DRUG CLINICS MIGHT BE 'NECESSARY EVIL'

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 who 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 this 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 had a
"very open drug scene", with as many as 6000 users a day in just one known
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 ratio
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 to-gether.

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 cent 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 clinics 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 pre-scribe 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: Mike Gogulski