‘I better not drop this’: The medical director delivering Victoria’s first injecting room

‘I better not drop this’: The medical director delivering Victoria’s first injecting room

May 8, 2023

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Dr Nico Clark worried he would be bored as medical director of Victoria’s first safe injecting room. But within weeks of starting, before the temporary trial site at North Richmond had even opened, he realised delivering the landmark social reform would not be easy.

“It reminded me when my first child was born, and you’re holding something precious in your hands,” he said. “You realise it’s young and fragile in some ways. You have a sense of, ‘I better not drop this’.”

Dr Nico Clark, the medical director of North Richmond’s safe injecting room.Credit: Luis Ascui

The facility on Lennox Street became permanent in legislation passed by the Victorian Parliament on Thursday after an independent review found the trial of almost five years was broadly successful.

But it has not been seamless, and the intense scrutiny on the project was new to Clark.

“I had no idea it would be so challenging or the fact it would be filled with so much drama,” he says, over pho and spring rolls at one of Victoria Street’s Vietnamese restaurants.

“Reversing overdose is, most of the time, not that complicated. I was thinking, ‘what am I going to do all day? I’m going to just sit here and wake people up; it’s going to be a bit boring’.

“Within a couple of weeks of starting the job, it kind of dawned on me this was going to be more [difficult] than I anticipated.”

The safe injecting room has been beset with complaints that it attracted more drug users to the area, increased the number of needles littered in neighbouring inner-suburban streets and worsened anti-social behaviour.

Some residents and the state opposition still question the logic of placing it next to Richmond West Primary School and say it should be moved.

“I feel like that doesn’t even need to be said, it’s so obvious to me,” said one mother, whose son attends the primary school and asked not to be named because of her employment.

Residents against the location of the safe injecting room protest on the steps of parliament on Thursday.Credit: Chris Hopkins

A security briefing for the Department of Education before the site opened in 2018 identified trespassers, visibility of potentially distressing incidents beyond the school boundary and the security of staff and students at after-hours programs as key issues of concern.

The school — where enrolments have recently dipped but which is otherwise popular for its leading Chinese immersion bilingual program — added CCTV, extra lighting and fencing, and ensures it has a staff member greet students at the gate.

Within a week in 2021, a man’s body was found near the school and another allegedly entered the grounds with a knife. Neither were clients of the safe injecting room.

Proponents argue the facility has to be where drug users are, and that residents were already exposed to injecting and overdoses in the hotspot before it opened. A state coroner recommended the trial go ahead in North Richmond after a spate of heroin-related deaths nearby.

It has saved an estimated 63 lives, safely managed more than 6300 overdoses by March this year, and lowered the number of overdoses in the neighbourhood that require an ambulance.

Clark acknowledges more could have been done early on to help bring the community onside.

“We need to take people on a journey, and I think we haven’t done that to the extent that we could have done,” he says.

He was more frank at the Harm Reduction International Conference in Melbourne last month, stating improving neighbourhood amenity was the toughest objective to meet.

“And yet, we were neither given the resources nor the permission to do this one. That was considered too risky for us to do; to engage with the neighbours,” Clark told the conference.

“When it comes to our interaction with the press, that is extremely closely regulated as part of the contractual agreement with the government.”

He believes reluctance to engage with the media means good stories of vulnerable people engaging with healthcare — such as treatment for hepatitis C — and other wraparound services thanks to trusted staff have been left untold.

An independent report by John Ryan acknowledged the facility had not overcome broader amenity challenges, noting public injecting remained a problem and the City of Yarra collects up to 18,000 needles a month.

Patricia Collocott resigned as chief executive of North Richmond Community Health, which runs the site, weeks after the release of the report.

Within months of visiting the North Richmond safe injecting room three years ago, Saade Melki quit heroin.

The 49-year-old was introduced to long-acting buprenorphine, a pharmacotherapy he injects once a month that stops withdrawal symptoms and the effects of heroin.

“I’ve been on that ever since,” Melki told The Age at a media tour of the injecting room as part of the harm-reduction conference last month.

Saade Melki, 49, stopped using heroin three years ago after being introduced to pharmacotherapy at the facility.Credit: Penny Stephens

He’s now looking at IVF with his partner, hoping to save for a house, and works as a scaffolder in construction.

More than 700 people have started opioid treatment through the safe injecting room.

The Ryan report said access to pharmacotherapy was significantly under-resourced in Victoria. The system is fragmented and challenging to navigate, creating high levels of unmet need.

It recommended trying hydromorphine, which was supported by Clark, the state opposition and Liberal Democrats, but the government blocked a proposal to allow its use on Thursday.

Whether North Richmond Community Health remains at the helm of the facility on Lennox Street is an open question.

The Andrews government is recommissioning the contract, and the Ryan report said a hospital should be involved in some way to expand wraparound services and mental-health support onsite.

Users at the safe injecting room are about 27 times more likely to have post-traumatic stress disorder than the general population and 11 per cent have been admitted to hospital for a mental-health-related condition.

A new provider, which could be a consortium that still includes North Richmond Community Health, for example, is expected to be announced by the end of the year.

Clark, proud of the work and the benefits to peoples lives, knows there is more to be done.

“It’s been incredibly rewarding … but it’s also the most challenging job I’ve ever done, no doubt about it.”

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