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Monday, 3 April 2000
Page: 15043


Mrs HULL (5:05 PM) —In speaking today on the issue of naltrexone treatment, at the outset I would like to applaud the Prime Minister on the government's Tough on Drugs strategy. It was a strategy that was long overdue. I will speak on the facts surrounding the use of naltrexone, and those facts may be for the benefit of those who are desperately in need. The figures of the former Department of Health and Community Services show that the prevalence of heroin consumption in Australia has remained at a relatively low level between 1988 and 1995, with one per cent of the population over 14 years reporting that they had used heroin and less than 0.5 per cent of the population reporting that they had used heroin in the 12 months before 1995. Consumption was concentrated in persons aged less than 30 years. While prevalence rates are low in comparison with other illicit drugs, the trend in more recent times for younger age groups appears to be towards more, rather than fewer, persons using heroin.

These figures are supported by the Australian Institute of Criminology data, which reveal that the number of deaths from heroin overdose or dependence has been increasing steadily since 1992. A recent study by the Turning Point Alcohol and Drug Centre in Melbourne has found that the increase in the total number of deaths is primarily due to the high incidence of deaths among males. However, the number of teenagers and women using heroin is increasing, with many naming heroin as the first drug they injected. This research, based on information from ambulance officers, has given a disturbing picture of heroin overdoses and the changing patterns of the use of the drug. While noting the increased use of heroin among young people and women, the study's preliminary findings also show that overdose victims in Melbourne are most likely to be male and aged about 27. It appears that the falling price of heroin and increased availability was fuelling a growing street scene, allowing our children easy access to this scourge on our society.

Naltrexone has been touted as a possible non-addictive alternative to methadone for the treatment of heroin addicts. Naltrexone operates by blocking the human body's receptors for heroin and other opiates such as morphine, so the `high' that an addict gets is not present when the drug is administered. Several pioneering clinical studies have been performed using naltrexone. These studies were successful in confirming the pharmacological effectiveness of the drug and demonstrate that naltrexone is a viable alternative treatment for heroin dependence. A study conducted by the Australian Medical Procedures Research Foundation in 1999 validates that naltrexone, when used in association with a rapid detoxification program, can be effective in increasing the recruitment of young heroin addicts into the program at an early stage of their addiction.

Similarly, a trial conducted at Westmead Hospital in Sydney, and backed by the New South Wales government, found that 60 per cent of former heroin users were not drug dependent after one year. The Westmead trial noted that, despite 90 per cent of users being treated with naltrexone not having heroin cravings, long-term maintenance is required to effectively keep former users from relapsing. With only methadone being available for 20 years in Australia, the opportunity to give the patients treatment at an early stage of their addiction has been lost as so many of the younger addicts reject the use of methadone when their addiction has been present for only a short time.

Naltrexone is available by prescription from GPs. However, the financial status of many users preclude them from gaining the benefits associated with the treatment. The clinical study conducted by the Australian Medical Procedures Research Foundation importantly identified that many patients, especially young mothers, found the daily cost for naltrexone tablets too high and dropped out of the treatment. Cost for naltrexone tablets in clinical trials are quoted at $7 to $10 per day, or $250 to $350 per month. The clinical data highlights that a 12-month detoxification program is required for most people. This equates up to $3,600 per year.

Figures provided by the Department of Health and Aged Care demonstrate that methadone has a cost per public patient of $2,100 per annum. With methadone's reduced costs compared to naltrexone, it is plain to see which treatment low income users are most likely to adopt—the addictive opiate, methadone. If naltrexone were to be listed through the subsidised Pharmaceutical Benefits Scheme, prices would be likely to drop by half. Before a medicine can be subsidised via the PBS, it must be assessed by the Pharmaceutical Benefits Advisory Committee. The member for Fowler should take note that the PBAC is a totally independent body, not a government committee.

In view of the importance of heroin addiction, consideration of naltrexone for PBS listing was fast-tracked and a special meeting was held in July 1999 by this totally independent committee. Unfortunately, naltrexone was unsuccessful in gaining listing on the PBS at this meeting. The reasoning behind the unsuccessful bid was quoted as being due to naltrexone's modest clinical efficacy in outcome measures of relapse and retention rates. There was also concern raised about the drug's toxicity and about the difficulty in treating patients who require strong analgesics in an emergency situation whilst on naltrexone.

The PBAC also quote that naltrexone showed no evidence of significant medical effectiveness. Coupled with the price of the medicine, the resulting cost effectiveness could not justify PBS listing. It would be my belief that it is the heroin that has the toxicity, not the naltrexone. It is the heroin that kills. Naltrexone can prevent the death. People who die after using naltrexone usually die because they have returned to their habit, not through using naltrexone. The company which produces naltrexone took legal action against the PBAC in an effort to have its product listed. The PBAC subsequently reviewed naltrexone and, in its December 1999 meeting, approved its listing on PBS purely for alcohol dependence. It remains unavailable on the PBS list for opiate addiction.

Naltrexone is a non-addictive alternative to methadone that has demonstrated in clinical trials that it is effective in the treatment of heroin addiction and has few demonstrable side effects. General practitioners have been prescribing naltrexone for a period of time specifically for the treatment of opiate addiction. The United States has had naltrexone approved for many years for the treatment of opiate dependence. The total number of clients in methadone treatment programs in Australia as at June 1998 was 24,657 people. Of that, 12,107 were from New South Wales. That is half of the total. There is a definite need for an expansion of treatment options. In the media release of the Australian National Council on Drugs on 29 May 1998, the chair of ANCD, Major Brian Watters, said:

... the Council agreed that there is substantial body of research evidence that supports the WHO and the Ministerial Council on Drug Strategy's endorsement of drug substitutions like methadone and buprenorphine, as legitimate treatment options for the management of heroin addiction.

“However, the Council believes that there is need for an expansion of treatment options that are grounded in evidence of effectiveness, that are adequately resourced and reflect the range of consumer preferences,”...

I admit the effectiveness of naltrexone programs depends on the social and psychological support system available to the addict. For naltrexone to be successful, it requires patients to have very competent carers and appropriately staffed detoxification centres and rehab units. I am a strong advocate of increasing the availability of rehab centres and am currently supporting the establishment of a rehab centre within the Riverina. My electorate has been clearly identified as an area of high need.

I conclude by saying that naltrexone is not a radical drug, and I believe that, by adding it to the PBS list, addicts will have the choice to join a detoxification program that can offer far more rapid results than existing programs without their having to endure financial hardship or resort to illegal activities to fund their treatment. I support Dr Jon Currie, Director of Alcohol and Drug Services at Westmead Hospital, in saying that I hope too that, when results of these trials are available, there will be sufficient evidence to support a re-application for PBS listing. It is vital that we have options for heroin and other opiate users who are aiming at a drug-free life that are not prohibitively expensive. (Time expired)