HEROIN TREATMENT PROGRAM DESERVES A FAIR HEARING

EACH year, more than 1000 young Australians die from heroin overdoses.
During the past 10 months, we have put naltrexone implants in 320 young
West Australians at high risk of death from overdose. We have removed four
because of local reactions, leaving 316 with implants. In that period, none
of the patients has overdosed.

You would imagine that this would be a cause for some celebration. Instead,
I have been subjected to continuous attack in The West Australian,
insinuating variously that I am unethical, profiting from the misfortune of
others, using "loopholes" in the laws, unwilling to comment to the paper
and misrepresenting scientific facts.

Virtually all of the critical comment about my treatment of people with
heroin addiction has come from people working in the area of drug
addiction. I find it interesting that no one has questioned their
motivation or representation of the scientific facts.

As an example, your reporter wrote, "Dr O'Neil branded both the
Fellows-Smith-Edwards and Raven studies as seriously flawed" (report, 8/6).
Has your reporter considered the possibility that the studies are seriously
flawed?

I have raised this issue with her several times but she has not taken up my
suggestion of having these research reports independently evaluated to
gauge their scientific merit.

I would have thought this was warranted, given the gravity of the claims
made in these reports, neither of which has been accepted for publication
in peer-reviewed journals.

The June 8 report quotes the rate of fatal and non-fatal heroin overdoses
as 46 per 1000 among the naltrexone group of patients, compared with 13 per
1000 among those on buprenorphine and two per 1000 for those on methadone.

Buprenorphine is a recent addition to the treatment of heroin addiction.
The argument, therefore, is essentially about whether there is any evidence
of a rise in the base rate of death from heroin overdose since my
naltrexone program was introduced as an alternative treatment to the
methadone maintenance program.

I began my naltrexone program in WA in 1997. Since then I have treated 2900
patients. Following on from the logic of these research reports, what
happened to trends in WA heroin-related deaths?

I quote from a report put out by the WA Drug Strategy, a government body
set up to coordinate the State's drug policy. It says: "Since the December
quarter 1998 (25 deaths) there has been an overall downward trend in the
number of HRDs (heroin-related deaths) in this State, decreasing by 52 per
cent to 12 deaths in the March quarter 2001." (Trends in Heroin Related
Deaths WA 1995-2001 Australia: 1988-1999: WA Drug Strategy).

Importantly, the mortality rates from opioid deaths in South Australia,
Victoria and New South Wales increased over that period.

Based on the trends in heroin-related deaths as set out in the WA Drug
Strategy document, it would be difficult to sustain the argument that
naltrexone has had any negative impact on the death rate among people
addicted to heroin.

It has been reported in your newspaper that I have been using a "loophole"
in Commonwealth legislation to prescribe naltrexone tablets and implants.

This is not the case. Legislation allows Australians the privilege of
access to unregistered medications if their condition is such that
premature death is likely to occur in the absence of early treatment.

It is legislation that has been used in many different medical situations,
not only in the case of naltrexone.

With more than 1000 young Australians dying each year from opioid
overdoses, surely there is a justifiable case for Australian families
having access to treatment that can lower this risk.

On May 22, I spoke to your reporter, together with Professor Sunderland
from Curtin University, to explain that the university was not interrupting
our supply of naltrexone implants.

Your reporter had a private letter from Dr Sunderland to me. Despite our
explanations, she reported that the university was going to stop the supply
of implants (report, 23/5).

This created a false impression that we were acting in a way that was
unethical and not supportable by the university. The implants are produced
by people working for me and not by the university.

Furthermore, the Curtin University ethics committee met recently and is
asking for more information before making a final decision.There have been
repeated insinuations that I am profiting from the use of naltrexone
therapy and the sale of naltrexone implants.

Nothing could be further from the truth. Many of the people who I treat are
unable to pay for their treatment but I have never refused to treat anyone
because they have been unable to pay.

My work with people with heroin addiction and their families and friends
has never been an income-generating scheme. On many occasions, we would
have gone out of business had it not been for the sacrifice of my staff,
the tireless support of many volunteers and the generosity of many people
and many organisations, including the Australian Medical Association.

Because of the financial predicament of many of our patients, the former WA
government was approached to provide naltrexone free of charge for people
on the program. Although it agreed to provide free medication, it made it
available only through "Next Step", the government's drug program.

This was an interesting strategy given that the people in charge of
providing access to free naltrexone were the people who were most
vehemently opposed to our naltrexone program.

Although the former government approved financial assistance for our
program, the board that was set up to oversee the disbursement of the trust
funds was made up substantially of people who had been critical of our
program.I believe your newspaper's reporting of this important issue has
been far from fair. It has largely ignored the overwhelming support our
program has received from the people who are, or have been, on our program
and their families.

THERE are many professional people who support our program but their views
have not been canvassed.

Our work has been underpinned by a large number of groups working
collaboratively, including the departments of psychiatry and pharmacology
at the University of WA, the department of pharmacy at Curtin University,
the WA Chemistry Centre and Dr Colin Brewer in London, a psychiatrist with
years of experience in the use of naltrexone implants.

West Australians should be proud of this work which has resulted in the
production of an implant that lasts up to a year. Nowhere else in the world
has this been achieved.

Your newspaper's reports invariably give precedence to the claims of the
so-called "experts" in the field who are the advocates of what is called
"harm minimisation". Clearly, over the years their programs have not
provided all the answers to the heroin problem in our community. No one
group or program can have all the answers for such a complex problem as
heroin addiction.

Is it not time that someone challenged the validity of the claims by these
"experts" and the motivation for their opposition to our naltrexone program?

Could it not be that some people believe that our program will take away
much needed funding from their programs? Is it not possible that the
forthcoming WA Drug Summit has been a stimulus for their increased media
activity?

All I ask from The West Australian is a fair hearing for our program and
for our patients and their families.

Unfair and biased reporting has the potential to do a great deal of harm to
them, as I believe has been the case in Queensland.