It is just before 9:30 in the morning, and as straggling commuters rush out of the Kings Cross subway station, a couple of rough-looking chaps mill about on the sidewalk of the entertainment district, smoking.
They are waiting for the non-descript door across the street, 66 Darlington Rd., to be unlocked so they can go inside and inject the drugs that are burning holes in their pockets – heroin in one case, oxycodone in the other – safely and legally.
The Sydney Medically Supervised Injecting Centre, which the clients affectionately refer to as the "shooting gallery," opened in 2001, the first of its kind in the English-speaking world (the pioneer was in Bern, Switzerland, in 1986) and still the only such facility in the southern hemisphere.
"Our primary goal is stopping people from dying of overdose," says Marianne Jauncey, the medical director.
But the service also helps reduce the spread of infectious diseases like AIDS and hepatitis C by reducing needle-sharing. And "it creates an opportunity to start a conversation" which, in turn, can lead to people getting the help they need – from a place to sleep to addiction treatment, Dr. Jauncey says.
Ricky (he asked that his last name not be used), a 48-year-old aboriginal man who injected drugs off and on for 28 years, says the supervised injection site provided him with a safe environment and, ultimately, helped him conquer his addiction to heroin.
"I used to shoot up in the back alleys. I was always scared of getting beat up or arrested or dying. The shooting gallery was a safe place," he says.
The centre has an injection room with eight cubicles staffed by nurses and a "chill room" staffed by counsellors. The discussions Ricky had there led him to Narcotics Anonymous and to ongoing counselling at the nearby Kirketon Road Centre, a community health clinic for marginalized groups like the homeless, drug addicts and sex workers.
Since the Sydney MSIC opened, 14,410 clients have made more than 860,000 visits, a numerical reminder that people who inject drugs do so frequently.
There have been 4,397 overdoses – but not one death.
It is noteworthy that not a single OD death has been recorded at any of the world's 92 supervised injection sites, including Insite in Canada.
In fact, the history (some would say ordeal) of the Sydney Medically Supervised Injecting Centre is remarkably similar to that of Vancouver's Insite.
Both were born of a public health crisis: In the late 1990s, heroin became cheaper, more pure and, as a result, more deadly. (Overdose deaths are soaring again, but largely due to growing use and abuse of other types of opioids like OxyContin and fentanyl.)
Sydney, like Vancouver, had at least one overdose death a day, and dozens of other ODs that strained police resources and health services, and a dramatic spike in HIV and hepatitis C infections.
All this created economic and image problems for the tourist-dependent port cities and, in turn, an environment where governments were willing to try something new, including harm reduction measures such as supervised injection facilities.
The Sydney site got off the ground much sooner – 2001 as opposed to 2003 for Insite – because of political pressure. One of the recommendations of an inquiry on police corruption (much of it related to bribery with drug money) was to create a supervised injection site; there was also a high-profile act of civil disobedience in which the Uniting Church allowed people to inject drugs on its premises in defiance of police.
But in both Australia and Canada, governments proceeded cautiously: Public health officials were granted the right to do research studies to see if supervised injection sites would reduce overdose deaths. In both countries, exemptions were made to drug laws, but only for research purposes and for a limited time.
The MSIC shook off its trial status in 2010 and became permanent, but not before losing its founding director in a political battle. Insite had to fight in court to remain open, and subsequently lost its founding directors in a political squabble.
Dr. Jauncey says research is no longer needed: Supervised injection, like other harm reduction measures such as needle exchange and condom distribution, has shown its worth, time and time again.
What is needed, she says, is to drop the moralistic opposition and expand these services.
"We need to be guided by the evidence and show compassion and pragmatism," she says.
The Sydney MSIC is so successful Dr. Jauncey sees far fewer clients with HIV and hepatitis C, and people overdosing in the streets is now virtually unknown.
"We've been giving people clean injection equipment for three decades now because it saves lives," she says. "It's imminently logical to also provide a roof and some care and save even more lives."