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The medical coalface of the heroin epidemic

Ines M Rio and Jonathan Epstein
Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00322
Published online: 19 June 2017

It’s time for Victoria to follow the lead of New South Wales and establish a supervised injecting facility

It happened again yesterday. Code Blue, carpark. We each quickly excuse ourselves to the patients we are consulting with, grabbing a pair of gloves on the way out. As we hurriedly stream out of doors and along the corridor, we check that someone is collecting the resuscitation kit. By the time we make it to the front door there are three general practitioners, a practice nurse and two drug and alcohol workers. The person who had run in to tell reception a few minutes earlier has disappeared. But the staff know by now to ask where we have to go. We run up four flights of stairs and see the usual sight; a woman cyanotic on the hard and dirty carpark concrete, injecting paraphernalia by her side and a friend behaving erratically and crying and screaming to her to wake up. We ask and examine, assess and talk, put an airway in, bag and mask, administer multiple doses of naloxone and call the ambulance.


  • North Richmond Community Health, Melbourne, VIC


Correspondence: ines.rio@optusnet.com.au

Competing interests:

No relevant disclosures.

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  • 2. Coroner Jacqui Hawkins. Finding into death with inquest. Court reference: COR 2016 2418. Coroners Court of Victoria. 20 Feb 2017. http://www.coronerscourt.vic.gov.au/resources/d48c9cdc-8db0-45b5-83c2-5ea6918e3ccd/ms+a_+241816.pdf (accessed Mar 2017).
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  • 5. DeBeck K, Wood E, Zhang R, et al. Police and public health partnerships: evidence from the evaluation of Vancouver’s supervised injection facility. Subst Abuse Treat Prev Policy 2008; 3: 11.
  • 6. Marshall BD, Milloy MJ, Wood E, et al. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet 2011; 377: 1429-1437.
  • 7. Van Beek I. The Sydney medically supervised injecting centre: a clinical model. J Drug Issues 2003; 33: 625-638.
  • 8. Jauncey ME, van Beek IA, Salmon AM, Maher L. Bipartisan support for Australia’s supervised injecting facility: a decade in the making. Med J Aust 2011; 195: 264. <MJA full text>

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