The ACT heroin trial

By Tarquin McPartlan and Vanessa Bushell CANBERRA — The idea of legal distribution of heroin to dependant users has been researched in Australia for the last four years. Some of the results have been used in the creation of heroin programs in Switzerland and the Netherlands. In Australia, however, the proposal for a government sponsored heroin trial has caused considerable controversy. Research done by Dr Gabriele Bammer, a research fellow at the National Centre of Epidemiology & Population Health in conjunction with the Australian Institute of Criminology has concluded that "a carefully controlled and rigorously evaluated trial" should be conducted in Australia to "determine whether or not the prescription of pharmaceutical heroin (diacetylmorphine) is a useful addition to current maintenance treatment options for dependant heroin users". The report and recommendations of Bammer's research were presented to the ACT government on June 27. It recommended a three month community consultation about the trial. Surrounded by controversy, that consultation period ended in late October but a decision has yet to be made about whether the trial will go ahead. The proposed heroin trial will examine the question of whether the expansion of opium treatment options to include both injectable diacetylmorphine (heroin) and oral methadone will be more effective than current maintenance which involves the provision of oral methadone only. Could the provision of heroin improve dependant users' and their children's health and well-being, financial stability, and access to welfare services? Could it reduce the spread of HIV, hepatitis and other blood borne diseases? Could it reduce criminal behaviour and cut prison, legal and police costs? The proposed trial would have three stages. The first two stages would smaller scale, local trial runs for the final full-scale two year trial which would involve 350 people from Canberra and 350 people from each of two other cities. Participants would be an equal mix of female and male and include people currently on methadone, people who have dropped out of methadone treatment, and dependant users who have never been on a methadone program. 175 people would have option of injectable heroin or oral methadone, 175 methadone only. Each stage of the trial would only proceed if the previous stage was successful. There are several reasons why the trial might be cancelled including, for example, if "trial heroin" appeared on the black market or if users moved to Canberra to get on the trial (even though they would be ineligible). Once the trial was finished (or cancelled) all participants would be guaranteed places on the ACT methadone program. The proposed trial guidelines do not allow takeaway doses of heroin and the program would provide a safe, clean, injecting environment with sterile equipment and medical supervision. In assessing the "heroin problem" it is important to distinguish between the effects of heroin and the effects of heroin being illegal. Prohibition has rarely been successful in controlling problems caused by drug use. The prohibition of alcohol in the US, for example, simply resulted in a huge black market, a growth in organised crime and the deaths of thousands of people who drank impure alcohol. Heroin was legally available in Australia until the late 1950s when, under pressure from the US, the Australian government banned its use for all but scientific purposes. But heroin is still used in many countries for medical purposes. Until very recently Britain allowed heroin on prescription for dependant users under a program begun in the 1920s. Health related justifications for the prohibition of selected substances are largely arbitrary. Alcohol and tobacco use, for example, cause much more physical damage than heroin which does not damage any organ. Australia has approximately 60,000 drug related deaths each year. Of these only 400-500 are heroin related, usually accidental overdoses. The range of moral arguments against illegal drugs cannot be separated from cultural discrimination, political and social control, and the enormous economic gains to be made on the black market. Globally the illegal drug trade is second only to the trade in illegal arms. In Australia drug laws serve as a method of social control. Illicit drug users, in particular heroin users, are stereotyped as either corrupt criminals out to take advantage of decent people or pathetic victims willing to do anything for "a fix". In reality, users of heroin are not a homogenous group and come from a wide variety of backgrounds. This is not to deny that heroin use can cause problems. But heroin users problems are far more extensive than physical dependence on the substance, including poverty, marginalisation, abusive treatment by police and welfare agencies, discrimination when seeking medical treatment, imprisonment, and so on. Currently, dependant opiate users have three options available to them — detoxification, undertaking a methadone program or the continued use of illegal heroin. Detoxification can be a physically and emotionally traumatic experience. The physical symptoms of withdrawal include insomnia, constant cramping in the arms and legs, vomiting, diarrhoea, hot and cold flushes, and constant running of the eyes and nose. The emotional effects of withdrawal vary, from vague depression to suicidal tendencies. If the person has had past traumatic experiences which heroin has suppressed, the trauma can re-emerge and be intensified by the withdrawal. For many people, heroin use is a symptom of their troubles rather than the cause. Another option is a methadone program. Methadone is a synthetic opiate substitute. It can take three months to withdraw off methadone and, while little is known about it's physical side effects, many people are on methadone for several years at a time. Methadone contains alcohol. This is a problem since 85-90% of people who have been using for more than five years have Hepatitis C. Methadone, like most drug treatments, works for some people, but not all. The third option is to continue to use black market or "street" heroin. This means having no idea what you're really injecting. The most frequent and gravest danger is the risk of accidental overdose — when the strength of street heroin increases, overdoses follow. The provision of pharmaceutical heroin would reduce the risk of overdose and, through the provision of sterile injecting equipment and a clean injecting environment, would reduce the risk of HIV and other blood borne infections. The Australian Federal Police (AFP) has loudly voiced its opposition to the implementation of a heroin trial. But the Woods Royal Commission into Police Corruption has given us a harsh lesson about the extent of police corruption involving drugs and it would be naive to assume that the AFP is not exposed to the same temptations. There has also been concern that the trial will send permissive messages to young people but as the heroin trial report states: "The addition of diacetylmorphine to maintenance treatment should not be linked with permissive attitudes to illicit drug use." The trial is about reducing the harm associated with heroin use, not giving free dope to anyone who wants it. There are risks associated with this trial, but it is just that, a trial, and the benefits could be great. For more information call the ACT IV League on (06) 247 3700.
[Tarquin McPartlan and Vanessa Bushell work at the ACT IV League, a peer-based support, education and advocacy service for injecting drug users.]