Editorial 2 Mister Meaner 4 News 5 Pharmacotherapies

Editorial
2
and all people on pharmacotherapy
Thailand's “War on Drugs”
Mister Meaner
4
treatments. Why?
reinstated!
News
5
HEP C Testing
18
There are plenty of reasons for
Pharmacotherapies it's your choice
There's been a lot of talk about
heroin making a comeback, but it
never really went away, as even at
the height of the “drought” in 2001,
over 80,000 people (0.5% of the
population) said they'd used some
kind of opiate in the previous year.
A heroin trial
in Australia?
12
In the end, the parliamentary motion by Senator Lyn Allison did not
pass through the Senate but hopefully it will revive the notion of an
Australian Heroin Trial.
Peace of mind by Colin
14
I never imagined that my peace of
mind would come from being on
‘bupe, but that’s where I’ve found it.
The Pain Paradox
16
Pain, it is a subject that strikes fear
into the hearts of most opiate users
For many this may seem to be
a sensible policy position for a
getting a hep C test, and there are
7
27
probably even more reasons why
people choose not to get tested.
country that has been known for
its heroin and methamphetamine
manufacturing and trafficking, but
Fractured Fairy tales
20
For a long time being positive
really meant nothing at all to
me though some naïve folk believe everyone who has it turns
yellow and that it’s contagious.
Making a difference
23
the consequences are dire.
Time for talk is over
29
Hepatitis C is spreading through
Australia's correctional centres at
an alarming rate and if allowed to
continue unchecked will result in a
Have you ever been made to
totally unnecessary and extremely
wait while picking up your
costly health problem not just for
methadone/'bupe, while the
prison inmates but for everybody
chemist serves another customer,
even though you were there first?
My story by Lee O.
25
In the mid 1990's I started working
for a brothel in Canberra to support not only my own but also my
partner's habit, and when one of
living in Australian society.
Reviews
31
Crossword
32
Member organisation
the owners offered me a “business
profile: WASUA
34
opportunity”, I couldn't refuse.
Contacts
35
DISCLAIMER
CREDITS
The contents of this magazine do not necessarily represent the
views of the Australian Injecting & Illicit Drug Users league inc.
(AIVL). AIVL does not judge people who choose to use illicit drugs
and welcomes contributions which express opinions and raise
issues of concern to people who use or have used illicit drugs. The
contents of Junkmail do not encourage anyone to break the law
or use illicit drugs. While not intending to censor or change their
meaning, Junkmail reserves the right to edit articles for length,
grammar and clarity. Junkmail allows credited reprinting by drug
user organisations and other community-based groups with
prior approval, available by contacting AIVL. Information in this
magazine cannot be guaranteed for accuracy by AIVL. AIVL takes
no responsibility for any misfortunes which may result from any
actions taken based on materials within Junkmail and does not
indemnify readers against any harms incurred. The distributions of
this publication is targeted – Junkmail is not intended for general
distribution. ISSN: 1445-2707
Editor: Sam Liebelt
Editorial Board: Sam Liebelt, Annie Madden, Dayle Stubbs, Fiona Poeder
Thanks to: The rest of the AIVL staff Team: Leota Patterson, Faye Irwin, Jude
Byrne, Tia Harrison, Wayne Capper, John Francis and John Van Den Dungen for
their input. John Carey for his artistic input, Phil for his cover concept and original
artwork. All of the individual drug users and others who have contributed articles
and/or graphics to this issue. (Individual credits are provided with each article and
graphic contributed)
Design & Layout: direttissima Printing: Goanna Print, Canberra
Australian Injecting & Illicit Drug Users League (AIVL)
Level 2, Sydney Building, 112-116 Alinga St, Canberra ACT 2601
Postal: GPO Box 1552, Canberra, ACT 2601
Phone: (02) 6279 1600 Fax: (02) 6279 1610
Email: [email protected] Web: www.aivl.org.au
3
Dear Must be right,
Dear Benzo the clown,
This question keeps popping up
so I'll do my best to give you the
“right” info. As a general rule of
thumb NO heat is the way to go.
Heating doesn't evaporate morphine, but if you boil the hell out of
it the morphine will start to break
down. However, when you heat MS
Contin, between 20% to 30% of the
morphine gets bound into the melting wax — and if you use heat for
something like Kapanol you will
lose even more of the drug, as it
bonds to the polymer beads that
Kapanol is largely made up of.
Injecting Benzo's is never a good
idea. You risk major vein damage,
abscesses, Hep C infection and if
a particle from the pill lodges in a
small vein and blocks it up there is
a very real risk of the affected part
“dying” from blood not being able
to get through and that part (arm,
leg, finger) having to be amputated.
Having said that some people will
still want to inject them so there is
some facts that can't be ignored.
What it comes down to is that to
inject the drug it has to be soluble in water. Drugs like speed or
coke dissolve fairly easily in water. Some drugs like brown heroin
need a bit of citric acid or some
vinegar to help them dissolve. NO
BENZO'S WILL DISSOLVE IN WATER. None of them. Heating them
won't help and neither will adding
acidifiers like vinegar.
So the answer is to take your time
and do your mixing with the water
at room temperature. It takes a little longer, but will get you 95%+
of the morphine in the solution.
Heaps better result. Let your mix
sit for a couple of minutes (the
longer the better) before you use it
and don't forget to filter your mix
with a .22 micron wheel filter to remove any smaller particles. Always
remember to swab your hands and
the injection site before you inject.
4
This means that by crushing the
pill and mixing them with water,
you will just end up with a big
gooey mess. Filtering this mix
with a pill filter (0.2 micron or
0.8 micron) will help to remove
larger particles that may block
up your veins, but it will also remove some of the drug. Better this
though than having an arm or a
leg removed!
So this leaves us where? Don't inject Benzo's unless you think that
arms and legs are optional. You'll
be lucky to get any effect from the
drugs this way so it's just not worth
it. Instead try sticking it under
your tongue and letting it dissolve.
You are guaranteed to get the full
amount of the drug this way and it
is extremely fast as it is absorbed
into the bloodstream without having to go through the stomach and
liver first. You could also try shafting (up ya bum!) but for this you
need to go through a few steps before you can take the pill.
Remember, Benzo's are not made
for injecting - if you choose to inject them you run the very real risk
of doing yourself real harm.
ACT backs supervised
drug use for addicts
Canberrans are the strongest
supporters of supervised injecting rooms, providing heroin on
prescription and allowing the
medicinal use of marijuana, a new
report reveals. More than 23,000
Australians, aged 12 or older, were
asked last year about their drugtaking behavior as well as their beliefs and attitudes. Almost 73 per
cent of ACT residents supported
the medicinal use of marijuana and
about 56 per cent were in favor of
supervised injecting rooms. More
than 38 per cent would back a trial
where drug users received heroin
on prescription. (I like the sound
of that! Ed.)
Source: Canberra times 30/08/2008
Coked up advisor /young
Australian of the Year
DISGRACED Young Australian
of the Year candidate, Iktimal
Hage-Ali, has told a court she was
depressed when she formed a 3
gram a week cocaine habit because her father and brother didn't
approve of her speaking publically
about Muslim issues. “My father
and brother weren't too happy
about me speaking about Muslim
issues,” she said.
Ms Hage-Ali is suing the NSW Government for unlawful arrest and
wrongful detention after she was
arrested on suspicion of supplying
cocaine in November 2006 - eight
days before she was named NSW
Young Australian of the Year. In
the media publicity that followed
her arrest, Ms Hage-Ali relinquished her state title, ending
her nomination for Young Australian of the Year.
But in the District Court today,
Ms Hage-Ali conceded that to an
outsider listening to phone calls
between her and Fahda, it would
appear she wanted drugs “to give
to other people.” However, even
though she ran a line of credit
with Fahda and told him she was
ordering cocaine for friends, Ms
Hage-Ali has maintained the drugs
were always for herself. The hearing before Judge Michael Elkaim
continues.
Source: Daily Telegraph online
(www.dailytelegraph.com.au) 11/12/2008
Over one million
registered drug addicts
reported in China in 2008
The number of registered Chinese
drug addicts has risen by a third in
the past three years, and has now
reached 1.08 million as of October,
said an official of the Ministry of
Public Security on Friday. According to the ministry, the number
of addicts was 785,000 in 2005.
Nearly 80 percent of the drug
abusers are heroin users, said
Zhang Xinfeng, the ministry's
deputy minister.
More than 56,000 drug dealers
had been arrested and 460,000
drug smuggle cases had been
dealt in the first ten months in
2008, Zhang said. The ministry
plan to build 45 non-compulsory
rehabilitation centers across
China, before which China only had
compulsory ones.
As some addicts found it hard to
rejoin the society, the government
plans to build up friendly environment in the new centers, Zhang
said. Totally 220 million yuan (
about US$32 million ) from the
central budget had been invested
on the construction of rehabilitation centers since 2006,
and 10 had been accomplished
and received more than 1,600
drug users.
Source: Media Awareness Project www.map.
org on 9th December 2008
Swiss approve heroin
scheme but vote down
marijuana law
A pioneering Swiss programme to
give addicts government authorised heroin was overwhelmingly
approved yesterday by voters who
simultaneously rejected the decriminalisation of marijuana. Sixtyeight per cent of voters approved
making the heroin programme
permanent. It has been credited
with reducing crime and improving
the health and daily lives of addicts since it began 14 years ago.
Only 36.8% of voters favoured the
marijuana initiative.
Parliament approved the heroin
measure in a revision of Switzerland's narcotics law in March, but
conservatives challenged the decision and forced a national referendum under Switzerland's system
of direct democracy. The heroin
programme has helped eliminate
the scenes of large groups of drug
users shooting up openly in parks
that marred Swiss cities in the
1980s and 1990s, supporters say.
The heroin program is offered in
23 discreet centres across Switzerland, which offer support to nearly
1,300 addicts who have not been
helped by other therapies. Under
supervision, they inject doses
measured to satisfy a craving but
not enough to cause a high.
Source: Media Awareness Project www.map.
org on 12th December 2008
5
Needle exchange and the
new drug czar
SNP rejects plan to cut
benefits for drug addicts
Australia target of
Israeli Ecstasy
President-elect Obama's staff recently floated the name of Republican Jim Ramstad, a Republican
from Minnesota who is a recovering alcoholic, as the possible
“drug czar.” While the nomination
of someone with personal experience of addiction to this post is, in
principle, something worthy of applause, Ramstad appears to see addiction and recovery through too
personal a lens, putting ideology
ahead of science.
The Scottish government has rejected plans by Westminster to force
unemployed drug addicts to seek
medical help to keep their benefits.
Fiona Hyslop, the SNP Education
Secretary, said she did not believe
that taking away benefits would do
anything other than lead addicts
back to a life of crime. Labour attacked the move as “despicable”
and accused the SNP of abandoning
drug addicts and condemning them
to a life on benefits.
Israeli police intelligence reveals
that crime syndicates operating out
of Israel view Australia as a booming market for the party drug. In
March, 45-year-old Israeli man Benjamin Rosenfeld was sentenced to
21 years' jail for importing 112 kilograms of the drug MDMA, the main
ingredient of ecstasy, with a street
value estimated at $45m.
Crucially, he opposes needle exchange programs to prevent the
spread of HIV among addicts,
which is one of the best-studied
interventions in public health. He
even voted against allowing Washington, DC to use its own money to
fund these programs. Washington
currently has the nation's highest
HIV infection rate and IV drug use
is the source of nearly one-fifth of
AIDS cases.
The stand-off between the Scottish government and Westminster
comes despite meetings between
Ms Hyslop and Tony McNulty, the
Employment Minister, to discuss
plans to reform Britain's benefits
system. Ms Hyslop appears to have
rejected parts of the package aimed
at tackling addiction among the
unemployed and improving addicts'
literacy skills to raise their employment prospects. In a letter to Mr McNulty, Ms Hyslop wrote: “I remain
unconvinced of the benefits of using
the threat of sanctions to coerce
people into attending skills assessments and training.”
Two decades of empirical research
on needle exchange should provide the foundation for the nation's
drug policy, not a former addict's
personal experience. Sympathy is
not a substitute for rigorous, dispassionate analysis. If the Obama
administration is determined to
nominate Rep. Jim Ramstad to the
position of “drug czar,” it needs to
explain why his personal experience and opinion disqualifies the
weight of scientific evidence.
Source: www.stats.org on 3rd December 2008
6
Ms Hyslop's stance indicates that
the SNP intends to build opposition
to the plans in Scotland. A spokesman for Ms Hyslop said: “We don't
believe that cutting drug users'
benefits will do anything other than
lead some of them back to a life of
crime. “And we don't think that drug
users currently on treatment waiting
lists should make way for those referred by benefits offices. Those who
had been waiting for a long time
would suddenly find themselves at
the back of the queue.”
Source: Times online (www.timesonline.co.uk)
13th December 2008
According to Israel police, Israeli
crime gangs are smuggling large
quantities of ecstasy out of production houses in the Netherlands,
then into Belgium and Spain. From
there the smuggling route can be
traced through the Middle East to
Thailand or Singapore, and then
on to Australia. “We are well aware
that members of the organised
families here have established connections in Australia and view it
as a lucrative and growing market
that they are looking to exploit,” a
senior member of Israel's Coastal
Police central unit reported. Speaking on condition of anonymity because he did not have authorisation
to brief the media, the police source
said that Israeli police believe organised crime gangs were making
increasing use of couriers who carried smaller parcels of drugs. “This
has been the pattern, especially
because South-East Asia and Australia are such popular destinations
for Israeli backpackers when they
finish military service,” he said.
“Organised crime has been getting
stronger in Israel … Until we get
more resources here to fight the
criminals, we believe their smuggling operations will continue to get
stronger,” the police source said.
Source: The Age 13th December 2008
Pharmacotherapies –
it's your choice.
There's been a lot of talk about heroin making a comeback,
but it never really went away, as even at the height of the
“drought” in 2001, over 80,000 people (0.5% of the population) said they'd used some kind of opiate in the previous year.
If you have been a regular user of opioids and you want to pull
up, you might be thinking about pharmacotherapy or “going
on the program.” Previously this just meant methadone, as it
was the only option around, but nowadays there's Biodone®,
Subutex® or Suboxone®. This article will outline what the difference is between these, so you can decide which best suits
what you want from treatment.
Over the last 150 years several drugs seemed to be wonder
cures for opiate addiction: morphine “cured” opium withdrawal, heroin appeared to do the same for morphine, but each
caused dependence without solving the problem and health
professionals came to realise there was no wonder cure. With
the rise in drug use and the problems associated with drugs,
or prohibition, it became obvious that a solution to the problem of dependency and withdrawal was needed as willpower
alone wasn't going to work and so replacement pharmacotherapy came about.
What is
pharmacotherapy?
In Pharmacotherapy a user takes a replacement drug with similar effects to what they
have been using which covers the immediate
withdrawal symptoms, but has other benefits too. As it's cheaper than scoring it gives
financial relief and lessens the need for crime
and as it isn't cut with other substances and is
taken orally, treatment reduces the risks from
hep C or overdose and helps improve overall
health. Being on treatment also gives some
space from people or places connected with
scoring and using, and so helps users get a
social life outside the dope scene, and it can
lead to completely stopping using.
While giving up drugs for life may be the
ultimate goal for some people, for many users
treatment is a chance to get their life together
and have a break from the pressures that go
with running a habit. Now, after nearly forty
years, pharmacotherapy is seen as a practical and effective treatment and is a part of
Australia's commitment to the philosophy of
harm reduction.
Currently the two drugs used for opiate
pharmacotherapy in Australia are methadone (either as a syrup or as “Biodone®”)
and buprenorphine (either as Subutex® or
Suboxone®).
Methadone True or False
There are many different versions of the history
of methadone, here are just two.
Methadone was produced by Nazi scientists during WW2 on
Hitler’s order because the opium growing areas were controlled by the allies and it was named dolophine after him.
Methadone was first developed in Germany
during WW2 but it wasn’t originally developed
as a painkiller and its narcotic and analgesic qualities weren’t recognized at first as it
doesn’t resemble other known compounds. It
wasn’t until after the war that it was used as a
pain killer. The failure to recognise its value as
an analgesic was because initial doses were
too high and side effects resulted. As for the
name, it seems derived from the words ‘dolor’
meaning pain and ‘fin’, French for end.
7
Methadone
Methadone was recognized as being suitable
as an opiate treatment soon after it was
developed as it both alleviates physical
withdrawals and in larger doses blocks or
lessens the effects of opiates, so it discourages continued using. It also has a longer
half life than other opiates so most patients
only need to be dosed once a day.
Methadone was first used as a treatment in
Australia in 1969 and until recently was the
only option available. It comes as either the
yellow methadone syrup or as Biodone®,
which is a red liquid that has no other additives. Both contain 5mg of methadone per
milliliter of liquid (this can cause confusion as
people say they are on 50 mls but are dosed
with 10mls of liquid containing 50mgs of
methadone.) Methadone also comes as a tablet called physeptone but this is more usually
prescribed for pain relief, or when travelling.
Dosage varies depending on how much, how
often and how long the person has been using, but starting doses range from 15-35 mg
daily and are increased as needed until the
person is stabilised.
More recently, methadone has become available as Biodone®, which is the same strength
as syrup but has no additives. The absence of
alcohol and sugar make it a better choice for
people who may have other medical conditions like hepatitis or diabetes. Some people
report a different effect from Biodone®, but
there's no medical reason why this should
occur as both contain the same active ingredient in the same strength and this may be just
personal preference.
Methadone is an effective treatment as it
stops withdrawals and lessens cravings once
doses are stabilised, which frees people from
the worst effects of having a habit. This lets
people get themselves together and get on
with their lives, but being on the program
can be restrictive too. It takes time before
you are allowed takeaways and they are
limited so it can be difficult to adjust to the
routine of picking up your daily dose. Going
interstate or travelling for more than a day or
two is pretty well out of the question without
giving notice but running a full time habit
isn't always fun either and so, for most users,
going on the program is still a better alternative to a heroin habit.
8
Like all opiates long term, methadone will cause dependence. Withdrawals develop more slowly as it takes longer to
clear it from your system, but they usually last longer while
the severity will depend on your dose. The clinic will reduce
you if you plan to come off so that the effects are lessened
but it can be a long and tedious process to reduce from a
high dose. It's advisable to stabilise during the process so
you don't feel so bad that you start using again.
Buprenorphine
Buprenorphine (also known by its brand name Subutex®
and, in combination with naloxone, Suboxone®) was developed in the 1970s and was approved as a pharmacotherapy
in Australia in 2000. Buprenorphine works on the opiate
receptors in the brain, so it relieves withdrawals but, unlike
methadone or heroin, it is a partial agonist that blocks other
opiates from these receptors (see box below). This makes
it a good pharmacotherapy option and is why some people
prefer it to methadone. Many people report that it removes
their psychological cravings for gear and, once they stabilise
on their dose, they find they don't even think about using
(see Peace of Mind, pg. 14).
You can use on top of buprenorphine but the effect is diminished. Buprenorphine binds tightly to opiate receptors and
will stop other opiates binding, but over time the buprenorphine will leave the receptors and other opiates can take
their place. Therefore, if you use on top, how stoned you get
will depend on how much buprenorphine you've taken and
how long ago you took it.
Buprenorphine is taken sublingually. It bypasses the liver
and therefore is processed by your body faster than if swallowed. If swallowed the majority of the dose is broken down
before reaching the bloodstream and the effect is dramatically reduced.
Precipitated withdrawal
Because buprenorphine fits the receptors so well, it not only
blocks any gear used on top but also replaces any opiates
in your system straight away. There is a time lag before the
buprenorphine is felt and this gap in effect, or the reduced
effect from any opiates already in your system, can cause
“precipitated withdrawal”. Dosing with buprenorphine too
soon after using other opiates will cause this effect, which in
extreme cases will be intense hanging out.
This is why people starting on buprenorphine should wait for
any gear or methadone to leave their system before dosing (6
hours after using heroin, 24+ hours after methadone). Transferring from a large dose of methadone can bring on intense
withdrawals if the methadone is still in your system. For this
reason, doses are usually reduced to 30 mg of methadone
or less before changing over to buprenorphine, though new
evidence suggests that people can be transferred to buprenorphine from higher methadone doses.
Dosing
Doses will vary according to each person's use, physical condition and tolerance, but 8-24 mg daily holds most people.
Short term reduction doses of 8-12 mg or maintenance doses
of 12 - 16 mg daily are generally effective.
Once your dose stabilises, you can get alternate day dosing,
where a larger dose is taken every second day or you can get
an extra dose on Friday that lasts ‘til Monday. This means
fewer trips to the clinic or chemist so many people prefer it, but
as the maximum daily dose allowed is 32mg this may not suit
people on higher doses as they won't get double their normal
dose. This situation may change over time as buprenorphine
has a much lower potential for misuse than methadone.
Suboxone®
In 2006 Suboxone® was listed on the PBS (Pharmaceutical
Benefits Scheme) for use as a treatment option. Suboxone®
is a mix of Subutex® with Naloxone (also known as the brand
Narcan®, which is given to people who OD on opiates, as it
blocks their effect.) If injected, naloxone can cause sudden and
severe withdrawals so the combination product deters people
from injecting their dose. As Naloxone has no effect orally
it doesn't change how the buprenorphine works if taken as
intended and, as it is less likely to be injected, Suboxone® is
often preferred by clinics for takeaways.
Agonist/Antagonist,
What’s the difference?
Drugs like heroin or methadone are opiate agonists - they
fit the opiate receptors in the brain and are absorbed into
the bloodstream and give the full opiate effect or stone.
Naloxone is an opiate antagonist that fills the receptors
and blocks the uptake of opiates that get you stoned, and
if you are already stoned this will put you into withdrawal.
Naloxone is often known as Narcan®, which is a brand name
(such as Panadol® is for paracetamol). This is what Paramedics will generally use to reverse an opiate overdose.
How to get
on the program
If you decide to go on the program you have to
go through a set process. There may be some
variations from state to state but treatment is
accessed through a dosing service - either a
general practitioner (GP) or “the clinic”. Either
way you will see a doctor, who will prescribe
your dose.
Be warned: even though the clinic may say
there's no delay in getting treatment, they
may mean there's no wait after you have seen
the doctor, which may not happen straight
away. So be prepared for some delay after
you contact the clinic. In some areas this
delay may be several weeks so don't expect
to walk in and get a dose straight away, but
don't be put off by the wait and remember
to keep your appointment or you will have
to start all over again.
You may also get an appointment with a
counsellor to talk about your situation and
discuss your options. Even if it's not compulsory, research shows treatment is more likely
to be successful if all the aspects of treatment
are utilised, including counselling. By itself,
pharmacotherapy isn't a magic cure and it's
only one part of what should be a total treatment package which includes counselling
and support “within a framework of medical,
social and psychological treatment.”
Remember, if you want treatment to work its
best, be upfront about what and how much
you have been using. Think about what you
want to achieve before you go on treatment,
discuss this with clinic staff and keep an open
mind to their suggestions. It may take a while
to stabilise your dose so give it time before
you decide if it's working for you. If you are
having trouble getting on the program or you
want information on what's available in your
area or on any other aspect of treatment, then
contact your local user group (see Contacts
page in the back of this mag). Some will have
a worker that deals with treatments and
they can all provide helpful information and
support as you go through the rigmarole of
getting on the program.
Buprenorphine is a partial opiate agonist - it blocks other
opiates from the receptors like an antagonist does, but it
causes its own opiate effect like an agonist so you don't
suffer withdrawal symptoms as you detox from opiates.
9
Maintenance
or short term ?
Another decision is whether you want to bring
yourself down with a short term detox program or if you want to go on maintenance.
Reduction programs cover withdrawals while
you are coming down, with the dose reduced
over a period of days or weeks. It suits people
who want to pull up but don't want to go on
the program long term and it might be the
better option if you just want to get yourself
together without substituting one dependance for another.
Maintenance involves dosing for a longer
period of months or years. As well as covering withdrawal, maintenance programs have
better success in reducing drug use and other
harms such as BBVs (blood borne viruses)
or overdose. As you stabilise it will give you
a chance to get yourself together - sort your
finances, get back to work or study, or sort
out legal and medical issues. It also provides
an opportunity to access support from health
workers or drug counsellors and, as dosing
lessens the effects of opiates, it discourages
ongoing using.
Staying on the programme long term gives
you the chance to set up new patterns of behaviour and break old ones and can give you
some distance from users and using scenes so
it provides a chance to change your lifestyle
over time. It will suit people who have been
using for a longer period or who have a big
habit that will take time to come off, or people
who have other issues that need time to be
addressed as it gives you some space to sort
things out.
This will allow you time to deal with harms
that go with using and then, if and when
you feel you want to, you can deal with the
dependance itself.
The disadvantages are you become reliant
on the clinic for your dose and you have to
adhere to their rules or risk being cut off or
reduced in dose. You'll most likely also have
to give supervised urine samples for drug
tests which can feel demeaning and you may
cop discrimination if people know you are on
treatment.
10
If you are on a maintenance program you may get the option
of dosing at a pharmacy. This may be more local so you won't
have to travel as often but you will have to pay for your dose.
As well, you may get some takeaways but you will generally
need to give clean urine tests and will lose the “privilege” if
they think you have passed on or shot up your dose.
Side Effects
The side effects from Methadone and buprenorphine are
mostly similar to other opiates. These include: drowsiness,
constipation, nausea and vomiting, dry nose and mouth,
sleep problems, loss of appetite, headaches, sweatiness,
itchiness, and changes to sex drive or periods. They're rarely
so bad that people stop treatment and they can usually be
managed. More serious side effects may mean you need
to reduce your dose or that you need to try another option.
Always discuss any adverse reactions with your doctor.
WARNINGS
Mixing
It's dangerous to mix your dose with other drugs including
alcohol, tranquillizers, sleeping pills, or antidepressants.
Using other opiates, while on Methadone can lead to risk of
overdose.
Injecting
Methadone and buprenorphine are made to be taken orally
so injecting can be dangerous and may cause damage to
your veins, abscesses, or infections which can cause life
threatening problems like strokes, pneumonia or endocarditis (an infection in the lining of the heart).
So what's better ?
There's no single answer to this question. It will depend on
you, what you want from your treatment and if you really
want to stop using for good or just need a break for a while
or whether you want to be able to dabble on top. It's your
choice and you will have to decide. As the info here is only
basic, talk to someone at your local user group who can give
you more detail and let you know what is available locally.
You can also check out a new website which provides information on all aspects of treatment including maintenance,
withdrawal, detox and rehabilitation, as well as personal stories of people who have been through treatment themselves.
This might give you a better idea of what type of treatment is
right for you at this time in your life.
www.mytreatmentmychoice.com.au
!
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11
A Heroin trial in Australia ?
Dare we ask again! Dare we hope again!
In the end, the above Parliamentary motion
by Senator Lyn Allison did not pass through
the Senate but hopefully it will revive the
notion of an Australian Heroin Trial.
On the 31st of July 1997 The Ministerial Council on Drug Strategy in a communiqué stated:
“ If a number of preconditions can be
met the ACT government will undertake
a small trial of controlled availability of
heroin involving 40 people. ”
A mere nineteen days later, the Federal
Cabinet (aka John Howard) stopped the
proposal on the specious grounds that the
Commonwealth would have to pass special
legislation. The PM added another two cents
worth, stating it (a heroin trial) would “send
1
the wrong message” .
For the past eleven years the question of a
heroin trial in Australia wasn't worth wasting your breath on... eleven wantonly wasted
years. So many lives damaged or lost, so
much money dissipated, so many destroyed
families, so many BBVs contracted, so much
jail time accumulated, so much heartache,
so much lost hope and so much ICE... and we
almost had it!
12
Six years of rigorous scientific and social research was effectively trashed. Other pharmacotherapies have been introduced to deal with
heroin use, even those that have not passed
the TGA (such as naltrexone implants) are
given approval for certain trials to test on people who use drugs . It seems when it comes
to drug related matters science and medicine
are relegated into a parallel universe and we
deal with morality, hysteria and hate. Science
didn't matter John Howard's morals did and so
2
they did for eleven long years.
1
Dr. Alex Wodak.
The Heroin Trial Ten Years
on: How Politics Killed Hope.
http://www.crikey.com.au/
Politics/20070822The-heroin-trial-ten-yearson-giving-science-nochance.html
2
When the Australian trial was first mooted
only Switzerland and Britain were prescribing
heroin. In the intervening eleven years four
other countries have introduced heroin trials.
Germany, Spain, the Netherlands, and most
recently Denmark have decided that heroin
prescription is perhaps the most effective, humane response in terms of dealing with both
the social impact and the individual costs of
heroin addiction. Other countries, including
France, have protocols developed and are
waiting for Governmental approval.
https:www.mja.com.au/
public/issues/06/
wodak.html
3
O'mara, Erin.
An Aussie In London.
www.blackpoppy.org.uk
4
http://q4q.nl/methwork/
methadone/Newsletter15/
dutch.htm
5
http://cihr-irsc.
gc.ca/e/26516.html
6
http://www.encod.org/
info/DENMARKHEROIN_On
7
O'mara, Erin.
An Aussie In London.
www.blackpoppy.org.uk
Where in the world?
Britain (heroin on prescription since 1926,
special licence required since 1968)
Doctors have been able to prescribe heroin
since 1926, although the popularity of
the measure has waxed and waned over
the years. It is quite difficult to get a
prescription today.
Switzerland (1994)
The trail-blazing Swiss heroin trial commenced in 1994 and was extended following a
referendum in 1997. The program continues to
this day.
Germany (2000)
A multi site heroin assisted treatment trial
targeting two populations of methadone
non- responders and opiate
dependent people not in any other form of
treatment.
The Netherlands (2002)
The country has been trying to get this experi4
ment off the ground for twenty years.
Commencing with 25 clients in Amsterdam
and Rotterdam they hoped to have 750 clients
over 7 cities. The trial was for one and a half
years, it continues today.
Spain (2003)
The Spanish Scientific Society of Alcohol and
Drug Dependence applauded the measure,
stating that the therapeutic use of heroin “will
allow a normalisation and improvement of
quality of life for heroin addicts ...”
Canada (2005)
“Results from the European studies suggest
that medically prescribed heroin could greatly
help our most troubled heroin addicts for
whom we have no effective treatments” said
5
Dr Schechter .
Denmark (approved 2008) The proposed
Danish trial will be of two years duration with
500 participants. As Joergen Kjaer of the Danish Drug Users Union says: “Naturally we are
happy that our more than ten years of hard
struggles finally seems to be fruitful – but now
6
the fight continues for human conditions.”
“ It is so liberating for those
who qualify, it almost
defies description. I still
feel like I'm clutching the
winning lottery ticket in
my hands. My numbers
have finally come up.
And yes, it has completely
transformed my life. ”
3
One aspect all these countries have in common as a prerequisite for being admitted to
the trial or program is that the participant is
“ hardcore ”, a person who has tried and failed
all other forms of treatment. A person whose
life is so shattered that the Government and
everyone else involved can in all good conscience provide them with heroin. Erin O'Mara
explores this ethical conundrum:
“ I can't help but wonder whether it's all
been a bit too little, a bit too late. I question why it has taken 18 long years to get
here? Why did I have to wait until I'd
been chewed up and spat out of over ten
different treatment programs and doctors surgeries, of at least four rehabs
and an unaccountable number of detox
attempts? Why did I have to wait until I
finished selling my young body to men,
till I got sick and deeply depressed, till
I'd used every vein in my body from my
neck to my feet, till I'd contracted both
7
HIV and Hep C ? ”
It's immoral, its uncivilised, and most importantly it's inhuman to knowingly allow another
human being to suffer the endless negative
effects of long term heroin use. The HIV virus,
the B, C and D hepatitis, other infections, the
overdoses, the jail terms, the job loss, homelessness and don't say to me “they don't have
to do it”.
They clearly do! We are driven by something
we don't yet understand. No one goes through
all of that for some simple self-indulgent craving. We as a country need to have a good hard
look at ourselves, we are all too ready to rush
to other countries to aid the lost and dispossessed. We have them in our backyard, they
are heroin users. They are your sons, daughters, brothers, sisters, and –God forbid – your
next door neighbours ! Let's be kind, lets be
human, let's say now !
13
peace of mind
by Colin
I never imagined that my peace of mind would
come from being on 'bupe, but that's where
I've found it. I've been a long time drug user
(getting on to thirty-eight years), having first
smoked a joint at ten. By the time high school
came along I had discovered the magical
world of trips and other chemicals. By fifteen
my mind needed a good long sleep. I found
that sleep with heroin - the old cliché had me!
I'd met my new mistress. From that first shot
I was pretty full on – I could fill pages telling
the story of my drug use over the thirty or so
years that followed.
My drug of choice has always been heroin or
any opiate derivative or substitute I could get
my hands on. For many years I managed to
keep a level of control over my use until I married and my control began to slip. I was soon
feeding two habits and also had to be a father
and provider for my three children – things
had to change. This was the first time my drug
use was becoming unaffordable and it began
to cause problems for my happily sedated
peace of mind. After years of what I could
only call seasonal using (growing dope in the
summers and spending any profits on heroin),
it was time to make a serious effort to give up
using. I'd tried before, but my home detoxes
had never worked as I liked my drugs too
much. This time I had other reasons (a family)
and my partner at the time discovered NA.
I've never been able to make those twelve
steps work, not even step one, that my drug
use is my responsibility. Anyway, that was the
beginning of the end for my marriage. Trying
to save it, I started counselling which eventually lead to my first time on 'done after almost
seventeen years of using. Twelve months went
by, 'done seemed to be working, then from
nowhere it all went belly up. My marriage
was over, my wife kicked me out, wouldn't let
me see my three girls, plus all else that goes
with breaking up. I went back to my true love
(heroin) and was happy to be back to the
peace it offered.
14
I was back in my comfort zone, dealing, using and working
when I could. I spent some time in gaol, even though I wasn't
into crime to support my habit (other than dealing and growing pot).
During this period in my life I became involved with the Needle & Syringe Program and the ACT users group and through
this, more contact with counsellors. I spent the next ten to
twelve years in and out of detox and on and off the methadone
program. My now very ex wife was even allowing me to see my
kids on a regular basis but once again drug use took control - I
was back to the downward spiral of life falling apart.
It was time for drastic measures. This time the path was rehab – after all the stories I'd heard I knew this was a big step
for me to take. Off to rehab I went (could I make it work?).
Surprisingly, I lasted nearly six months before I was booted
out for breaking some petty rule. I tried to go and live with
my parents on the south coast, but it wasn't that long before I
was making trips back to Canberra for drugs and making excuses to my olds that I was going to see my kids. Eventually I
Things had changed – that sweet oblivion
had gone and I could no longer find peace
of mind.
returned for good and was back to old habits, but now along
with the mental anguish that my drug use caused, I also had
issues with pain from old sporting injuries and doctors were
no great help. They didn't want to give me drugs that I might
get addicted to.
Over the years of working with user groups I knew all about
the various treatments on offer, so after using and crashing
again, I first tried 'bupe.
It was one of the worst three weeks I'd ever gone through.
Physically I felt awful, so I stopped taking it, but I found out
later that I had a stomach ulcer and that was probably more responsible than the 'bupe for why I felt bad.
A couple more years rolled by. During this time I slipped back
into my old ways. But things had changed – that sweet oblivion
had gone and I could no longer find peace of mind. After a couple of failed attempts at making money as I used to, I was all
over the place. The scene had changed and a lot of my friends
had left town or died. Some even managed to give up drugs.
back on the gear again, but I couldn't cope, it
was all driving me crazy. On top of the pain
my ex had kicked out my youngest daughter
and I had to deal with family services as well
in order to get her living with me again. Then
I sought help from a program run by the ACT
Division of General Practice. They have advocate nurses to help people with home detox.
Now, this was not an option for me but they
helped me with doctors, so my options were
'done or prescribed medications. Both of these
I knew I could use over the top of if I wanted
to. I knew I had to stop using so neither of
those options would work.
Then it all really fell apart. First I fractured my back: this
was more pain to deal with. Tests to find out why I had shattered a vertebra revealed that I now had oesteo-penea, or low
bone density. Not surprising as most of my teeth had rotted
away – apparently nothing to do with years on and off 'done.
Then the knee that had given me grief since I had my cartilage removed twenty years ago had to be replaced, and in a
style that only someone like me could pull off I managed to
break my new knee. The orthopaedic surgeon had not seen
this done in twenty years of surgery – what talents we users
do have! More pain to cope with.
Now I was really up the creek. The only option offered to me
by pain management doctors was 'done, no thanks! So I was
One of the nurses suggested 'bupe as it is used
for post operative orthopaedic pain. You can
imagine my scepticism but I gave it a go and
once I worked out the dosage that I needed
to dull my pain I began to realise that all that
internal dialog that was driving me nuts was
gone. I no longer had to think about all that
goes with having a habit, it was all gone. Not
having to worry about where money was coming from, where to score etc, etc.
So that is how I found peace of mind and my
life is so much better for it - it's not perfect
but it's pretty good and I'm
happy. Don't get me wrong, 'bupe is not for
everyone but if you really want to give using
away give it a go. Be sure you give it a chance
to work and maybe you too can find some
PEACE OF MIND!
15
The Pain Paradox
by Dr. Tim Mitchell
(reprinted from Black Poppy Magazine, Issue 11, United Kingdom)
Pain, it is a subject that strikes fear into the
hearts of most opiate users and all people on
pharmacotherapy treatments such as methadone, buprenorphine and buprenorphine/
naloxone. Why? Because opioid dependent
people have well documented difficulties
in receiving adequate treatment for any
pain they experience. One of the barriers to
people entering hepatitis C treatment is the
fear of being left to suffer through chronic
pain associated with treatment side-effects.
This lack of access to pain management also
leads to people being reluctant to disclose
a history of opioid use for fear of being
under-treated or not receiving treatment at
all and in turn, this is often used as further
‘evidence’ that opioid users will lie to get access to drugs. In reality, people simply don’t
know what to do and live in constant fear of
ever needing serious pain relief. Not surprisingly there is little research into this issue.
One of the few studies conducted was done
at the University of Adelaide and this article
reproduced from our sister magazine in the
UK, Black Poppy is one of the few summaries
available of this ground-breaking and important research. Finally, with this evidence,
opioid users might be able to get someone to
listen to their concerns about pain…
For thousands of years, opium and its derivatives have been used for their powerful
pain killing effects. But now scientists believe that repetitive opioid use may actually
lead to an increased sensitivity to pain. This
paradoxical difference – between the short
and long-term effects of opioids – could
have important consequences for anyone
who uses opioids regularly.
In order to understand how people respond
to pain, researchers need a way of inducing
pain experiments that carries no serious
threat of damage to the volunteer. A popular
method for doing this is the cold pressor
test, in which people are asked to submerge
their forearm in a bucket of icy cold wa16
ter (~1°C) and keep it there for as long as possible. The
amount of time the person can withstand the cold water is
used as a measure of pain tolerance.
When researchers at the University of Adelaide used
the cold pressor test to explore how opioids affect pain
tolerance, the results were astonishing. In one study they
compared pain tolerance in a group of people maintained
on methadone with a group of drug-free control subjects.
You might expect that the methadone group – with an average daily dose of 62mg, sufficient to kill an opioid-naïve
person – would have been able to tolerate pain better
than the control group. The opposite pattern was found.
The control group lasted an average of about 1 minute in
the cold water; the methadone group averaged less than
20 seconds!
Other studies have shown that a reduced tolerance to
pain applies not only to people on methadone, but also
to people receiving other opioids such as morphine and
buprenorphine (Subutex®/Suboxone®). There are also
indications that heightened pain sensitivity can persist
even when a person stops using opioids. But do opioids
actually cause an increased sensitivity to pain? Or are
people with a greater sensitivity to pain more likely to use
opioids in the first place?
To establish whether opioids actually cause an increase in
pain sensitivity, scientists would need to make a group of
people become dependent on opioids and look at whether
pain tolerance changes as a consequence. Since studies
of this kind would be considered (rightly) unethical in humans, they have instead been conducted in animals. (no
less unethical in our opinion but there you go! – Ed.) The
results clearly show that opioids do cause an increased
sensitivity to pain. Rats exposed to successive morphine
injections show a gradual lowering of pain tolerance; rats
exposed to injections of saline show no change.
If opioids can cause an increased sensitivity to pain, then
what are the implications for regular opioid users? One
issue of particular concern is what happens when people
who use opioids – especially those maintained on methadone or other substitute opioids – require opioids for the
treatment of pain. The danger is that such people may
receive inadequate pain relief if standard protocols for
treating pain are applied.
To explore this possibility, the University of Adelaide researchers used the cold pressor test to look at how much
pain relief people on methadone get when they are given
intravenous morphine. Whereas morphine was found to
drastically increase pain tolerance in drug-free control
subjects, it had minimal effect in methadone users – even
at the morphine dose levels well in excess of those normally given post-operatively. These findings suggest that,
in addition to being abnormally sensitive to pain, in the
first place, opioid users are likely to receive very little pain
relief from standard doses of morphine.
To make matters worse, some clinicians may be reluctant
to prescribe adequate opioid doses to people who use
opioids. Reasons for such reluctance could include fears
of side effects (e.g., respiratory depression, overdose),
a belief that methadone and other maintenance medications may contribute to pain relief, or uncertainty about
patient motivations (e.g. drug-seeking). Patients may be
reluctant to disclose a history of opioid use for fear that
this may impact on how they are treated. For these reasons, the management of pain in people who use opioids
is complicated.
Beyond the challenges of pain management, having an abnormal sensitivity to pain may have wider implications for
the wellbeing of opioid users. Pain is not merely a physiological process – it’s an unpleasant subjective experience that can have a powerful negative effect on mood.
A persistent sensitivity to pain could be associated with
negative mood states (e.g. disphoria). If so, it’s possible
to imagine a cycle whereby heroin use leads to greater
pain sensitivity and more negative mood states, which in
turn lead to further compensatory heroin use, and so on.
In several experiments where people have taken opioids repeatedly over many days, a gradual shift towards
dysphoria has been observed. However, the psychological
consequences of an abnormal sensitivity to pain remain
unclear, and more research is needed.
Leaving aside such speculation, it is clear that the way we
understand opioid tolerance may need to be revised in
light of these findings. Tolerance is often thought of as a
single process, whereby a drug’s potency declines with repeated use; in other words, a process of desensitization.
But now it appears there may be a second process at work
– at least in the case of how opioids affect our ability to
perceive pain – involving a gradual increase in sensitivity
to pain; a process of sensitization. This would help explain
why opioid users are not only less responsive to the pain
killing effects of morphine than opioid-naïve individuals,
but also more sensitive to pain to begin with.
ence at a cellular level – including those that
give rise to changes in pain sensitivity. The
hope is that such understanding may help
to develop more effective pharmacological
interventions for both the treatment of pain
and opioid dependence.
One strategy already being investigated
involves co-administering opioids with a
class of drugs known as NMDA antagonists.
These drugs block activity at the NMDA
receptor, which is involved in the development of opioid tolerance. Studies in animals
suggest that NMDA antagonists can help to
prevent the development of opioid tolerance and associated increases in pain sensitivity. But does this also work in humans?
In the United States, a combination drug
product called Morphidex® - a 1:1 mixture
of morphine and the NMDA antagonist
dextromethorphan intended for use as an
analgesic – has been put into development
by US drug company Endo Pharmaceuticals. To date, results from clinical trials of
this drug have been mixed. Despite early
findings that people on Morphidex® for
pain may require lower doses than people
getting morphine alone, a more recent and
definitive study found no such advantage.
One priority is to develop better treatment
strategies for the management of pain in
opioid users. Realising that the standard
morphine dosing protocols are unlikely to
be effective for such people, the University of Adelaide research group are now
investigating whether other opioids such as
remifentanil provided better pain relief.
Beyond seeking improvements in how drugs
are used clinically for pain relief, another
priority is to achieve greater awareness of
how opioids may alter pain sensitivity –
among both opioid users and the medical
community. In these endeavours it is crucial
that the voices and experiences of opioid
users are heard – especially those who have
ever sought treatment for pain. With such
cooperation it can be hoped that a solution
to this painful paradox – short term gain,
long term pain – may be uncovered.
In recent years significant progress has been made in trying to understand the changes that cause opioid dependFurther reading: White, J.M. (2004). Pleasure into pain: the consequences of long term opioid use.
Addiction Behaviours, 29(7), 1311-1324.
17
There are plenty of reasons for getting a
hep C test, and there are probably even more
reasons why people choose not to get tested.
These will vary depending on a person's
individual circumstances, what's going on
in their life, their attitude to the health care
system, their support network/s, their social
network/s, etc. The list is pretty much endless
and everyone needs to weigh up the personal
pros and cons of being tested and what that
may mean for them.
Telling others about your test result
There's no legal obligation to disclose your hep C status to
anyone including your employer, family, friends, health care
workers or the police. While hep C is a notifiable disease,
that just means the health authorities have to be told when
someone first tests positive to hep C, and this is done without your personal details being disclosed.
Some reasons why people get tested
What does testing involve?
Testing for hep C is done using blood tests
and can be done for free through bulk-billing
doctors or sexual health clinics if you have a
health care card.
The basic tests for hep C
(and what they show) are
– Antibody test:
have you been exposed to hep C?
– PCR hep C detection test:
do you have the hep C virus?
– PCR viral load test:
how much virus is in your blood?
– PCR genotype test:
what type of hep C do you have?
About a quarter (25%) of people who are
exposed to hep C will clear it naturally, but
unlike hep B and some other viruses, clearing
hep C does not mean you have immunity. If
you have had hep C but cleared it, you will test
positive to hep C antibodies (which your immune system produces), but won't be positive
to the hepatitis C virus test. So the test for the
hepatitis C antibodies will show if you have
been exposed to hep C, but you won't know if
you have the active hep C virus or not.
For that you will need a second blood test
that actually looks for the virus. This is usually called a PCR test and a positive result
indicates that you have an ongoing hep C
infection. If you test positive to an antibody
test but negative to a PCR test, it indicates
you have been exposed to hepatitis C at some
time but that your body has cleared the virus.
188
It's up to each person to decide what advantages there
might be for them in being tested for hep C and whether to
go ahead, but there are some definite benefits from knowing
your status.
Whether you get a negative or positive result it can be a
relief to know what your status is. Many people report that
they look after themselves a little (or a lot) better when they
find out they have hep C and for some people it motivates life
style changes like getting on a drug treatment program and
then at some stage looking at treatment for hep C. Others
are surprised to find that although they have anti bodies they
are free of the hepatitis C virus and some people only realise
this after years of thinking they've had active hep C.
Being tested often makes people more aware of hepatitis C
and this alone can have positive effects on people's injecting
behaviour.
Many people change their injecting behaviour when they
find out whether they have hep C or not. For example, if you
don't have it you may be more careful about only using new
injecting equipment for every shot, so you avoid the risk
of infection. If you do have hep C, you may make a point of
always mixing up for yourself and keeping your equipment
close when using with other people.
Some people may think, incorrectly, that once they are positive safe injecting doesn't matter anymore. They may not be
as careful about using other peoples' equipment, though
they still risk reinfection or getting another strain (genotype)
of hep C, which can make hep C treatment more difficult.
Getting tested is also the first step in treatment as you will
need to know what genotype (or strain) you have and how
much of the virus is in your system (known as your viral
load). The results from these tests will determine how long
you will need to be on treatment and what your prospects of
success are as some strains respond better than others.
Some reasons why people don't get tested
There are heaps of reasons why people don't get tested for
hep C. They can be complex or simple, based on fact or perception, but all are legitimate if they are a genuine barrier to
people getting tested.
Reasons for not being tested include
– Not thinking you are at risk
this is common amongst new injectors,
although research shows that new
injectors are one of the groups most at risk
of hep C infection, with up to 50%
becoming hep C positive within one year
of starting to inject
– Fear of a positive result
people don't want bad news and just
knowing you have hep C can make some
people feel sicker than before
– Fears of discrimination and isolation
if / when others find out you are
hep C positive
– Shame associated with injecting
and therefore avoiding going to the doctor
or other health services
– Lack of knowledge
of hep C or the availability of testing
– Concern that a positive result will result
in compulsory treatment
– The attitude that “everyone's got it so why bother?”.
A user recently related her post-test experience to me:
I wish I didn't get tested as early on as I did. I was the only
one in my group of friends who got tested. At the time, I
didn't know a lot about hep C and was totally open and
blasé about the whole thing. When my injecting friends
knew, it made sense for me to always go last when sharing as those going before me had the attitude of “well,
we don't know if we have it, but you definitely do'. I do
not believe that I would have re-used as much of other
peoples' equipment as I did if I hadn't known my status.
Of course, the first issue this scene raises is that of sharing
injecting equipment. But the scenario also raises the issue
of being tested for hep C. The barrier is that, if you get tested
and are positive, you will have to go last when sharing. The
easiest way to remove this barrier is to avoid sharing in the
first place. But also, if everyone knows their hep C status,
people are more likely to practice safe injecting – positive
people can look after their friends and negative people can
look out for themselves.
It's your choice whether to get tested or not but keep in mind
that not knowing if you have hep C, but being at risk, places
some responsibility on you to make sure that you aren't possibly exposing others to hep C.
Be Informed
If you don't know a lot about hep C testing
and what it may mean for you, get in touch
with your local drug user organisation (you'll
find all their contacts on the inside back cover
of this magazine). They can give you all the
detailed information you need to make a good
decision about whether hep C testing is something you might want to look at.
A Hepatitis C Vaccine ...
What’s the chance?
There's been some buzz lately about the
possibility of a vaccine being developed for
hep C, but what is the likelihood of it becoming a reality?
The hep C virus is a wily little thing, with a
number of strategies to keep itself safe,
which when combined makes the development of a vaccine difficult.
Hepatitis C has a high replication and mutation rate and there are several different
strains or genotypes.
Any vaccine would probably not be able to
cover all genotypes, so it seems a vaccine
would have to be developed for each one and
there are currently 6 or 7 genotypes, with
many sub-types. In addition, there's the issue
of what type of vaccine as there are two types
- preventive vaccines which stop you from
getting a virus and therapeutic vaccines which
help your body to get rid of a virus after it gets
into your system.
It's a difficult problem to solve and, while
there are a number of potential vaccines in
development, you'd be advised not to hold
your breath - a vaccine for hep C is still quite a
few years away. Safe injecting is still the best
way to prevent hep C infection and will be for
the foreseeable future.
19
“For a long time being positive really meant nothing at all to me – it's not like you can see
it – though some naïve folk that I know believe everyone who has it turns yellow and that it's
contagious. It's been years. I hadn't used heroin at all since I found out. It really doesn't matter, it's not HIV – it's not like AIDS!!!!!!! Thank God. But Anyway, I was going to tell you…”
Fractured Fairytales
For A Modern Day Fallacy
- I Mean Falsity
“I've got a couple of kids,
they've been tested and they
don't have it. None of us is
contagious, or contaminated….”
ing Housing!
Fuck, fuck, fuck…Everyone here
has to know and then tell everyone, everyone else's business.
“So what's the issue? I really
don't know. I've read up on
it… there are so many brochures around nowadays…”
(think I've learnt my lesson – I
won't stuff it up for you again –
God forgive me, I just wanted a
friend, an adult to talk to, talk
about adult things – like S.E.X.).
Made a mistake, a BIG MISTAKE!
I should have known better.
Been there, done that.
“There's no life for us here
anymore – sorry kids.”
“Yes, I'd love to; it's been
so very, very long….”
Move along. Gotta go now.
How I'd love a shot right now.
“On the pill? No….”
Immediate assumption – Alert!
Alert! JUNKIE at 10 o'clock
(even if you haven't used in…
God, who knows how long.
“Is it safe?...Yes, but…….”
“Sick? No, don't feel anything….”
“Happy, you ask? Who, me?”
“Oh, me and the kids.”
“Of course we're happy,
were happy, we get by…
Got by I should say.”
“Get a little lonely myself
sometimes, but otherwise… It
doesn't really make any difference to me, but others, others see it a bit differently…”
“No, I don't know why either.”
“Anyway, back to the story,
this is what happened”:
Casually mention it to someone
you'd like to be friends with –
why not? They're smart, intelligent, got kids the same age –
we could be friends – Dream a
dream kiddo. A normal life for
us all, ha, ha, ha. Joke's on me.
“Come over for coffee.”
Housing! Public Fuck-
20
Don't live in public housing – everyone knows everything/everyone's business….
Talk about being ostracised.
At the very least DON'T
TELL ANYONE NOTHING.
“Explain – please explain
Mummy? Why can't Alice play
with me anymore? Why can't
Meagan come over to our
house? What about my birthday party – you promised, you
said!!!!!!!! Mummmmmmyyyyyyy.”
I just awoke from a nightmare – only it wasn't.
Another move, another
school, another life.
Sorry kids, it'll be easier here –
“Condoms?... Haven't got any.”
Is that the door closing?
I've had too much to drink.
What did I say? Remember
stupid, remember. Fuck.
fuck fuck... Wasn't that the
kids' soccer coach? Didn't he
say training was on Tuesday?
Don't panic, it'll be okay.
“What do you mean there are
no more spots on the team?
Two days ago there were
too many empty spots….”
“This is my baby, she
wants to play….”
This is my life, I want to die.
Can't do that, not allowed to do
that. My babies need me – I've
fucked it up again. God I could
handle a shot – no! No! No – I
don't want to use anymore.
“The city will be better for
all of us. I'll get another job,
there'll be so many places
to see. I'm sorry that... ” (I'm
sorry for so many things).
a very good idea…”
“I know you'll miss your
Aunty and grandmother,…
yes! Yes! Yes! I KNOW…
you'll miss your friends,
you'll make new friends.”
“No it's not that, it's just…
even with condoms… I
have this “issue”..”
“Yes, the cat can come.
No, you can't bring the
dog – not enough room. I
TOLD YOU ALREADY, IT'S
AN APARTMENT………..”
“No, I DO NOT HAVE AIDS….
It's just hep C, and I think it's
only fair to let you know before
we…. because of blood… Should
I call back tomorrow then?”
“Please don't, don't cry…”
(where're the pain killers packed – my head).
“No, okay. The day after?”
“I'm sorry, I didn't mean to
yell. Please help your sister
to pack the car. The dog will
be fine, your Aunt Lucy will
look after him….yes you'll
see him again” “Ring him?
Why not, at least once a
week. Just stop crying now,
please…” “Now dry your eyes
and help your sister outside.”
(God help me I need a shot).
“Well yes, of course I want the
girls and I to move in right
away, but I don't think it's a
good idea… I'm menstruating…”
“No, not that, not herpes….”
“Yes, I know what you said,
it's just since we've been here
we've had to stay in the car,
I mean… a motel… and the
girls need to be settled.”
“References? Of course I
have them – what sort?”
“I can't sell the car! How
will I find a job?”
“Thanks Sis, just until next
week. By the way, how is the
dog? The girls are asking
and they really miss him….”
“Thanks Sis, I really appreciate it.”
“Mum, Mum…I'm begging you.
We've had to sleep in the car
for the last two nights…I'm not
using, Mum. Please…………”
Number 172A to counter 6 please.
“Here's my drivers licence,
Medicare card and key card.”
“Alright, I'll call on Wednesday.” (God I need a shot).
“What do you mean not enough
points? There's nothing else.”
“It's just that after yesterday… when we…”
“Where are we staying?
Um…a friends house.”
“OH, I see… I GET IT ALRIGHT!.”.
“The address? What does it
matter? I've just come about the
payment. It was due yesterday.”
“No, thank you very much…”
“Mum? Is that you?.”
“Three weeks? You're saying
three fucking weeks until we
can move in? That's not what
you said on the phone, you
said it wouldn't be a problem
to come up straight away….”
“We have to wait to move
in to the new place and
I've had to hock everything
to pay for the motel.”
“Just a bit to tie us over…”
“Yes, I'm looking for a job.”
“The girls are fine. They sent
their love and best wishes….”
“They said we could move
in next Wednesday, that's
why we need it.”
“I know we moved
but we had to.”
“What difference does
it make? It was due and
you haven't paid it…”
“I DON'T KNOW THE EXACT ADDRESS! I'll call you with it later.
“No, it's not for drugs Mum.”
So how long until we
get the payment?”
“Mum? Mum? Mum, are
you still there?”
“WHAT DO YOU MEAN A
WEEK? They're hungry now.”
“Hey Sis!”
“Family? I don't have any.”
I mean died…had to leave….
broken relationship…”
“I love you too.”
“We can't wait a week……”
“Yes I'm reliable, very reliable….”
“You've spoken with
Mum, Oh!....”
“…Charity – I'd rather not..”
(God I need a shot)
“No, I don't think that is
“Listen, I AM NOT USING!”
“It's just for a little while girls...”
“Why did I only stay at the last
place 6 weeks, and the months
before that? (think girl, think
fast…….say sister was so very
sick, my mother is dying)
21
“Yes I know you're hungry. I
won't be too long. Just keep
your heads down and have a
nap. Jess, listen to your sister…”
o'clock in the morning.”
“Sure other stations are open
24/7, but this one isn't, they
close at 10… See you have some
Maccas – share it with you?”
“Yes your honour, six months,
fortnightly supervised access.”
“Now snuggle up. Don't
leave the car girls. Take
care of your sister Jess.”
“Thanks. Is that your cat?”
“A methadone program?
Why would I need to
go on a program sir? I
haven't used in years.”
“What do you mean
they're not here….”
“I understand sir, a program…” (God I need a shot)
“An hour, not longer I promise. Be good, I love you.”
“I am calm. I just want my
kids back. I only left them
to go get some Maccas…
not even ten minutes.”
“What do you mean there's
no room here? I gotta work.
My girls need me…”
“Because she's older”
“No, don't take the cat out…”
“I know it smells… JUST
DO NOT LET IT OUT…”
“I'm sorry, I didn't mean
to yell, it's just…..”
“Move along? I've got as much
right as you to stand here.”
“It is not too crowded… look,
please, have a heart, I need
to make some money tonight.
I've got responsibilities…”
“I know, I know, we all
have, it's just….”
“Okay, but if you get a job can
I come back here while you're
gone?” (Fuck I need a shot)
(What a night… I wonder if
we've still got some aspirin)
“Girls, Girls? Open the
door. GIRLS! WHERE
ARE YOU? ………….”
“Miss? Miss? Are you alright?
You seem to have passed
out or something. You don't
want to do that around here.
Can I get you anything?
Should I call an ambulance?
Here, have a sip of this…”
“Your kids? Sorry, haven't seen
them. No kids around here….”
“Yep, saw a police car about
half an hour ago…came from
up the road I think. But you
can't go up there now, It's 2
22
“What is this about?
Where are they?...”
“No, I do not use drugs! I am
not “out of it'…I haven't used in
years. I just want them back…”
“Court. Why? They're my kids.”
“Abandoned! You're kidding. I love my babies, I
haven't done anything to
hurt them. They need their
mother………” (I need a shot).
“Yes your honour, I understand.”
“I would have had a job
and a flat if…but….”
“Score? No, I don't use
anymore, not since I
found out I had hep C.
I'm not from around here
anyway. I just gotta make
some money, I need to
get my kids back.”
“A shot? Yeah, why not.”
“No, I don't have a fit. You
don't have a spare fit?”
“I'm hep C positive… you go
first… thanks, I needed that.”
by John Francis
Have you ever been made to wait while picking up your 'done/'bupe,
while the chemist serves another customer, even though you were there first?
Did you ever feel that nurses and/or doctors ignored your requests for more
pain medication while you were in detox just because you were a drug user?
Have you ever wondered what happened to the complaint you dropped
into the suggestion box?
And do you feel you have the right to complain when you receive any
drug treatment service inadequately?
The following is one such experience I had
just because, as a drug user, I decided to get
on a methadone program to be more functional and productive.
A few days back, I went to my chemist to pick
up my methadone. Being a work day, I was
short on time as I had to start work soon. The
pharmacist however, in spite of acknowledging that he had seen me and hearing that I
had to get to work soon, decided to go out
for some personal reason saying he would
be back in a couple of minutes. This “couple
of minutes” ended up being twenty and was
time I could ill afford. Now, needless to say I
ended up late for work.
This experience made me think. Would the
pharmacist have behaved in the same manner with one of his “normal” and “regular”
customers? I don't think so. This attitude of
the pharmacist also stemmed from the belief
society normally has of people who use drugs
or who are on pharmacotherapy – “Oh, they're
just junkies”; “They can wait, they don't have
anything important to do”; “These people
don't have normal lives like the rest of us,
they don't work, they just live on handouts”.
This stereotype has now prevented me from
exercising my rights as a consumer. If this
were the case with a non-drug user/“ordinary
person”, they would have taken the service
provider to task. They would have exercised
their rights.
Interestingly, consumers of most services do
have a say in how the service is provided to
them and also have the right to make a com-
plaint if they feel they were treated unfairly.
But this does not seem to exist when you
speak of any kind of drug treatment service.
Why? Is it because of the stigma that's associated with drug use and drug users? I think so.
There is enough evidence and examples
around to prove that involving consumers in
the planning and delivery of services improves
the overall quality of the service and benefits
all involved. For example, the mental health
and disability sectors have led the way in
giving a voice to consumers of their services
and all have benefited from consumer involvement. But why hasn't the government ensured
that the drug treatment sector does the same?
A key reason could be that no evidence exists
which proves that involving consumers of
drug treatment services actually improves the
quality of the services. And the government
rarely listens unless there is documented
scientific evidence to back a claim.
A good example of this is the (Needle and
Syringe Program) NSP initiative – weight of
evidence that NSP is effective against blood
borne virus transmission (particularly for HIV)
has meant the continuation of the program.
We are aware that drug user organisations are
funded to run training programs around HIV
and hep C and the involvement of drug users
in these initiatives has led to a lot of success. The same success can be gained in the
drug treatment sector with drug users being
involved in the planning and
delivery of drug treatment
services.
23
With this in mind, AIVL decided to address the
issue with the Treatment Service Users (TSU)
Project. With funding from the federal government and collaboration with a highly respected research body like the National Centre for
HIV Social Research (NCHSR), the TSU project
was set to be a very unique and important
project. The goal was to discover what levels
of consumer participation (i.e. involving
people who receive a health service, like drug
treatment, in the planning and delivery of the
service) exists in the drug treatment sector?
And what are the obstacles that prevent these
levels being improved upon and how can they
be improved? Phase 1 of the TSU project set
out to answer these questions.
After interviewing both drug treatment service providers, consumers of drug treatment
services and analysing existing literature and
policies, phase 1 came up with some very
interesting findings:
– People who access drug treatment
services are engaged at a very tokenistic and low level. For example, many drug
treatment services have suggestion boxes
and complaints processes, but these are
there only for face value. Nothing useful
ever comes out of them. No suggestions
are actively utilised and no complaints are
acted upon.
– Many drug treatment service providers
said they did not have the resources
(funds) for consumer involvement and felt
that consumers of their services didn't
care much about getting involved in their
service. However, on the other hand, most
consumers who were interviewed felt they
really wanted to be engaged and consulted.
A lot of these consumers also felt they
needed training so that they could effectively participate in improving the services
they access.
24
With phase 1 of this project providing some
very interesting insights, AIVL decided on a
phase 2. In this phase, AIVL will provide five
drug treatment services with basic financial
resources ($9,000) to actually involve their
consumers in important aspects of the service, such as planning, delivery and the recruitment and training of staff.
The five drug treatment services that have
been chosen for phase 2 are: The Langton
Centre in NSW; Inner Space, Oven's & Kings
Community Health Centre and DASwest in VIC
as well as Cyrenian House in WA.
To stay abreast of the project, look out for updates on the AIVL e-list, articles in your local
drug user organisation newsletters and also
the AIVL website, www.aivl.org.au.
Please feel free to contact me directly, the
Project Officer, for any information or if you
have any questions. My email is johnf@aivl.
org.au and you can also call me on (03) 9329
1500.
I am sure that not just me, but a lot of us know
that the TSU Project will be a success. And
people who access drug treatment services
will have a greater say on how these services
are provided to them and, therefore, have
more control over their own health.
My Story
by Lee O
In the mid 1990’s I started working
for a brothel in Canberra to support not only my own but my partner’s habit, when one of the owners
offered me a “business opportunity”
I couldn’t refuse - an ounce of heroin on credit, enough for my partner
and I to pay back the money we now
owed and enough to reduce both our
habits with. Well, that was the original idea but of course none of what
we planned ended up happening.
During the day my partner was to go into town to sell the
gear while I was at home looking after our two young girls.
It turned out that he was shouting more than what he was
selling, so unfortunately I ended up having to go back to
working for a brothel to try and pay back some of the money that was used.
Early one morning I was coming home
from working all night and I knew as
soon as I put my key into the lock that
something had changed.
I opened the door and normally my partner was asleep on
the couch but this particular morning he wasn’t. I checked
on my daughters and they were still asleep in their beds. I
checked my room where the gear and the money was supposed to be and it was all gone and my partner was nowhere
to be found.
Finding all this just shattered me because
when I was given the gear on credit I was told
that if anything happened and I couldn’t afford to pay for “the product” that I would
have to work off the money I owed them at
one of their brothels in Sydney. I really didn’t
want to have to do this, I didn’t want to be
separated from my girls but I also felt that it
was impossible for my girls and I to just take
off. So I waited for about 4-5 days before I
called the dealers to explain what had gone
down.
About 3 days after my partner disappeared,
my daughters (aged two and a half and three
and a half) told me what daddy had been doing to them while I was working. Both my
daughters where very explicit and detailed
with what they told me and due to their age
I had no choice but to believe them both. So
after everything, to be told this by my girls
just broke my heart - I was devastated for
them.
So I sought help from the Department of
Community and Family Services (DoCS). I
rocked up to their office in Queanbeyan and
asked to speak with someone regarding my
daughters and the fact that I wasn’t coping
very well. I was invited to sit in a room with
my daughters while we waited to be seen.
After a short wait a woman walked in and sat
behind a desk. She asked all sorts of questions regarding my name, age, my daughters’
names and ages, etc. Then I proceeded to tell
the women why I was there, I told her the
truth about everything, my having a habit,
how I’d been supporting it, what my daughters had recently told me, the whole lot.
25
I explained what I thought my family needed, for my girls to be put into temporary care
while I went to detox. Then my girls could
join me when I got into rehab. The DoCS
woman basically told me that they couldn’t
do anything to help my girls and I because
there had been no notifications made about
me neglecting my daughters. I tried to argue my case but I was quickly becoming
disillusioned.
Anyway, over the next week everything came
to a grinding halt. After I had been to DoCS
for help I had gotten a script from a Doctor
for Rohypnol. I had arranged for a friend to
babysit my girls and I went home. Later on
that evening I woke up in a panic not knowing where my daughters were. I had forgotten
that they were with a friend. So in my mind
I’m coming up with all these devastating scenarios that I think may have happened so I
called the police. While I was waiting for the
police to arrive I remembered where my girls
were. But most embarrassing was that I had
to explain all this to the police.
So DoCS got their first notification. It was
only a few days before they got their second
because I had left my baby girls on their own
when I went to score. I had only just put
them to bed when I got the call to meet up
with him. What was supposed to only take
15 minutes turned into an hour. When I got
home there was a note stating that the police
now had my children and that they were at
the police station. So DoCS got their second
notification.
The next few days passed in a blur - I was
getting everything ready to go to Sydney
to work off my debt. I had arranged with a
friend to look after my girls for the next two
weeks and left her with my key card so she
could access any money she would need to
do this properly. I wasn’t happy with having to be away from my girls, especially after
all they had been through, but I felt I didn’t
have much of a choice. I had to pay back my
debt.
I had been working in Sydney for about 10
days when I was told I could go home, so I
phoned my friend to let her know that I was
on my way home when she informed me that
26
DoCS had come and removed my daughters from her care.
The DoCS officers said that there had been a report stating
that the girls were being neglected and this was like the 3rd
notification.
When I got to Canberra I went straight to the DoCS office in Queanbeyan and told them the story. I was basically
told that my girls had been removed from my care due to
neglect and that there was going to be a court case. I was
also told that one of their officers would arrange to meet me
at my place to collect some of my daughters’ things and to
sign some paper work. Thankfully I was allowed to see my
girls and say goodbye to them one last time before they were
completely removed from my care.
It then took me the next 5 years of jumping through hoops
and doing what the Department thought I should do to be a
better parent. But when it was all said and done the restoration process was rushed and the Department couldn’t wait
to be rid of my girls and me. At the time I was just happy to
have my daughters back, I didn’t stop to think if I got the
Ward of the State title removed in court from my daughters,
who were going to help pay for all the counselling etc that
they will now need.
While my daughters were in foster care they were made to
feel like where they came from was dirty and that I didn’t
care enough for them and that I cared for drugs more. The
foster parents told blatant lies - I don’t know how these two
evil people were able to register and become foster parents.
I can’t believe that the Department allows foster parents to
decide whether they want anything to do with the maternal
parents or not. I find this criminal. I know why it took me
so long to get my girls back and that was because the foster
parents had this idea of me being this crazy criminal that
can’t control her urges and that they have to protect my girls
from me. It was completely ignorant and bloody wrong. It
still pisses me off and it’s been many years since I’ve had my
beautiful girls back at home.
As you could imagine, especially when a foster parent is
told why the children are in care, they have a preconceived
idea of what people who use this drug look and act like. It’s
wrong. People shouldn’t be fostering children if they aren’t
open to helping to do the best for the family unit, not just
the child.
Thailand's “War on Drugs” reinstated!
by Sam Liebelt
On the 2nd of April 2008, Thailand's new
Prime Minister Samak Sundaravej reinstated
Thailand's “War on Drugs”. For many this may
seem to be a sensible policy position for a
country that has been known for its Heroin
and Methamphetamine manufacturing and
trafficking. But the true consequence of such
a “War on Drugs (and Drug Users)” is one that
potentially has a huge loss of life, liberty and
further reduces drug users' access to health
and social services because of fear of being
identified, imprisoned, forced into treatment
or even murdered.
1
“Thailand’s ‘war on drugs’,
International Harm Reduction Association and Human
Rights Watch Briefing Paper
Many may remember back in February 2003
the Thai Government, under then Prime Min-
ister Thaksin Shinawatra, launched a “War on
Drugs”, purportedly aimed at the suppression
of drug trafficking and the prevention of drug
use. In fact, a major outcome of this policy
was arbitrary killings, and further marginalising current illicit drug users. In the first three
months of the campaign in 2003 there were
some 2,819 people killed in 2,559 separate
1
murder cases. The Thai government, even
with significant evidence to the contrary,
maintains the majority of these were killings
undertaken by rival drug gangs. If this was the
case I would think this homicide rate would
continue without the government-declared
“War on Drugs”. (In Thailand the average
homicide rate is approx 400 per month).
27
During this “War on Drugs”, Thai government
officials at the highest levels were encouraging violence and discrimination against anyone suspected of using or trafficking drugs,
without due process or concern for how this
will affect access to health services for users
who most need it. The fear that the government instilled in the entire Thai population,
not only in drug users, is something that can
obviously only reduce people from seeking
appropriate help and support for a drug use
issue, whether it be for themselves, a family
member or even friends.
One of the scariest aspects of this policy
and its reinstatement is the sheer lack of any
compassion for people who use drugs, or
acknowledgment of their human rights, by the
very people who should be upholding them.
The Prime Minister stated on the 20th of
February 2008:
“ It is impossible to avoid killings when
implementing drug suppression. When
the crackdown is underway, killings will
2
take place. ”
and Interior Minister Charlem Yubamrung
stated in Parliament:
“ For drug dealers if they do not want to die,
they had better quit staying on that road…
drug suppression in my time as Interior
Minister will follow the approach of
Thaksin. If that will lead to 3,000 to 4,000
deaths of those who break the law, then
so be it. That has to be done… For those
of you from the opposition party, I will say
you care more about human rights than
3
drug problems in Thailand .”
(as they all should be – Ed)
With approximately 50% of drug users being
HIV positive in Thailand the reinstatement
of this policy could have disastrous effects
on HIV levels among the drug using population and in turn the entire Thai population.
What many (who are watching the roll-out of
this policy) are expecting to happen again
is not a reduction in drug use in the country,
but forcing people who do use drugs to take
more risks, contract more diseases and seek
less help. Evidence from 2003 shows that
it did nothing to stop the amount of people
who were using; It only made it more dangerous for them, their families and the general
population.
28
The foundation of the “War on Drugs” in 2003
and 2008 is government compiled “blacklists”
and “watchlists” of suspected drug users and
traffickers. Insiders noted the processes for
preparing the lists were rushed, without any
real process and widely open for abuse by officials wanting to settle old disputes. Combine
this with rewards (in the form of cash) and
penalties (such as job loss) set for local and
provincial officials to reduce the numbers on
these lists with-in a deadline, is a recipe for
absolute disaster. With nearly 3000 deaths
during the 2003 campaign, disaster is an
understatement.
Thailand's “War on Drugs” has been under
constant scrutiny from worldwide bodies,
such as the United Nations Special Rapportuer on Extrajudicial, Summary or Arbitrary
Executions, International Narcotics Control
Board (INCB) and the United Nations Human
Rights Committee to name just a few. Peak
organisations from around the world have
been sending many requests to the Thai government regarding the “War on Drugs” such
as The International Harm Reduction Association (IHRA), Thai Aids Treatment Action Group
(TTAG) and the Australian Injecting and Illicit
Drug Users League (AIVL). The majority of
these have either been ignored or their recommendations taken with a pinch of salt.
What still amazes so many opposed to another “War on Drugs” is that no real effort has
been made to investigate and hold accountable those responsible for the actions and
outcomes of the 2003 campaign, and that no
real measures have been taken to “ensure
oversight, professionalism and accountability
4
in drug suppression efforts” in this new war.
It seems even with the pressure from worldwide bodies and clear lack of concern for Thai
users' human rights, this new war could end
with even more death, destruction, astonishing Hep C/B and HIV rates, and no real dent in
the drugs trade except making it even more
dangerous for everyone. Hopefully, the events
of 2003 will not be repeated, but that's something we can only wait and see.
For a detailed report on the 2003 “War on
Drugs” check out the Human Rights Watch
report entitled “Not Enough Graves”. This
can be found at www.hrw.org/sites/default/files/reports/thailand0704.pdf
2
“Bloodbath feared in fresh
anti-narcotics drive,” Inter
Press Service News Agency,
February 27, 2008 online at
http://www.ipsnews.net/
news.asp?1dnews=41370
3
“Thailand’s ‘war on drugs’,
International Harm Reduction Association and Human
Rights Watch Briefing Paper
4
Thai AIDS Treatment
Action Group (TTAG)
press Release –
February 14th 2008
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Needle Exchange Programs in Australian Prisons
by Wayne Capper
Hepatitis C is spreading through Australia's correctional
centres at an alarming rate and if allowed to continue unchecked will result in a totally unnecessary and extremely
costly health problem not just for prison inmates but for
everybody living in Australian society. As the average
custodial sentence is under 6 months, infected people
are returning to their families and communities on a daily
basis. Blood Bourne Viruses (BBV's) such as hep C, hep B
& HIV are infecting prison populations due to the large
number of injecting drug users being incarcerated and
the lack of sterile injecting equipment being available to
users in prison.
While legislation prohibits access to sterile equipment in
prison at this time, potentially up to 100 people will have
used unsanctioned equipment that has been jealously
guarded, often repaired and roughly resharpened using
match box flint and even sometimes the concrete walls of
prison cells.
According to the wishes of the ACT Government, the new
prison known as the Alexander Maconochie Centre (AMC),
which is expected to commence operation in August 2008,
is to be built and operated with compliance to the ACT Human Rights act (2004). The Chief Minister, John Stanhope,
is quoted as stating “We want to make sure that prisoners can serve their sentence close to family and friends,
that they have every access to programs to help them
rebuild their lives; that their human rights are protected”
(author's italics). This includes access to health care
programs available to the broader community, including
needle and syringe programs (NSPs).
20 years ago, NSPs were introduced into Australian communities as a major component of a concerted and holistic approach to arresting the spread of the HIV (AIDS) virus
within the community. Research has shown this intervention to be a resounding success for very little cost at containing the outbreak of HIV and other BBV's. Now with hep
C infection rampant in inmate populations in Australia,
the time has come for prison needle exchange programs
(NEPs) to be initiated into Australian correctional settings.
A total of 11 countries including Germany, Spain and Scotland are operating prison NEP's with all evaluations being
overwhelmingly positive and the data from
these findings being freely available to all
who wish to enquire. Australia, who has a
rich history of taking the lead on the world
stage for implementation of positive and
sometimes unpopular health and welfare
programs, has fallen behind
on this issue and only the immediate
introduction of prison NEPs nationwide will
rectify this. To do otherwise suggests to
our fathers, brothers, sisters and mothers who are incarcerated that as a society
we don't care and this borders on criminal
neglect of our duty of care towards these
human beings.
With this in mind, on Tuesday the 20th May
2008, AIVL held a National Public Forum on
NEPs in Prison. Guest speakers included:
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Services, St Vincent's Hospital Sydney
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Association of Australia
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Discrimination Commissioner
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Australian National Council on Drugs
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The Connection
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cate, Corrections Coalition Committee
The venue for the forum was the ACT Legislative Assembly and all available seating
was taken prior to commencement. There
was a good mix of people from government
boe!opo.hpwfsonfou!BPE!bhfodjft-!dpnmunity health & welfare groups, prisoner
advocates and the general public.
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The time for talk is over and to quote Alex Wodak,
“No more is it a matter of IF we need them (NEP’s),
now it’s just a matter of when”.
Listed below are the topics the guest
speakers delivered their talks on with a
very deliberate underlying theme that the
time for talk is over and the time for action
has arrived.
Alex Wodak spoke of the evidence for effectiveness and safety of needle exchange
programs in prisons overseas and how best
to implement them in Australian prisons
with the recommendation that NEPs should
be introduced urgently to Australian prisons not just as a pilot program but as a
full expansion program across the entire
prison system.
“Prisons, Politics and Health” was the title
of Michael Moore's talk and it dealt with the
courage and leadership that must be shown
by the women and men in positions of
authority to get prison NEPs off the ground
and working within the corrections system
to halt the spread of blood borne viruses
(BBVs) in correctional communities.
ACT Human Rights and Discrimination Commissioner, Dr Helen Watchirs, discussed
the Government's response to an audit on
Human Rights compliance, in particular for
Infection control and harm minimisation
within the new ACT prison, the Alexander
Maconochie Centre. The ACT Government's
response was (predictably) “ACT Government policy does not support a needle and
syringe exchange program at this time. It
is an ongoing policy consideration for the
future” . An interesting fact raised by Dr
Watchirs was that, from next year, people
will be able to directly litigate Government
Departments that have violated their human rights under the act.
1
“How To” was the major theme from
speaker Gino Vambuca as well as different
prison NEP models. Gino also exemplified
the practical steps of how bleach was made
30
1
available within NSW prison and how this mechanism
could be used as a model for the implementation of NEPs
in prison. Understanding that this isn't just a problem for
inmates of correctional centres, but also for custodial
staff who believe that having NEPs operating equates
with an unsafe workplace, as well as the negative health
impacts on the community at large as newly-infected
inmates are released back to the community.
The three next steps identified are:
Increase public awareness of risks.
Apply pressure to governments so they are aware of
the potential legal, economic and health risks they
face by not acting on this issue.
Work closer with all prison staff and their unions on
the risks they face by not having a needle exchange
program and collaborating to determine the best NEP
model for introduction to the prison system.
Wayne Capper finished off the round of talks with a personal insight of the plight of injecting drug users currently within the prison system; the very real story of violence
and standover tactics that proliferates from the banning
of sterile injecting equipment in prison allowing a black
market to thrive within its walls.
The speakers then made themselves available to answer
any questions from the gathered public. They were joined
on this panel by John Van Den Dungen, Coordinator of
The Connection and Debbie Wyborn, Womens Prisoner
Advocate and a member of the Corrections Coalition
Committee.
The general feeling of the speakers and the public was
that this is a serious health issue that needs to be addressed immediately. There needs to be acknowledgement that by advocating the need for prison NEPs, we
are not condoning drug use. Rather, we recognise that
people will continue to inject drugs whilst in prison and it
is our opinion that inmates should have similar access to
preventative health measures and sterile injecting equipment comparative to the rest of Australian society.
PDF copies of all the speakers' presentations are now on
the AIVL website for all those who were unable to attend
the forum and for any other interested parties. Go to
www.aivl.org.au and follow the links.
http://www.hrc.act.gov.au/assets/docs/humanity(final).pdf .
JUNKIE/USER CULTURE – AND ALL THAT OTHER STUFF
There's honesty, hard-gripping reality, the stuff you can relate to - and
then there's something that's not. Our resident expert reviewer takes you
through the world of junkie culture. Sit back, relax and get some cultcha.
Spun
Christiane F
(2002)
(Constantin Films, 1981)
Not ever having been an amphetamine user,
the movie Spun, spun me out. It's one of the
most engaging drug user movies I've ever seen.
Based on a series of articles published in
“Stern” magazine in (1978) then ghost written
into a book “Wir Kinder vom Bahnhof Zoo”
(We Children From The Bahnhof Zoo), “Christiane F” chronicles the life of a 13 year old
Berliner in the mid 1970s. Her burgeoning affair with drugs develops nicely alongside her
blossoming love affair for fellow user Detliev.
For anyone who has any experience of drug
use at its most problematic, this is a film that
will speak to you. Watching this film, I rarely
said “ah arh that's BULL SHIT” as I have so often done in filmic portrayals of junkie life and
culture - think Candy. Another plus if you like
Bowie, is his brief appearance and the films
soundtrack of his music. The girl who plays
Christiane is incandescently beautiful; at the
beginning she portrays youth's confusion and
the need to belong with great sensitivity, she
then goes on to portray one of the best hanging out scenes I've had the discomfort to witness. All the other characters are adequate
but you can barely take your eyes of the principal character. I couldn't decide if it made me
want to run off to rehab (No! No! No!) or run
out and score!
It's always hard to review a drug movie depicting a drug you don't know, of course there are
some cross over experiences, but the minutiae, the allure of the drug can escape you. Not
with this movie, this movie is a treasure! The
actors are spot on - Mickey Rourke is the meth
cooker with cowboy boots (say no more). The
cameo by Eric Robbers is sublime - he plays a
gay financer for Mickey's cooking ingredients.
Britney Murphy, Mickey's “girlfriend”(I put it
in inverted commas for a reason) and Mena
Suvari, the dealer's partner, are just too good.
Their portrayals of their individual fucked up
personas are extraordinarily engaging.
Excellent
Very good
Good
Watchable
Is this a joke?
However, the most riveting aspect to this
movie is the directing and photography. The
way they take you into that speed buzz is so
intense you can almost feel it... everything
goes dizzyingly, nauseatingly, spininngly fast.
A quirky aspect of the movie is the question of
“normal”. The guy who's not dealing or cooking and thinks he is “normal” (just snorts
sometimes) is a central character. But he is
the most fucked-up out of this merry band of
misfits. Brittany Murphy sums it up when she
says “But you're not normal”. Got to see the
movie to see what I mean and it's worth it.
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Crossword
45
32
across
down
1. Device used to clean the mix
before shooting up.(5/6)
5. Legendary Jazz sax player and junkie Charlie..... (6)
9. Internal body organ that cleans the blood. (5)
12. New York junkie rock legend who wrote
the song “Heroin”. (3/4)
13. A blood born virus that affects the liver. (3/1)
14. Part of a Bong that you pack the mull into. (4)
16. A group of like minded people who relate
to each other.(5)
18. Lead singer’s first name from the Eurythmics. (6)
19. Scratch it. (4)
21. You will be stuck in this when you are
unhappy about your lifestyle.(3)
23. You ask your dealer for this when you have
no money. (6)
25. Another name for a shot. (3)
26. #47 down says he has none of this but we
don’t believe him. (3)
27. In the UK injectable drugs are also called
Class…..Drugs. (1)
32. When my baby, when my baby smiles at me,
I go to … (3)
33. Legendary late, rocker/junkie, once a
New York Doll, then a Heartbreaker. (6/8)
36. NSW gaol at … Plains. (3)
37. You could use this if #4 down is not available. (3)
39. Judges, Cops, Politicians, Screws and straights
in general are this. (6)
41. A puff on a joint. (4)
42. ……………… the dragon. (7)
44. Smack, Hammer, Horse, H,……. (4)
46. Last name of #28 down. (8)
48. Jack back to find this.(5)
51. Go to the clinic to do this. (4)
52. Length of time spent in gaol. (3)
54. Class of drugs made from opium. (6)
55. Indigenous Australian band Yothu ....... (5)
1. First name of junkie Author who wrote
“Naked Lunch”, “Junkie”. (7)
2. ……….. of the needle. (3)
3. Illegal, unlawful. (7)
4. Device used to bring veins to the surface
when injecting. (10)
6. ……….. is for quitters.(5)
7. The type of user who only uses
on the weekend. (12)
8. & #35 down Name of legendary London,
rock god, the epitome of junkie cool. (5/7)
10. Shoot in this not in your artery. (4)
11. First name of young actor who died of a
drug overdose outside the Viper Room in LA.
Immortalised in the TISM song
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15. The Extraterrestrial who likes to
phone home. (1/1)
17. Wise, older members of #16 across. (6)
20. These replaced vinyl records. (1/1)
22. ……. and them. (2)
24. Dance party. (4)
28. First name of famous Australian painter
and user who died of a methadone o.d.
in a motel room on the south coast of NSW. (5)
29. I ......... the Sheriff (4)
30. They …………… their dope. (8)
31. Name given to an injecting drug user. (6)
33. Smack, Hammer, H, Harry, …………. (4)
34. Collective name for mind altering substances. (5)
35. Last name of junkie rock god from #8 down. (7)
38. A rodent. (3)
40. What could happen if you take too much or
mix your drugs. (1/1)
43. Valium is one of this type of drug. (5)
45. Goey, ice, base, crystal, meth, …………. (5)
46. You have to .… before you can run (4)
47. First name of the chief Stooge,
notorious Detroit junkie. (4)
49. The original psychedelic,
mind expanding drug. (1/1/1)
50. Short name for a popular prescription drug
brought on the street as a Heroin substitute. (3)
53. When you want to score you go and get …… (2)
33
Member Organisation
Profile:
WASUA
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