Directly across the road from the Kings Cross train station you'll find the only medically supervised injecting centre in the southern hemisphere — but that's set to change.

After a spike in drug-related deaths in Melbourne's North Richmond, a trial safe injecting room has been green-lit by the Victorian Government.

Initially the state Labor Government was reluctant to support the facility and there has been resistance from some local businesses.

But Ingrid Van Beek says if her experience setting up the Kings Cross room in the 1990s is any guide, the community will come to support the room.

Effectiveness of Sydney's MSIC: Over one million visits have been made to the service

Over one million visits have been made to the service Over 7000 drug overdoses treated without a single death

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Dr Van Beek, the founding director of Uniting's Medically Supervised Injective Centre (MSIC), says there were two fatal overdoses a week in the lead-up to the centre opening, and around 25 non-fatal overdoses for every death.

"During the 1990s there was this glut of heroin that affected the whole country, but it arrived here at the eastern seaboard first," she said.

"Drugs were very readily available, very cheap and we saw a growing population of people living on the streets, homeless, who were injecting in public. Of course that open drug scene lead to people feeling very unsafe in this area.

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"With every death that we would hear about, we would just feel a bit more numb."

Ingrid Van Beek was the founding medical director of MSIC. ( ABC RN: Fiona Pepper )

Dr Van Beek say there wasn't one event that prompted the establishment of the centre — rather, a growing feeling that something needed to be done.

But it was uncharted territory, and not without its issues.

"The drug users themselves, when the facility opened, I think they couldn't quite believe it," she said.

"I think they thought we were trying to trick them or something.

"I was absolutely terrified that something would go wrong and that not only would that mean that we'd blown our chance here in Kings Cross but that would also stop others from opening elsewhere."

At the time Dr Van Beek says that the Australian model of the safe injection clinic was heavily scrutinised and far more formal compared to other existing centres operating throughout the world.

But quickly, the local community got behind the centre.

"Once we opened and the impact of the injection centre started to become clear, the support in both the residential and the business community here too, continued to increase," she said.

Directly across the road from the train station, MSIC operates in the heart of Kings Cross. ( ABC RN: Fiona Pepper )

So how does the facility actually work?

Marianne Jauncey, the medical director for the centre, says the facility is much like any health service.

"The difference is that when we provide clean injecting equipment to users we don't tell them to go away," Dr Jauncey says.

"That is, in essence what makes us so different from any other health service."

MSIC ensures that drug use equipment is disposed of safely. ( ABC RN: Fiona Pepper )

Coming through the facility on a Monday afternoon, the foyer is empty, except for two reception staff employed to welcome and register clients.

The clinic may be quiet, but Dr Jauncey says that can change quickly. With an average of 160 visits a day, there is a constant flow of people.

"The days can be really variable, so at the moment we'd have eight or nine individuals, that can change. In 10 minutes time it might be empty, and in 10 minutes time there might be 25 individuals in the service. It's hard to predict," she says.

"Like a number of health care services … you don't know what the day is in front of you and you just have to deal with whatever is handed to you on that day."

Stainless steel booths where MSIC clients self administer drugs under supervision. ( ABC RN: Fiona Pepper )

In what is referred to as stage two, half a dozen clients are seated at the eight stainless steel booths, self administering drugs.

"People by definition have brought their drugs with them, so this is not a heroin prescription service," she says.

"This is a service that supervises drug injecting, when people have already obtained and purchased those substances."

Nurses and counsellors are on hand to provide clean injecting equipment, offer bins so equipment can be disposed of safely and most critically, step in if any adverse reactions occur.

Safe drug injecting equipment is supplied to all of the MSIC clients. ( ABC RN: Fiona Pepper )

"Obviously the most common reaction is an overdose. Our staff are immediately on hand to intervene, which is why nobody dies in supervised injecting facilities," Dr Jauncey says.

Dr Jauncey says that in the clinic's 16-year history, there hasn't been a single death, despite dealing with over 7,000 overdoses.

Nursing unit manager Julie Latimer says her team deals with a spectrum of overdoses a couple of times a day.

"About 75 per cent of our clients just require oxygen management. People might start to look slightly sedated, less responsive, and at that point our staff can step in and give them oxygen," she says.

Oxygen is on hand everywhere you look at the centre, ready to treat an overdose. ( ABC RN: Fiona Pepper )

"Then there's the more serious ones that actually require resuscitation. That then requires placing the client on the floor and then resuscitating them and often giving them Narcan to reverse the effects of the heroin or opiates that they've had."

The final step in the process, stage three, takes place in the aftercare area — a kitchenette with couches, a little library and a counselling room littered with brochures and oxygen bottles.

"It's really about making sure people understand what the options are available to them and forming a therapeutic relationship with somebody and that's how we make the difference," Dr Jauncey says.

"It's not just watching them inject and sending them on their merry way. It's about allowing them to be as safe as possible and then forming the connection — that's what's crucial."

Stage three is the final part of the process at MSIC. ( ABC RN: Fiona Pepper )

'Thank you for treating me like a human being'

When asked how clients respond to the service, Dr Jauncey says the most common response is "thank you".

"Thank you for treating me like a human being, thank you for being kind, thank you for not sneering at me," she says.



In the 10 years Ms Latimer has worked at the Kings Cross centre, she says it is the clients that keep her coming back to work each and every day.

"They're a really special bunch of people and I think it's a group of people who don't get treated like everyone else does in society.

"I feel that this as a service is a very special place in that they're given the love, attention and respect that everybody deserve."

And there is an air of excitement amongst the MSIC staff about the announcement of the North Richmond facility.

"I'm really excited about that, it's great news and we're really excited to get onboard and offer that service they need," Ms Latimer says.

'An otherwise pretty uneventful health service'

Dr Van Beek recently spoke at a community meeting in Melbourne's North Richmond, and says the community's concerns were very similar to those in Kings Cross.

"I got the same sense as I did here in Kings Cross: this community fully understands the complexities and is very clear-eyed about what this can and can't do," she said.

"I think it is very ready and [the room] is an appropriate area."

Drug users are continually supervised by nursing staff, ready to treat any overdoses. ( ABC RN: Fiona Pepper )

Despite the backlash against the Kings Cross centre, Dr Van Beek has been instrumental in helping other communities lobby for similar facilities.

"If this model helps other jurisdictions, that's something I feel really proud of," she says.

Dr Jauncey says after 16 years of operation, it is satisfying to challenge the assumptions made about safe injection clinics.

"People say: 'I thought it would be violent; I thought it would be chaotic.' There's this perception that anything to do with drugs involves chaos and violence," Dr Jauncey says.

"So it's nice to showcase an otherwise pretty uneventful health service operating as health services do."