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Abstract
Drug Consumption Rooms (DCRs), where injecting drug users (IDUs) can use pre-obtained drugs in a hygienic and
professionally supervised low threshold setting, aim to engage high risk IDUs, reduce public drug use, injecting-related
morbidity and mortality, and improve access to drug treatment.
This thesis evaluates the service demand, accessibility, utilisation, and coverage of Australia s first DCR, the Sydney Medically
Supervised Injecting Centre (MSIC), located in an area with a history of illegal shooting gallery operation. MSIC impact on
injecting practices and injecting related health, and referral to drug treatment were also examined.
Methods included cross-sectional IDU surveys, key informant interviews, staff focus groups, analysis of client registration and
surveillance data and routinely collected data on needles and syringes - including multiple indirect prevalence estimation,
and prospective follow-up of MSIC referrals.
Shooting gallery users expressed demand for and willingness to use the MSIC. Injecting episodes previously occurring in
shooting galleries appear to have been transferred to the MSIC, although shooting galleries continued to operate at a
reduced level. The MSIC service model was accessible, with few refusals of entry, high levels of client satisfaction and limited
non-use for reasons relating to the model. MSIC engaged high risk IDUs - regular injectors, sex workers, and those injecting
in public places and shooting galleries - who were also more likely to be frequent attendees. MSIC clients were more likely
than other IDUs to inject in public places and shooting galleries, be HCV seropositive, have riskier injecting practices and
more severe injecting related health problems. MSIC achieved good coverage of the local IDU population (70.7%, range
59.1%-86.7%) and modest coverage of their estimated total injecting episodes during its operating hours (8.8%, range
7.3%-10.8%). MSIC use was associated with improvements in injecting practices and health. Frequent MSIC use was also
associated with higher rates of referral to drug treatment than less frequent use. Drug treatment referral uptake was
positively associated with a recent history of daily injection and sex work and negatively associated with a lifetime history of
psychiatric treatment and/or self harm.
This research was confounded by substantial changes in heroin availability during the study period but provides new
evidence on DCR coverage, impact on injecting practices and health, and referral to drug treatment. Implications for future research are discussed.