Page 1 under a photo of Dr Gabriele Bammer:
Drug trial addicts to come 'out of a hat'
By Kirsten Lawson
Choosing addicts to join the heroin trial next year is likely to come
down to picking names out of a hat.
Trial architect Gabriele Banner of the Australian National University
said yesterday that to be eligible, addicts had to have been living in
the ACT since 1993 and on (or previously on) the methadone program.
Beyond that, a random choice appeared the fairest way to select the 40
addicts to join the first stage of the trial, she said. There were an
estimated 1000 addicts in the ACT.
But she urged users not to start queuing up just yet there are a
series of issues still to be sorted out and Dr Bammer believed it
would be well into next year before a trial began.
The trial was unexpectedly given the goahead at a meeting of health
and police ministers in Cairns on Thursday, although some changes were
made to the original proposal.
The changes included making addicts pay for the heroin, although how
much was still to be decided, Dr Bammer said. It was also agreed to
wait until the results of the Swiss heroin trial have been evaluated
by the World Health Organisation about February next year.
The heroin would not be made in Australia but would be bought from a
legal manufacturer overseas.
It would be selfadministered at a clinic, but the location of the
clinic was yet to be decided,taking account of security, accessibility
and public acceptability. The proposal had budgeted for about $125,000
to refurbish an existing building, she said.
The clinic would include counselling, social work and nursing services,
and a general practitioner would prescribe the drug.
The amount of heroin given would depend on individual addicts on how
much they needed and whether they were also taking methadone. But
three times a day would be the maximum number of doses.
During the first stage of a trial lasting about six months addicts
would be subjected to a series of clinical tests to check the effect
of heroin on the body, including the effects of different doses and
the effects on driving. (It was thought that people were safe to drive
if they were stabilised on heroin, but not if they had had too much,
were using other drugs as well, or were in withdrawal.)
Three states will be doing different heroin treatment trials alongside
the ACT. The ACT would also give a trial to a methadone alternative
called Buprenorphine. Dr Bammer said it was important that heroin was
tested in the context of other drug trials because that kept heroin in
perspective. Heroin was only one of a number of treatment options and
would be effective for only some people.
"It's important that we don't set it up as some sort of holy grail or
panacia that's going to solve everybody's problems."
Dr Bammer works for the National Centre for Epidemiology and
Population Health.
[unquote]
The editorial on page 17 of the Canberra Times of August 2nd is
titled:
[quote]
Sanity at last on drug trial
AT LAST a majority of the eight Australian Governments have seen the
obvious and are going to support the heroin trial in the ACT. It
probably became obvious to thoughtful politicians quite some time ago
that the policy of prohibiting drugs on pain of heavy penalty as the
primary method of controlling drug addiction was not working. However,
they also realised that many less thoughtful voters would reel with
horror at the thought of dealing with heroin addiction in any other
way. Heroin is a nasty, addictive drug and we should do all we can to
curb its use, but there has been so much propaganda about heroin that
a large majority of the population greatly overestimate its effect on
the human body. But it seems, particularly in the ACT, that a large
number of people in the population are beginning to realise that the
effect of heroin prohibition on the body politic is far more
pernicious than its effect on the human body of those unfortunate to
be addicted.
The new realisation is not just that prohibition is not working, but
that the policy is actually creating more addicts the very opposite
of what the policy was designed to do.
With prohibition and penalties in place, providers of the drug have to
take higher risks or have to pay other people more to take those risks
for them. It means the price of the drug on the street goes up. If it
were a nonaddictive product, this would not matter too much; people
would just stop buying it. But heroin is addictive. A significant
proportion of users (but by no means all) become addicted and are
willing to pay a very high price for their drug.
Invariably, they spend their own assets with destructive effects on
family and friends. They also borrow and steal. But more periciously
they try to get others hooked so that they can share their drug costs
as small time dealers. Prohibition over the years, has created large
numbers of smalltime dealers who actively try to get others hooked.
The higher the penalties, the greater the risk, the higher the price,
and the greater the profits for big dealers. The drug trade becomes
very profitable with huge amounts of money at stake. There is enough
money to bribe police and even judicial officers to protect the big
and medium dealers.
Then there is the health problem. With prohibition the manufature of
the drug is irregular and the drug is mixed with other substances so
it is impossible for users to know the precise dosage. Many overdose.
About 500 deaths a year occur in Australia. Frequently users share
needles, adding to the risk of HIV and hepatitis infection.
All of this stems from prohibition. Since the 1950s the steady
increase of government money going to the futile attempts at
prohibition has resulted in a steady increase in the number of
addicts.
Besides, prohibition is crazy jurisprudence. Criminal law punishes
those who injure the person or property of others. Punishing drug use
makes the victim and perpetrator the same person. It should be seen as
a health problem; not a crime.
The heroin trial is the first welcome step in that direction.
Obviously it must be run with a strong educational message against
drugs. This is not inconsistent; it is just applying different
approaches to treatment, cure and prevention.
[unquote]
The Canberra Times Saturday Forum on August 2nd, 1997 an article titled:
[quote]
Stemming flow of heroin's evils
Public pressure has forced politicians off the fence to address the
heroin problem, writes BRENDAN NICHOLSON.
THE ACT's heroin trial won wary support from most Australian
governments this week largely through the persistence of two local
politicians and the growing public awareness of the scale of the
indirect damage illicitdrug use is inflicting on society.
Since the Wood Royal Commission revealed with appalling clarity the
extent to which drug money contributed to the corruption of the New
South Wales police force, Australians have quickly become impatient
with the lack of results from existing drugcontrol strategies.
Heroin is a problem because its users become addicted to a substance
that is illegal and therefore available only at extortionate prices,
frequently under unsanitary conditions and with only the level of
quality control a criminal organisation motivated by money is
interested in providing.
As such, it is a trigger for both disease and crime, such as
burglaries, carried out to feed the habit.
Now, public pressure has forced politicians to climb down off fences
and look for options.
For New South Wales Premier Bob Carr and others that choice was, to
some extent, made possible by the fact one of the boldest
possibilities was found in somebody else's back yard.
It has been a remarkable and positive reflection on the nature of
politics in the ACT that the heroin trial plan has been able to
survive with broad bipartisan support since it was suggested by a
Legislative Assembly committee in 1991.
Independent MLA Michael Moore has campaigned hard for the trial with
Health Minister Kate Carnell, a pharmacist in her previous life, able
to argue eloquently enough for it to win support from Victoria, South
Australia and, finally, Tasmania against strong opposition from
Western Australia (despite the deaths of about 50 addicts this year),
Queensland and the Northern Territory.
In most states, and the neardestruction of the trial because of
Carr's recent prevarication is a good illustration, there has been
such willingness to use the heroin tragedy as a political football
that noone was game to go anywhere near any trial that sounded
vaguely radical.
With the National Party in NSW maintaining strong opposition to a
perceived soft approach to drugs, there was little hope of Carr
winning bipartisan support for active involvement in such a trial in
NSW.
Carr became embroiled in the issue in recent weeks because of the view
that, as the source of the ACT's heroin, Sydney should be one of the
three cities providing a total of 1000 users to take part in stage
three of the trial if the two pilot stages proved successful.
Any decision on Sydney's involvement has been put off until the ACT
pilot is accessed.
In recent months, talkback radio and newspaper letters columns have
been full of desparing tales from parents, friends and partners of
users trapped in a sleazy spiral of sickness, crime and painful death
that has ignored boundaries of class, wealth and education.
Then, in Cairns this week, the Ministerial Council on Drug Strategy,
made up of Australia's police and health ministers, approved the trial
as one of several measures to be tested across Australia in a
concerted national attempt to deal with the growing heroin crisis and
a direct death toll that has reached 600 a year.
Carnell said the Counil's comprehensive resolution is the most
dramatic breakthrough in drug treatment in Australia in more than 25
years.
The old perception that heroin users are somehow an underclass that
society is better off without anyway, has given way to an awareness
that a frightening number of Australians are dying in the streets
because of their habit.
The annual death toll from opiate misuse has reached 600 more than
Australia's toll in all the years of the Vietnam war. It is estimated
that between 2 and 3 per cent of users died each year.
While under 5 per cent of injecting drug users are believed to be HIV
positive, it is estimated that 50 to 60 per cent carry hepatitis C
with its legacy of cirrhosis and liver cancer.
But the damage to society is certainly not limited to these heroin
users and research has shown the cost to the general community to be
disproportionately high.
The 1995 National Drug Strategy household survey revealed that 1.4 per
cent of those surveyed had tried heroin and that 0.4 per cent had used
the drug in the preceding 12 months.
Heroin use has increased over the past 10 years and the users are
becoming younger. Ther are believed to be about 1000 users in the ACT.
The trial is certainly only a small step towards a solution and it
does not amount to the legalisation of heroin.
The proposal for it was based on four years of research by the
National Centre for Epidemiology and Population Health in
collaboration with the Australian Institute of Criminology.
Some of the trial's critics say it sends a message that heroin use is
being encouraged. Other say Canberra could be hit by a "honey pot"
effect with addicts pouring into a city whose streets, they believe,
are paved with heroin. To prevent that happening, those wanting to
take part in the trial will have to prove they are longterm ACT
residents.
The conservative argument that those stupid enough to use heroin
deserve all they get and should not expect to be bailed out by
society, ignores the enormous social damage that reverberates through
society from the point of the needle.
Needleexchange programs have helped to slow the spread of diseases
such as HIV/AIDS and hepatitis C among intravenous drug users who
frequently saved time and money by sharing needles.
But users frantic for a fix are believed by the Australian Federal
Police to be responsible for a high proportion of burglaries and other
such crimes against property in Canberra and elsewhere.
The quick and nasty burglary with more damage done than property taken
is likely to be the work of a user who cannot afford his shot.
The trial will be linked closely to the ACT's existing methadone
program which provides a lessdangerous alternative to heroin for
dependent users.
Methadone swallowed as a syrup can prevent heroin withdrawal symptoms
in a user for 24 hours while someone dependent on heroin may be
injecting that drug more than four times a day.
Some users complain that methadone does not take them to the same
euphoric plateau as heroin. It leads to dependancy and an overdose can
be fatal.
The ministerial council imposed several conditions which Carnell said
would be incorporated in the program and then put to the ACT Assembly.
The first stage of the trial will involve 40 heroin users who will be
allowed to buy the drug at low cost. It will not be given free as was
originally intended.
Those involved will also be given the drug, buprenorphine, to help
overcome withdrawal symptoms and reduce the likelihood of relapse.
That trial is expected to take about six months. Buprenorphine has few
sideeffects, is safe at high doses and its effect lasts for two days
allowing dosing on alternate days instead of daily as with methadone.
It may be less useful in treating the severely dependent.
The ministers said the trial would only move on to a second pilot with
250 users once the first stage had been thoroughly evaluated and found
to be successful.
They agreed that the ACT trial should proceed as long as it did not
breach Australia's international legal obligations. The plan must also
be put to the International Narcotics Control Board and the Commission
on Narcotic Drugs.
Carnell agreed to amend the trial where necessary to meet the treaty
obligations, to include withdrawal treatment and longterm abstinence
in the trial objectives, to charge for the drug at the same rate as
for methadone about $30 a week and to take account of the World
Health Organisation's evaluation of a similar trial under way in
Switzerland. That is due out in February.
Section (c) of article four of the United Nations Single Convention on
Narvotic Drugs 1972 obliges parties to it to limit the production,
manufacture, export, import, distribution of, trade in, use and
possession of drugs "exclusively to medical and scientific purposes".
On the face of it, the proposed ACT trial would appear to fit that
formula.
As part of the comprehensive national strategy announced in Cairns,
Victoria will carry out a trial of oral morphine, the synthetic opioid
LAAM (levoalphaacetylmethadol) which is an analgesic similar to
morphine, buprenorphine and naltrexone, which, as a heroin antagonist,
blocks the effects of heroin.
Naltrexone is longlasting with few sideeffects but patients have to
be completely free of opiates before it is used or it induces
withdrawal symptoms. It works best with highly motivated individuals
who want to break their habit.
Naltrexone has been used overseas in trials of a very rapid
detoxification approach. Because naltrexoneinduced withdrawal
symptoms are so unpleasant, the drug is administered in those
detoxification programs under a general anaesthetic.
South Australia will trial naltrexone, buprenorphine, LAAM and
tincture of opium.
NSW will trial buprenorphine and naltrexone.
The trials will be coordinated through a new Expert Advisory Committee
on Illicit Drugs.