HEROIN SUBSTITUTE TEST MAY BE TRIED

A pilot medical trial of an injected substitute for heroin could start
in Sydney this year, with a handful of addicts receiving treatment up
to three times a day.

The proposal - to offer supervised injections of the potent painkiller
hydromorphone as a first step to weaning users off drugs - will
reignite the long-running debate over whether prescribing heroin could
entice into treatment people who have rejected other established
therapies such as oral methadone.

Prime Minister John Howard has been implacably opposed to prescribing
heroin itself. Four years ago he vetoed a planned heroin trial in the
ACT.

But the government would have no power to prevent a trial of
hydromorphone - a registered opiate in widespread use in Australian
hospitals - if it were approved by a research ethics committee.

Hydromorphone, also known by its brand name Dilaudid, offered an
almost immediate, short-lived "high" so similar to heroin that some
users could not tell them apart, said Wayne Hall, the director of
public policy and ethics at Queensland's Institute for Molecular Bioscience.

Professor Hall said the drug might break the "deadlock" surrounding
heroin prescription, if it showed that severely addicted people could
be treated successfully in the health system. It might pave the way
for a future trial of medically supervised heroin injections.

But Professor Hall emphasised that only about 5per cent of addicts
were likely candidates for either therapy. The publicity surrounding
heroin trial proposals had been "out of all proportion to its likely
benefit", he said.

Richard Mattick, the director of research at the Sydney-based National
Drug and Alcohol Research Centre, said that if he were granted ethics
approval he would approach a Sydney hospital this year to conduct a
pilot survey with just a few patients receiving 32 milligrams of the
drug two or three times daily.

Initially it would focus on how well the drug was tolerated and
whether there were side-effects.

The patients would also be prescribed a small dose of oral methadone,
with a view to weaning them off injecting, Dr Mattick said. From
there, they "ideally" would move to methadone only, and then to
complete abstinence.

A larger trial - monitoring the progress of hundreds of patients
across Australia - would be needed to determine whether hydromorphone
had a potential role in treating heroin addiction in the community, Dr
Mattick said.

In a paper published in this week's Medical Journal of Australia,
Professor Hall and Dr Mattick wrote that the two drugs could be
distinguished in urine tests, meaning researchers could tell if
patients continued to use street heroin.

Another advantage was that hydromorphone lacked, "the political
symbolism of heroin", making it more likely that a trial could proceed
without excessive public attention.

Professor Hall said he wanted to raise the possibility of an
injectable heroin substitute because a heroin trial was not
politically viable "for a government of either persuasion". A recent
heroin "drought", which researchers hold responsible for a fall in
drug-related deaths, made such a trial even less likely.

But Alison Ritter, head of research at Melbourne's Turning Point
Alcohol and Drug Centre, said even if hydromorphone was successful,
doctors still would not know how many more addicts could be treated if
prescribed heroin were available, and Australian researchers should
continue to push for a heroin trial.

"We do know that prescribing heroin will attract them into treatment,"
Dr Ritter said.