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Why a Newsletter?
The proposal that there should be a trial in the ACT to give heroin (or more accurately diacetylmorphine) and other opioids to dependent users in a controlled fashion has generated a great deal of interest and speculation. Research is currently under way to determine whether or not such a trial is feasible. An important offshoot of the research is to stimulate informed debate about ways of dealing with illegal drug use in Australia.
The aim of this occasional newsletter is to provide up-to-date accurate information about trial-related research and about the political events surrounding the feasibility considerations.
Current Research
The research at this stage is focused on investigating whether or not a trial would be workable and to this end a large amount of information needs to be gathered and analysed. Much of this work has wider applicability, either to generally improving treatment services for illegal drug users or to informing drug policy considerations. The research therefore has value regardless of whether or not a trial is eventually conducted.
Several projects are under way and funding has been applied for a number of others. The projects which are under way are:
Projects for which funding is currently being sought include:
A number of other studies are currently being planned, including economic analysis of the proposed trial, a survey of victims of crime and an analysis of the ACT drug market.
It is anticipated that the Stage 2 research will be completed by mid-1993.
The Advisory Committee
An Advisory Committee has been established which will meet three times during 1992 to discuss and provide guidance for the Stage 2 process.
The members of the Advisory Committee are:
Co-chairmen
Professor Bob Douglas, NCEPH
Professor Duncan Chappell, AIC
Members
Dr Tony Adams, Department of Health Housing and Community Services.
Dr Robert Ali, Drug and Alcohol Services Council, SA.
Chief Magistrate Ron Cahill, Magistrates' Court, ACT.
Professor Terry Carney, Faculty of Law, University of Sydney, NSW.
Assistant Commissioner Peter Dawson, Australian Federal Police, ACT Region.
Associate Professor Wayne Hall, National Drug and Alcohol Research Centre, NSW.
Associate Professor Margaret Hamilton, Department of Community Medicine, University of Melbourne, Victoria.
Professor David Hawks, National Centre for Research into the Prevention of Drug Abuse, WA.
Mr Kerry McDermott, Commonwealth Attorney General's Department.
Mr Michael Moore (MLA), Legislative Assembly of the ACT.
Chief Inspector Christine Nixon, NSW Police Service.
Ms Marion Watson, Assisting Drug Dependants Inc. ACT.
Dr Don Weatherburn, NSW Attorney General's Department.
Dr Alex Wodak, Alcohol and Drug Service, St Vincent's Hospital, NSW.
Reference Groups
Reference groups including Australian and International researchers, service providers, police, users and others with a particular interest in the feasibility research are currently being established.
The function of these groups is to provide expert opinion on various issues and to comment on draft documents.
The Research Team
People conducting research for the feasibility study are:
Dr Gabriele Bammer, Research Fellow, NCEPH, (Co-ordinator and various projects).
Dr Jim Butler, Senior Research Fellow, NCEPH (Economic issues).
Ms Peggy Daroesman, Research Assistant, NCEPH (Description of the Mersey program).
Ms Kate Elliott, ANU 9, NCEPH (Preparation of grant applications).
Dr Ann Larson, Visiting Fellow, NCEPH (Estimation of user numbers, young users survey).
Dr David Legge, Senior Research Fellow, NCEPH (Philosophy and practice of service provision).
Dr Bob Marks, Senior Lecturer, University of New South Wales (Economic Issues).
Mr David McDonald, Senior Criminologist, AIC (Various projects).
Ms Amanda Neil, Research Assistant, NCEPH (Economic issues).
Ms Jennifer Norberry, Criminologist, AlC (Legal issues).
Mr Remo Ostini, Research Assistant, NCEPH (various projects).
Dr Keith Powell, Visiting Fellow, NCEPH (Residency criteria).
Dr Beverly Sibthorpe, Visiting Fellow, NCEPH (User surveys).
Dr Patty Solomon, Senior Lecturer, University of Adelaide (Trial design - statistical issues).
Ms Heather Strang, Executive Research Officer, AIC (Police Issues).
Ms Helen-May Timiney, Research Assistant, NCEPH (Preparation of grant applications).
Dr Grant Wardlaw, Visiting Fellow, AIC (Various criminological projects).
The Four-Stage Process
It was decided that the entire project should be divided into a four-stage process, with a decision point on whether or not to proceed further at the end of each stage. Stage 1 was conducted from May to July 1991 and entailed examination of the in principle issues involved in the trial (see below).
The research currently being undertaken is for Stage 2 and involves determining whether or not a trial is workable. If a decision to proceed further is made at the end of this stage, Stage 3 would be a small-scale pilot study. The trial itself would be Stage 4.
Legislative amendments and the controlled supply of currently illegal drugs will not be needed unless and until the research reaches Stage 3. If a full-scale trial (Stage 4) eventuates it will be designed to unambiguously answer questions about whether or not the provision of heroin in a controlled manner offers significant treatment advantages over what is currently available.
Stage 1
The research conducted in Stage 1 involved examination of:
It was concluded that in principle the potential benefits which could stem from a trial outweighed the potential costs and that, while there were significant constraints on how a trial could be structured, there were no absolute barriers to the conduct of a trial. The recommendation was, therefore, that the research move to Stage 2.
The Seminar: 'Heroin Treatment - New Alternatives'
In November 1991 NCEPH and the AIC, in collaboration with the National Drug and Alcohol Research Centres (NDARC), organised a seminar to inform decision makers about the outcomes of Stage 1 and to promote further debate about the issues. The seminar was also supported financially by the ACT Board of Health and the ACT Attorney-General's Department.
Invited speakers included police from New Scotland Yard and the Mersey region of the United Kingdom and from Amsterdam, as well as representatives from the Australian Medical Association, the Royal Australasian College of Physicians, the Commonwealth AIDS Research Grants Committee, the Commonwealth Department of Health, Housing and Community Services, the National Drug and Alcohol Research Centre and the Anglican Church.
Speakers at the seminar strongly supported the need for Stage 2. Copies of the proceedings are now available (see Publications below).
The Political Context of the Research
In the last 20 years there has been a series of reports on drugs and drug dependency produced by various government-sponsored committees, Royal Commissions and inquires. In essence, the reports have reiterated important points with a good deal of consensus on the nature of the problem and appropriate ways of dealing with it; the recommendations have focused on education, treatment and law enforcement. Since 1977 the reports have argued for harm minimisation rather than the elimination of drug use. Only some of the reports considered heroin maintenance for dependent individuals and they generally argued against it with one calling for research using a limited trial. It should be noted, however, that the context in which most of these deliberations took place was rather different from that existing now, particularly as HIV/AIDS was not an issue. Every report lamented the lack of empirical information on which to base decisions and called for informed public debate and more research.
In 1989, the Government of the Australian Capital Territory (ACT) appointed a Select Committee to inquire into and report on HlV, illegal drugs and prostitution in the Territory with particular reference to: "(a) the effectiveness of current legal and social controls enabling action to prevent the spread of HIV; (b) the effectiveness of current legal controls on prostitution and drug-taking; (c) alternative social, medical or legal proposals which may assist in restricting the further spread of HIV; and (d) other such matters relating to the issues of HIV in the ACT which the committee considers should be drawn to the attention of the Assembly" (Legislative Assembly for the Australian Capital Territory, Select Committee on HIV, Illegal Drugs and Prostitution, Second Interim Report, 1991, piii).
The Select Committee was particularly influenced by information provided by practitioners and administrators in the Merseyside area of the United Kingdom that prescription of heroin to people registered as being addicted to that drug had beneficial effects in reducing crime and improving quality of life. They also found advocates among Australian practitioners for a trial "to assess the impact of a policy shift towards the controlled availability of heroin to people already dependant on that drug" (Legislative Assembly for the Australian Capital Territory, Select Committee on HIV, Illegal Drugs and prostitution, Second Interim Report, 1991, p2).
The Stage 1 feasibility research was conducted at the request of this Committee and Volume l of the resulting report was included in full in the Second Interim Report of the Select Committee. That interim report recommended that "the Government approve a feasibility study of the logistics of conducting a trial to provide opioids, including heroin, in a controlled manner". It recommended further that funding of $60,000 be provided to help meet the costs of the research and that "the appropriate Minister inform the relevant Federal, State and Territory Ministers, through the National Campaign Against Drug Abuse, of the feasibility study and seek national co-operation through the Ministerial Council on Drugs Strategy" (Legislative Assembly for the Australian Capital Territory, Select Committee on HIV, Illegal drugs and Prostitution, Second Interim Report, 1991, p7).
There were representatives of both Labor and Liberal parties on the Select Committee and it was chaired by an Independent, Mr Michael Moore MLA. The Liberal Party member, Mrs Robyn Nolan MLA, appended some additional comments, including that the funding requested should come from federal sources and that political commitment from Federal, State and Territory Governments should be obtained before proceeding to Stage 2.
The Second Interim Report was presented to the ACT Legislative Assembly on 15 August 1991 and Mr Moore and Mrs Nolan spoke to it at some length, with Mr Moore moving that the report be noted. Debate on the motion was, however, adjourned and was not resumed in the life of that Assembly.
The Stage 1 report received substantial media coverage and attracted a number of Letters to the Editor. Two examples give an indication of the flavour of the coverage. The Canberra Times editorial on August 1, 1991 was headed "Let's have a pilot heroin program". It concluded "What is needed is a strictly controlled pilot program to test the idea. It would be from its successes and failures that the rules for wider programs would be devised. It deserves a go. It might work. Nothing else seems to". An influential news item headed "Free-heroin trial 'stupidity'. Pickering, Cochran unite against plan" followed a few weeks later. This reported opposition by the NSW Minister for Police and Emergency Services, Mr Ted Pickering and the National Party Member for Monaro, Mr Peter Cochran.
In February 1992 elections were held for the ACT Legislative Assembly. In its 19 January policy statement "Protecting Canberra's Community", the Labor party (which gained 8 of the 17 seats) listed under its objectives for the next three years to "reject unilateral action to use Canberra for experimentation with the supply of free heroin". There was no reference to the trial proposal in Liberal party policy statements (they gained 6 seats). The Michael Moore Independent Group (which gained 2 seats) included in its policy statement "Support the proposed Opioid trial in the ACT" and that the Government should "Implement the next stage of the heroin study".
In April the feasibility research was discussed by the Ministerial Council on Drug Strategy (MCDS). In the resultant resolution the Ministerial Council noted "the progress made by the National Centre for Epidemiology and Population Health (NCEPH) in undertaking a feasibility study not involving the distribution of any drugs, into heroin treatment options" and recommended that the results of the feasibility study be reported to MCDS.
The ACT Labor Government continues to be cautious about the feasibility research which is currently underway. Nevertheless, given that the research has the support of MCDS to the extent that the Ministerial Council wishes to receive results of the feasibility study, we expect that the ACT Government will co-operate with the project.
Grants Awarded
In December 1991 the project was awarded $445,000 over 5 years by the Australian National University's Strategic Development Fund. The purpose of this fund includes to "identify and develop new areas of research perceived as particularly fruitful, in the national interest and inadequately addressed elsewhere in the country", to show sensitivity and responsiveness to issues which are considered important by government and to conduct research which has use in the public sector. The grant is to employ a co-ordinator for the project at a Senior Research Fellow level and to provide research assistance and fieldwork support for that person.
A grant of $5,040 has also been awarded by the Criminology Research Council for work towards identifying the number of heroin users in the ACT.
Further Information
For further information about the feasibility research contact:
Dr Gabriele Bammer, Research Fellow & Co-ordinator, Feasibility Research into the Controlled Availability of Opioids, National Centre for Epidemiology and Population Health, Australian National University, GPO Box 4, Canberra ACT 2601.
Phone (02) 6125 0716, Fax (02) 6125 0740.
Publications
National Centre for Epidemiology and Population Health. 1991. Feasibility research into the Controlled Availability of Opioids. Volumes 1 and 2. NCEPH Australian National University, Canberra.
Bammer G. 1991. A heroin trial for the ACT? National AIDS Bulletin 5(10)
27-30. Reprinted in ACTCOSS News January 1992 as 'Controlled Distribution: Drugs
on Trial', 18-21.
Bammer G. 1991. 'Proposed trial of controlled availability of heroin - results
of police survey. Australian Federal Police Association Newsletter. No.
20 (September/October) 15-16.
Bammer G. & Gerrard G. (eds) 1992. Heroin Treatment- New Alternatives.
Proceedings of a One-day Seminar, Becker House, Canberra, November 1991.