HEROIN DEATHS - THE BODY OF EVIDENCE

THE TOXICOLOGY of modern tragedy is explored in a bulging blue-bound volume
that Dr Jim Gerostamoulos thumps on to the table in the Victorian Institute
of Forensic Medicine. His recent PhD thesis on deaths through heroin
overdose, the volume represents his strong technical credentials for leading
a new attempt to help reduce the horrendous heroin toll, likely to claim up
to 300 lives in Victoria this year.

Gerostamoulos, senior researcher at the institute, is heading a multi-agency
investigation project examining the minutiae of 25 specially selected cases
in the hope of learning what can be done to prevent future deaths.

It has taken him out of his laboratories, and into lanes, public toilets,
homes and other places where heroin users have been found dead.

The deaths have been treated with the intensity usually reserved for a
homicide investigation. Police and scientists have been combining their
efforts to identify the risk factors.

From August 16-21, this material will begin to emerge as the Victorian
Coroner, Graeme Johnstone, begins a series of inquests that will represent
the most intensive focus upon heroin overdoses carried out in Australia.

"I am concerned with the number of deaths, and concerned that we really need
to learn as much as we can about methods of preventing these deaths," says
Johnstone. "Obviously, one of the major intentions of this project is to
look at ways of preventing avoidable deaths."

Recently, for instance, a series of three inquests showed that snoring from
which a heroin user could not be roused, believed to be "sleeping it off",
was in fact a danger sign of overdose and possible death through a blockage
of the airways.

The technique of clustering inquests has been valuable in producing
recommendations from coroners to prevent or limit further deaths from fan
fires, tractor rollovers, single vehicle accidents and, in particular,
police shootings.

The gaps in existing knowledge on heroin deaths are summed up by the
institute's scientific head, Dr Olaf Drummer, who says: ``Basically, we
still don't know why anybody dies from heroin, let alone why so many and why
it's increasing. We have ideas and have had for many years.

"A lot of the investigations done up until now have been routine. You have a
CIB-based constable coming to a scene, treating it is as if it were just
another death, and you get some information presented to the coroner as part
of brief.

"We often didn't know whether this person was a regular user or not, what
they were up to in the last week before their death."

Gerostamoulos has been helping police get statements from doctors and
pharmacists; generally working out what was going on in the often very
complex lives of heroin users.

The issues often involve poly-drug use, people mixing other drugs with
heroin, and how it generally reduces the body's ability to tolerate heroin.

Strong pointers have come from a survey of the 434 deaths in Victoria in
1997-98. It found 44per cent of people who died had mixed heroin and
benzodiazepines (these include Valium and Rohypnol). Another 37per cent had
mixed heroin with alcohol. Only 14per cent had taken heroin alone.

Another theme is the effectiveness and accessibility of treatment, including
inside jails, and the reduced tolerance for people just released from jail.
"Doctor shopping", in which users may visit a number of doctors in one day
collecting scrips for prescription drugs, will also be examined.

For his doctorate, Gerostamoulos looked at 40 deaths in Victoria between
1994-96, studying the toxicological effects of the drug as it breaks down in
the body from heroin to forms of morphine.

He says heroin kills some people within five or 10 minutes of the injection,
but others die from four to eight hours later. The drug suppresses the
brain's ability to maintain breathing, and becomes more dangerous when
combined with other drugs, like alcohol, which affect the same mechanisms.

In his job, Gerostamoulos sees a lot of bodies going through autopsies.
Inevitably, it produces a clinician's detached approach, but the latest
project differed a little.

"It's just different seeing a body in a natural context rather than in a
mortuary," he says."It was the particular scenes, where these people had
OD'ed, the sad nature of their death.

"I got the feeling that most of the cases were people alone, not necessarily
lonely, but lacking friends, who possibly had issues such as depression to
deal with, who had had a pretty torrid time in their lives, and it had come
to an abrupt end.

"The whole thing for me was just the sadness of these people OD'ing on
heroin and giving their lives away at such a young age."

The people in the study were aged between 18 and 42 but in the past two
years, people aged between 15 and 56 have died from heroin.

Although the inquests will reveal the full picture, a glance through the
coroner's files reveals the range of heroin tragedy.

Most of the deaths are recorded in a manila folder in slim volumes
containing the bare essentials necessary for what is known as a chamber
finding by the coroner, without having held an inquest.

In the files are the toxicologist's report, containing the levels of
morphine and any other drugs, statements from those close to the deceased
person, the facts of what happened, who found them, and a bit of background
about their lives.

Nestling among the papers is usually an envelope of photographs that show
the detritus of death: the needle, the spoon, the little swabs, the position
of the body.

Death by heroin is not pretty. Faces are purple or grey, the flesh can be
mottled. Usually the signs of frantic attempts at resuscitation are present:
the clothing torn or snipped by ambulance officers.

Nearly 60per cent of deaths occur at home. Sometimes users die with their
partners asleep beside them, other times on their own.

Many of those who die are people who are heavily addicted and live in single
rooms in boarding houses. Some are discovered only when their odor seeps
into the corridor.

But heroin seems to cross all stratas of society, all suburbs. The files
told many stories:

A big, blond country boy who drifts to the Big Smoke and dies, stooped over
in a filthy corner behind a city restaurant.

The wealthy businessman whose dabbles with cocaine embolden him into trying
heroin. Despite one overdose when an ambulance revives him, he tries it
again - with fatal consequences.

A woman who dies in a Flemington flat after binge drinking and reportedly
snorting an enormous amount of heroin.

The New Zealand girl who stops off to buy heroin after a nightclubbing
session and is found dead in the morning by a frightened young man who had
smuggled her home to his room.

The middle-aged woman who dies in a Footscray park after a heroin binge with
two men.

A lonely woman from a good home in the eastern suburbs whose diary reveals
her losing struggle to get her life on track and stop using so much "stuff".

A prostitute who uses heroin once a week, on her day off, and then sets out
to clean her flat furiously. She is found on the floor, a rubbish bin
between her legs.

Most people do not want to talk about the heroin deaths of people they know,
but two families agreed to talk to The Age for this article, setting the
scene for the new coronial phase of the heroin debate.