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Recommendation delayed
We had planned to make a recommendation about whether or not a trial of controlled availability of heroin for dependent users was logistically feasible at the end of September, however the August meeting of the Advisory Committee recommended that the decision be deferred until June 1994. They felt that more time was needed for the research findings to be fully analysed, written up and disseminated to give the community and policy makers the opportunity to consider and debate them. They also wanted detailed consideration of the location of a service, its mode of operation, policing issues and costings to be undertaken, as these will be important determinants of whether or not a trial is feasible.
Progress reports on the feasibility study were recently presented at the 25th Annual Conference of the Public Health Association of Australia and the 9th Annual Conference of the Australian and New Zealand Society of Criminology and these generated some media interest.
There are also two new working papers which are descibed briefly below.
Becoming an ex-user - would the controlled availability of heroin make a difference?
The primary aim of this study was to gain some insight into what the effects might be on stopping dependent heroin use if heroin was made available in a controlled manner through a 'heroin trial'. To do this we documented the 'stories' of a diverse group of people who have been dependent on heroin in the recent past. We explored how the participants had come to give up heroin. They were also questioned on their views about the proposal to conduct a 'heroin trial'.
For some of the analysis, participants were divided into four groups: those who had given up with minimal or no formal treatment, those who had used detoxification, those who had used methadone and those who had been in a therapeutic community.
Of the 18 people interviewed, 17 were asked their views about a heroin trial. Forty-seven percent were in favour of a trial, 41 percent were not in favour, and 12 percent were undecided. In each of the four groups into which participants were allocated, there were people who were in favour and people who were against a trial. Of 12 respondents, 11 would have participated in a heroin trial if that option had been available to them at the time. Of 14 respondents, 5 indicated that they may be tempted to start using again if a trial were to go ahead. A survey of 45 ex-users conducted during Stage 1 of the Feasibility Research found that 62 percent were in favour of a trial going ahead; 22 percent were against; and 16 percent did not know. Only 2 percent thought they might start using again to get on a trial; 19 percent were unsure.
The views of the participants and information which can be drawn from their stories highlight a number of potential benefits and problems of a trial. The potential benefits include providing a new treatment option which could allow some people to 'stabilise' their lives. It might also reduce crime and health problems and provide a drug that was easier to withdraw from than methadone.
The potential problems include that there would be people who would 'rip off' a trial and others for whom it would not be a helpful alternative. There are likely to be people whose lives would be 'stabilised', but who would not find the motivation to deal with underlying problems or become drug free. A number of participants were opposed to a trial because they thought it would work against dependent users being helped to lead 'normal' lives. There are people who may start using again. The particular design of a trial might also lead to logistic problems.
These potential advantages and disadvantages of a trial need to be weighed up along with the results of all the other components of the feasibility study before a final decision about the controlled availability of heroin can be made.
Participants were also asked about how they had made the decision to stop using, what the role of treatment had been, and how they had maintained their decision to be abstinent.
A diversity of experiences was reported about how the decision to stop using was made. For most participants a range of factors was involved. Many were consistent with factors identified in previous studies and included 'hitting rock bottom'; change because the situation or environment changed; maturing out; fear of the law; and the influence of family and friends.
Advantages and disadvantages of a range of treatment services were reported, with a focus on methadone programs, therapeutic communities and Narcotics and Alcoholics Anonymous. The results highlight that different treatments and services work for different people at different times. Not only do a range of treatments need to be available, but there also need to be various supports for people who want to stop dependent use without formal treatment.
Key factors in maintaining abstinence were reported to be relocation and avoiding old haunts; supportive close relationships; professional and peer support; dealing with past personal issues; remembering the past life; learning a new way of living; the rewards of a conventional lifestyle; work; use of other drugs; and spiritual influences.
This small investigation seems to have been the first of its kind in Australia. It shows that studies of ex-users can be valuable in informing existing policy regarding the provision of treatment services and proposed policy changes.
Does childhood sexual abuse contribute to alcohol, heroin and/or other drug problems? Proceedings of a one-day workshop.
This one-day workshop examined the evidence for a link between childhood sexual abuse and alcohol, heroin and/or other drug problems. ACT-based service providers and researchers were invited to attend and an overview of some of the available data and of current research is provided. There is also a summary of the workshop discussion. The topics covered were:
For each of these topics there are issues still under debate and others for which there is considerable agreement. This document aims to provide a summary of "where we are at" so that there is a clearer vision of how services can be improved and of what research needs to be conducted.
The priorities identified at the workshop were to:
This workshop is an important component of the feasibility consideration concerning a 'heroin trial'. Clearly if a trial was to proceed, it would need to take account of a potential link between heroin dependence and childhood sexual abuse as part of the total treatment context in which a trial would operate.
Changes to the Advisory Committee
Mr Michael Brown of the Drugs Policy Unit, Federal Justice Office, Attorney-General's Department has replaced Mr Kerry McDermott as an observer.
Changes to the Research Team
Staff returning
Deborah Tunnicliff, Research Assistant, NCEPH (general assistance)
Projects completed
Iain Anderson, Research Assistant, NCEPH (studies with heroin users)
Corinna Lee, Research Assistant, NCEPH (studies with heroin users)
Greg Morris, Research Assistant, NCEPH (studies with heroin users)
Aaron Stowe, Research Officer, NCEPH (studies with heroin users)
Sue Weekes, Research Assistant, NCEPH (ex-users)
Further Information
For further information about the feasibility research contact:
Dr Gabriele Bammer
National Centre for Epidemiology and Population Health
Australian National University
GPO Box 4
Canberra ACT 2601
Phone: (02) 6125 0716
Fax: (02) 6125 0740
New Publications
Working Papers
Bammer, G.; Weekes, S. 1993 Becoming an ex-user - would the controlled availability
of heroin make a difference? Feasibility Research into the Controlled Availability
of Opioids Stage 2 Working Paper Number 4.
Bammer, G. (editor) 1993 Does childhood sexual abuse contribute to alcohol,
heroin and/or other drug problems? Proceedings of a one-day workshop held at
the National Centre for Epidemiology and Population Health, The Australian National
University, 22 June 1993. Feasibility Research into the Controlled Availability
of Opioids Stage 2 Working Paper Number 5.
Reprints
McDonald, D.; Stevens, A.; Dance, P; Bammer, G. 1993 'Illegal drug use in the
Australian Capital Territory - Implications for the feasibility of a heroin
trial'. Australian and New Zealand Journal of Criminology, 26, 127-145.
Bammer, G.; Douglas, B.; Moore, M.; Chappell, D. 1993 'A heroin trial for the
Australian Capital Territory? An overview of feasibility research'. In Heather,
N.; Wodak, A.; Nadelman, E.A.; O'Hare, P. (eds) Psychoactive Drugs and Harm
Reduction: From Faith to Science. (Selected papers from the Third International
Conference on the Reduction of Drug-related Harm.) Whurr, London, 137-150.
Other
Bammer, G. 1993 'The ACT proposal for a 'heroin trial' - progress report
on the feasibility study' Abstracts of 7 Years and Counting. Health beyond 2000.
25th Annual Conference of the Public Health Association of Australia, Sydney,
September/October, 37 and Abstracts of Crime and Social Division. 9th Annual
Conference of the Australian and New Zealand Society of Criminology, Sydney,
September/October, 70.
Humes, G.; Moloney, M.; Baas Becking, F.; Bammer, G. 1993 'The ACT Aboriginal
community AIDS project' Abstracts of 7 Years and Counting. Health beyond 2000.
25th Annual Conference of the Public Health Association of Australia, Sydney,
September/October, 66.