The Great Success of Naltrexone with Drug Addicts
This week Channel Seven’s TODAY TONIGHT ran a segment about Dr George O’Neil in Perth whose clinic specialises in Naltrexone implants. It was a positive story. In fact, they compared Dr George O’Neil to Dr Victor Chang (heart surgeon), Dr Fred Hollows (ophthalmologist) and Dr Fiona Wood (skin burns specialist and Australian of the Year) as an outstanding medical benefactor to Australians. In George O’Neil’s case, his work is saving addicts, from ice, heroin, cocaine, alcohol and other drugs of addiction through his invention of an implanted Naltrexone injector.
I know Dr O’Neil and another doctor, Dr Stuart Reece who have developed this program with hundreds of patients in Perth and Brisbane respectively, who have successfully recovered from their addictions. Some of them were featured on the television program.
The National Health Minister Tony Abbott was also shown saying he supported Dr O’Neil but would not commit to approving Federal (and State) funding for Naltrexone implants. It was the same old story, “we are waiting on trials but they look encouraging.” Naltrexone implants work in helping addicts turn away from heroin addiction.
There has never been a better time for us to renew our message that these implants not only work but that they must be made available to drug addicts. Think of how much better lives would be, not only for addicts but for their long-suffering families; think of how the crime rate would drop if the addicts didn’t have to turn to prostitution, stealing and dealing to pay for their habits; think of how fewer assaults and break ins would occur if this insidious addiction and constant search for more heroin was not a part of life.
TODAY TONIGHT presented this segment and it had real value. Naltrexone implants do work. Naltrexone implants should be available (perhaps even offered as an alternative to going to jail for drug possession). In Queensland a wonderful, highly professional and skilled doctor, Dr Stuart Reece, who was trained by Dr George O’Neil also conducts the implant procedure.
We should not have to try and get our drug addicted kids to Perth and Brisbane to have this implant treatment. Instead of spending its money on this remarkable implant system of helping drug addicts, the NSW Government persists in putting its money into the Medically Supervised Injecting Room.
It is almost impossible to read a true press report about the Injecting Room in King’s Cross. You would be surprised at your own conclusions after reading the Injecting Room’s Final Report.
I said in Parliament, “The Kings Cross ‘Shooting Gallery’ is a dismal failure. After studying the Final Report of the Evaluation, July 2003, the following observations can be made concerning the 18 month trial: the $3.7 million spent over 18 months on the Kings Cross ‘injecting centre’, would have provided over 150 residential drug rehabilitation beds to help get young people off drugs; out of the 3810 individuals who registered at the centre, only 235 clients were referred for treatment of drug dependence. Only 140 took up the referral.
No evidence was presented of how many of these 140 clients were cured of their drug addiction, or completed the drug rehabilitation programme. There is no follow up. Only 6 overdose deaths were assessed as prevented by the staff. The dramatic decreased in drug overdose deaths was as a result of the heroin drought, not because of the injecting centre.
Obviously the Kings Cross legal shooting Gallery ‘injecting centre’ was a dismal failure and should be closed down. The $2 million annual cost should be transferred as a matter of urgency to drug rehabilitation programmes, such as the successful Salvation Army Bridge drug programme, or the Naltrexone implant program.”
However, the shooting gallery report is objectionable on other grounds:
CULTURALLY: It clearly sends the wrong message about drug use culturally. Over 10% of those responding to the questions asked, said the presence of a shooting gallery would increase their drug use. This translates to an extra 650,000 users state-wide if more shooting galleries were approved. It is obvious that the program condones the use of illicit drugs: that is why pregnant patients were excluded, because of concerns about the effects of these agents on the developing foetus, and the Government’s disinclination to be responsible for such documented damage. The Government is caught being two faced on the consequences of the use of illicit drugs.
MEDICALLY: It assumes that these drugs can be given short or long term to patients without any difficulties. The report confirms the significantly worse health status of the drug injecting patients compared to non-users, despite a long involvement with “treatment services.”
This includes immunosuppression – with decreased wound healing; increased infections with bacterial and viral agents. It also includes increased emotional and psychological impacts and the drug users’ lifestyle deficits including their decreased child-rearing and reproductive fitness which is highly relevant to this young age group. Medically speaking, the continued use of illicit drugs, whether in an injecting room or not, increases poly-drug use, hormonal detriments, depression of mental and physical activity as well as nutritional and lifestyle factors.
MORTALITY: The mortality analysis is methodologically in error. Why were the 3,810 patients’ names and dates of birth not run through the NSW registry of death to determine the real mortality rate? This is a serious omission. It is a mandatory requirement of the “harm minimization” hypothesis. If this radical experiment in harm minimization was so fantastic, let them prove it. Why was it not done? Other researchers use these registries. Overall, the report is written by some of the leading harm minimization spin doctors in the nation. There are many examples of overt and implicit bias.
SPIRITUALLY: In running the Drug Injecting Room, the Uniting Church’s Uniting Care is merely using government funding to achieve what Judge Judy proclaimed: “the deaths of drug addicts by programs of free needles and free injecting places so they might die at their own hand from their own drugs.”
How much better to emphasize zero tolerance, greater effort to stop the importing of drugs, tougher policing of drug pushers and drug criminals and adequate funding for rehabilitation programs such as the Naltrexone program. The Government’s money should be spent on anti-drug prevention and education, and more innovative and accessible treatment with drugs such as Dr O’Neil’s Naltrexone implants and more rehabilitation facilities. We advocate compulsory rehabilitation programs for addicts and drugged offenders. The Church should help people overcome their addictions through education and rehabilitation, not through aiding them to continue in their drug abuse.
This approach prevents addictions developing, helps rehabilitate those on drugs and educates people about the consequences of addiction. For over the twenty-seven years my leadership of Wesley Mission Sydney, I sought to restore and reform the individual. Churches should help clients get over their addictions, not encourage them in them. I do not help addicts die. I believe in investing resources in nightly outreach programs on suburban and rural streets, conducting counselling programs, holding seminars in suicide prevention, providing education, training and rehabilitation programs for the homeless, addicted and unemployed, running residential rehabilitation programs with an amazing success rate, and through supporting the Naltrexone program.
This approach prevents addictions developing, helps rehabilitate those on drugs and educates people about the consequences of addiction. My call is to restore and reform the individual. The Government must help clients get over addiction, not encourage them in it.
When the Drug Summit Legislative Response Amendment (Trial Period Extension) Bill 2007 was introduced into Parliament a week or so ago, I said: “The purpose of the bill is to continue the trial of the Sydney Medically Supervised Injecting Centre for another four years, until 30 June 2011. The Christian Democratic Party has always strongly opposed the Kings Cross injecting room. We opposed its establishment in 2001 and we remain opposed to it. Our opposition is based upon one fundamental principle: harm reduction is far better than harm minimisation.
There is no such thing as a safe level of drug use. Drug addiction can be stopped only through preventative measures, such as detoxification, treatment and rehabilitation. This facility does not help drug users kick their habits. It simply provides a legal rubber stamp for users to continue their deadly habits. If this disgraceful bill is passed and the room remains open until 2011, it will have been operating for 10 years. Ten years is not a trial; it is government-supported drug institutionalism.
The International Narcotics Board specifically stated that the Kings Cross injecting room breaches the international conventions against illicit drug use. Currently 8 per cent of injections in the room are for ice. We all know the impact of that drug. On the one hand, the New South Wales Government spends millions of dollars fighting the spread of drugs in the community. On the other hand, the Government says that people can use drugs so long as they do it in “our place”.
The drugs consumed at the centre are illegal. They are illegal in the community. They are illegal at my house and they are illegal at your house. The guise of extending a trial will not save the Government from being accused of acting outside the law. Public funding of at least $2.5 million per year is being wasted on committed drug addicts who have no intention of quitting.
Why are New South Wales taxpayers encouraging the habit of these drug users when others who want to quit cannot access facilities? Many parliamentarians in this debate referred to the crowds of people wanting help.
The funding for the centre could pay for 109 drug rehabilitation beds or 700 Naltrexone implants for heroin users for one year. New South Wales can use the funds much better elsewhere. In a State where the Office of the Director of Public Prosecutions has to stop prosecuting child sex abusers to save $4 million, we can still find $2.5 million to provide facilities so that people can continue to abuse themselves.”
Naltrexone is sometimes used for rapid detoxification (“rapid detox”) regimens for opioid dependence. The principle of rapid detoxification is to induce opioid-receptor blockade while the patient is in a state of impaired consciousness so as to attenuate the withdrawal symptoms experienced by the patient.
The rapid detoxification procedure is followed by oral Naltrexone daily for up to 12 months for opioid dependence management. There are a number of practitioners who will use a Naltrexone implant placed in the lower abdomen, to replace the oral Naltrexone.
The television program TODAY-TONIGHT showed that this method is successful in “curing” the subject of their addiction. No Australian has died from a heroin overdose while they’ve had an active long lasting Naltrexone implant in. Dr O’Neil needs NSW and Federal Governments especially to put their money where their mouth is, and not just with token platitudes or promises of “one day” that never eventuate. Over half of the addicts Dr O’Neil treats are from NSW. Many of the addicts he is treating save the taxpayers much more.
Dr George O’Neil is leading the world in improving medical procedures for detox and recovery from addiction, but he needs our help to continue to treat the high number of addicts that continue to arrive seeking recovery from their addictions.
There are many other addictions that are being helped by Dr George O’Neil’s work too, and the headlines that Naltrexone grabs do indeed deserve our support, as do those affected by addiction of any kind.
In Parliament recently I stated: “What have been the so-called benefits of the injecting room to date? Newspapers report that 1,700 overdoses have occurred on the premises without one fatality. So the New South Wales Government has supported 1,700 episodes where people willingly put themselves close to death. How is that a success? This centre, which receives $2.5 million in funding per year, resulted in zero occasions when a person walked away from drugs. It resulted in zero occasions when anyone became free from drugs or was rehabilitated from drugs. Unfortunately, two other countries followed New South Wales in setting up injecting facilities—the United Kingdom and the INSITE Program in Canada.
In the current issue of the Journal of Global Drug Policy and Practice, Dr Colin Mangham, who is one of Canada’s foremost leaders into theory and practice of drug prevention, draws out the problems and failings of injecting facilities. His article analyses the assessments that are done in these types of injecting rooms, and Dr Mangham concludes that a bias exists to retain these facilities, backed by the philosophy of harm reduction. Policy pundits and the media lent their support without fully considering harm reduction. The article states that evaluations of these injecting rooms include:
… considerable overstating of findings as well as underreporting or omission of negative findings, and in some cases the discussion can mislead readers. The reports show no impact on the key issues that would most warrant its existence … getting clients into treatment and off of drugs, reducing overdose deaths.
New South Wales shows a similar bias. The so-called independent evaluation of the injecting room, which was released in July 2003, was put together by five researchers. It is interesting to note who those five researchers were. Three were colleagues of the injecting room’s Medical Director at the University of New South Wales medical faculty and a fourth shaped the proposed injecting room trial at the New South Wales Drug Summit in 1999.
I question the independence of the evaluation. It is like getting five alcoholics to report on the impact of alcohol abuse. Earlier this year Drug Free Australia released a report on the so-called merits of the centre. Over 1,700 overdoses that did not result in one death may sound good, but not one user went off drug use or overcame drug addiction. On the information provided, we could conclude that 1,700 lives were saved. But not so fast! An overdose is not always fatal. The Government estimated that the injecting room saved four lives per year. However, that does not account for the enormously increased overdose rate. When this is factored in, the injecting room may claim to have saved 0.18 lives in its 18 months evaluation period. When the figures are annualised, on average the centre saved one person every eight years.
According to the final report on the evaluation of the Sydney Medically Supervised Injecting Centre, 1 per cent of dependent heroin users die each year from heroin overdose and they inject at least three times per day. The injecting room would have had to host 300 heroin injections per day before it could claim to have saved even one life per year. The room currently hosts 87 heroin injections per day. At this rate, this method of treatment may save one life every 3.5 years. Judged on its results, the centre would be closed down. The injecting room was set up to handle 330 injections per day. But the room’s own figures show an average of 208 clients per day, which is only 63 per cent of its proposed capacity. The New South Wales Government has already wasted a third of its investment. This bill seeks to keep the injecting room open till levels drop to 75 per cent of current levels. That is only 156 clients per day—less than half the level the room was designed for. The supporters of this room know that community support for and use of the centre is dropping and is seeking to keep it open as long as possible.
At school, an effort rated at below 50 per cent is marked “fail”, but with the New South Wales Government, it means an extra four years! It does not mention that the overdose rate in the room is 36 times higher than that on the streets of Kings Cross, at least 40 times higher than the client’s average before they entered the injecting room, 49 times higher than estimated national overdose averages. According to their own registration data, before the room opened clients were overdosing only once for every 3,200 injections. The rate of opiate overdose inside the room now is one in every 129 injections. This begs the question: Why so many overdoses in the injecting room? The injecting room’s own evaluation stated:
“In this study of the Sydney injecting room there were 9.2 heroin overdoses per 1,000 heroin injections in the MSIC, and this rate of overdose is likely to be higher than among heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than heroin injectors who did not use the injecting facility, they were often injecting on the streets, and they may have taken more risks and used more heroin in the MSIC”.
I repeat that—”they may have taken more risks and used more heroin in the MSIC”, according to the centre’s own report What really concerns me is that there have been no referrals over the last period of investigation. The Salvation Army had a total of five referrals in five years. Wesley Mission Drug Arm, which is filled to capacity every week with people seeking rehabilitation, has never had a referral from the medically supervised injecting centre.
Consequently, far from combating the problem and helping these people to stop harming themselves, the injecting facility has actually encouraged them to try harder, to try wilder mixes of drugs, and to push themselves right to the point of death. For six years the New South Wales Government has funded a drug experimentation laboratory where users can push their boundaries and where they have medical help immediately on hand from a nursing sister if they go too far. We are now extending that so-called trial for another four years.
The final evaluation of the Sydney injecting room was released in mid-2007. The spin doctors have communicated success without the full facts being conveyed or maybe even closely considered.
The injecting room cannot save lives when it encourages addiction. The addictions have not gone; if anything, they have increased. The voices of addiction are still calling and the likelihood of emotional and physical death is still very high. If a person does not quit, the injecting room at best can only delay the inevitable. The person is not likely to quit while the New South Wales Government is telling them it is okay to continue.
As the Government said, those who go to the medically supervised injecting centre are the most drug-dependent and most needy of people—people who are the most vulnerable. Because the centre has no program of treatment or referral for rehabilitation, they are totally dispensable. No-one cares as they decline into death. Some asked: What price do we put on a drug abuser’s life? Our concern is the total elimination of death and their successful rehabilitation to life. The Greens Party said we should care for the users of the medically supervised injecting centre so that they can use the centre to inject themselves.
That kind of care is as useful as the care of a florist at the crematorium. I oppose this bill in the strongest terms.”
REV THE HON. DR GORDON MOYES, A.C., M.L.C..
You can view the news story on Dr George O’Neil on Today Tonight’s website by clicking on the following link: http://au.todaytonight.yahoo.com/article/39984/none/oneil-naltrexone-implant
