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Injection room without provable effect

Publisert 2003-08-06

One injection room, established in Sydney, Australia in May 2001 has been evaluated after 18 months. The researchers did not succeed in showing any preventative effects on overdose mortality.

3810 persons were registered as visitors in the injection room in Sydney during the 18 months long trial period. The visits varied from 1 to 646 visits pr. Registered user, on average 15 visits per user. 56 861 injections were carried out during the period. At 61 per cent of the visits there was injected heroin, and there was injected cocaine at 30 percent of the visits.

Comments: If one suppose that every one of these persons carried out on average 2 injections a day (which is low - at least for heroin users), one persons injections during the period would have counted up to around 1000 injections (500 days of 2 injections) on average and for the whole group something around 3 810 000 injections. Even if the real number of injections should be only half of that number, one can see that the injection room covered only a small fraction of the total number of injections in the group during that period.

409 overdoses were treated in the injection room, which renders about 7,2 overdoses per 1000 visits. 329 of these were heroin related (60 per cent) while 60 were cocaine related (15 per cent. 13 (3 percent) were related to benzodiazepines and 7 (2 per cent) were related to other opiates.

Comments: 409 overdoses is a high figure. If the rate of overdoses should have been as high also outside the shooting gallery, the same group would have had an occurrence of 27 022 overdoses outside the injection room during the same period, or 1501 overdoses per month. It is not probable that the figure was that high. The report says there was about 20-40 ambulance missions because of overdoses every month in the Kings Cross area, where the injection room is situated, even covering persons who were not registered injection room visitors. One can here probably see the same effect as also has been observed in The Netherlands and Germany, that the injection room visitors feel sure to be rescued in case of overdose and therefore take bigger doses within the injection room than outside. Taking into account the great risk for lasting brain damage that every overdose represents, the high number of overdoses in the injection room is particularly precarious.

During the preceding months before the opening of the injection room the number of overdose ambulance missions and overdose deaths was very significantly reduced in the Kings Cross area, as well as in the whole New South Wales region. This reduction is in the report attributed to a reduction of availability of heroin in Australia at that point of time.

The reduction in opiate overdose deaths went on after the opening of the injection room, both in the Kings Cross area and in the whole of New South Wales. This reduction is in the report attributed to an ongoing reduction of heroin availability. It was not possible to discern the injection rooms eventual share of this reduction in ambulance missions to overdoses from that of the general reduction in heroin availability The share of ambulance missions to opiate overdoses in the Kings Cross area in the opening hours of the injection room changed very little from the same calendar period preceding the injection room trial. It was not possible to prove that the presence of the injection room influenced the number of overdose deaths in the Kings Cross area.

Comments: Considering the low coverage of injections, which this injection room has, it would have been very optimistic to expect significant effects on ambulance missions and overdose mortality. There are so many factors influencing the frequency of overdoses and the mortality from it. The Heroin availability is one of them. But also general trends, in which phase of an heroin epidemic the area or the city finds itself, the dissemination of methadone, the availability of health care service for drug addicts and so on. In Oslo the overdose mortality has been reduced by more than half the two last years. This development cannot be attributed to the reduction of heroin ensuing the Afghan war alone. And there is still no injection room.

The report says it's likely that the injection room staff averted some overdose deaths among those who visited the room, as a part of the 329 heroin overdoses, which were handled by the staff, might have been lethal if they had occurred elsewhere. On the background of such an assumption the researchers assume that the staff members have prevented at least 4 deaths per year.

Comment: These are assumptions, which cannot be documented. It would be as relevant to speculate how many of the overdoses occurring in the injection room that would not have happened if the injection room hadn't been there. Neither have there been any attempts to assess if any of the injection room visits resulted in an overdose or an overdose death ensuing the visit, when the visitor had left the injection room.

In Norway there is now a campaign going on in some media in order to influence politicians and the public opinion in favour of injection rooms. An example is one article in the paper Aftenposten last Sunday. The headline says: "Researchers: Injection room saves lives. The Injection room in Sydney is a success, comprehensive investigation shows". Those of you, who can read Norwegian, can read the article here. You can read an Australian point of view here here.

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