The paramedics who treat overdosed heroin addicts want a safe injecting room trial.

The Richmond traders and locals who deal with users and their needles want a trial.

The local government backs it.

Health experts across the fields demand it.

And Victoria's coroner has twice recommended the state trial a medically supervised injecting room.

So what is stopping Australia's most progressive political leader, Premier Daniel Andrews, from trialling, yes trialling, an injecting room in Melbourne's heroin hotspot in North Richmond?

In his own words, Mr Andrews says he has always opposed the idea. He also won the 2014 state election with a policy of no injecting rooms.

"I know there are some that would like us to go further but I've been very clear, we have no intention to change our policy setting on this," Mr Andrews said on Thursday.

The Premier has been consistent on the issue — he does not think an injecting room is the silver bullet.

Over the term of his Government the public calls have grown louder after a surge in heroin-related deaths.

Thirty-four people died around busy Victoria Street in one 12-month period.

Advocates hoped the coroner's court recommendations would have been the tipping point for Labor to implement a trial.

State coroner Sara Hinchey told a parliamentary inquiry in June about the case of a Richmond toddler who was stabbed by a needle that had been left in the tanbark at his childcare centre.

"That was a very disturbing incident for his family and an example of why it is not just something that should be looked at as an aesthetic issue, but also as a health-related issue for those who are exposed to the debris associated with injecting drug use," she said.

Political risk of the status quo

The coroner's core purpose in a death investigation "is to identify opportunities for prevention", which is why two coroners concluded "that it is desirable for a supervised injecting facility trial to be established in North Richmond,'' Ms Hinchey told MPs.

Despite many of his Cabinet ministers — from both right and left factions — backing an injection room, Mr Andrews remains steadfast.

There is political risk to stay or change.

On one hand the Andrews Government is placing at further risk the inner-city seat of Richmond, where the problem lies, as well as surrounding left-leaning inner-city seats under threat from the Greens.

But as his supporters clearly spell out, introducing safe injecting rooms is gold material for an Opposition already hell bent on making law and order the number one issue at the 2018 state election.

The Coalition, under Matthew Guy, have banged the crime drum incessantly and have chanted that Labor is soft on crime.

"It sends the wrong message to our kids and effectively says we've given up on preventing drug use," shadow mental health minister Emma Kealy said on Thursday.

"To have government-sanctioned drug taking sends the wrong message to our kids."

If the idea is presented in the law and order space, the notion of people using illegal drugs in a safe place will not resonate well with voters who are already concerned about crime.

And while a swag of experts back a trial, Victoria Police have not formally endorsed the proposal.

Sensitive to suggestions he's soft on crime, Mr Andrews rarely says no to requests from the police.

At this point, their endorsement of a trial is perhaps the only thing that could change the Premier's mind.