NO PANACEA FOR DRUG ADDICTION

EVEN people who disagree with Dr George O'Neil's views on treatment for
heroin addicts could not doubt his dedication to their well-being.

It is clear that Dr O'Neil has a passion for healing. He has thrown himself
single-mindedly into his work of helping addicts to kick their habits
through his naltrexone program.

The pressures of running his clinic have been unremitting and he has
absorbed an emotional and physical toll. He belongs to a small group of
exceptional people who - by their example of practical compassion - can
give people hope for a better society.

However, this does not necessarily mean that Dr O'Neil has all the answers
to the problems of heroin addiction. One of the by-products of his
sometimes controversial work has been to draw attention to heroin addiction
and the medical and other issues associated with it. This, in turn, has led
to a useful public debate.

A view that is emerging strongly from the debate is that there is no
panacea for addiction, that treatment should vary in keeping with the needs
of patients. According to this view, naltrexone should be one of a range or
combination of treatments used.

Although Dr O'Neil can claim some outstanding success for his clinic, there
have also been deaths among people who had been treated there. He has
acknowledged that there had been 60 to 70 deaths since he began treating
addicts with naltrexone 3 1/2,* years ago.

A two-year study of 3617 WA heroin addicts by psychiatrist James
Fellows-Smith and general practitioner John Edwards found that those
prescribed naltrexone had a one in 61 chance of dying, compared with one in
100 for addicts on the streets. People prescribed methadone had a mortality
rate of one in 458.

Dr Fellows-Smith said naltrexone patients risked death when they suddenly
stopped treatment: most deaths among these patients occurred within a month
of ending treatment. The most likely cause of the death rate among such
patients was that naltrexone lowered their tolerance for opiates.

The research findings do not invalidate the use of naltrexone to get people
off heroin. However, they amount to a compelling warning about the
vulnerability of people who end the treatment.

And they reinforce the message that addicts on naltrexone need vigilant
carers to encourage them to stay on the program and off heroin. Dr O'Neil
has fitted with naltrexone implants patients who do not have carers, an
innovation that has not been used for long enough for a thorough assessment.

The debate about treatment for heroin addicts serves to show how
complicated the issue is. It has focused on the clinical aspects of
treating addicts and this should also be discussed at the drug summit
proposed by the Gallop Government.

The summit will not come up with any easy solution to the problems of
treating addiction but it should try to devise a flexible system that
offers a range of treatments according to addicts"needs.

But that is only a part of the much bigger problem of increasing numbers of
people, particularly the young, turning to illegal drugs for escape or
relief. The summit would not be doing its job if it did not search for the
underlying causes of this and recommend ways in which they could be combated.