BY MATTHEW DAVIS
As risk factors like unemployment, poverty and homelessness rise, so too does the prevalence of heroin use. In Western Australia, official 1997 figures estimate that there are between 43,200 and 57,600 active heroin users. The number of deaths from heroin use has increased from 16 in 1991 to 80 in 1997.
Harm minimisation and demand reduction are the most sensible policies for reducing heroin usage. Needle exchange programs, free heroin trials, methadone and naltrexone programs are preferable to increased incarceration or funding for police forces.
Such programs should be fast-tracked and given proper funding, along with public education programs to encourage safe injecting practices and a realistic and community-based approach to reducing the risks associated with drug use.
Harm minimisation strategies, such as needle exchange programs, have been hugely successful in helping stem the spread of HIV/AIDS amongst heroin users. Australia has one of the lowest incidences of infection amongst this group: only 2%. However, state funding cuts to needle exchange programs endanger this progress and put at risk the more complex task of halting the spread of hepatitis B and C, of which there are 14,000 new cases every year among users. Government resources and attention are also lacking in research on drug use within prisons, where needle sharing is common.
The National Drug Research Institute's (NDRI) Professor Tim Stockwell believes that it is important to avoid overemphasis on safe injecting rooms and heroin prescription programs in a harm reduction strategy. Other life-saving but less sensational strategies, he says, include education about safe injecting practices to prevent the transmission of diseases like hepatitis B and C, the wider provision of methadone and making naltrexone available.
The first prescription of methadone in Australia was in 1969, by Dr Stella Dalton, a private psychiatrist in Sydney. The use of methadone has since spread, even though it has been outlawed in two states. It was first used in Western Australia in 1973, although state funding did not eventuate until 1977 and commonwealth funding did not come until 1985.
Methadone is still only reaching a small fraction of users one of its chief deficiencies being that it is itself highly addictive.
Although naltrexone has been available for more than 20 years, most of the clinical trials have been limited to small groups of 50 or less and it remains a highly experimental drug. A large naltrexone trial was conducted in 1998 in WA. Users' comments were generally positive and it appears that naltrexone, when used with family counselling and anti-depressants, is effective as a detoxification method of heroin withdrawal.
However, as part of its war on drugs, Richard Court's Liberal state government has decided to slash funding for the Subiaco-based clinic that supplied naltrexone, breaking a promise to fund the service into next year and possibly ruining hundreds of lives.
But demands for further naltrexone trials won't go away; the NDRI, a West Perth-based lobby group of academics campaigning for harm reduction policies, is still pressing for naltrexone trials.
The institute hopes further trials will clear up remaining issues associated with naltrexone's use, including occasional aggressive behaviour from users and a fear that it reduces users' tolerance to heroin and may increase the chances of overdoses.
More funding is also needed to help bring together user groups, concerned individuals and support groups which can push for public information campaigns and more funding.
But all of the above programs for a sensible heroin policy will be possible only if the opposition of some powerful forces in society is overcome. These forces include governments, Christian fundamentalists and the ideology of economic rationalism; WA justice minister Peter Foss has laid the blame for heroin use on parents in dysfunctional families, while the Vatican has ordered that no Catholic organisation can run a safe injecting room.
Capitalism, Karl Marx wrote, entails a loss of self. Heroin use means that workers are increasingly criminalised, locked up and robbed of control of their lives. Socialised medicine and community-based care offer the potential to liberate individuals from the social stigmas and lack of control that characterises existing health care systems. All workers deserve a legal and political system that treats them with dignity and without prejudice.
Socialists in Perth are planning a conference of heroin user and support groups to discuss an alternative to the zero tolerance approach and how best to publicise that alternative. Our long-term goal is to help build a community-based organisation similar to Melbourne's Community Campaign for Heroin Reform to advocate for the rights of heroin users in Perth. We welcome all enquiries and expressions of interest. Email <tassy@multiline.com.au>, phone (08) 9294 3292, or visit the NDRI web site at <http://www.curtin.edu.au/curtin/centre/ndri>.
[Matthew Davis is a member of the Socialist Party in Perth.]