[Picture from inside looking out at "Michael Moore at the Civic
Methadone Clinic: in favour of injecting clinics for Canberra."]

DRUG CLINICS MIGHT BE 'NECESSARY EVIL'

Special injecting clinics are the latest proposal in the fight against
a worsening drugs problem where heroin is getting cheaper, purer and
more accessible, says Peter Clack.

GOVERNMENT-RUN clinics for injecting heroin users have been placed
squarely on Canberra's agenda.

Some will deplore it and others will praise it. But a growing number
of people from across the health, law-enforcement and welfare sectors
see it as a necessary evil.

Heroin, as with all illicit drugs, has the ability to stir deep
emotions. There are those that shrink uncomfortably from the idea of
addicts shooting up in a Government-run clinic. They might see this
latest move as a gimmick, another humiliating retreat from the front
line of the drug wars.

But whichever side of the argument you come down on, things are
getting worse.

It seems clear that the concept of zero tolerance, the hard-line views
taken by many governments and law-enforcement agencies, are not the
answer to the complex phenomenon.

Last week the state conference of the Western Australian National
Party supported controlled heroin trials.

The mayors of Australia's capital cities, meeting in Brisbane, sought
a new approach to drugs, saying the current strategy was not working.

Aided by improving technology, heroin and other drugs pour into the
country in quantities so huge that the frequent drug busts by federal
agencies make no difference to street prices or availability.

Heroin is getting cheaper, purer and more accessible. Police probably
detect no more than 1 per cent of heroin being brought into Canberra.
There is a growing list of casualties. The national death toll from
heroin overdoses approached 800 in the 12 months to July. Probably four
to five times as many overdosed but survived.

In Canberra, 10 heroin users died from overdoses in the 12 months to
June and 300 were treated by ACT Ambulance Service paramedics.

They treated 42 overdose victims last month alone.

Given the worsening scenario, the ACT Health Minister, Independent MLA
Michael Moore, is seriously considering what he terms "early
intervention centres", which would contain rooms used as injecting
clinics.

Providing syringes

At first glance this raises some staggering problems of public
liability if users died on the premises. Would government officers
inspect or test the heroin? Would they help with injections and
provide syringes?

How would such a network be put in place in a city of scattered town
centres such as Canberra? And who would pay to have clinics open 24
hours a day?

These questions were put to senior ACT officials and ambulance
workers, who said they saw the potential benefits of offering drug
users the chance to inject drugs in a clean and supervised
environment.

One experienced ambulance paramedic told of his emotions when the
overdose victim was dead before he got there. He and other officials
and police spoke of the sense of shock and grieving of parents when
they were told their child had died from a drug overdose.

There are serious questions to be overcome. How can laws be changed so
police, who are duty bound to arrest drug offenders, do not intervene
and arrest drug offenders as they arrive at or leave the clinics?

The chief executive of the ACT Department of Health and Community
Care, David Butt, told of his visit to Frankfurt, Germany, this year,

where he went to see injecting clinics in operation.

He said Frankfurt had a "very open drug scene", with as many as
6000 users a day in just one local shooting haunt. There would be 20
calls a day to treat overdoses.

But opening Government administered clinics had had a deep and
profound effect. In 1991, 141 had died of overdoses in Frankfurt. By
1997 the number had fallen to 22.

An estimated 70 to 80 per cent were diagnosed with HIV. By 1998, this
ration had fallen to 18 per cent.

Crime had fallen and police and the drug-using community had better
relationships. Medical staff, including junior doctors, did not
interfere in the injecting process or in the substances. They provided
sterile trays or syrup for methadone users and were there to help them
if they collapsed.

The clinics were made possible by using harm-minimisation rather than
stern law enforcement. Heroin problems were treated in a bipartisan
way, and police, prosecutors and health and drug agencies worked together.

Called "crisis centres" in Frankfurt, counsellors and social workers
are on hand to help drug users if they want help.

City police no longer arrest for the personal use of heroin. Instead,
they focus on dealers.

Overdoses reduced

Dr Alex Wodak is the director of the Alcohol and Drug Service at
Sydney's St Vincent's Hospital, and president of the Australian Drug
Law Reform Foundation, and he is among Australia's most prominent in
the field. Michael Moore is the Foundation's past president.

Wodak spoke of injecting clinics in several cities in Switzerland,
Germany and Holland. Overdose rates and rates of drug-related crime
had been reduced dramatically.

Australia's rate of overdose deaths was rising at 12 per cent a year.
In NSW alone 12,000 people were on methadone programs. Australia had

about 200,000 people who were injecting heroin amphetamines and cocaine.

Drugs were widely used in prisons, where the dangers of HIV infections
were extremely high, because of shared needles. Fifty per cent of male
prisoners and 80 per sent of female prisoners injected drugs. When
they returned to the community, they brought the diseases with them.

A user would inject 50 times a month outside prison and once or twice
a month inside prison.

The 1996 Royal Commission into the NSW Police called for the
introduction of safe injecting rooms, but a NSW parliamentary
committee rejected it in favour of the status quo.

"This left police in a terrible position and they had to keep turning
a blind eye to injecting rooms in NSW," Wodak said.

Unofficial injecting rooms were set up in the back rooms of sex
shops.

There were many myths about heroin. It could be injected for life in
safe amounts and the only health issues were the addiction itself and
constipation.

British doctors have had the legal right since 1926 to prescribe
heroin to patients, and some do. Heroin is widely used in Britain in
serious illness to alleviate pain.

Many wealthy people use heroin and still have stable
lives.

Moore plans to introduce proposals in the next sittings of the
Legislative Assembly to create the clinics. His proposal will meet
with guarded support from the Labor Party, rejection by Independent
Paul Osborne, and sympathy from former policeman Dave Rugendyke.

But the strongest opposition is likely to come from within the Liberal
Party.

Checked-by: Rich O'Grady