Australian
Medical
Association
Endorses
Heroin
Prescription
Trial
6/4/99
The Australian Medical Association has come out in support of a heroin prescription experiment in that country. At their annual conference last weekend, delegates approved a motion put forward by Victorian doctors to endorse clinical trials similar to the one completed in Switzerland two years ago. The AMA is expected to lobby the Health Minister, the federal Attorney General, and Prime Minister John Howard to establish the trials, in which long-term addicts who have failed at other treatments will be given prescribed doses of heroin in a medical setting. Australian harm reduction advocates were thrilled with the news. Dr. Alex Wodak, Director of Alcohol and Drug Services at St. Vincent's Hospital in Sydney, responded to The Week Online's e-mailed request for comment on this story. "The unambiguous support of the Federal body of the AMA for a heroin trial is very significant on several counts," he wrote. "First, it is consistent with the stand the BMA, forerunner of the AMA, took in 1953 when heroin production and importation was first prohibited in Australia. The BMA opposed that overseas-instigated decision at the time (see Manderson D., 'From Mr. Sin to Mr. Big,' Oxford University Press, 1993). The AMA is right to lead the battle now to use scientific research to find more effective responses to an urgent problem." "Second, it is consistent with the notion that independent, peer reviewed medical research following due scientific process and free of political interference is the bedrock of progress in medicine." "Third, it is consistent with the notion that medicine, to be effective, must at all times be brutally realistic. The increasing number of deaths from drug overdose in Australia is an indictment of our community, calling for an honest appraisal of the costs and benefits of current measures and a fair consideration of alternative options. By any honest appraisal, current policies have failed to stem the increase in these deaths. (Overdose deaths doubled in Australia between 1991 and 1997.)" "Next, it is consistent with the notion that health and social interventions are often effective in dealing with heroin dependence. Unfortunately, we must in all honesty acknowledge that law enforcement measures are often expensive, ineffective and counter-productive." "It is also consistent with the impressive results of the Swiss trial (which was very much a preliminary study), the recommendations of the WHO Expert panel which reviewed the Swiss trial ('there is a need for further studies to establish objectively the differences in the effects of these different opioids'), the results of the Swiss national referendum on this subject in September 1997, the decisions by several European Governments to establish heroin trials and recent publications on the subject (Drucker, E., Vlahov, D. 'The Lancet,' 1999, Bammer, G. et al, 'Science,' 1999)." "Finally, it is consistent with the needs of public health and crime prevention to develop effective interventions for that small population of treatment-refractory, severely dependent heroin users. [These are the users who] account for much of the heroin consumed and the drug related crime perpetrated, and for whom, at present, our community has no effective response." The AMA's endorsement comes in the wake of a special five day drug summit held in New South Wales last month. Members of Parliament defeated a proposal to establish a heroin trial there by a margin of just 78-67. But Prime Minister John Howard, a proponent of US-style "zero tolerance" drug policies, has been outspoken in his opposition to any such experiment, insisting it would "send the wrong message" about drug use. And two years ago, clinical trials begun in the Australian Capital Territory were scuttled, reportedly in response to pressure from the US State Department, threatening to shut down Tasmania's pharmaceutical opioid industry if the trials proceeded. Browse our past coverage of heroin prescription and other issues at http://www.drcnet.org/wol/archives.html. The Lindesmith Center has compiled an excellent collection of research on heroin prescription, available online at http://www.lindesmith.org/library/focal1.html.
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