THE BIG FIX

Despite the best efforts of methadone programmes, two more heroin addicts
die in Australia every day. As Queensland prepares to embark on trials of
naltrexone, a methadone alternative. Christine Retschlag examines the
conflict between proponents of the two treatments.

IT STARTS with the sweats followed by a wave of intense pain and gut cramps
before it builds into a crescendo of chills and rashes which burn to the
bone.

Drug addicts call it "hanging out" and right now they are frantic for their
next big "fix" -from the bureaucrats.

The Queensland Government is emerging as the Mr Big in a debate about
whether the heroin addiction treatment naltrexone should be introduced as
an alternative to methadone.

Treatment lobby groups are feeling strung out at suggestions the potential
new "wonder drug" needs extensive trialling before it can be introduced,
despite being available overseas for more then 30 years.

These are the family and friends of those hooked on heroin who believe
existing methadone treatments are killing our kids.

So convinced are they of their claims, they say they plan to sue the state
and federal governments on behalf of several thousand people.

Pat Assheton, founder of treatment lobby group Drug-Aid which has worked
with more than 10,000 families and friends of addicts around Australia,
lost her 26-year-old son to a heroin overdose last year.

She says the methadone programmes aren't working and wants naltrexone to be
registered in Australia.

"The methadone lobby have been jealously guarding methadone for several
reasons - it is a guaranteed bank cheque of a considerable amount," she
says.

Ms Assheton believes some doctors have a vested financial interest in
keeping patients on methadone for life as an easy long-term source of
income.

"We are horrified, we don't want to have to say this but the proof is in
the pudding. I'm not against the intention of methadone - to replace
endorphins -but the product is wrong."

"It belongs in the 18th century. It is full of contaminants such as
ethanol. It is a chemical cocktail."

However federal AMA president and Queensland GP Dr David Brand has serious
concerns after the safety of naltrexone.

Methadone is used to feed the opiate receptors in the brain and is given
orally in a liquid form which has to be taken daily in front of a
pharmacist. It costs $3-$5 a treatment.

Addicts refer to it as the "liquid handcuff" because they have to go to the
same pharmacist every day for treatment and can be required to open their
mouths to see that the methadone has been swallowed. It is liquid gold to
some addicts, who use it to barter for heroin on the street.

And there are other drawbacks. Some critics believe methadone is three
times more addictive than heroin and that prescribing it for an addict
hands them a life sentence of treatment.

The alternative treatment being pushed for, naltrexone, is currently
allowed in Israel, the United States and Europe.

Taken in tablet form, it is a non-addictive treatment embarked on once an
addict is fully detoxified via sedation or a faster method which involves
anaesthetic.

It is relatively cheap - each tablet costs about $5 - and stops physical
cravings for heroin if taken every day.

Advocates say it should be taken for a year, after which an addict should
be well on the road to recovery.

Assheton says almost every request by doctors to the national Therapeutic
Goods and Health Department to use naltrexone in treatments has been
rejected.

"Very often it is denied. It is bureaucratic pig-headedness that decides
who will treat or not treat. We are dragging the chain and our kids are
paying the price for it," she says.

"They are totally misinformed, especially GPs, about how to handle drug
dependency. The law has come between the doctor and patients."

The State Government has indicated it is prepared to trial naltrexone but
Health Minister Wendy Edmond this week warned she would not rush any
decision on whether to allow it as a registered drug.

She says the next state Budget will include a Queensland trial of naltrexone.

This will include the Israeli model - rapid detoxification under general
anaesthetic and accelerated detoxification with sedation.

"I don't think it is methadone versus naltrexone. It is not a case of one
or the other but increasing the range of options you have," she says.

"Concerns have been raised by the experts about the rapid detox programme
which is why I have said we need to look at it more closely. The doctors
who participate in it, if anything went wrong, wouldn't have a leg to stand
on."

"Yes methadone is a substitute for another addictive agent but it replaces
the need to get up every day and the first thing you have to do is find a
fix and pay for it."

"I simply do not accept people are dying on heroin now and we must rush
into things without doing it properly."

But one person who wishes the states would make up their mind quickly is
"Alana".

Three weeks ago, she was in the grips of her love/hate relationship with heroin.

Now, after dumping her nemesis for naltrexone, she is "clean" for the first
time in four years.

She had made repeated attempts to kick the habit under methadone.

"Methadone is just like scoring," she says.

"It is just as expensive and it is just as hard to come off. It is the same
as a heroin detox -you start spewing, get cramping in the stomach and legs
and your bones hurt from the inside out. Your nose is running, your eyes
water and you get hot and cold rushes."

'THE Queensland system with methadone is ridiculous. They want you to sit
in a room full of junkies all talking about smack, half of them on the nod,
and they expect you to stay clean."

"They are too conservative and too backwards. They don't dose you correctly
up here so you need to take heroin to supplement it."

She is under no delusions about naltrexone, describing the first day on the
treatment as "reasonably difficult" and listing similar withdrawal symptoms
to those under methadone."

But now she is left with only the psychological cravings rather than the
physical.

"The beauty of naltrexone is you go through hell but it is only a couple of
days. I've only been clean 20 days but that's a lot longer than I ever have
before," she says. "There are still withdrawal symptoms. Being on
naltrexone, I feel like I'm free. I'm not condemned to go to a clinic every
day."

"I'm taking it one day at a time. I have no craving today to go and use -
every junkie I see makes me more determined to make something of my life."

"Because of the naltrexone I now have the choice to control my life
whereas, before, heroin was making every decision for me."

"I cannot count on my fingers how many friends I've lost to heroin. Every
day they are dropping like flies."

"Both governments are saying they will build as many jails as they can to
put these 'scumbag junkies' behind bars but once drug addicts are in jail,
there are no recovery programmes."

"Wouldn't it be better to spend one-tenth of the money and get these
people's lives back again?"

Dr Brand, however, says he is hesitant about the drug because of concerns
raised in New South Wales that many addicts are dying after trying it.

"My understanding is (on naltrexone) you can become sensitised to heroin so
that if you take your usual dose, it can kill you. It is not without its
problems," he says.

"They absolutely have to be trialled - let's not just chuck some medication
over and see how it works."

"My concern is some of these trials aren't being done as scientific trials
but as a bit of political window-dressing."

Brand rejects lobby-group suggestions that the medical profession has a
vested interest in supporting methadone because of financial incentives to
keep addicts as patients.

"There is a certain number of doctors who manage a large number of heroin
patients but most doctors find managing methadone more trouble than it's
worth," he says.

"If naltrexone works, let's go for it. People will still die two a day and
probably will in 20 years' time. It is unlikely we will find a magic cure
to this."

In the meantime, the problems of heroin addiction continue to plague Queensland.

A "disturbing" number of drug overdoses has led Emergency Services Minister
Merri Rose to order the Queensland Ambulance Service to expand its training
of ambulance officers to include administering the heroin antidote Narcan.

Ambulance paramedics also will use vital minutes after recovery from an
overdose to explain to people that they have just escaped death and to give
them information on medical and counselling services.

James Toth, clinical director of the Alcohol and Drug Foun dation of
Queensland's drug rehabilitation centre Logan House, says the more
treatment options available the better. The work of Logan House, near
Logan, is based on non-chemical-based rehabilitation after an addict has
been detoxified for up to a fortnight.

But he says neither methadone nor naltrexone is a magic cure, because
addiction is more than a physiological problem.

"If we are dealing with a dam that's got a lot of leaks, neither naltrexone
or methadone are going to plug all the leaks."

Toth says it would be sensible to trial the drug. "It would be dangerous to
exclude any form of treatment."

But all the while, as the battle goes on, time is running out for heroin
addicts. By the end of today, another two will be dead.

Seeking a miracle

ANNA travelled to Israel last year hoping naltrexone would be the miracle
cure for her heroin addiction.

She'd had a series of attempts to break her dependency, which started at 14.

Anna, 23, says she was on methadone for a year but for nine months of that
time also used heroin. The pilgrimage to get naltrexone was a last resort.

"I went because I tried many programmes in Australia -detox, rehab and
methadone -everything you can find and I still don't know the answer," she
says.

Strongly supported by her family, Anna underwent the full $US11,OO0
($19,000) treatment. It involved an overnight stay in hospital to undergo
the rapid detoxification programme, consultations with an Israeli doctor
and instructions to take half a tablet of the drug every day for a year.

But her recovery was derailed when she was seriously injured in a car crash
a month later.

"I started using (heroin) again within a month of coming back from Israel,
and it is as if I have never been," she says.

"They say naltrexone works as a shield against heroin because it stops you
feeling the cravings and withdrawals but after using for so long, heroin is
my shield against the world, so not being able to feel it does not equate
to me."

A shortcoming of the programme, she says, was the lack of follow-up
counselling, and she found it hard to maintain the impetus on her return to
Australia.

"It's easy to be swimming around the Mediterranean but coming back to
Australia there's real psychological issues back in the real world and
somehow coping," she says.

The situation was exacerbated because naltrexone rejects opiates, which
meant receiving pain relief for her injuries became difficult.

"I stopped taking it (naltrexone) and was then being treated with
painkillers like morphine and pethidine, and when I left hospital I started
using (heroin) straight away," she says.

Anna, who now has two jobs, still uses heroin once a day but now believes
she has her addiction under control.

Of naltrexone, she says: "You have to be willing to do the same slog as you
would with anything else; it is a back-up, not a cure, but it should be an
option." --

Morgan's Story

Being dependent on a drug, being illegal or legal, never gets explained
before you try it, the pain and the loss one would soon suffer had been put
across to me at first then I would not have had to go through hell and
fight until my fingers and knuckles were broken, just to get back to
normality, reality.

Heroin is a substance that has taken more than words and emotions can
explain, if its damage could been noticed on our bodies like a knife, my
appearance would be as if I was put through a a blender. The scars are
healing slowly for my family, friends that I have left, and of course
myself.

The time it would take to heal isn't possible in twenty life times, only a
few of my scars would ever heal.

Lifelong the rest for real.

I made the choice to take drugs in the first place, so OK I made the
choice. Anyone who knew the pain that such a white rock could do. The
choices it could make for you. I've been on the lowest levels but nearly
two months now I'm back on earth clean.

Naltrexone took me off one hundred and twenty mills (sic) of Methadone
syrup. Methadone I find out the hardway (sic) is ten times harder to get
off than heroin is, but I ended up on a gram and a half of heroin as well.
When nothing else works and you can see that nothing else works what have
you left to loose(sic).

Nothing at all except your life.

Edited extract from DrugAid publication

Checked-by: Joel W. Johnson