HEROIN'S REAL CRISIS: KNOWING THE DEMON

Where to start? With the young man lying in the CBD, with the Prime
Minister and his zero tolerance, or with the city residents and their
abhorrence of syringes? Maybe it begins in the suburbs, where most users
come from, or the detoxes and rehabs, where they hope to get clean. For
many, it begins with the police doing their busts, the courts handing out
their punishments, and the prisons slamming their gates. But for an
increasing number who are personally affected, it can start where it ends,
with a young person hitting the ground after hitting up - at risk of early
death.

Let's start with the young man. His face is hollow and shockingly pale. It
is the color of dirty snow. Maybe he has had a dirty hit. The young woman
standing over him thinks so. "I saw him score in Russell Street," she says.
"He got his fit off the foot patrol." It is just days after police blitzed
the corner of Russell and Bourke, and the dope pulses on. So does the young
man's breath, but only just. An office worker has tilted his head to one
side and opened his mouth. Another calls the ambulance. A crowd presses
forward for a closer look. "It happens all the time," the young woman says.
No one demurs. They are absorbed in the latest instalment in the saga of
what some say is the heroin overdose capital of the world.

Three hundred and fifty-nine people, mainly young, died from heroin-related
overdoses in Victoria last year. In the CBD, one person died a fortnight.
The "drop" rate is much higher. Five minutes after the young man in the
grey T-shirt hit the pavement, the blue-uniformed paramedics were at his
side with oxygen and Narcan, the heroin-blocker. On average, they are doing
it more than 10 times a day in metropolitan Melbourne now, twice the
call-out rate of 1998. But single days can easily yield 30 overdoses.

It is an epidemic we have failed to understand, let alone stop. Heroin has
been demonised rather than dealt with. That much is clear from the
escalating death rate and volume of users. The kid on the ground is just
the most visible of a quarter of a million Australians thought to have
tried the drug. Up to 89,000 are said to be dependent. But no one knows the
true number, or exactly why they use. As with all illegal pursuits, there
are no precise figures, just estimates , and like the stereotype of the
junkie, that is a photofit version of reality.

To get beyond the shadow-play means encountering two conflicting worlds,
and a mountain of ambivalence. On one side are users and their explanations
and illusions, on the other, society, with its expectations and
enforcement. They are at odds and estranged.

One side calls for prohibition, the other for permissiveness, and whatever
communication exists takes place through a syringe, darkly. Just look at
the overdose victim. He is about 20 and dressed in familiar denim and Nike.
But his brown eyes, wide and staring into space, and his skinny body, limp
and sunk into the pavement, set him apart. The crowd pushes forward until
it is almost on top of the saliva trickling from his brown, scummed lips.
They are unfazed by the packet of B & H's in his back pocket, but can't get
over the death in the crook of his arm.

You can see it in their eyes. They want to glimpse existence on the edge.
Nudging forward, as if to rub shoulders with the risk the young man has
taken, a balding man asks "Is he dead?" It is the lure and repulsion of
heroin's Russian Roulette. Is a junkie the rebel of his imagination, or the
victim of his neediness?

With the use and prohibition worlds steaming ahead on such different
assumptions, who can tell? Illicit drugs are said to cost Australia close
to $2billion a year, and consume $7billion on the blackmarket. Yet users
remain as stylised, and therefore cliched, as the cop parading his haul of
white powder. Neither explains or tackles the youth sub-culture that is
killing nearly 800 young Australians a year.

Heroin is a consumer success story, undiminished by blaming, busting and
"education". Most of the $620million governments were, in 1992, estimated
to spend each year on the drug problem goes to law and order. Even though
for 15 years, Australia has officially embraced a policy of harm minimisation.

The result has been a dramatic increase in the number of users and overdose
deaths, and a decrease in the average age of users. Drug overdose deaths
doubled in Australia between 1991 and 1997. In Victoria, they doubled
between 1997 and 1999. At the same time, the average age of first-time
users fell from 26 to 16.

And, as Bernie Geary, of Jesuit Social Services, points out, expensive
attempts at education have failed. "Sending a drug worker in a leather
jacket to schools only titillates the kids," he says. "We haven't got the
resources to do the real work, because people still think there's a war to
be won against drugs. A war against drugs is a war against drug users, that
is, a war against our children. That's an immoral war, and it has been lost."

A recent Melbourne City Council meeting called to discuss supervised
injecting rooms reflected the complexity. Sunk into high-back swivel
chairs, councillors listened as a drug expert, Dr John Fitzgerald, told
them it was "an opportune moment to nip the problem in the bud". There was
no magic bullet, he said, but there were useful steps, including a safe
injecting room. "No time left for grandstanding or headline chasing," Cr
Kevin Chamberlin argued. But the council decided to put off a decision.

Before it did, Cr Chamberlin savaged the Lord Mayor, Peter Costigan, a
supporter of supervised injecting rooms, who was in favor of a delay. "You
don't understand the issue, that's the problem," he thundered. It is a
charge that can be levelled at most of us. Even though the World Health
Organisation in the early 1990s established there was no such thing as a
typical drug user, we assume there is. Maybe it is because, by banning
heroin, we have thought we can block out its appeal, and lump together
those who use it into a single, disillusioned category.

But users are as diverse as the drugs they consume. While most of those on
the street are from abused backgrounds, often with little family support,
education or money, there are a profusion of suit-wearing "recreational"
users: professionals, including a sizable number of doctors, who shoot up
irregularly for the buzz, or the momentary relief. This group, thought to
number as many as 175,000, manages like most of those who try heroin to
avoid becoming heroin dependent.

It is an outcome that challenges the inevitability of the heroin horror
scenario, and suggests that the graphic new TV ads, depicting the despair
of addiction, will not turn off the young.

No one claims to know what will. The most optimistic strategy is aimed at
cutting the death toll and rise in addiction, along with a decrease in
associated health problems, such as hepatitis C and AIDS, and a reduction
in drug-related crime. This approach, likely to be at least partly embraced
by the State Government's Penington Committee next month, involves moving
tentatively away from the prohibition model to sanction so-called safe, or
supervised injecting rooms, along with a more open attitude to heroin
trials, that is allowing addicts access to legal opiates.

The alternative, favored by the Prime Minister, Mr John Howard, many CBD
residents, and the Salvation Army, is to maintain zero tolerance, that is,
the focus on cops and courts, with so-called "shooting galleries"
prohibited and heroin kept strictly illegal.

Through the lives of half a dozen addicts and the arguments of the key
protagonists, The Age will explore these options in the coming week. We
will look at the links in the heroin chain, from the first hit to the first
bust, detox centres where junkies dry out, some to get clean, some to hide
from police and the "rehab" or rehabilitation roundabout, with its delays
and inevitable failures.

We will examine the courts and what they offer heroin users, criminal
activities used to support a habit, and jail, where most hard-core addicts
end up. We will consider the mental illness affecting some users, the
agencies that keep them alive, the myths that surround heroin, and the
mentors some need to get straight. It is a journey that is at the same time
predictable and surprising. Heroin can be deadly, but it is a mix of drugs,
notably alcohol, which kills. Users are visible in groups in the CBD, but
most die at home alone. Junkies can be desperate enough to jam battery acid
up their arm, and yet still insist on drinking organic orange juice.

Detox, a word many associate with cure, is problematic, not just because it
can be hard to access and introduce young pill-poppers to heroin, but
because once clean addicts have lower tolerance and are much more likely to
fatally overdose.

The world where "whacking up" can be more important than waking up is,
paradoxically, a world where addicts dream the most conventional dreams.
Suburban homes with white picket fences, loving families and jobs are high
on a junkie's wish list, at least for the 15 to 25 per cent who become
addicted, and lack the will or money to stay employed and manage their drug
use.

It is the same story in other countries. The difference is that for some,
such as Switzerland where the funding bias is in favor of health, not law
and order, and heroin is available to addicts on prescription, overdose
deaths have halved, and drug-related crime fallen.

Holland, which has embraced liberal drug laws, has reportedly kept its
overdose deaths steady at around 50 a year, while Australia with a similar
population, is losing more than 700. With Victoria's overdose death rate
predicted to nearly double again, to 500 in the next few years, it is
difficult to argue with experts, including the conservative Australian
Bureau of Criminal Intelligence, that, "current policies are not working".

If they were, the young man who "dropped" before a curious crowd in the
city would not now be in the arms of the paramedics. Today is his lucky
day. With his eyes still swimming in rheumy liquid, he lifts his head.

"How are ya?" one of the blue-uniforms says. "How ya feelin?" But he is on
his feet, rubbing the bridge of his nose and striding towards Bourke
Street. The office types pull back and head home. Later tonight he will
need another hit.