Injecting Centre should open to pregnant women if they need it

On Monday July 25, the Daily Telegraph ran a front page story titled Child Drug Room Lunacy in which it said “children as young as 16 and pregnant women” would be welcomed into Sydney’s supervised injecting centre to shoot up heroin.

We can easily understand the horror and revulsion people feel at the idea of a pregnant woman injecting an opiate, but have you tried to imagine how lonely and harrowing it would feel if you were pregnant with an untreated drug dependency?

People are afraid of the Medically Supervised Injecting Centre because they don’t understand what it does. When pregnant women are brought into the conversation, this fear predictably turns into hysteria. Shocking headlines which sensationalise the stories of desperate people are a major threat to the the supervised injecting centre, which otherwise operates quietly and unobtrusively to save lives and connect people to vital services.

The centre’s proposal that their help be extended to young people and pregnant women needs to be embraced, however unpalatable this idea may initially seem.

Language such as ‘drug room’ and ‘shooting gallery’ used by the Telegraph implies that the supervised injecting centre is some kind of fun but seedy hang out for the criminally deviant.  So what is it really like inside the injecting centre? And why should we “let” pregnant women and young people in there?

I was privileged to tour the medically supervised injecting centre as part of my employment for a  peak medical body. I have to admit that I was reluctant to take the tour at first, feeling that I didn’t want to enter such a “dark”, “seamy” or “underground” place.

Our guide was a registered nurse who had worked at the centre for several years. Situated on busy Darlinghurst Road, the centre has an inconspicuous facade that makes it looks like an unbranded accountancy office. If you didn’t already know what it was, you would be none the wiser.

Inside it has the appearance of an ordinary waiting room. Metal chairs with vinyl upholstery run  along two walls. There are stacks of dog-eared magazines. Clients come in through the front door and move through various rooms, then exit by the back.

Stage one is reception. Staff take the client’s name, basic demographic data, and the drug they are going to be using. It’s a condition that a client must be a legal adult. They cannot come with a minor. They also have to be proven a regular user.

There is a bank of eight stainless steel carrels, each with two chairs and a large plastic yellow sharps bin. Every surface has been wiped and sanitised. Clients are supplied with clean syringes (size depending on the drug they plan to inject), medicated swabs for the injection site, vials of purified water, and cotton for filtration.

In an adjacent room are oxygen and narcotic reversal machines that can be administered in the event of an overdose. These machines have ensured that although the centre has seen more than five thousand overdoses, there has not been a single fatality.

An enclosed courtyard at the back is called the ‘chill out room’. This is where a client can have a cup of tea or coffee and hopefully open up to staff about their life and their situation. Health promotion posters cover the walls. There are brochures and staff to help clients secure services they may need, such as accommodation support, drug and alcohol treatment programs, and detoxes. It is here that clients of the centre have also willingly participated in valuable research studies over the last 15 years.

“There is a real misconception that the people who use the injecting room are violent and inherently criminal, but they’re just people,”  says Dr Marianne Jauncey, Medical Director of the supervised injecting centre. “They’re people with their own set of stories and sadness. Often they have significant histories of trauma and abuse. It’s a real privilege to work with these people.”

Although it opened in a climate of public outrage, KPMG figures confirm that 78% of local residents and 70% of local businesses now support the facility. So do more than fifty related organisations including the Royal Australian College of General Practitioners, NSW Nurses Association, New South Wales Police Force, and St Johns Anglican Church, Darlinghurst.

It is a compassionate and practical health service that seeks to connect with people who inject drugs. Its stated focus is on harm reduction. It is grounded in overwhelming international medical evidence that injecting centres save lives and improve community safety.

So what about these pregnant women? Why should we “allow” them to access the same services and facilities as other people in need? Let’s be clear, this is not the same as a shop trying to expand its customer base. These are prospective women in need, albeit in very small numbers, who have already been refused access to the service.

“It is a shocking situation that pregnant women are taking drugs”, agrees Dr Jauncey, “But it’s not a reasonable response to turn them away.” She believes the best approach is to actively engage women who are not on treatment or therapy and get them linked in to the services they need. She can’t do that if she has to refuse them entry.

“For someone who is already opioid dependent, the safest thing you can do is ensure she doesn’t go into withdrawal, which can lead to premature labour or miscarriage,” says Dr Jauncey. “This is the firm view of the Royal Australasian College of Physicians and many other services. It’s a considered view based on evidence.”

Not only do such unhelpful articles as the Telegraph’s miss the point medically, they also paint a picture of a heartless woman who, because of her pregnancy, is somehow public property. This fuels dangerous views that the actions of such a woman should be criminalised.

In their book Transforming Addiction: Gender, Trauma and Transdisciplinarity, Greaves, Poole and Boyle argue that moralistic blaming and shaming narratives “create a situation where pregnant women with addiction issues are afraid to seek treatment.” The insistent focus on drug use in pregnancy “illustrates a conflux of sexism, objectification, stigma and social control”. The US Women’s Media Centre has also criticised the media’s reinforcement of stigma, stereotypes and sensationalism when representing women using opioids during pregnancy, whilst ignoring treatments that are known to work.

It’s easy to react to sensationalist reports about pregnant women using “ drug rooms” with shock and revulsion.  Ironically, the Telegraph itself quoted the proposal that the biggest risk to the injecting centre was “public perceptions”.

Despite the best efforts of the police and health services ready to help, it’s a reality that some people, including pregnant women, become addicted to prescription and street opioids like heroin.

Although we might not like the idea of such places, these people need support not vilification. Compassionate experts at the medically supervised injecting centre know much better how to direct vulnerable people into care than sensationalist journalists and politicians do.

Danielle Spinks (c) 2016