Howard blocks heroin trial
Dr GABRIELE BAMMER from the National Centre for Epidemiology and Population Health at the Australian National University directed the research which led to the formulation of the ACT heroin trial. The research was conducted in collaboration with the Australian Institute of Criminology. Dr Bammer was interviewed for Green Left Weekly by PAT BREWER on August 20.
Question: Yesterday the federal cabinet decided to stop the heroin trials that have been planned and supported by the health ministers' meeting in Queensland some weeks ago. How will that affect the testing of medical procedures for heroin addiction?
It means that the prescription of heroin won't be possible as one of the trials that were agreed to in Cairns. For heroin to be prescribed, not only would laws have to be changed in the ACT, but federal laws would have to be changed, and the Commonwealth would also have to get permission from the International Narcotics Control Board. The Commonwealth government has made it clear that it's not prepared to do that.
So the heroin trial is no longer possible. But it was being formulated in the context of a whole range of other trials, new treatment options for heroin-dependent people, and those trials will be able to go ahead.
Question: Can you give some background as to the way this trial was set up? How long has it taken to get to this stage?
We got involved with this research when it began in 1991. It came about when the ACT got self-government, and the first Legislative Assembly set up a bipartisan select committee on HIV, illicit drugs and prostitution.
The committee chair, Michael Moore, came to Professor Bob Douglas, the director of the National Centre for Epidemiology and Population Health, and asked if we'd be interested in trialing heroin prescription.
Bob's response was to bring together drug treatment and drug policy people from around Australia and to put the question to them. They unanimously said: run a careful feasibility study. First look at whether or not it's feasible in principle. If it's feasible in principle, then move on to look at whether it's feasible in practice. Think about how you'd run a clinic, how you'd do the evaluation, what the risks are.
That process took us four years. We spent three and a half years working with opponents and proponents of the trial, working through all the issues.
At the end of that stage, we looked at all the evidence and we said, "We believe that the benefits of running the trial outweigh the risks".
We put forward a very standard clinical trial, the sort a drug company would conduct for any other new medication. First you would learn more about the drug itself, then you would do a comparison between that treatment and standard treatments to see whether this treatment had anything to offer, and then the last thing would be to look at whether it was cost effective.
In addition, we were to look at the social implications. There were a number of concerns people had, and we said, "These are all testable. We need to look at whether it causes people to move to the ACT, whether it gives the wrong message, the effects on driving, the effects on the black market, whether it further marginalises users." Those are all things that should be looked at as part of this trial.
Question: Why did it all suddenly turn around within the span of the prime minister's pneumonia, from something that was "in principle" supported by the health minister, to a flat no?
It got caught up in the broader debate about legalisation and decriminalisation. People who were opposed to legalisation and decriminalisation used this as a battering ram.
I think it is a real concern that it shouldn't send the wrong message, but we have to see that in the context that most prevention activities aren't working. If we had a heroin prescription trial, we would have to start looking seriously at how well prevention and law enforcement were working. Unless you have prevention, treatment and law enforcement all working, you're not going to be able to do anything about the drug problem.
I guess the turnaround essentially came because people who were opposed to the notion of legalisation saw this as the thin end of the wedge.
Question: What will this decision mean for future medical research proposals that are in some way problematic?
Both the ACT and the Commonwealth said that they didn't want to do this unless the rest of the Australian states were more or less on side. That actually did happen, and I don't think it necessarily has implications for other controversial things unless laws have to be changed.
What was disheartening was that the final decision wasn't made in full knowledge of what the proposal was, and seems to have been captured by one particular broader debate that this was trying very much to stay out of.
The advantage of running a heroin trial at the same time as all the other trials was to keep heroin in perspective, and of course it was getting it out of perspective that's been problematic.
We've always said this is unlikely to be a major treatment option. Other options are always going to be much cheaper, and they will be the mainstay, but there is likely to be a group of people for whom other things don't work, or it might be a good way of getting people into treatment earlier. What we want to do is just see whether heroin prescribing has a place.
Question: Have there been expectations that are now problematic among the people who try to help those who have the addiction?
That's the saddest thing about it all. Both people who are using and people who are the parents of users had hoped that this might be something that would offer them a way out, or a way of getting their lives back under control, and I think they're feeling very let down.
What's also been quite difficult is the vilification of users, as part of the campaign that's been run opposing the trial. I think that people have lost sight of the fact that these are our sons and daughters, brothers and sisters, cousins and friends; they're not the "other"; they are also us, and all sorts of people can get trapped by heroin dependence.
The campaign that's been run that has said that users have got themselves into trouble, and therefore have to wear the consequences and shouldn't be helped, is terribly damaging.