HEROIN, AN ETHICAL DILEMMA

CATRIONA JACKSON Listens To The Arguments In Favour Of Providing Safe
Injecting Rooms For Drug Addicts And Considers The Likelihood Of Such Rooms
Being Provided In The ACT.

LAST Tuesday night Jude Byrne told a theatre full of strangers about her
brother Justin's death. Like her he had been a heroin addict.

Over the two decades of his addiction he had tried every kind of
rehabilitation and treatment there was. Last year, in September, he was
found dead, at home, with the needle still hanging from his arm. He was 37.

If there had been someone there, if he had had a place to inject where
nurses stood by, he would still be alive, his sister said.

She told of her family's reaction. Some said, ''Oh, he was on drugs, was he?
Well, perhaps it is for the best.''

"It is not better that my brother is dead," she said.

For the five minutes it took Byrne to tell her story the room full of
lobbyists and politicians, addicts and moral crusaders making their point in
safe-injecting debate were hushed. They were in the Canberra Theatre to
debate the issues, at a forum convened by the Health Minister, Michael
Moore.

Byrne pleaded with the audience to accord drug addicts the same respect as
the rest of the community; to provide the same heath-care facilities that
would be provided to any other group dying at the rate of 800 a year; to
give them an option other than shooting up in alleys and toilets and stair
wells; but just keep them alive, if nothing else.

Moore was on the verge of putting his safe-injecting-place proposal to the
Assembly last month when shaky support from the Australian Labor Party and
Greens MLA Kerrie Tucker prompted him to withdraw it. He intends to try
again, perhaps mid-year, after community debate and the final draft of the
drugs policy, so that safe injecting can be seen in a broader policy
context.

Within the ALP Simon Corbell is strongly for the proposal, Wayne Berry is
firmly against, but it is the leader that matters. Jon Stanhope still
insists that Moore honour what he describes as a promise to secure
Commonwealth funding for a juvenile rehabilitation centre, and answer
numerous questions about the safe injecting place, before the proposal will
be considered. As last week wore on he moderated his rhetoric, saying that
after Moore had satisfied his conditions Labor could perhaps see its way to
supporting him. Some say Labor's reticence is related to not wanting to give
the for-mer Independent a ''win''.

Stanhope believes Moore has handled the proposal very badly, endangering it
through a lack of consultation and insufficient information about the exact
nature of the proposal. He says Moore must take the community into his
confidence, not just assume they will trust him.

Moore utterly rejects Stanhope's view. He says he could have worked in
secret with the Heath Department, and hatched a fully formed plan, but that
was not the way he wanted to do things. He says the process has been
extraordinarily open and that the debate about the details of the proposal
has now begun in earnest.

It seems some liberals, likely Kate Carnell and Gary Humphries, will support
the move, but the party is to be allowed a conscience vote on the issue, so
bipartisan political support is out of the question. Moore does have the
strong backing of the ACT Director of Public Prosecutions, Richard
Refshauge. In a letter the DPP wrote to the minister last week he said,
''When we deal with those who find they are dependent on drugs in a way that
recognises their humanity and dignity we can say that we are dealing with
the problem as a civilised society ought to do.''

Expanding on his position later he said that safe injecting places should
have a very high priority in the broader policy context for two reasons:
''Firstly it is unacceptable for people to be dying as a prop for
prohibition policy'' and safe injecting places would be "an important way of
gaining access to the drug-using community, to allow us to deal with it as a
social and health issue, rather than as a criminal one''.

He admitted there would be some legal complications, as would be expected
when a legal facility is established for use of illegal drugs, but after
close consideration he did not see them as insurmountable.

Another of the issues raised by Labor and others has been cost, with the
best estimates available being from the 1997-98 NSW Joint Select Committee
Report into Safe Injecting Rooms, the only serious investigation into the
issue in Australia. They range from $265,000 a year for a service co-located
with a needle exchange, to $306,000 for an eight-hour-a-day service with
four staff on Health Department premises, to $993,000 for the same standard
service open 24 hours a day.

Moore says he is looking at expenditure around the lower end of those
estimates but that detailed financial calculations have not yet been
finalised, because the shape of the service is not yet decided. Overseas
evidence pointed to 24-hour services not being desirable, on the underlying
theory that limited opening hours instilled some discipline into injecting
habits, and helped users take control of their lives.

The committee's chairwoman, and now retired NSW Labor MP, Ann Symonds, says
she was shocked when the majority of the 11-member committee recommended
against a trial. She says the whole report reads as though the trial should
go ahead, but politics intervened at the last minute.

In the dissenting report that she and three other members wrote, they quote
Commissioner James Wood, from the 1997 Royal Commission into the NSW Police
Service. He says, ''At present, publicly funded programs operate to provide
syringes and needles to injecting drug users with the clear understanding
they will be used to administer prohibited drugs. In these circumstances to
shrink from the provision of safe, sanitary premises where users can safely
inject is somewhat short-sighted. The health and public-safety benefits
outweigh the policy considerations against condoning otherwise unlawful
behaviour.''

In trips to the Netherlands and Germany to look at established injecting
rooms, Symonds said, the most striking factor was not only bi-partisan
political support for the injecting rooms, but high-level support in police
and business (one of the injecting rooms was funded by a bank), and in the
general community. She says it will be very difficult to go forward without
that, but it must be tried.

Moore concedes that running a successful trial will be harder without
bipartisan political support but says once the trial is up and running
''people will see that the sky hasn't fallen in, and that the service offers
addicts a gateway to treatment and better health''. He says it is hoped that
people like the Prime Minister, but also his opponents in the politics and
the community in the ACT, will change their minds.

The rooms will not only contain safe injecting facilities, but also have
staff on duty to look after addicts' everyday health needs, to patch up cuts
and scrapes, or check out a throat infection, or discuss treatment and
rehabilitation options.

Again international experience indicates that one way to keep the trial on
track is to establish a high-level monitoring group that would meet
regularly to sort out any problems and look at better ways of doing things.
Overseas groups include a top policeman, law officer, politician, business
and user representative. Moore intends to follow this lead, and Refshauge
and Stanhope are strongly in favour.

Moore has been mulling over what to call the room, other than just a safe
injecting place. He thought perhaps The Gateway, after Symonds said that was
what the rooms provided. Byrne had another suggestion, Jason's room, or
Sally's room or John's room, after any of the thousands of people who might
still be alive had their last injection been in a safe place.