Melbourne, Australia – Saade Melki started using heroin the same week his father died. He was 24. Over the next 20 years, the Lebanese-Australian struggled with addiction.
He also struggled to hold down jobs and became distant from friends and family. He would get clean and had multiple relapses while trying to kick his addiction.
That life, he says now, “I didn’t want it anymore”.
In early 2020, a chance encounter turned his life around for the better when he went to visit Melbourne’s first ever Medically Supervised Injecting Room at the North Richmond Community Health Center – a space where people can use drugs safely, knowing that medical staff are on hand should anything go wrong .
Known locally by the abbreviation MSIR, this is where Melki met Margo, his now fiancée, who was also an active heroin user. Margo had lost a partner to a drug overdose. She also witnessed Melki experience his first overdose at MSIR, without whose emergency assistance Melki said he would have died.
“All I remember is waking up with an oxygen mask on and feeling a little outside, like ‘Oh, what happened?’ And Margo was there, crying and saying… ‘You almost died,’ he said.
“Every time I went [MSIR]there was at least one person with an oxygen mask who was rescued,” Melki recalls, referring to the lack of oxygen people experience during an overdose.
After that experience, Melki focused on getting clean and began a long-acting treatment with buprenorphine, which he calls a “wonder drug” and gets free monthly with MSIR. Injected subcutaneously, it prevents drug users from experiencing withdrawal symptoms for at least a month.
In the end, Melki got clean. He also survived cancer and now, at the age of 49, he works as a scaffolder. It has enabled him to pay for his car and save to hopefully buy a house and pay for IVF treatment as he and Margo plan to have children. Melki has also reconciled with his mother, whom he now sees every day, and has reconnected with the friends he lost to addiction.
“Everyone is back, and yes, I just want to keep it that way,” he said.
Funded by the Australian government, the supervised injection room at the North Richmond Community Health Center was established in 2018 to “help turn the tide of heroin-related deaths” in Melbourne, according to a recent review of the facility conducted by the state government.
The review noted that there were 20 overdose deaths in Richmond in 2015 alone. Since opening, more than 6,000 overdose cases have been treated at the facility, and none have been fatal. Modeling indicates that about 63 drug-related deaths have been prevented since the opening of the MSIR, “equating to about 16 lives saved each year,” the review said.
“It is very clear that this facility has changed lives and saved lives,” said Victoria’s Prime Minister Daniel Andrews last month when he announced that the facility would be made permanent after a five-year trial period and evaluation rounds.
“Stories of people dying in back alleys and gutters, stories of literally dead bodies in that local community meant we had to do something different, something challenging,” he told local media.
Earlier this month, journalists from Southeast Asia and Australia were invited by the international advocacy organization Harm Reduction International (HRI) to visit the MSIR. Proponents say the facility could set a valuable example for Southeast Asia, where governments are more focused on punishing drug use than providing facilities that can save lives.
The drug situation in Southeast Asia is significant. The United Nations Office on Drugs and Crime (UNODC) has warned that drug production and consumption is increasing regionally. More than 1 billion methamphetamine pills were seized by authorities in Southeast and East Asia in 2021 alone. Opium poppy cultivation also increased in Myanmar last year, with the UNODC raising concerns about the health impact of increased heroin production in the region and beyond.
According to a 2022 report, there are no medically supervised legal drug use areas in Asia report from HRI. Of the 16 countries with such facilities, all were in the global north, with the exception of one in Mexico.
What is a safe injection room?
MSIR’s reception is littered with motivational art and drug safety warnings in English and Vietnamese. North Richmond has a large Vietnamese community and has earned the title of “Little Saigon” for its plethora of Vietnamese restaurants and businesses.
Drug users are asked at reception about their health status and the drugs they will be using that day before being led to a manned injection room with partitioned cubicles where they are given an injection kit with a clean needle. They may also seek medical attention if they have trouble finding their veins, which is a common problem among people who inject drugs frequently.
Those using MSIR are encouraged to go to a community room and access free addiction treatment and health services, including dental care and testing for hepatitis, a virus that causes liver damage common in people who inject drugs.
Dr. Nico Clark, MSIR’s medical director, said the facility has had nearly 400,000 visits since 2018 from some 6,000 users of the service. Most use heroin and sometimes methamphetamine.
A contextually unique element of MSIR is its location in an area of high drug trafficking and public drug use. Just “a few hundred yards” from a street “where people buy and sell heroin,” Clark said.
“The other unique thing about our service is that we offer a range of health services locally” that are not available elsewhere in the local community, he added.
Despite its success in saving lives, MSIR is not without flaws.
While proponents of the MSIR model point to providing a safe and guarded environment that protects drug users from harm, critics of the Melbourne facility say public drug use remains highly visible in the Richmond area and local residents and businesses feel unsafe due to loud gatherings near the facility, as well as erratic or violent behavior, according to the state government’s recent evaluation.
MSIR also falls short when it comes to other needs, such as mental health services, which the review describes as “a missed opportunity.”
Injecting in public and discarded needles and syringes remain a challenge in the area, the review said.
“At its core, an injection service is a health response. The main goal – saving lives – is well accepted in the community. But unlike other evidence-based health policies that prevent death and provide life-changing support, injection facilities are often highly contested in the public conversation,” the review noted.
Helen Clark, the former Prime Minister of New Zealand and current President of the Global Drug Policy Commissionalso visited MSIR in April.
“The thought of it all being paid for by the public is very encouraging. And there is clearly a need for much more in the cities and states across Australia. My own country has nothing like it,” Clark said while visiting journalists.
The zero-tolerance policy for drugs in Southeast Asia
Southeast Asian countries primarily adopt a zero-tolerance approach to drug use.
In Vietnam, anti-drug use measures fall within the legal framework of the country’s HIV prevention efforts, said Nguyen Minh Trang, program manager of the harm reduction and addiction treatment program at the Hanoi-based nonprofit Supporting Community Development Initiatives (SCDI) . .
“But there are still restrictions because harm reduction is needed not only in the field of HIV, but also in other areas, such as overdose,” she said, adding that the law only allows a licensed physician to administer drugs that reverse an opioid overdose to make.
Vietnam is “more progressive” than many other countries in the region, Nguyen said, as services provide drug users with clean needles and syringes, but no safe space where those needles are then used.
If Vietnam were to consider safe injection facilities, Nguyen said, new laws would be needed to ensure people aren’t arrested or discriminated against.
While Thailand appears to be more liberal and is the first country in Asia to legalize the private sale and consumption of cannabis, Nilawan Pitakpanwong, a member of the Thai Drug Users’ Network, also pointed out that laws need to be changed to encourage drug users. protect from damage.
“Our drug users are self-injecting [home]or in the woods, or on the farm [so] nobody knows they inject. So this is not safe for them,” she said.
“If we have a drug use room for them, they can just come in and inject and we have a doctor and technician professional to watch [after them] and to help reduce overdose.”
Years of drug prohibition have led to a global fear of drugs, says Dr. Gideon Lasco, an associate professor at the University of the Philippines. Harm reduction has also been politicized as it is seen as a Western obligation in the region’s post-colonial societies.
“It’s easy for politicians to say, ‘Oh, but we shouldn’t do that, because we won’t let the West dictate us,'” said the doctor and medical anthropologist.
“If we see this as kind of a journey from this very punitive regime to something more progressive and effective, then the first step is to try to dismantle this kind of highly criminalized approach that leads people to spend so much time in prison before even get the trial,” he added.
But the Philippines — where former President Rodrigo Duterte’s “war on drugs” led to thousands of murders of drug users and dealers — is likely “still a long way from” accepting supervised injection facilities, Lasco said.
“Mass incarceration is still there and the punishments are so harsh.”