My patient, Jenny, had to sleep with her dirty, old landlord one night
last week. She had no rent money.

Jenny is 25 and heroin-dependent. She has failed the two treatment
options available to her. I have failed her.

She could not tolerate the methadone program (a heroin substitute) due
to side-effects. The abstinence-based programs were beyond her. She
needs a heroin program, and quickly.

Critics will say that prescribing heroin for Jenny will "send the
wrong message". The message, at present, is increased death rates due
to overdoses of heroin, increased rates of hepatitis C, increased
crime, full jails due to drug-related crime and a blossoming black
market that has placed cannabis and now heroin even in the schools.

It has increased the strength of heroin and halved the price, without
quality control or GST - some message!

The critics also say that heroin will be provided to novice drug
users. Not so. These programs are for mature drug users where all else
has failed (vide Jenny) and a trial is not needed - the Swiss have
done the research: it works.

Other options are needed by clinicians in the field. Other opiate
substitute programs using LAAM (a long-acting methadone),
buprenorphine and slow-release oral morphine (my favorite) are to be
researched in Victoria. I support extra research, but we need them
now.

We also need drugs for detoxification, especially for young addicts.
The new crop are aged between 15 and 23. Abstinence is a possibility
for them, especially if augmented with naltrexone, the opiate blocker.
Buprenorphine works well for detoxification and also lofexidine, a
safe drug registered in the UK.

One hurdle is that these drugs are not registered for use in
Australia. But we overcame this with naltrexone by establishing an
education program for doctors through diehard work of the College of
General Practitioners and Lurline Waters of the Victorian Medical
Post-Graduate Foundation. So big hurdles can be jumped.

The critics carp about education and here I agree, not only to provide
the full facts for students but also for parents. And how I wish, as a
doctor and a father, I'd had education on parenting adolescents. Could
this be done through the school system?

For Jenny, and others in her position, let us approach the issue
pragmatically and offer new options urgently.

Dr. JOHN SHERMAN,
St Kilda