1. Twenty-one years of operation at the Uniting Sydney Medically Supervised Injecting Centre (MSIC) Australia

MSIC opened in 2001 under the auspices of the Uniting church. A clinical model, with a medical practitioner overseeing operations, was adopted for several reasons including 1) historic community acceptance of the model in other harm reduction services; and 2) the service focus on reducing drug-related deaths through naloxone (and supplemental oxygen) administration for overdose. This would not have been allowed without trained clinical staff, as the opening of MSIC predated the introduction of take-home naloxone in Australia. The model brings with it certain advantages and disadvantages; an advantage - being a clinical service enabled MSIC to continue operating through the COVID-19 pandemic as they were deemed ‘essential’, and linkage with clinical networks enabled access to personal protective equipment (PPE). A disadvantage, once a clinical model is established it appears difficult to garner political support for additional facilities that operate under different service models. Attempts to gain support for DCRs that allow other methods of consumption have failed in Australia. /p>

Irrespective of service model, MSIC and Uniting have achieved important political and practical successes including advocacy (with local political support) for drug law reform, strong collaborations with local service providers, physical co-location of a public health service, and a successful bid, in collaboration with University and hospital clinicians/researchers, for funding to establish Australia’s first hydromorphone treatment trial