DRUG COCKTAILS THE REAL KILLERS

Multiple drug abuse - not the "myth" of heroin purity - was killing most of
Sydney's heroin addicts, the first comprehensive study in Australia into the
incidence of heroin-related deaths has found.

The study by the National Drug and Alcohol Research Centre at the University
of New South Wales targeted Sydney's south-western suburbs, where Cabramatta
has emerged in the past decade as the heroin dealing centre of Australia.

Its report, Heroin Related Deaths in South-Western Sydney, examined the
coronial files of 176 deaths between 1992 and 1994 - 157 male and 19 females.

"The majority of cases [deaths] involved heroin in combination with other
drugs: alcohol 40 per cent, benzodiazepines 30 per cent and anti-depressants
9 per cent," the report said.

In only one-third of cases was morphine the sole drug detected at
post-mortem examinations, while in 7 per cent of cases methadone was also
detected.

"Despite high purity of heroin in the region, most deaths continued to
involve polydrug use," the report found.

"An increase in the awareness of the role of multiple drug use, among both
heroin users and service providers, in what are termed "heroin overdoses' is
essential.

"Both heroin users and service providers need to be disabused of the myth
that heroin overdoses are solely, or even mainly, attributable to
fluctuations in heroin purity."

The report painted a frightening statistical portrait of the "average" user
- - Anglo, Australian-born, male, aged 30 and unemployed - and when and where
he would fatally overdose: in Cabramatta on any Thursday night in July.

Its authors say that in 1979 there were 70 fatal heroin overdoses
nationwide, compared with 550 in 1995.

In recent years Sydney's south-western suburbs have become a major concern
to drug and alcohol service providers, police and policy makers. Cabramatta
especially has emerged as a major distribution point for cheap heroin with a
high purity ranging from 59 per cent to 80 per cent.

The report said that there were 20 deaths recorded in the area in 1992,
while in 1996 there were 54.

Seventy per cent of the deaths occurred in public settings, "with Cabramatta
being the location in which deaths most frequently occurred [38 per cent]".

It said heroin-related fatalities in the region grew throughout the study
period and it called for "specific and innovative responses ... if the rise
in the number of fatal cases is to be curbed".

"Possible interventions include educating heroin users on the dangers of the
use of other drugs in combination with heroin, the provision of safe
injecting rooms to reduce the number of street-based fatalities, expansion
of methadone maintenance services in the region, distributing naloxone
directly to heroin users, and an improvement of responses to overdoses by
witnesses."

Naloxone is used by doctors and ambulance officers to reverse rapidly the
effects of heroin overdose.

The report said appropriately staffed safe injecting rooms "would provide
immediate assistance in case of overdose".

Checked-by: Melodi Cornett