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.]
