GETTING OFF THE ADDICTION

Doctors caring for people with chronic, relapsing illnesses usually
prefer to have a range of treatments available so they can choose the
one that suits each patient best.

It is no different with heroin addiction. Yet for 30 years A7ustralia
has relied primarily on treating this major problem using one drug,
methadone.

Last year, a national scientific project was established to test the
effectiveness of four other drugs. It might have been five, if a trial
of heroin had not been ruled out by the Prime Minister. One of the
drugs, naltrexone, has also been embroiled in controversy because of
its heavy promotion by commercial interests.

Clinical trials of these four drugs have been welcomed by drug
researchers, although some point out the irony of exploring new
therapies when there are long waiting lists for the one that is known
to work, methadone maintenance.

DETOXIFICATION: Withdrawal from heroin, which is usually less severe
than from alcohol or benzodiazepines, can be done slowly, using drugs
such as clonidine, or rapidly, under a general anaesthetic. Either
way, it is not a treatment for heroin dependence, say experts.

Relapse is common, with an average of 10 to 14 attempts before
becoming abstinent. Drug-free patients need help to learn new ways to
cope with the unpleasantness of life and while they grieve for losses
caused by their addiction.

METHADONE: There are about 23,300 people on methadone in Australia,
1,000 of them in NSW prisons. Numbers are growing by about 15 per cent
a year and the methadone program is estimated to cost the country more
than $40 million annually.

Studies have proved methadone reduces heroin use and drug-related
crime, as well as improving the health and social functioning of
patients. But it has risks.

In NSW, 36 people died from a methadone overdose in 1994, according to
a study reported in the Medical Journal of Australia in February.
However, the therapy saved an estimated 64 other lives, say the
researchers.

The first two weeks on a methadone program, when the right dose is
being established, is the most dangerous period. Twenty-six of the NSW
fatalities were in people using black-market methadone.

Poorly trained doctors, inadequate supervision of patients, access to
large numbers of take-away doses, and using methadone with other drugs
such as alcohol are the main factors contributing to death, research
shows.

OTHER THERAPIES: About 3,000 people are expected to participate in 13
or more national trials of four drugs - naltrexone, LAAM,
buprenorphine and sustained release oral morphine. The drugs have some
advantages over methadone. Buprenorphine and LAAM, for example, are
safer and can be dispensed more cheaply. But their effectiveness needs
to be determined.

There has been a lot of media and commercial hype about naltrexone as
a miracle cure for addiction, with little scientific evidence. Success
may be due to the fact that those people who can afford it have the
motivation and financial and family backing which makes them more
likely to become abstinent anyway, say experts.

Heroin has been prescribed to addicted people in the UK for 70 years.
A recent pilot study of its effectiveness there found it benefited the
health of long-term drug users who had failed several times at other
therapies, and reduced their criminal activity. A third of the
participants in the trial chose injectable methadone in preference to
heroin.

An Australian trial of heroin has the support of many drug experts as
well as the Australian Medical Association, but not the Prime
Minister, who believes it would "send the wrong message".