BEST MEDICINE TO BE FOUND IN TRIED AND TESTED METHODS

Michael Wooldridge counters that alternative treatments offer heroin
addicts the prospects of a better future.

On Tuesday last week I sat with State and Territory health and law
enforcement ministers from around Australia and considered the findings of
a major evaluation of the treatments available for heroin addiction.

Had this study been about heroin trials or injecting rooms, you would have
read about it on the front page of every newspaper. Instead it was about
treatments that work - not all the time for all people, but where overall
the data shows cause for optimism as we move forward in caring for those
with heroin addiction. A pity that it did not get more publicity.

The National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)
was started three years ago by all Australian governments and carried out
by the National Drug and Alcohol Research Centre. Instead of making policy
decisions based on anecdotal reports and poor science, we determined that
time and money were needed to carefully evaluate, with the best scientific
methodology, the treatments and approaches available. The assessments
examined and compared a range of factors: effectiveness, safety, health,
social and economic outcomes.

This has been a most worthwhile investment. The main finding is that
treatment for heroin dependence can work and result in health and social
benefits to both the individual and the broader community. Specifically the
study found that maintenance treatment with methadone, buprenorphine and
Levo-alpha-acetylmethadol (LAAM) produced substantial benefits for
drug-dependent individuals and reduced the use of illicit drugs and
criminal activity. Their spending on heroin and other drugs decreased by
more than 75 per cent from an average of more than $2,600 in the month
before entering treatment, to about $600 after three months in treatment.

Similarly, the study found marked decreases in criminal activity as a
result of being in treatment. The proportion of people who dealt in drugs
in the month before treatment was 23 per cent, compared with just 9 per
cent in the sixth month of treatment. The findings are consistent with the
international literature which has consistently shown methadone maintenance
decreases illicit drug use, criminal activity, injection-related risk
behaviour and improves health and social functioning.

Compared with these rigorous trials, the data on the benefits of heroin
trials remain very shaky. In some European cases there is yet to be any
evaluation data, and in the case of Switzerland the World Health
Organisation found the methodologies questionable. There was no control
group, and while there were improvements in the health and welfare of
participants, this could not be directly attributed to the provision of
heroin as opposed to any other treatment, such as methadone or
buprenorphine, the treatments available in Australia.

The report concluded that there was no convincing evidence that heroin
prescription generally led to better outcomes than methadone treatment,
even for hardcore users. In addition, provision of prescribed heroin is
unlikely to be as cost effective as existing treatments such as methadone
and buprenorphine.

A heroin trial does not get users off heroin, but is at best an interim
step to a longer-term drug treatment program. For these reasons it is not
an option the Federal Government will consider. Instead, we will now
carefully consider the findings and recommendations of the NEPOD study to
guide an implementation strategy. We must ensure that accurate information
on the available safe therapies reaches health care providers, drug and
alcohol clinicians, opioid users and the general community.

While methadone has been available here for many years, buprenorphine has
only recently been registered for use in managing opioid dependence. Its
listing on the pharmaceutical benefits scheme will increase access and
affordability of this effective treatment option. LAAM is not registered
for use in Australia.

The presence of illicit harmful drugs in our community is frightening and
sad. As a father, doctor, politician and minister I can readily understand
why there is despair, and why we all continue to hope for the magic
solution and feel tempted to try something and anything.

However, there is no magic bullet and probably will never be. Governments
will always consider and review the options available but owe it to all of
their constituents - drug users, their families and friends, health-care
providers and the wider community - to make decisions on the best available
evidence for effective, sustainable and safe outcomes. Heroin trials do not
provide that. The options we have and are considering do.