ADDICTS FACE A HOPE WITHDRAWAL

Heroin's new grip on country Victoria is at the centre of a medical
imbroglio that has pitched doctor against doctor and created tension between
the health services in the neighboring towns of Ballarat and Creswick.

The Minister for Health, John Thwaites, is having to intervene to sort out
an impasse that stems from the inability, or possible unwillingness, of
Ballarat to cope with its burgeoning drug addict population.

As reported in The Sunday Age last week, the old gold city is seeing 50,000
needles a year distributed to heroin addicts, and police have busted a
series of drug dealers who set up to service the local market.

Ballarat is also the focal point for efforts by the State Government's chief
drug policy adviser, Dr David Penington, to galvanise community and
municipal action on heroin issues.

The new row has been sprung on the government just when it was feeling good
about pledging a four-bed youth detoxification centre in Ballarat by next
April, to be the first in regional Victoria.

This still leaves unresolved the question of treatment for adult users,
though.

Officially, the entire western region of Victoria is supposed to be catered
for by two beds in the Western General Hospital in Footscray, but this is
insufficient for demand.

Ballarat has no hospital-based detoxification program of its own, and last
week its acting chief executive, Dr Ian Graham, said that the "last thing I
want to do is to set up a detoxification program in the corner of a medical
ward of the acute hospital of Ballarat Health Services".

He said acute hospital-based drug treatment was a model used about 20 years
ago, and while some acute medical treatment would be necessary, he was keen
to bring about a comprehensive drug management program in Ballarat that
might involve residential and other services.

But Mr Thwaites is flagging some tough future negotiating to get the
existing Ballarat Base Hospital to provide some detox beds, as already
happens in other regional hospitals.

"Geelong, Warrnambool and other hospitals do it, and are funded through the
casemix system for it. Detox is done on a mainstream basis, and that is seen
as the best way to do it," Mr Thwaites says.

"However, we'll certainly talk to Ballarat to see if we can work out an
outcome that's suitable for them."

The crisis came to a head because the little 10-bed Creswick Hospital
threatened to withdraw Ballarat's access to its de facto drug and alcohol
detoxification program, run by local Creswick GP Janus Fraillon, a noted
expert in the field.

Dr Fraillon is fighting a rearguard action to resist the change, which he
attributes partially to parochialism. "They don't want outsiders, and people
from Ballarat are regarded as outsiders, which I think is strange."

His view, reinforced by Health Department advice, is that the boundaries of
a hospital are set by the clients of the hospital's medical staff.

"They're people. They've got just as much right to live as anyone else, and
they've got a fatal disease ... addiction is a disease, and even if it
wasn't, it does produce disease. People who are long-term drug users get
hepatitis C or B, or HIV ... we can stop that."

A former East Malvern GP, Dr Fraillon developed a speciality in drug and
alcohol withdrawal, and is a former national secretary of the Alcohol and
Drug Foundation.

In 1988, aged 56, he went to Creswick to retire, but within a year had
opened the doors of his home to a general practice that "snowballed" into a
service for drug and alcohol withdrawal.

Using the technique known as logotherapy, devised by the Austrian
psychiatrist Victor Frankl, he has treated hundreds of patients and claims
to have a non-recidivist rate of 50 per cent after one year, much higher
than other methods.

"It's a here-and-now therapy," he says, "saying, OK, you may have a
psychiatric problem of an organic origin, or because of the way you were
brought up, but here we are now, what does your life mean to you and where
do you want to go from here?"

The patients go into hospital for five to seven days, where they are
chemically adjusted and supported through the difficult period of reducing
drug dependence, and then they have counselling as a follow-up therapy.

With referrals from all over the region, he has fully utilised his access to
the local hospital.

Patients used to be mostly alcohol dependent, but in the past couple of
years heroin addicts have formed a much higher proportion.

In the past six months, he has admitted 53 patients for detoxification, of
whom 40 came from Ballarat - outside the official catchment of the Hepburn
Health Services.

In the early 1990s, the population of Creswick raised $1 million to stave
off a State Government plan for closure of the hospital, allowing it to
continue as a 10-bed acute hospital.

One of the main reasons for the campaign was so that locals could be treated
close to their relatives and friends, but according to the hospital's other
three doctors, many are now afraid to use the hospital because of the heroin
addicts there.

The doctors, James Maher, Vincent Russell and Brian Hepper, say the hospital
is an inappropriate place to treat them and in a letter to the local paper
this week claimed:

There are no security staff at the hospital and if a patient becomes
aggressive, staff have to wait for police to arrive. Staff have often
complained they feel unsafe.

It is difficult to get other patients admitted because beds are often full,
meaning they have to go to Ballarat instead.

Medical patients complain they do not feel safe and several have refused
readmission. They were concerned about the withdrawal patients wandering
about the hospital at all hours of the day.

Last week, Hepburn Health Services' chief executive, David Lenehan, told Dr
Fraillon that he would no longer be able to admit patients from outside the
Hepburn catchment. One of the reasons given was to force Ballarat to take
its own share. The deadline was August 1, but this has now been extended by
three months. Mr Thwaites has bought time for negotiation with Ballarat by
promising funding for Creswick to employ an extra nurse or support worker to
help occupy and care for the withdrawal patients.

Dr Fraillon acknowledges that his patients are up at night, fully clothed
and watching television in the lounge, and there has been the occasional
incident - people absconding, others bringing drugs in for their friends.

His proposed solution is for Creswick Hospital, with extra government
support, to renovate and set up an unused nurses' home in the hospital
grounds as a secure, stand-alone detoxification unit.

"One of reasons not to have it in Ballarat, but close by, is that the
dealers are in Ballarat. There aren't that many out here," he says.

The proposal was news to Mr Thwaites. But he is open to any good ideas.