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Monday, 3 April 2000
Page: 15040


Mrs IRWIN (4:55 PM) —I move:

That this House:

(1) notes the increase in deaths caused by heroin and the increase in the number of first-time users under 25;

(2) notes the positive results in the use of Naltrexone in the treatment of heroin dependence for some addicts; and

(3) regrets the recent decision by the Pharmaceutical Benefits Advisory Committee to exclude Naltrexone from the Pharmaceutical Benefits Scheme other than for the treatment of alcohol dependence.

Despite the Howard government's Tough on Drugs strategy, heroin is used by an estimated 300,000 Australians, and the number is rising. The National Drug and Alcohol Research Centre says that heroin is now one of the leading killers of young Australians. There has been a 120 per cent increase in heroin related deaths in south-western Sydney between 1992 and 1995. The number of Australian teenagers who have tried heroin has jumped almost threefold in the past three years. In Cabramatta, in my electorate, residents and business proprietors are understandably unsympathetic. Nationally, an average of 48 property offences are reported to police every hour, and the Australian Institute of Criminology blames 90 per cent of household break-ins on heroin addicts. This is from a letter I received last week:

Unless the illegal drug trade in Cabramatta is completely cleaned up by 30 June 2000 the concerned citizens of Cabramatta will contact the international news media and warn them that overseas visitors will be in grave danger of being bashed and robbed by desperate drug addicts heading to Cabramatta to buy their drugs.

Mr Deputy Speaker, you can see the frustration we are facing with this situation, and people are much more candid when you talk to them in the street. Let me read you another letter, actually to the Prime Minister, written by a patient at a naltrexone detox clinic just up the road from my electorate office. It says:

I am writing to you in the hope that I can help you understand the benefits of treating heroin and methadone addicts with rapid detox using naltrexone. Last January—

That was January last year—

I was able to pay for my treatment. It was the beginning of life for me.

This 41-year-old mother of two had been on methadone for the last 10 years. She says to the Prime Minister:

I have a real understanding of the drug problem in Australia as I used for twenty-three years in Sydney, Melbourne, Queensland and South-East Asia. I have been charged for trafficking in Melbourne, using and possession in Sydney and the Gold Coast. I understand how it feels to be treated like society's refuse. I have changed from a useless junkie into a caring responsible productive citizen ... Naltrexone is really a miracle drug. I am here alive today because of it. Please—

she says to the Prime Minister—

don't let any more Australians dependent on heroin or methadone endure one more day. Please give them back their freedom. My father fought in World War Two for this country so we could be free. Please don't let drugs take that freedom from us.

The rapid detox centre in Speed Street, Liverpool, which incidentally assists a limited number of people who cannot afford to pay, has hundreds of letters of gratitude. A common phrase is, `My life has been saved.' The Westmead Hospital naltrexone trial made riveting TV. That is how open and transparent it was. About two-thirds of the patients are drug free after six months, and that is a good success rate.

Dr Jon Currie, who led the trial, believes naltrexone can help some, not all, heroin addicts. He says that it should be on the Pharmaceutical Benefits Scheme. He says that it is a tragic thing that it is not. Dr George O'Neil over in Perth, another genuine front-line, hard-nosed medico who has treated well over 1,000 people, says the same thing. Dr Siva at the Liverpool detox centre says the same thing. These people are close to the problem, close to the families and closer to the realities than most of us would like to get. I put it to the Pharmaceutical Benefits Advisory Committee that naltrexone, which they recognise as being effective for alcohol addiction and have approved for inclusion in the PBS, is also effective for treating heroin addiction.

It will work for less than a fifth of alcoholics. The people it will help overcome alcohol dependence will have to be carefully screened and naltrexone prescribed under authority. It should be the same with heroin addicts. We know it gets people drug free for a sufficient interval for some life changing to be done. Naltrexone is not a cure for any addiction, but rehabilitation best starts free of physical addiction. And that is where the real story begins. The psychosocial reasons for addiction are complex, and we are only just beginning to develop psychological approaches to maintain drug-free lives. It is the behavioural therapy, not naltrexone, which counts most.

The evidence that was used in rejecting naltrexone just was not appropriate. In fact, because the reasons behind every person's addiction are different and complex, there is no perfect measure. This is not a headache, and naltrexone is not aspirin. Heroin addiction might be an epidemic, but there is no single medication for it. You cannot stamp out heroin use. You have to stop the reasons behind it, and that is going to be different for each and every addict. That is the reason naltrexone should be available as one of a number of treatment options.

We as a society, as well as those whose addiction most alienates them from society, need every tool available to deal with this dragon. Naltrexone has been around for more than a decade. The popular perception is on the instant cure side, the magic wand, the silver bullet. That is completely wrong. So too is the rapid detox side of naltrexone. It is very useful for detoxification, but it does not matter how someone with a drug dependency gets detoxed. What is so useful about naltrexone is its blocking ability and its safety. It does two important things. It takes away the urge to use, and it blocks a high. If you have a drug dependent person who has real motivation and the support of family and friends, naltrexone is a godsend. Without motivation, it is of no value.

That is where the PBAC decision is so cruel. Naltrexone is only suitable for those with the spirit to break the cycle. Their despair is greater having seen naltrexone based programs almost come within reach. They are left with counselling—and a lot of good work is done there—and they are left with methadone. Counselling accepts a high relapse rate, and methadone provides a substitute addiction which you can feed up with continued heroin use. Naltrexone works on methadone addiction too. Naltrexone offers a next stage to methadone—which, incidentally, can be a lifetime's supply. Naltrexone, for what it is worth, offers a cheaper treatment option.

I am not against methadone. The numbers, around 23,000, on methadone are growing at about 15 per cent a year. It is estimated that every dollar we spend on methadone saves the community $4 to $5 in reduced health costs and crime. Those are the minister's figures. Naltrexone could be in the same league. Heroin is down to about $20 a cap in Cabramatta. You cannot stop it. About 80 to 90 per cent of women in Mulawa have a drug problem. Narcotics are coming into our jails, and if we cannot keep them out of there we cannot stop them coming into the community and bringing increasing grief for families. Naltrexone, used properly, can save lives. It can be cost effective. In the right professionally run program with prescriptions under authority, it can be rigorously monitored. We can see what we are getting. Let me read a letter from `Amber' to show the kind of happiness we or the PBAC could bring to a troubled world:

Dear Dr Siva and Staff

I won't ever be able to thank you enough for your treatment and support. You saved my life!

Since being rapidly de-toxed at your Liverpool clinic I have been able to go on and lead a happy and normal life.

My family still cannot believe that they have their daughter back and my younger sister has all of a sudden got an older sister!

When I wake up in the morning instead of thinking of heroin I think what a precious gift life really is. I'm now six months clean and at the end of my treatment. I cannot explain the pleasure I get from the simplest things in life.

So many doors have opened for me since being detoxed.

Can we deny this to so many who cannot afford the medication? Aren't our young people worth giving at least a second chance? That chance is naltrexone based treatment. I beg the PBAC to reconsider its decision and to give a chance to some of the 300,000 Australians trapped in dependency.


Mr DEPUTY SPEAKER (Mr Andrews)—Is the motion seconded?


Mr Price —I second the motion and reserve my right to speak.