The Sydney Medically Supervised Injecting Centre: reducing harm associated with heroin overdose

The Sydney Medically Supervised Injecting Centre (MSIC) commenced operation on a trial basis in May 2001. Operating within a clinical model, the Centre's primary objective is to reduce the morbidity and mortality associated with drug overdose. Staff include nurses authorized to administer naloxone to reverse the central nervous system depressant effects of heroin, according to clinical protocols developed and modified for the Centre's setting. Data were collected on clients' drug overdose history, demographics, and recent drug and alcohol use at each subsequent visit. The MSIC registered 3747 injecting drug users and supervised 56 861 injecting episodes (61% to inject heroin, 30% to inject cocaine and 9% other drugs) in the first 18 months of operation. A total of 409 drug overdoses occurred (80% heroin, 15% cocaine and 5% other drugs) during this time. Among the heroin overdoses treated, 25% also required naloxone. Risk factors identified included history of heroin overdose, heroin as the main drug injected, engagement in sex work, frequent attendance at the MSIC, and otherwise injecting in a public place. Being in methadone maintenance treatment and a daily injector at registration were protective. Overall, It is likely that the early intervention provided by the supervised setting of the MSIC reduced the morbidity and mortality that would have otherwise been associated with these drug overdoses had they occurred elsewhere. Better understanding of risk factors for heroin overdose has the potential to also prevent heroin overdose in this and other settings. Acknowledgements The authors acknowledge the clients and staff of the Sydney MSIC for their participation in this research and UnitingCare ACT.NSW for its ongoing courage in overseeing this initiative.