Reframing Addiction: Lessons from Dr Nico Clark’s Work in Australia

In 2018, Melbourne’s North Richmond suburb was becoming overwhelmed by a heroin crisis.

Drug use took place openly in car parks and overdoses were common, with ambulances a daily sight in public areas.

That year, Victoria opened its first – and still only – supervised injecting room, a controversial but groundbreaking move aimed at reducing casualties from overdose and taking drug use off the streets.

At the heart of the project was Associate Professor and current Head of Addiction Medicine at Royal Melbourne Hospital, Dr Nico Clark, an addiction specialist who served as the former Medical Director at the North Richmond Medically Supervised Injecting Room (MSIR).

Dr Clark has worked in the field of addiction medicine for over 25 years, including 10 years with the World Health Organisation in the Substance Use Team.

Determined to challenge stigma and reframe how Australia responds to addiction, Clark spoke recently to ABC Radio National’s series Changing Australia about his experiences and lessons learned from the facility. [1]

Providing a Safe Space to Save Lives

The injecting facility was established to reduce harm without encouraging drug use. Clark emphasises that the safe space has done just that, with the facility recording half a million visits and 7,000 successful overdose revivals during his time as Medical Director.

Ambulance call-outs for overdoses in the surrounding area also decreased by around 40%.

But, alongside the reduction in fatal overdoses, the facility provides a supportive space to encourage dialogue and help.

For Clark, issues go beyond one site: “That’s a broader question about how we design our society, how we provide support services for people who are homeless, for people who have mental health needs, for people with substance use needs.

“What’s the role of the police? What’s the role of healthcare services?”

The statistics reflect a wider public health strategy known as harm reduction, focusing on minimising the negative impacts of drug use rather than criminalising the individuals who use substances. [2]

Issues with Stigma

Despite the evidence-supported positive impacts of the facility, public opposition to the supervised injection facility remains, often driven by stigma rather than concrete evidence, in Clark’s opinion.

Surrounding communities may worry that the centre encourages drug use or impacts the safety of cities. Yet, stigma ignores the fact that many people struggling with addiction are survivors of trauma or abuse, or victims of socioeconomic disadvantage.

Clark argued that stigma around addiction is often rooted in fear and oversimplification: “As communities, we often identify a group of people we can place on them everything that’s wrong in our society. It’s a shortcut for dealing with some of the more complex issues.”

The stigma then has many impacts; not only does it affect public opinion, but it also changes the way that funding and policy are managed.

Centres like that of North Richmond are expensive to set up and keep going, and public perception can greatly influence the political willingness to put investment into such services.

That stigma, he suggested, makes it easier for policymakers to overlook addiction services when setting budgets, leaving drug and alcohol treatment as one of the most underfunded areas of healthcare.

The Link Between Addiction and Emotional Trauma

To combat the long-standing stigma of people struggling with addiction, Clark stresses that more awareness of the underlying reasons behind addiction is needed.

Many people turn to substances as a way to cope with trauma they have experienced, such as childhood abuse or other formative events.

For many of those who used the injecting room, Clark found addiction was linked to trauma. “Quite a lot of people in our society have enormously painful things happen to them,” he said.

“One of the most common stories that people told me was that they were sexually abused when they were children. Then you take some alcohol or [a drug] and suddenly feel like it’s gone away and you think, wow, this feels like how I should feel.”

That cycle, leading to dependence or addiction, he suggests, points to deeper challenges for society: ensuring children grow up safe, and supporting those who carry the weight of painful experiences from their upbringing or early years.

Beyond One Facility: The Future of Addiction Care

Since leaving the Medically Supervised Injecting Room in North Richmond, Clark has turned his focus to First Step, a not-for-profit hub in Melbourne providing integrated care.

“Instead of sending people around to get mental healthcare from one place, primary healthcare from another place and addiction care or legal problems elsewhere, they’re provided under the one roof by people who try and build a trusted space.”

But such models remain rare, and Australia, like many countries, faces a chronic lack of services for people struggling with drug and alcohol addiction.

“Drug and alcohol services are the most underfunded sector of our healthcare community,” Clark explained.

“There is really good data saying that it’s good value for money to invest in services that help people recover from addictions, and recovery is possible, but they’re still the most underfunded section of our healthcare community.”

Despite the challenges of the sector, Clark said working in addiction medicine has been unexpectedly rewarding: “Everybody was a person with a unique story. Sometimes it can be difficult hearing the stories that people have had, but other times it can be really uplifting.

“Hopefully, I’ve made a difference in some people’s lives. I feel like I’ve been really lucky to have ended up working in this area.”

From Australia to the UK: Are Narratives Changing?

Melbourne is by no means alone in grappling with how best to respond to drug-related harm in the community.

Canada has rolled out dozens of supervised consumption sites in cities like Vancouver, where studies show they reduce deaths without increasing crime. [3]

Meanwhile, in Switzerland, facilities have been operating since the 1980s as part of a broader harm-reduction approach that includes heroin-assisted treatment, helping to stabilise lives and reduce public drug use. [4]

In 2001, Portugal famously decriminalised all drugs, shifting resources into treatment and support rather than punishment – an experiment that has since influenced global debate. [5]

The UK, by contrast, has so far resisted opening supervised drug consumption rooms, despite support from health experts, local authorities, and even devolved governments such as Scotland’s.

Glasgow has been at the forefront of this push, pointing to persistently high rates of drug-related deaths, but political disagreement between Westminster and Holyrood has stalled widespread progress.

At the start of this year (2025), Scotland finally opened the first official Drug Consumption Room (DCR) in Glasgow, but for the rest of the UK, for now, the UK’s approach remains focused on law enforcement alongside treatment services, though advocates argue that a shift towards harm reduction is long overdue. [6]

Clark’s reflections raise a crucial question: will Australia follow countries like Switzerland in expanding harm-reduction services, or remain caught between public anxiety and the realities of a health crisis?