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Alex Wodak: The Tolerance Room ten years later

Dr Alex Wodak marks a significant anniversary:

In 1999, 1,116 young Australians died from a heroin overdose. In parts of the country, more young Australians were dying from a heroin overdose than from car crashes. There were six heroin overdose deaths in 1964.

NSW accounts for half the heroin overdose deaths in Australia with 10% of these deaths occurring within two kilometres of Kings Cross. In the late 1990s, many people familiar with the physical and emotional complications from illicit drugs had decided that providing a safe place to inject drugs supported by nurses with resuscitation equipment would be better than leaving these people to inject in parks, laneways or toilets. Interest in establishing an injecting centre was growing in Sydney, Melbourne and Canberra.

In 1997, there were almost a dozen places in Kings Cross where people were able to inject drugs in rented rooms or cubicles. Kings Cross has been Australia’s biggest illicit drug market for most of the last half century. But these rooms and cubicles were run by criminals. The Wood Royal Commission documented that police corruption linked to these illegal injecting centres was extensive. And the many drug users who could not, or would not, rent rooms or cubicles injected in parks, laneways or toilets. Kings Cross residents hated having to see that.

In 1997, Justice James Wood published the report of his Royal Commission into the New South Wales Police Service.  In response to Wood’s recommendation, the NSW Parliament established a Select Committee to estimate the costs and benefits of a trial of a safe and sanitary injecting room and recommend whether or not such a trial should proceed. Although the enquiry identified many benefits and few risks, a majority of the committee voted against a trial.

A diverse group then started meeting in the Wayside Chapel, Kings Cross, committed to establishing an injecting centre to encourage NSW authorities to reconsider the question. In January 1999, the NSW Premier, Bob Carr, announced that he would convene a Drug Summit after the next state election but that the question of an injecting centre would not be included in the agenda. The Wayside Chapel group decided to accelerate their plans and establish before the Summit an injecting centre, called ‘the Tolerance Room’. We hoped that this would result in the question of an injecting centre trial being included in the agenda of the Drug Summit.

In 1997, the Howard government adopted a ‘Tough on Drugs’ policy. In August that year, Major Brian Watters had said chillingly that ‘there are worse things than death when it comes to addictions’. The Wayside Chapel group preferred the values of tolerance, compassion and reverence for life to the values inherent in a War on Drugs. Reverend Ray Richmond of the Wayside Chapel was the informal leader of this group. The group understood well that establishing the injecting centre breached existing legislation and had agreed to jointly accept responsibility for any consequences which might flow from their act of civil disobedience. About 30 people came together from all walks of life to establish the Tolerance Room. There were parents of drug users, some drug users, nurses, doctors, a former politician and a businessman.

The Tolerance Room opened for a few hours on 4 May 1999 and a few subsequent occasions. It received an avalanche of publicity beginning with an angry denunciation by Prime Minister Howard on nation wide television. Three of the injecting drug users who had used the facility were arrested by police but their charges were later dismissed contemptuously by a magistrate.  The Tolerance Room was raided by police on a few occasions. Reverend Ray Richmond, as the agent for the landlord, was charged with ‘aiding and abetting’ the use of illicit drugs. These charges were later dropped. When the NSW government agreed to include the question of an injecting room in the Drug Summit, the group disbanded the Tolerance Room.

At the Drug Summit, the question of a trial of a legal injecting centre was regarded by many as a pivotal matter. Premier Carr gave a statesman like address. Arguments flowed back and forth. Support for establishing an injecting centre trial grew. Parliamentarians were allowed to vote according to their conscience. A majority of votes supported the establishment of an injecting centre trial including some Coalition politicians.

On 27 July, St. Vincent’s Hospital was formally invited to accept responsibility for establishing the trial of a medically supervised injecting centre. Later, through controversial circumstances, St. Vincent’s Hospital was required to relinquish responsibility for this project. The Uniting Church accepted an invitation to establish and run the centre and has done so magnificently. More than eight years after the medically supervised injecting centre finally opened in May 2001, the NSW government still requires that it remains a research project, notwithstanding numerous reports demonstrating significant benefits and cost effectiveness and despite the lack of evidence of significant adverse consequences. Support of the injecting centre by residents of the Kings Cross area has remained consistently above 70%. When Bob Carr retired as Premier of NSW in 2005, he included the medically supervised injecting centre as one of his ten greatest achievements.

There are now 70 drug consumption rooms in operation in 40 cities in 8 countries. Every year, these numbers creep up.

It’s time the values of tolerance, compassion and reverence for life replaced the values of fear and intolerance in our national approach to illicit drugs. There are many dangerous ways to use illicit drugs but the most dangerous way of all is using illicit drugs for political purposes.

On 26 June 2008, Mr Ban Ki-Moon, the Secretary-General of the United Nations, called on member states “to ensure that people who are struggling with drug addiction be given equal access to health and social services”.

“No-one” he said “should be stigmatised or discriminated against because of their dependence on drugs”.

Earlier in 2008, Ban Ki-Moon said in the context of HIV prevention there “will be no equitable progress so long as some parts of the population are marginalized and denied basic health and human rights”, including “injecting drug users”.

After the MSIC was opened in Kings Cross in 2001, the British Columbia government opened a similar centre, called ‘Insite’, in Vancouver, Canada. When the Federal government attempted to close Insite, pro bono lawyers took out an injunction.

The matter came before Justice Ian Pitfield of the Supreme Court of British Columbia,  who ruled in May 2008 that ‘the blanket prohibition contributes to the very harm it seeks to prevent. It is inconsistent with the state’s interest in fostering individual and community health, and preventing death and disease.’

He said the proposed intervention by Ottawa, when applied to Insite, threatens a person’s constitutional right to life and security because “it denies the addict access to a health-care facility where the risk of morbidity associated with infectious disease is diminished, if not eliminated.”

Pitfield pointed out that people who drink alcohol or smoke tobacco to excess aren’t denied treatment and those who are addicted to illegal drugs should not be denied a form of health-care treatment. ‘I do not see any rational or logical reason why the approach should be different when dealing with the addiction to narcotics … Simply stated, I cannot agree with. . . Canada’s submission that an addict must feed his addiction in an unsafe environment when a safe environment that may lead to rehabilitation is the alternative.’

For the Tolerance Room group, keeping people alive was the highest priority and the permanent achievement of abstinence, if that happened later, was a welcome bonus. For critics of the injecting room, the only thing that mattered was enduring abstinence. But dead injecting drug users cannot become abstinent from drugs.

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#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18