In a bustling office space in the heart of Melbourne's CBD, Fiona Cook is packing clean syringes and alcohol wipes into an already-stuffed backpack.
A member of The Living Room, a primary health service in Hosier Lane, Ms Cook routinely joins the outreach team to support people experiencing homelessness and stop those using drugs from re-using needles.
"You're more likely to hurt a vein, you're more at risk of bloodborne virus, there are just really dangerous injecting habits that can happen," Ms Cook says.
"The drugs are already there, they're going to be used, it's about how to make it safer."
She says the team's never been busier.
"We head out 365 days a year, twice a day," she says.
Over the year to February, The Living Room says it witnessed a significant increase in drug use in the CBD, with the service handing out almost 150,000 clean injecting kits as part of its needle and syringe program.
In 2021-2022, the program helped an estimated 8,000 people. In the first 10 months of this financial year, it's already seen 9,600.
"Any rhetoric that heroin use is on the decline is incorrect," Living Room CEO Ben Vasiliou says.
"We're seeing numbers go back to the same level as 2018-2019."
The Living Room will this week make its submission to the Victorian government's review into setting up a supervised injecting room in Melbourne's CBD.
Headed by former police commissioner Ken Lay, the review is tasked with weighing up competing and passionate views about the impact of the state's first centre in North Richmond and the need for another in the heart of the city.
The Living Room's submission argues a CBD facility is crucial to saving lives — an argument they say is backed up by their injecting kit heatmap of the CBD.
The map plots locations where the health service's outreach team has either handed out clean injecting kits to people in need, or collected used kits.
Blotchy red lines show demand has been largely concentrated around Elizabeth Street, Swanston Street and Flinders Street.
"People plan to inject those drugs typically not long after they collect the kits from us," Mr Vasiliou says.
"The concern is that we know that people are injecting in laneways, public rest rooms and often alone, which makes it very difficult to revive anyone who has an overdose."
Recent data from the Victorian Coroners Court found that between July 2020 and June 2022, Melbourne had the highest number of fatal heroin overdoses of any local government area with 29 deaths, followed by 28 in Brimbank and 23 in the City of Yarra.
Heroin-related ambulance call-outs in the City of Melbourne also increased, jumping to 390 from 305 the previous year.
"We're losing a person a month to heroin overdose," Mr Vasiliou says.
"Every month that we don't act, we lose another life."
In March, almost 80 CEOs from health, housing and legal groups submitted a joint letter to the Victorian government calling for a supervised injecting room to be established in Melbourne's CBD.
One of the letter's signatories was cohealth, the community health organisation tipped as the government's preferred operator for the proposed CBD facility.
Frontline workers say facility will offer safety to drug users who are already in the CBD
A few blocks away from the Living Room, cohealth outreach worker Kit Regan can often be found patrolling the city's streets — sometimes for up to six hours at a time — providing food and clothing to people experiencing homelessness, as well as referrals to doctors, addiction medicine specialists and housing support.
They say the service has seen a threefold increase in the number of clients reaching out for help in the CBD in the last six months, as people return to the city post-COVID.
"We're also seeing a much higher increase in the number of people overdosing, and we're giving out preventions for overdose a lot more," they say.
Kit, who has been a part of the outreach team for 18 months, rejects criticisms that a CBD facility could provide more incentive for drug users to come to the city.
They point out their current clients aren't travelling to the North Richmond injecting room to use drugs.
"It's a different community. North Richmond is another community and we've got a different community in the city, and they're choosing to be here for a whole lot of reasons," they say.
"They're already here. They're already using. They're using in the street, they're using in public, they're using in toilets.
"Offering a safe, clean and helpful place to use isn't going to increase the numbers. It's just going to give them a better place to use."
Cafe owners fear 'thoroughfare' location could drive customers away
In 2021, the Andrews government purchased the former Yooralla building on Flinders St as its preferred location for a second injecting room, but the building has sat empty.
Plans for a facility opposite Queen Victoria market had also originally been put forward, but were later dropped due to community backlash.
Community health organisations now fear the government has lost its appetite for a second injecting room, particularly after Premier Daniel Andrews cited changing drug patterns as the reason behind why the review's reporting timeline was pushed back.
"We know the pandemic has significantly changed aspects of the CBD, including population, foot traffic, drug harm, the types of drugs people buy, and where they consume them and homelessness patterns," a government spokesperson says.
In Degraves Street, local traders say a CBD injecting room, particularly one on Flinders St, would drive customers and tourists away at a time when businesses are still struggling to recover from Melbourne's COVID lockdowns.
David Perrotta has run Cafe Andiamo for almost 18 years, and says he supports a CBD injecting room — provided it's in a different location.
He, alongside several other business owners, have made a submission to Mr Lay's review.
"Put it somewhere else where there's not a big thoroughfare, where it won't affect businesses," Mr Perrotta says.
"I'm not saying not to have an injecting room, but at the front door, the heart of Melbourne? It just doesn't make sense."
Rafael Camillo, who is an active member of a CBD residents group, says he's concerned about potential safety risks, and wants an increased police presence in the CBD.
"The state government should fix rehab services first before even contemplating another injecting room," he says.
"The injecting room is just a bandaid solution."
The police union has also voiced concerns, noting a review of the North Richmond centre found it did not overcome the "amenity challenges" created by a pre-existing drug market in the area.
That independent report, published this year, found the the facility was broadly successful, having saved 63 lives and safely managed more than 6,000 overdoses.
Community consultation for the CBD injecting room will run until May 16, with a report expected to be handed to the government by the middle of the year.
