QUICK-FIX CONCERNS

Last week's investigation into Dr Stuart Reece's naltrexone-based treatment
of heroin addicts has stirred up a storm of controversy.

DOCTOR Stuart Reece moved quickly. By 7am last Saturday morning, the
charismatic Brisbane GP had compiled a 14-page document, headed "Lawyer's
Briefing On Libellous Article", and was faxing it to the homes and
workplaces of his staunchly loyal supporters.

Many of those supporters -- despondent, drained parents of heroin addicts
treated by Reece in his SouthCity 7-Day Medical Centre at Highgate Hill --
would soon be astounded and angry.

To the mothers and fathers enduring the indescribable misery of being
unable to help children end a heroin-dependent lifestyle with its attendant
crime, deceit, humiliation and, perhaps one day, death, the pain from
reading The Courier-Mail last Saturday was too much to bear.

"You cannot know what it is like to live every day with this disgusting,
evil addiction, worrying that the next phone call will be the police saying
our boy is dead from an overdose," said one mother.

"Stuart is our only hope and now he's being crucified for doing the work to
take them off heroin and get them clean and normal again."

Reece, a deeply religious fundamentalist Christian who has treated almost
850 addicts since deciding, in July 1998, to embrace and aggressively
promote the heroin-blocking drug naltrexone as a treatment, came out fighting.

The overall tone and thrust of the articles, he wrote in his rebuttal,
amounted to character assassination, religious vilification and an overt
charge of formal psychotic delusion.

He charged this reporter with having "Marxist anti-wealth affections" and
of speaking for a "leftist lobby"; he accused his medical peers, who spoke
out in an unprecedented way to raise their grave concerns about his work,
of committing scientific fraud and betraying "the trust and the health of
the generation with which the medical profession is entrusted"; he
denounced the medical establishment for being "so clearly particularly
uncomfortable with the concept that many patients can be rendered drug-free".

And then, as supporters began writing their own censuring letters and
e-mails, Reece got back to his work.

There would be patients to see, rapid detoxifications to organise, oral
naltrexone to prescribe, and $500 implants, stamped "Not validated for
human use"; and "Not validated to replace oral naltrexone", to insert
surgically.

In the medical profession, however, highly respected authorities including
drug-addiction experts and psychiatrists, Professor John Saunders and Dr
Ian Curtis, were greatly alarmed.

Neither they, nor the bureaucrats who report to Health Minister Wendy
Edmond, nor some of the leading medical brains in Queensland, had any idea
of the deaths among Reece's patients until reading it last Saturday.

Reece knows of 24 or 25 deaths. While it is true heroin addicts have a
mortality rate of about 2 per cent and, therefore, some of his patients
would have died anyway, leading clinicians believe Reece's figures could be
the tip of the iceberg.

In the conservative language of doctors who have an ethical responsibility
to patients to "do no harm", and a cross-duty to the patients of other
doctors, they plainly express opinions that a number of deaths might have
been avoided under a different treatment regime.

They ask: has the clinical practice of an overly zealous doctor with a
highly motivated religious faith that binds him to disciplined abstinence,
indirectly led to more deaths than would have been the case had he never
begun treating heroin addicts?

Their concerns are not unsupported by other data. In the five years to
1998, the number of opiate overdose deaths in Queensland averaged 38; yet,
in 1999 by which time Reece had treated some 300 heroin addicts, it had
spiked to 70. Health Minister Edmond has known of these figures -- and of a
possible linkage -- for some time.

The international medical literature over many years has cautioned the use
of naltrexone because of its associated mortality rate.

Naltrexone is widely lauded as an excellent drug for addicts. But it is
imperative that they are carefully selected (only 5 to 10 per cent are
suitable for it). That is because, when they relapse, they have lower
tolerance levels, are more vulnerable to overdose and more likely to die
than if they had continued using heroin and never been treated with naltrexone.

"A lot of parents express views about the effectiveness of naltrexone
which, I regret to say, are unrealistic," Professor Saunders said.

"The evidence in my judgment is compelling -- that methadone treatment is a
safer treatment than other forms of treatment for heroin-dependence,
including naltrexone. Now, Dr Reece does not agree with that."

In this complex and emotion-charged debate, many people believe they have
the answers. Doctors. Carers. Addicts. Devout Christians. Politicians. And
many parents who have only praise for Reece say his work gives their
children a clean lifestyle and potentially saves their lives.

But the platitudes mean little to Anne Reynolds. Her son, one of Reece's
patients who relapsed, is dead. She wonders if Paul is among the 24 or 25
of whom Reece has knowledge.

She desperately wants other parents and addicts to get a more educated
understanding. She wants to tell the medical board how she and Paul were
swept up by Reece's evangelical zeal and extraordinary enthusiasm for
naltrexone being "the only way".

She wants to stress Reece did not offer alternative treatments nor properly
explained the downsides and grave risks.

SHE wants to tell how she had no idea of the multiple layers of support her
son would need to beat his addiction; that the limited rehabilitation Reece
directed Paul into was grossly inappropriate and harmful.

She wants to make it clear that health regulatory authorities from Edmond
down have not just failed in their duty of care but, until the recent bout
of publicity, looked the other way despite concerns dating to 1999 over the
Highgate Hill practice.

"I understand where the parents of heroin addicts are at with their
desperation because we were there, too," says Reynolds.

"But my son is in a box now. Maybe people need to see that box to
appreciate my concerns. We do not have another chance. My son would have
been better off using (heroin)."

Then there is Julie Perrett. She has, she says, complained since August
1999 to the Health Rights Commission, the Australian Medical Association of
Queensland and Health Minister Edmond about Reece after the tragic outcomes
for two of her loved ones who were patients.

"I explained to (Edmond) that I have written to these other people and that
they won't do anything," says Perrett.

"I asked, 'Why is this program being allowed to run when there are no
rules?' I asked her if this was how drug addicts were looked after under
her Government. I asked her heaps of questions about the way this program
was run and when I received a reply, it was, 'Can't help you. Write to the
Ombudsman'."

A spokesman for Edmond said last night: "It is not possible for us to check
our records after-hours, but we will certainly look into this."

But as one GP who works in the same area as Reece wrote in a letter passed
on to Queensland Health: "It is about time we spoke up as a profession
about the risks that Dr Reece is putting his patients at . . . (he) should
be suspended by the Medical Board of Queensland pending a full
investigation into his dubious practices and should be accountable for an
audit into the contribution that he has made to the deaths of many young
people in Brisbane.

"These addicts are having naltrexone implants inserted that are unproven
with no studies to back up their use; are not registered with the
(Therapeutic Goods Administration) in Australia; and are not authorised for
use in humans.

"Stuart must be very certain of what he is doing because his medical
indemnity insurance company will wash its hands of him for doing this. If
the parents of even only one of the dead children that he has produced took
him to court he wouldn't even be offered a representative from his
insurance company."

Until last week, public criticism of Reece's work with drug addicts was, as
Alcohol and Drug Foundation chief Bob Aldred says, "like knocking
motherhood and apple pie -- it just wasn't done".

An uncritical media, vocal support from patients and parents, a powerful
following and a medical establishment that kept its concerns in-house
permitted Reece to continue with what Saunders called "unfettered enthusiasm".

This week, however, something changed. Doctors, parents, addicts and carers
have related their own experiences with Reece. Individually, they are
troubling -- with claims of what patients regarded as "ritualistic
exorcisms" by Reece among the least serious. Together they add up to what
one of the most respected medical authorities in Queensland has described
as a "probable public health disaster".

The concerns have been on the public record for a week. Yet not once has
Health Minister Edmond or her advisory staff contacted this reporter to
seek any information.

Saunders was baffled, referring to a "muted response" from the guardians of
public health when, he says, the concerns were such there should have been
an urgent and robust response.

"There has been a groundswell of concern," says Saunders. "I think the
system has failed."

IT also has emerged that the naltrexone implants made by Perth's Dr George
O'Neil -- a Christian fundamentalist with a much bigger naltrexone-led
practice -- are being over-ridden by addicts in Brisbane taking large doses
of heroin. The vast majority of those addicts with an implant are not told
they also need oral tablets.

Bob Aldred is appalled.

"Eminent, respected senior medical professionals have made unprecedented
public criticisms of Dr Stuart Reece's medical practices and procedures,
but the Minister says she has to wait for an official complaint to be made
despite the fact many young lives now are knowingly at considerable risk,"
he said.

"Parents and families deserve better from our political leaders. Many have
placed false hope in naltrexone and now must live knowing that the implant
in their child could be the gateway to their child's death.

"The power to act is only vested with the Government. Without immediate
action we can be certain more will die.

"With heroin overdoses doubling every 12 months in Brisbane we need
political leadership that will act to provide hope, not this political
impotence that is covering the coffins of young lives in papers adorned by
the Queensland Government letterhead."

Late yesterday, Edmond issued a statement. She said she had followed legal
advice and, on Thursday, "signed a direction to the Queensland Medical
Board to investigate matters related to the practice of Dr Stuart Reece".

Previous legal advice indicated that unless some new allegations came to
light or a complaint was lodged with the Medical Board, there was no basis
for taking action.

Her new position was described as "in the public interest and based on her
significant concerns about issues that have been raised".

"Put simply, we are proceeding but our case would be a lot stronger if we
had people with formal complaints," Edmond said.

Her direction to the Medical Board says that the investigation "should
address a range of issues related to procedures used by the clinic and Dr
Reece".

"It includes the issue of what mechanisms are in place for follow-up with
patients."

Meanwhile, Reece remains intensely focused on his work. In his 14-page
rebuttal, he asks: "Why is enthusiasm an indictable offence?

"Why is it wrong to believe, even passionately, that every patient has a
right to a drug-free life, particularly if that patient freely expresses
the wish to strive for this?

"Since when is it a heinous crime to make your colleagues think, or to tell
them to see things they have long considered in one way, in a different light?

"Clearly, with drug deaths spiralling under harm minimisation, it has been
reasonably suggested that this policy, more than others, needs to be
scrapped urgently."