The medically supervised injecting room (MSIR) is a government-funded space within the community health centre. It is open to anyone, and provides needles, condoms, sanitary pads, phone chargers, food, and other things that users may need for safety and comfort.
Visitors can stay for as long as they like. Staff mentioned an average of about 20 minutes, and visitors tend to talk to staff about housing problems, social situations, family dynamics, and relationships, on top of discussions about safe substance use.
Needle injection room
Prior to entering the needle injection room, visitors register (they may use an alias) and are logged on to the computer. Visitors need to bring their own substances and the centre asks what they will be using.
Only those who will be injecting may enter — friends who are not injecting may not enter the space. There are single and double seating options for visitors to inject solo or with a friend.
Everyone has to self-inject only — while staff can help safely find veins, staff cannot help visitors inject. There are oxygen bottles and other medical resources on hand, and a mixed staff of nurses and harm reduction practitioners in case of overdose.
The MSIR also provides services focused on the needs of heroin users. People across the spectrum (homeless, working, long/short term users etc.) appreciate the opioid withdrawal management drug which blocks feelings of sickness which accompany withdrawal symptoms.
As an ex-heroin user who co-hosted our visit stated, the MSIR has been a welcoming and comfortable space. The management drug allowed users to live their lives, including travelling with a partner and visiting a doctor without stigma.
Given that dental services are not easily accessible and oral health is a priority for heroin users, the MSIR set up an in-house oral health care service. Services include oral checkups, fillings, and tooth removal.
Drug outreach lawyers are also well-connected with the MSIR and they provide legal services.
Heroin use in the state of Victoria was increasing around the time the centre opened, but overdose cases in the geographical vicinity near the MSIR were going down. When Covid hit after that, drug use in general went down.
Though the centre may not have been the only influence on drug use and overdoses, it seems to be serving the community well.
Although we are likely a long way away from an injection room in Singapore, we can take good examples from the ethos and operations of the MSIR. Providing stigma-free spaces for substance users, prioritising agentic decision-making and safe use, and recognising and understanding the drug-specific and complementary needs of substance users are all key principles.
It was beautiful to see how the MSIR centres visitors/users and the fullness of a person’s life. It’s not just about support in safe substance use, it’s also about the visitor having a safe space that is inviting and caring. It’s about everything that life entails — including housing, relationships, family dynamics. These are global issues that apply to users everywhere, including in Singapore.
Ex and current drug users in Singapore have also spoken about the power of social support, family understanding and peer networks. They’ve also highlighted the stigma that they’ve felt, and how respect and care are crucial in person-to-person connection.
This conference focuses on harm reduction services that are provided and policing, accessibility and funding issues. The user-centred approach that the MSIR utilises helps us to stay grounded in the needs of substance users themselves, and the fullness of being and life that we should constantly keep at the forefront as we continue with drug policy work.