Homelessness among clients of Sydney’s supervised injecting facility

Abstract

Purpose The Uniting Medically Supervised Injecting Centre (MSIC) opened in Sydney, Australia, in May 2001. Homelessness among people who inject drugs (PWID) in Australia has been increasing, and establishing how supervised injecting facilities (SIFs) might best support clients into housing is an important goal. The purpose of this paper is to update knowledge regarding the accommodation status of MSIC clients, thereby supporting a better understanding of the complex needs of these clients. Design/methodology/approach Client accommodation status at MSIC registration (first visit) and in a brief survey (conducted in May 2016) were compared; unstable accommodation was defined as rough sleeping, couch surfing, hostel, boarding house or crisis accommodation. The bivariate logistic regression analysis was used to explore the association between socio-demographics and accommodation status at both time points; a paired t-test was used to compare the visit records for those who reported stable and unstable accommodation in May 2016. Findings Of 232 clients who were present at MSIC during the week the Brief Survey was conducted, 107 participated. Most were male (79 per cent) with a mean age of 41.4 years. A total of 64 (60 per cent) identified as living in unstable accommodation; having increased from 40 per cent at the time of registration (first visit). There were significant positive associations between unstable accommodation status and unemployment, imprisonment and history of overdose, all measured at registration. In May 2016, unstable accommodation status was significantly associated with age of first injection and with unemployment status (as measured at registration); those living in unstable accommodation in May 2016 had a lower number of visits, a lower number of referrals to health and social services and a lower number of overdoses at MSIC than those living in a stable accommodation. Originality/value The rates of unstable accommodation among MSIC clients have been increasing. These findings highlight the importance of SIFs and drug consumption rooms as venue to address the essential needs of PWID, such as housing. The window of opportunity to support PWID who experience housing instability seems to be narrower than for those who live in stable accommodation.

“Beyond Safer Injecting”—Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility

“…Research from different international settings has consistently shown that more marginalized people use SIFs [5]. Despite different settings [5], frequent SIF attendance increased the likelihood of referral to health and social services [11,13] and engagement in drug treatment [31,32]. However, we found that such indicators of SIF service use were weaker determinants for requesting support than variables indicative of marginalization (i.e., homelessness, heroin use), self-identified needs and existing contact with relevant services.…”

“…Uniting’s Sydney Medically Supervised Injecting Centre (referred to as Sydney SIF herein) is the first and longest-running supervised injecting facility in the Southern Hemisphere, and over 16,000 clients have registered with the service since 2001. Sydney SIF clients manifest high levels of marginalization and unstable housing [13]. Overall, there are indications that the population of people who inject drugs (PWID) is aging in Australia [14,15] and elsewhere [16].…”

“…Referrals to health and social services, including drug treatment, at the Sydney SIF are similar to other low-threshold programs, in that they are opportunistic, require the identification of clients’ needs and can benefit from trusting relationships between staff and clients. Research has indicated that the clients who attend the Sydney SIF more frequently are more likely to accept a referral to health and social services [11,13], but these investigations have been limited in scope and have not directly addressed the changes, if any, in clients’ needs since their initial visit. In this study, we aimed to assess: (1) the current health and social needs of Sydney SIF clients; (2) transitions between lower- and higher-risk health and social indicators since the initial visit; and, (3) the determinants of seeking support.…”

Assessing Drug Consumption Rooms and Longer Term (5 Year) Impacts on Community and Clients

“…37 This is consistent with studies that have shown, over shorter durations, a positive relationship between SIF utilisation and likelihood of referral to health and social services. [47][48][49][50] Shorter term studies from Vancouver's Insite have reported a large volume of referrals made in a 12month period, with a substantial proportion (40%) for addiction treatment 51 and a concurrent 30% increase in the uptake of detoxification services. 52 Kennedy et al 38 found that SIFs can play a role in the cessation of injecting drug use through referrals into treatment.…”