IN SEARCH OF PEACE, THEY PAY THE PRICE

To step into George O'Neil's Naltrexone clinic is to step into altered
states of consciousness - not just drug-induced ones, but the changed
realities of everyone affected by heroin.

The lost children inside this clinic in the inner-city Perth suburb of
Subiaco are ours. Most of the time they're invisible, hidden in other
people's families, dying in alleyways we don't walk down, shooting up in
safe houses we don't see, going to jail or just staying out of it, wrecking
parents' marriages, destroying their own lives.

Dr O'Neil doesn't hide them. He sweeps them from under the carpet of
anonymity into the full glare of as much publicity as he can get. This is
the antithesis of the conventional approach to drug therapy that focuses on
confidentiality and privacy - progenitors of secrecy, shame and
criminality, as he seems to see it.

For the uninitiated, it is a shock. You are barely in the door and you find
yourself with a box-office ticket to a detoxification or implant procedure
- - especially if you are in a position to influence the public debate.

You learn that this is also a place where realities collide. The young
people lying on vinyl mattresses on the floor are in various stages of
rapid detoxification. Many are drenched in sweat, some are comatose, some
toss and turn and jerk and others crouch with their heads in their hands.
Some will live and some will die. They are all trying to get off heroin.

Most are tended by volunteer carers, and some by one or both parents. A man
in his 30s or 40s tries to hold his daughter's hand as she tosses and
turns, her hand flailing unconscious rejection, her body in torment. Her
torment is his. It is written on his face, and in his rapid breathing. It
takes no psychological skill to read this script: my baby, my baby, where
have I gone wrong?

On this day, one of two days a week when the clinic does detoxes, there are
bodies everywhere - most prostrate on mattresses in the recovery room, some
in the corridor, some unsteadily upright and walking. It does indeed look
like the Third World, as one government medical officer warned me it would,
or perhaps a war zone.

Dr O'Neil appears in hand-painted T-shirt and casuals, fraternally kissing
a young woman patient on the cheek as he passes, exchanging pleasantries
with a tall young man in a rugby sweater who walks hesitantly close to the
wall.

He introduces himself and beckons to his surgery, where I am introduced to
Steve, lying on a surgical bed behind a room divider, a young woman friend,
and her mother, who sit in chairs at the foot of the bed.

Steve is lithe, tanned, good-looking and talkative. His friends look
shell-shocked. Dr O'Neil talks to Steve quietly, quickly, his words
scattering across the proceedings in soft, staccato bursts, questioning him
about his life, his relationships, his state of mind.

Was he depressed, ever suicidal? Depressed, yes, suicidal, no. He is 39, he
has been using heroin since he was 15. This time, he says, he has lost
everything. His wife, his kids, his house, his business, the whole goddamn lot.

"I don't want to kill myself, I just want to get off heroin," he says.

He seems a bit confused. He is here for a Naltrexone implant but expected a
detoxification process first. Dr O'Neil says the implant will help the
detoxification, and he may need two or three.

Steve signs a consent form, and they decide where the implant should go -
around the hip-line on his right side.

It's a simple procedure.

The syringe goes in along a 10-centimetre pen line, the flesh gradually
expanding into a hard little pillow to accommodate the Naltrexone.

Steve joins the chorus of silent misery on the floor, making the first big
down payment on his own escape - the extreme physical discomfort of rapid
detoxification.

What follows will be a fight for survival. If he takes oral Naltrexone
every day, the Naltrexone will blunt any physiological craving to go back
to heroin; if he "forgets" his daily tablet and succumbs to re-using, he
will probably overdose. For rehabilitating addicts, that is frequently a
death warrant.

But for Steve (and others with Naltrexone implants), he may get another
chance: the slow-release Naltrexone supports their vital functions just
long enough to keep them alive and get them back on to oral therapy.

If he gets a second or a third implant, the heightened release levels may
protect him from overdosing at all for long enough to sustain a full recovery.

This at least is the theory.

The Naltrexone implants are the newest addition to the biomedical
technologies developed at Dr O'Neil's premises in his controversial
campaign to break WA's heroin epidemic. They are still regarded as
experimental, and they are done on a case-by-case basis with Therapeutic
Goods Administration approval for high-risk patients in danger of overdosing.

An obstetrician and gynaecologist by training, this Irish-born father of
six is an unorthodox figure in the medical world, drawn to work in
addiction therapy through encounters with drug-addicted young mothers. He
is also an inventor with a track record of several medical instruments to
his credit in common use in hospitals around the world.