You Can't Help Them When They're Dead

Sydney Morning Herald

Saturday April 10, 1999

Adele Horin

We need safe injecting rooms and heroin on prescription to keep addicts alive.

THERE'S not a dry eye in the room when Tony Trimingham finishes his presentation. He doesn't say a word. He simply darkens the room, switches on a recording of Eric Bogle's haunting song, One Small Star, and presents a slide show, featuring his son, Damien.

It begins with naked baby shots and moves through Damien's growing up years: gorgeous toddler, kindergarten pupil, determined young footballer, star athlete. We see Damien with a girlfriend, his father . . . and then the slides are grainy black and white, and we see Damien dead, at 23. Overdosed on heroin. "I hope when people talk about drug deaths and junkies you will remember these pictures," says Tony, "because we are talking about real families, people in pain."

Australia has a touching faith in drug rehabilitation programs. But keeping kids alive should be the first priority of a drugs strategy. For the truth is, addicted users are likely to have a long career, perhaps 10 or 15 years on heroin. And this will be interrupted by, usually, 10 to 14 sincere, but failed, attempts at rehabilitation.

That was Damien's story. He had been clean for eight months before he overdosed. He did not get to his 30s, when heroin addicts are most likely, with or without treatment, to give up.

John Howard has put more money towards drugs rehabilitation programs than any previous prime minister, and should be congratulated. But the search for a magic cure is short-sighted unless we also find a way to keep addicts alive and healthy.

This is the unpalatable truth Howard refuses to face. Abstinence is hard to achieve and to maintain. Some succeed after one program. Most don't. Only 10 per cent of addicts are abstinent within the first year of finishing a program, according to the authoritative review of Australian treatment programs, Methadone Maintenance Treatment and Other Opioid Replacement Therapies.

We can't easily stop people from using heroin. But we could do a lot more to stop them from dying, getting HIV and hepatitis C and/or a prison record.

On a recent visit to Switzerland, Tony, who runs Family Drug Support, saw evidence of a more enlightened approach to keeping alive users who were not treated as moral degenerates and outcasts. He visited a controlled injecting house in an ordinary street. An old nun happily pointed it out to him.

He was struck by its ordinariness. The presence of health workers meant there had been one death in four years. Australia's injecting places are laneways and back stairways like the one where Damien died. In 1997 the heroin death toll reached 600, and may approach 1,000 this year.

Trimingham also visited a heroin-dispensing centre; users had to be at least 25 and to have failed two previous treatments. The waiting room was like a surgery with information about treatments. Abstinence was not the goal. But 8 per cent of people who had been on the dispensed heroin program later gave up heroin, about the same abstinence rate as for Australia's rehabilitation programs.

In Australia, parents want a magic bullet that will get their kids off heroin overnight. But it doesn't seem to happen like that. It happens, more often, when young people want to settle down, have children, go to university, get their career on track, when they find something in their lives more meaningful than heroin.

Howard doesn't want to send the wrong message by endorsing heroin trials and injecting rooms. People argued a similar line against needle-exchange programs - by giving out free needles, the State would appear to condone an illegal act. But needle-exchange programs have been credited with averting an AIDS catastrophe among Australian drug users.

Few believe controlled injecting rooms or legally dispensed heroin are the panacea. But they ought to be trialled in Australia, along with other treatment methods so that we can compare a range of outcomes for users, including health, employment, crime, and longevity.

The moral high ground is no place to stand when young lives are at stake. Ask Tony Trimingham.