WHEN WILL WE ACT ON OUR HEROIN CRISIS?

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

Checked-by: Mike Gogulski