During a heated hearing of the parliamentary inquiry into illicit drugs last month, chairwoman Bronwyn Bishop passionately affirmed the Howard Government’s zero tolerance, tough-on-drugs approach, expressing horror at those who would seek to decriminalise drug use.
Bishop’s comments came during a fiery clash with one of the inquiry witnesses, Dr Alex Wodak, from the Australian Drug Law Reform Foundation, who was passionately defending the nation’s long-established ‘Harm Minimisation’ approach to drugs, which includes strategies like methadone and needle exchanges.
It is only through looking at this bigger debate that we can understand the Federal Government’s bizarre support for widespread prescribing of the unproven and experimental naltrexone implants for heroin addicts, predominantly in Perth, where perhaps 2000 addicts have been treated.
On Monday, leading experts on illicit drug treatment called for the shutting down of the widespread prescribing of the implant, until proper trials had taken place and formal regulatory approvals had been granted. One concern is that after treatment, addicts have a reduced tolerance to heroin, making fatal overdoses more likely.
The next day, the proponents, including Dr George O’Neil, who makes the implants, argued that the need for the implants among the addict community was greater than the need for the trials, and that he knew they were safe anyway.
The fact that the Federal Government apparently has given its blessing to the widespread prescribing of an unproven and potentially dangerous drug therapy is an international scientific disgrace. In these days of ‘evidence-based’ health care, this serves as a perfect case study in the clash of science and ideology.
The financial support from the Government has come in the form of funding for a trial — a trial that is small, involving just a few dozen addicts, and is designed in such a way that its results will be of very limited value. Meanwhile, the Government is turning a blind eye to the daily prescribing of a treatment that has not yet even been formally approved by the Government’s own Therapeutic Goods Administration.
In a country with a stronger and more confident and courageous bureaucracy such defiance of normal regulatory procedures would not be tolerated. Dealing with illicit drugs is not simple, but there is more common ground here than the polarised debate reveals, and well-established ground rules that could be brought into play.
The vocal critics of the prescribing of the implants actually support a niche role for the drug, but they want to see it properly trialed to know its benefits and harms. The proponents of naltrexone agree there should be trials, but want them properly funded. Creative policy-making is urgently needed to find a way through. The stakes are high, because this case sets an important precedent: if you have the ear of government you may be able to circumvent normal protections and standard procedures that apply to medical treatments.
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Aside from the bellicose “tough on drugs” rhetoric from the likes of Bishop, there is support for the harm minimisation approach within the Government. As Alex Wodak told the parliamentary inquiry last month, the feds give millions to needle exchanges and all kinds of other strategies to reduce the harm associated with drug use, not least because harm minimisation has helped Australia deliver a proud record of fighting HIV/AIDS.
It’s time that all those concerned about the uncontrolled prescribing of naltrexone implants, and those who still have some faith that good science can give credible answers, to make their voices heard in Canberra. Maybe they might listen.