A/Prof Nico Clark is the medical director of the medically supervised injecting room in Melbourne, and an addiction medicine specialist at Royal Melbourne Hospital. He has worked in a range of settings including, the WHO in Geneva and remote indigenous communities.

The push for a drug consumption room in Melbourne came from decades of advocacy from supporters of harm reduction, concerned community members, emergency services and the families of those who had overdosed in Richmond. Supported by brave politicians and coronial findings, support was collectively built until all major political parties and stakeholders agreed to a trial. No sooner than it had opened it immediately became a political football, with stigmatising media articles and polarising politics. Despite its positive impact and high throughput, it came under fire from anyone wanting to attack the government. In this context, the pressure was on the fledgling Medically Supervised Injecting Room (MSIR) to be a risk-free zone and stay out of the newspapers, while at the same time catering to the most marginalised people in the community. Being the most scrutinised health service in the country took its toll on staff and clients of the service, yet, despite that, 4 years on it has seen almost a third of a million visits, and close to 6,000 overdoses. It has become one of the major providers of hepatitis care and opioid pharmacotherapy in the city. This presentation tells the story of the MSIR, from its grass roots advocacy campaign, its design, opening, and expansion, the development of its low threshold health services, and the events that have challenged it along the way.