Pubdate: Sun, 13 Feb 2000
Source: Age, The (Australia)
Copyright: 2000 David Syme & Co Ltd
Contact:  250 Spencer Street, Melbourne, 3000, Australia
Website: http://www.theage.com.au/
Author: Peter Ellingsen

SEARCHING FOR AN EPIPHANY IN A NEEDLE AND A TOURNIQUET

IT IS not yet 11am, and already more than 80 "sharps" lie in the
scratched yellow box hanging off the wall. More are scattered on the
ground, close to the rock that serves as an altar to heroin. This
alcove, next to the Wesley Church in Lonsdale Street, is a communion
site for more than 100 people every day. They come to hit-up and
anyone interested in saving their souls will first have to save their
lives.

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 taskforce 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 taskforce,
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 favor 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 the two years. As Penington taskforce 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
tranquilisers 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 strewnwith 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."
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