Searching For An Epiphany In A Needle And A Tourniquet

heroInsight April/May 2000

Source: The Age (Australia) - 13/2/00

For here, beside the chapel housing Rupert Bunny's painting of The Prodigal Son, the young people inhabiting this teenage wasteland dice with death. Nearly 50 have overdosed since October. Yet they don't want to die. Just get high.

To keep them alive, Wesley nurse Jo Beckett checks the alcove every 10 minutes looking for users `nodding off'. She has saved countless lives by reviving mainly young people whose search for epiphany has taken them into drugs rather than dogma. The irony is not, however, that the church's other Bunny painting is of Abraham sacrificing his son. But that metres away─still on the Wesley site─is an all-but-completed $220,000 supervised injecting facility.

The so-called `shooting gallery' cannot open because the State Government is worried about a public backlash, and Wesley is worried about the Government. There are good intentions here, but dodgy politics. It is typical of the cant surrounding heroin use, an epidemic that is killing close to 800 people every year. When the Government task-force into heroin use headed by Dr David Penington reports next month, it will almost certainly back a proposal for supervised injecting rooms. The months of waiting since the Wesley facility was built has had more to do with finessing public opinion than logic. Heroin is a drug which, as a Melbourne coroner noted last week, kills because there is no one on hand who understands the fatal signs.

Such injecting facilities have proved helpful overseas. They are not a solution. But then, nothing is.

As Professor Margaret Hamilton, a member of the heroin task-force, says, all strategies in the field are flawed or compromised.

`That makes them hard to sell,' she explains. `Agencies get into the trap of promising solutions they know are not (solutions). Injecting facilities are an example. Heroin overdose fatalities will rise whatever we do.'

But, she emphasises, supervised injecting warrants a trial. It is perhaps 5 per cent of the answer. It will reduce `the hassle and intimidation on the street'.

What you can see in the Wesley rooms is not a dope den, but a cafe with a clinical edge. It seats 35 in plastic chairs that are specially designed to prevent anyone who has injected from slumping, and, as so often happens, choking to death. Only injecting users over 18 will be admitted. Ms Beckett and two nurses will provide supervision and counselling. The actual `shooting' room where users inject consists of a long stainless steel table, along which there are six cubicles. Users enter with their gear on a tray─syringe, tourniquet, swabs, cotton wool, water, and spoon. They will wash their hands, make up their `mix' of water and heroin, inject into a vein, then put their sharp (needle) in a container.

Ms Beckett and her team will help users find a vein, but won't whack them up. Users will be encouraged to stay for 20 minutes to assess their condition. `Most want to talk,' Ms Beckett says. `And we want to talk about how much to use, the danger in dropping, and health and accommodation issues.' Security cameras will monitor the door and smoking area outside to prevent dealing. `I prefer to see it as primary health care unit,' Wesley's crisis manager, Mr Bernie Durkin, says. `There's no such thing as safe injecting.'

The facility has polarised public opinion. Those in favour point to the runaway death toll, and the fact that lives will be saved if a nurse is on hand with CPR and oxygen or to call an ambulance.

Apart from nearby residents who don't want addicts and needles at their front doors, opposition has come from those fearing that such facilities will make heroin even more attractive. Based on the European experience, where the opening of such facilities has coincided with both diminishing overdose death rates and crime, this seems unlikely.

And, anyway, what is the alternative? Finger-wagging and law enforcement has not worked. As Mrs Imogen Clark, the mother of a heroin addict, said: `Drug busts of even quite large hauls have little or no effect on supply.'

High-profile crackdowns on dealers, who are not, in most cases, the `Mr Bigs', but addicts selling to support a habit, only moves the trade. It does nothing to stop it. The needle exchange program distributed more than four million syringes last year to an increasingly young clientele.

All the bluster of zero tolerance and the Prime Minister's `war on drugs' made no difference to an overdose death rate which has doubled in two years. As Penington task-force member, Mr Bernie Geary, says: `We're in retreat. We're just clearing land mines.'

At all levels the response has been inadequate. Despite 15 years ago endorsing a policy of harm minimisation, the nation has continued to funnel hundreds of millions of dollars into cops and courts.

The most recent Premiers' Conference on Drugs, in April, 1999, offered little that was creative. Rather than embrace a suggestion to examine depression as an underlying contributive factor to addiction, the conference stuck with law and order issues. As Mr Craig Mercer, manager of a Smith Street needle exchange says: `Nothing changes if nothing changes.'

Victoria, despite increasing its budget for addiction programs─allocating an extra $40 million to treatment in 1998─saw its overdose death rate in the first three months of 1999 double that of the year before.

The State Government is now considering a package of policies to redress the imbalance. Apart from a police diversion scheme to steer first-time offenders away from court, low-risk addicts are likely to get home detention as an alternative to jail, with money diverted from prisons to post-release support. Corrections Minister, Mr Andre Haermeyer, says: `Law enforcement is very much parking the ambulance at the bottom of the cliff We spend $55,000 a year to keep users in jail, then just $30 on follow up when they get out, and are at risk of overdosing.'

The system is so slanted towards arrest and detention and away from prevention and treatment, that magistrates have confided to Mr Haermeyer that they send young users to jail, even though that is not their preference, because to release them means they will be dead in days. The Government is considering the introduction of drug courts, where drug-savvy magistrates deal with cases, but that is not enough.

As Mr Haermeyer understands, the focus on the symptoms of addiction have clouded its underlying causes, and the way we treat them. Nurse Jo Beckett, for instance, has around 16 addicts each day wanting to go into a detox centre. But such is the shortage of beds, they have to wait up to two weeks, and when they get out, they get back `on'. There are so few rehabilitation slots for anyone other than those with private health insurance, users end up instead in heroin mecca, emergency accommodation. This past week, as governments agonised over heroin deaths, Ms Beckett made 48 calls to save one user by placing him in a detox bed. All failed.

As one of the country's leading authorities on drug use, Professor Hamilton understands the problem. `Drug use is so symbolically laden,' she says. `If you suggest what is rational, be ready to be attacked. We need to get to a point where people hop off their hobby horses and become open to think about the whole issue.'

Most heroin-related deaths occur when the drug is mixed with tranquillisers like valium or cerapax, or with alcohol. Many users do not know mixing is deadly.

Heroin trials, another initiative being considered, are likely to lower the death rate, but not nullify it, just as the use of the heroin substitute, methadone, has not prevented deaths.

Turning Point, the organisation Professor Hamilton heads, is trialling two new heroin alternatives; LAAN, a long-acting drug similar to methadone, and Buprenorphine, a drug that reportedly is able to combine the effects of narcan, the narcotic blocker, and opiates.

But no matter how successful, neither will be the magic bullet. Heroin use is more complex than physical addiction. To get off and stay off, users need support. So do their families. In the city of Yarra, this has led to a harm reduction unit being set up by 60 parents. As Vera Boston, of the Yarra Drug Forum, says, `The criminal justice system is too crude.'

Demand for needles at her Hoddle Street health centre has grown to the point where it is 60 per cent of all her business. `It's taking over,' she says.

Ms Boston says the forum has helped stabilise addicts when they get out of jail or detox. Also helpful is Narcotics Anonymous (NA).

What is an NA meeting like? It will probably be conducted in a darkened room, and kick off with someone like Bob, who told an inner city NA gathering: `I'm Bob, I'm an addict, and I've been clean for a month.' `Hi Bob,' 80 other addicts responded. He is a well-spoken man, in a check shirt, with short dark hair. He says he has had the `shine' knocked off him. He was clean six years and slipped back. `Relapse,' he called it. Now he is clean again, and for the first time in his 40 years, has a flat of his own.

He has a square jaw and the barrel chest of a wrestler. `If I cut my hair, trim my fingernails, I look like I'm happening,' Bob says. `But inside I'm still in despair. My mother is older than she needs to be. She's been praying for me for years.' He goes on: `I had a really nice meal tonight, nice lunch today, and have a small, tidy place to go home to. That's a hell of a lot more than I had a year ago.'

Among the crowd are young women with small children, men with shaven heads, others with dreadlocks. A woman in her early 20s with a blond bob and peaches-and-cream complexion, talks in the exaggerated vowels of a public school. But she's been using for five years. That tipped her out of university and into suicidal ideas. She says she pictures her bed strewn with 24 dozen white roses to make her corpse look lovely. `Ten days clean,' she smiles.

She has moved back in with her parents. `Like, my brother talked to me today,' she says. `He hasn't talked to me for four years. I know it sounds really silly, but it's a miracle for me.'

Writing in Heroin Crisis, researcher Ms Catherine Mary Dale quotes the author Antonin Artaud. `As long as we have not been able to abolish human desperation, we do not have the right to try and suppress the means by which man tries to clean himself of desperation.' It is a view addicts understand.

As a former addict we will call Alan, explains addiction: `I still don't really know what it means. I'm glad to be away from it, but part of your heart and soul stays in it.' He has been coming to NA for years. `It's not that they have PhDs or anything,' he says of the group. `But I need to come and talk to these guys.