’s my plan.”

This series was supported by the City of Yarra.