DRUG WORK NOT BEYOND PUBLIC SCRUTINY

IN YESTERDAY'S Soapbox, heroin treatment doctor George O'Neil said all he
wanted was a fair hearing for his naltrexone program, his patients and
their families. Unfair and biased reporting, he said, had the potential to
do a great deal of harm to them.

Dr O'Neil is correct. He is entitled to a fair hearing by The West
Australian; but other people with legitimate points of view have the same
right. Unfair and biased reporting does have the potential to harm; so too
does unquestioning journalism.

The West Australian has never questioned Dr O'Neil's dedication to the
plight of WA's heroin addicts, their families and loved ones. It has no
reason to doubt he holds strong Christian values. Nor is it waging a
campaign to have him or his Subiaco clinic closed down.

Far from being unfair to Dr O'Neil, The West Australian over several years
has reported accurately on his work, his campaign for government and public
financial support and published sympathetic editorials and letters to the
editor.

It has published interviews with, and photographs of, his patients, their
families and loved ones claiming that both oral and implanted naltrexone
has saved their lives and, more recently, that they are not concerned the
implants are not approved for human use.

But Dr O'Neil and his naltrexone program are not beyond scrutiny. This
newspaper would be negligent in its duty to the community if it failed to
report all the issues surrounding this controversial treatment for heroin
addiction.

Journalists at The West Australian work under an industry Code of Ethics
which states the two fundamental principles of journalism are respect for
the truth and the public's right to information.

Dr O'Neil states that there have been no overdoses recorded among his
patients fitted with naltrexone implants. This is not in dispute.

However, Victoria Park drug treatment doctor Neil Beck, who once worked
with Dr O'Neil, raised a valid point when he questioned what would happen
to patients once the implants started to fade. Dr Beck said patients would
become susceptible to overdosing if they did not have another implant
fitted and/or had their underlying problems corrected.

What Dr O'Neil fails to mention in Soapbox is that there has been one
overdose death in the eastern States involving a patient fitted with an
implant, or that there have been 82 deaths (Letters, 3/3) since he began
treating addicts with oral naltrexone almost four years ago.

He takes issue with reports by The West Australian of medical studies by
Leederville psychiatrist James Fellows-Smith and general practitioner John
Edwards; and Nedlands clinical haematologist John Raven. Reports of their
findings have been accurate. The authors stand by their methods and do not
retract any of their findings.

Dr O'Neil may disagree with the studies' findings but this does not
necessarily make them wrong.

He will be hard-pushed to discredit another report, from the National Drug
and Alcohol Research Centre's National Evaluation of Pharmacotherapies for
Opioid Dependence, which was prepared for the Inter-Governmental Committee
on Drugs and ultimately will be handed to Federal and State health and
police ministers.

The preliminary report, like the Fellows-Smith/Edwards and Raven studies,
raised concerns about the high number of fatal and non-fatal overdoses
among patients prescribed oral naltrexone. It reported: "Patients who
entered naltrexone treatment were statistically (approximately seven times)
more likely to experience a heroin-related overdose than patients who
entered agonist (methadone, buprenorphine, levo-alpha-acetylmethadol)
treatment."

Dr O'Neil claims The West Australian has reported that he has used a
"loophole" in the law to use naltrexone implants. This newspaper has never
used the word "loophole" in this context; it has accurately reported that
naltrexone implants are not approved for human use or validated to replace
oral naltrexone.

He is allowed to use the implants under the Federal Therapeutic Goods
Administration's Special Access Scheme for category A patients which
defines them as "persons who are seriously ill with a condition from which
death is reasonably likely to occur within a matter of months, or from
which premature death is reasonably likely to occur in the absence of early
treatment."

Nor has The West Australian insinuated, as Dr O'Neil has claimed, that he
has profited from the misfortune of others.

Only three weeks ago, this newspaper interviewed "Belinda" who said that
when she did not have the money to pay Dr O'Neil up-front for her
naltrexone implants, the clinic arranged to direct debit her bank account
$10 a week. She was quoted as saying: "George never turns anyone away."

When details of the amounts Dr O'Neil charges his patients, or other
doctors to whom he supplies implants, have been printed, the paper has done
so with information from his invoices from his clinic.

Dr O'Neil disputes a report by The West Australian that Curtin University
had stopped the further supply of naltrexone implants to him until he
received ethics committee approval and the implants passed a clinical
trial. The report was accurate and based on a letter from Curtin University
School of Pharmacy head Professor Bruce Sunderland to Dr O'Neil on May 17.

It said: "I therefore, find it necessary to inform you that until a trial
protocol has been passed by an Ethics Committee, that naltrexone implants
for individual patients cannot be made."

Neither Professor Sunderland, nor Professor Charles Watson, in a follow-up
interview, have disputed this. Dr O'Neil still does not have ethics
committee approval and the implants still have not passed a clinical test.

THIS newspaper has also accurately reported a complaint lodged with the
Medical Board of WA about Dr O'Neil's use of naltrexone implants.

It also has reported the decision by the Medical Board of Queensland to ban
a Brisbane doctor from using implants he buys from Dr O'Neil because of
concern that he posed an imminent threat to the wellbeing of vulnerable
people and immediate action to protect them was needed. Medical boards are
independent bodies, not driven by media reports.

Dr O'Neil states that his work has been underpinned by various (Australian)
institutions and Dr Colin Brewer, of London, whom he described as a
psychiatrist with years of experience in the use of naltrexone implants.

What Dr O'Neil does not disclose is that he sells implants to Dr Brewer and
that Dr Brewer provided his clinic with advice on how to get them into
Britain without paying VAT.

Dr O'Neil criticises The West Australian for not canvassing the views of
the many professional people who support his work but he fails to deal with
the concerns of the equally professional people who do not believe that
naltrexone offers a "silver bullet" solution to heroin addiction.

Health Minister Bob Kucera has said that while the Government supports Dr
O'Neil's naltrexone program, he cannot endorse his use of implants; WA
Health Department chief psychiatrist George Lipton has said he would not
allow implants to be used in WA's public hospitals.

National Drug Research Institute Emeritus Professor of Addiction Studies
David Hawks states: "What is known is that naltrexone is itself
life-threatening in some cases . . . if being on naltrexone, but then
reverting to heroin, increases the risk of overdose, this increased risk
must be taken into consideration when recommending naltrexone in the first
place."

This is the same concern raised in Fellows-Smith/Edwards, Raven and NEPOD
reports that looked at the number of overdoses resulting from the sudden
lowering of tolerance to heroin and other worrying trends including the
suicide rate.

The West Australian shares Dr O'Neil's horror over WA's drug scourge; he
and his naltrexone program have a role to play in the battle against it.
But so does The West Australian, by providing the community with information.

To quote Dr Hawks: "While it is clear that naltrexone is effective for some
patients . . . it is clearly not a panacea. Neither is any other form of
treatment currently available."