OVERSEAS HEROIN TRIALS POINT THE WAY AHEAD

Prescription heroin for a small minority of users should be part of our
armoury for meeting drug addiction, argues Alex Wodak.

The main reason for a scientific trial of heroin prescription in Australia
is to develop an effective way of managing a small minority of severely
entrenched heroin injectors who do not benefit from all available treatments.

Getting this group off street heroin and into treatment would benefit the
drug users, their families and - most importantly - the non-drug-taking,
taxpaying and insurance-paying members of the community. All of us lose
heavily under the current arrangements.

In publicly supporting a trial of prescription heroin, the National Crime
Authority has joined a long and growing list of distinguished individuals
and organisations from health professional and law enforcement backgrounds
which have concluded that this research is a fundamental step before we can
make sustained progress on illicit drugs.

Over the last several decades, worldwide efforts to try to control illicit
drug use by relying on law enforcement have failed resoundingly. To achieve
sustainable progress, illicit drugs must be regarded principally as a
health and social issue, albeit with strong continuing support from law
enforcement.

Efforts to improve the way the community responds to illicit drugs must be
allowed to benefit fully from scientific research. A heroin prescription
trial is no panacea but it is an important centrepiece of a comprehensive
approach likely to deliver better outcomes.

In Switzerland, two-thirds of the heroin users are estimated to be in
treatment now, with 18,000 receiving methadone, 1,000 in ambulatory
drug-free counselling and 1,200 in residential rehabilitation. Only 1,000
treatment refractory patients receive prescription heroin.

After a three-year trial, 71 per cent of voters in a national referendum in
Switzerland in 1997 supported retaining prescription heroin as a treatment
option. Why would the conservative Swiss support heroin prescription if it
had not significantly benefited the community?

In Australia, only about one-quarter to one-third of heroin users are in
treatment at any time. We should aim at making that two-thirds of our drug
users. This will require increasing the capacity of the treatment system,
expanding the options available and improving the quality of treatment. The
aim should be to reduce the number of deaths, and the incidence of disease,
crime and corruption. The community, ready for change, is ahead of most
politicians.

It would be irresponsible to complacently assume that the problem of
illicit drugs has been conquered simply because heroin has become scarce
and drug overdose deaths have dropped sharply this year.

The argument that interdiction is more successful than previously is
dangerous. Clearly, the National Crime Authority does not believe that a
policy based on interdiction is ever going to succeed.

Drug treatment in Australia has improved considerably in the last five
years following a welcome injection of Commonwealth and State funds.

But doctors and other health professionals trying to help young
drug-dependent people to stay alive, and maybe one day abstain from drugs,
still struggle with inadequate resources and choices unnecessarily
restricted by politically imposed constraints.

When dealing with any chronic, complex, relapsing and remitting condition,
doctors and their patients get better results when there is a broad range
of therapeutic options.

Heroin has been available for the management of drug users in Britain since
1926. This followed the recommendations of an expert committee which
concluded that such treatment was acceptable when all others had failed to
help drug dependent people lead "a normal and useful life". Only 300
patients are currently maintained on prescription heroin in Britain,
compared with 30,000 in methadone treatment.

Elsewhere, a rigorous heroin prescription trial has been under way in the
Netherlands since 1998. A pilot heroin prescription trial has begun in
Germany with a definitive trial planned to start soon in six cities. Spain
is committed to a heroin prescription trial but has not yet started it.

Other countries thinking seriously about a heroin prescription trial
include Denmark and Canada. Scientists are exploring the possibility of
such trials even in the United States.

The views of the Prime Minister on this issue are well known, but a change
in political leadership will occur sooner or later.

It is no longer a question of whether a heroin prescription trial will be
conducted but when.