FINDING A NEW HIGH WITH FAMILY AND AN EXTRA $2,000 A WEEK

Naltrexone implants are the latest weapon against heroin addiction. Julie
Robotham reports.

Mark says the polymer block under his skin is his salvation.

So far, it is saving him $2,000 a week, several hours every day and his
marriage and family. Possibly, it is saving his life.

The implant will leak a steady stream of the anti-addiction drug naltrexone
into Mark's bloodstream around the clock for up to six months. It will stop
the 33-year-old self-employed carpenter craving the heroin he began using
three years ago to ease pain from an injury. If he takes heroin, the
naltrexone will stop him getting high.

Meanwhile Mark's tolerance to opiates will plummet, making him more
vulnerable to overdose if he does use again. He hopes the $1,000 implant
will keep him physically away from the object of his addiction while
counselling deals with any psychological urge to backslide.

"With tablets you can spit it out, or hide it under your tongue," Mark*
told the Heraldthis week. His wife supervised an earlier attempt to kick
heroin with oral naltrexone. "It was hard for her. She didn't need another
kid to look after."

Trust is returning to the relationship as Mark spends more time at his
South Coast home. "I used to get up at 3am and drive to Cabramatta to buy
heroin and then go to work in Sydney and then go back to Cabramatta before
going home. It was five or six hours of driving a day."

Mark is one of the first three heroin users in NSW to receive the implant,
inserted under the skin during local anaesthetic. The controversial
treatment has been used in hundreds of patients in Western Australia,
Victoria and Queensland, but has caused deep divisions among doctors and
addiction specialists. Proponents say they prevent overdose deaths and help
patients stick with medication. Detractors say they are untested and oversold.

The director of research at the National Drug and Alcohol Research Centre,
Associate Professor Richard Mattick, said evidence from Australian medical
trials showed naltrexone tablets were much less effective than claimed
three years ago, when they were first publicised as a heroin "cure".

"The suggestion that the implants are the better, improved miracle cure is
tiresome," Professor Mattick said. "It's important not to over-promise to
families."

The implants, which are not formally approved by the Federal Health
Department, are prescribed under special provisions which allow doctors to
sidestep the usual rules for individual patients at risk of death.
Prescribers argue this applies to heroin users because of the possibility
of overdose.

Professor Mattick said while doctors were entitled to use the exemption,
"the broad prescription of these devices goes against the spirit and the
intention of the [Therapeutic Goods] Act".

But Dr George O'Neil, who has treated more than 450 patients in Western
Australia with naltrexone implants, said they were a genuine advance over
tablets, which are available to addicts only on private script.

He says the drug works best when there are fewer opportunities to avoid it.
"Even with their mother caring for them, the success rate [with tablets]
was only 20 to 30 per cent. When the mothers crushed the tablets [to stop
spitting out] that increased to 60 to 70 per cent and when we started
teaching mothers to measure their urine it was 80 per cent. With implants
they're full of naltrexone whether they like it or not."

The Sydney psychologist overseeing the NSW patients' treatment at Edgecliff
Medical Centre, Mr Ross Colquhoun, said methadone suited some people but
others found queuing for a daily dose humiliating. "These people live in
pain and humiliation. They don't need any more. [Addiction is] not a
wilful, indulgent thing. It's a neurological disorder," he said.