Oped in Canberra Times of July 29, 1997, followed by a letter from
the Director of the research project:

Drug trial courts disaster

The documented evidence behind free heroin programs suggests that Kate
Carnell may be mistaken in her enthusiastic endorsement of another
experiment in the ACT, argues PETER TRICKETT.

THE ONAGAIN offagain herointrial proposal seems to be back on the
agenda for the Australian health ministers' conference in Cairns on
Thursday. Before the Chief Minister, Kate Carnell, stands up and
advocates it at that meeting on behalf of the ACT Government and by
implication the people of the ACT some important and disquieting
facts about this medical experiment need to be made known.

Michael Moore, who outdoes even the Chief Minister in promoting the
trial, claimed in a lengthy column in the Canberra Times on July 15
that policy makers are now "thinking rationally" and hence the
heroin trial has "gained widespread acceptance".

But what if it could be shown, through a documented scientific survey,
that if the trial goes ahead as many as one out of every three former
heroin users who have successfully kicked the habit are likely to
resume using again simply in order to qualify for the free heroin
program?

And what if the same survey should also indicate that a significant
number of former addicts view the issuing of free heroin as futile and
even counterproductive in combatting the problem of drug addiction?

Not only are such findings available, they come from an unexpected
one might even say unimpeachable source: no less than the medical
researcher who has devised the ACT heroin trial, Gabriele Bammer.

In 1993, during her preliminary research on the heroin trial proposal,
Dr Bammer undertook a survey of a sample of former heroin addicts. The
results showed that more than onethird believed that a trial could
tempt them to resume drugtaking in order to get access to free
heroin.

The results of this research were set out in a working paper entitled
'Becoming an exuser: Would the controlled availability of heroin
make a difference?' The paper was published by the national Centre for
Epedemiology and Population Health at the Australian National
University.

Although the numbers surveyed were relatively small, the paper reports
that 36 per cent of the exusers interviewed thought they might be
tempted to start using heroin again in order to qualify for a place in
the trial. A fairly typical response quoted was that of exaddict
"Kylie", who told Dr Bammer, "Yeah, I've thought about it [joining in
the trial] because I love heroin, I really do,"

Furthermore, a significant number of the former addicts were fiercely
critical of the idea of a free heroin program. Dr Bammer reports that
"Andrew", another exuser, told her, "It'd be a total disaster. It'd
be offering to people the drug that the person is there for help for
... They'd still be a junkie. They'd still be sick. It's offering no
way out."

A third exuser, "Gary" is quoted as saying of the proposed trial,
"It's not going to help. It's not going to stop: the more heroin
you've got the more you want."

There are many more comments in this vein. The point that needs to be
answered is: why have the proponents of the trial made no attempt to
make these adverse findings more widely known in light of their
obvious relevance to the herointrial debate? Is it because the
results would undermine their case?

One of the arguments most commonly heard in support of the proposed
ACT heroin trial is that it will be based on a Swiss trial which
reportedly has had some positive results.

But how valid is this comparison? The answer is that although there
are some points of similarity, closer examination of the two trials
reveals some highly signidicant differences.

One of the five goals of the Swiss heroin program was abstinence
"elimination of the consumption of illegal drugs", to quote the
official wording. There is no such goal for the proposed ACT program.
In the entire 88 page blueprint for setting up the ACT trial,
abstinence and rehabilitation receive barely a mention.

I queried this point at a recent public meeting in Canberra addressed
by one of the heads of the Swiss trial, Robert Haemmig. Neither Dr
Haemmig nor Dr Bammer, who was also present, felt able to explain or
justify the ommission of rehabilitation as a goal for the ACT program.

This is all the more surprising since Dr Bammer's own research has
shown that Australian public opinion is strongly in favour of heroin
treatment focusing on the achievement of abstinence. In a paper in
1995 she wrote, "The discussion about the ACT heroin trial will be
judged solely on such issues as whether a "stable maintenance dose" of
heroin can be devised, whether there is any reduction in drugrelated
crime and drug overdose deaths, and whether the participants are
healthier and feel better through being given a regular daily supply
of free heroin instead of having to buy their own. With these
criteria, the trial could arguably be deemed a "success" even if it
left the participants more addicted to heroin than when they joined
the program.

The criteria for admission to the Swiss heroin trial were also much
more restrictive than for its proposed ACT counterpart.

To qualify for the Swiss program where users were charged $15 per
heroin dose instead of being given the drug free participants had to
have been using heroin intravenously for at least two years (the
average in fact turned out to be 10 years) and to have had at least
two failed attempts at alternative therapy such as a methadone
program.

For the small ACT pilot trials, in contrast, participants will be
required only to be currently on a methadone program or to have been
on one in the past. And for the proposed threecities trial involving
1000 participants, eligibility will be extended even to heroin users
who have never been in treatment. What this seems to mean in practice
is that almost anybody could come along and sign up.

UP UNTIL the past few days the Chief Minister has shown unflagging
enthusiasm for this sociomedical experiment as indeed she did for
the suggestion by the Wood Royal Commission that "shooting galleries"
be set up for addicts to inject their heroin.

It is perhaps not entirely irrelevant to recall that only a few weeks
ago Mrs Carnell was also waxing enthusisatic over the "implosion" plan
for the old Canberra Hospital. We all know now the outcome of 'that'
experiment.

Perhaps the Chief Minister should be asking herself whether the free
heroin experiment might just might in human terms lead to an even
greater disaster.

And surely questions must also be asked about the ethics of proceeding
with the heroin experiment when there is already documented evidence
that it is likely to do serious harm by tempting back many former
heroin users who have managed, often through great personal effort, to
overcome their dependence on the drug.

[Mr Trickett is a former medical and science reporter for several
newspapers]

And from Letters to the Editor, The Caberra Times of July 31st, 1997:

Potential risks have been considered

I WELCOME Peter Trickett's critical appraisal of the heroin trial
proposal (CT, July 29, p.9).

One of the key elements of the feasability research was to document
carefully all the potential risks and ways in which they could be
minimised or eliminated.

The recommendation that a trial should be undertaken was based on the
overall analysis that the benefits outweigh the risks. As Peter
Trickett points out, one risk is that some exusers may be tempted to
relapse in order to obtain a place on a trial.

What he misrepresents, among other things, is the eligibility and
selection criteria, which will ensure that such people will not
qualify for a place. The issue of abstinence is, of course, critical,
but it is important not to raise false expectations. No currently
available treatment is particularly successful in helping those
dependent on heroin to become drugfree before they are ready.

It has always been intended that achievement of abstinence will be one
of the trial measures. Heroin will not be a panacea, but it may be an
effective and costeffective addition to current treatment options
that is what the trial is aiming to find out.

The Swiss trials have shown that participants in a heroin prescription
trial are able to become abstinent and that they do so at a rate
comparable to and, indeed slightly higher than, the average rate at
which dependent users become drugfree. The Swiss trials have also
shown that the savings to the community after the trial costs have
been deducted are 45 Swiss francs (about $45) per participant per day.


GABRIELE BAMMER
Director,
Heroin Trial Feasability Research