Phyll Dance

The ethics of experimental heroin maintenance.

In response to widespread concern about illegal drug use and the associated risk of the spread of HIV/AIDS, a study was undertaken to examine whether it was, in principle, feasible to conduct a trial providing heroin to dependent users in a controlled manner. Such a trial involves real ethical issues which are examined in this paper. The general issues examined are: should a trial be an experiment or an exercise in public policy?; acts and omissions; countermobilization; termination of a trial, and payment for drugs and for a trial. The specific issues examined are: selection of trial participants; privacy; issues for staff working on a trial; coupling the trial with other treatment, and issues for researchers. A number of alternative approaches to the various ethical issues are presented and discussed.

Australian reports into drug use and the possibility of heroin maintenance

Official Australian reports into drug use reveal a high level of agreement over the nature of drug use and the problems associated with drug use. We examine the lines of argument which make up the shared approach of past reports into drugs, and assess to what degree the connections between these lines of argument are changing. This assessment reflects on the possibility of arguing that heroin should be made available for the treatment (including maintenance) of heroin-dependent users. This paper is derived from a report prepared for a feasibility study which examined whether or not heroin should be made available in the Australian Capital Territory in a controlled manner. After a close reading of a number of official reports, we conclude that it is possible to argue that heroin should become available.

Illicit Drug use in the Australian Capital Territory: Implications for the Feasibility of a “Heroin Trial”

The National Centre for Epidemiology and Population Health and the Australian Institute of Criminology are jointly engaged in a study of the feasibility of conducting a trial to provide heroin and other opioids to current heroin users in a controlled manner. (This is referred to by the short-hand of a “heroin trial”.) Heroin and other illicit drug use in the Australian Capital Territory (ACT) is being researched as part of this process. We present a brief overview of the demographics of the ACT, the patterns of illegal drug use, drug prices, trends in drug use, the impact of illegal drug use and estimates of the number of heroin users in the ACT. Illicit opioid users in the ACT are not an homogeneous group of people and most are far removed from the stereotypical “junkie”. Existing data suggests that the ACT may have some 1,000 dependent heroin users and over 3,000 non-dependent users, but more work is required to develop a more precise estimate of numbers. A combination of quantitative and qualitative data is essential for highlighting the potential advantages and disadvantages of a trial and for determining whether or not a trial is feasible.

The st. Oswald's Day Celebrations: “Carnival” versus “Sobriety” in an Australian Drug Enthusiast Group

“St. Oswalds Day” is celebrated each year in Canberra, Australia, in a day devoted to drug using and excess. “St. Oswald” is an invention of a group of illicit drug users, who parody orthodox religion and satirise straight society in the celebration. The group are drug enthusiasts — that is, while not dependent users of any illicit drug their drug use, in both its variety and intensity, is much more than recreational. Drawing on both interview data with twenty-seven “Oswaldians” and participant observation with the group, the article outlines the nature of St. Oswalds Day, followed by a discussion of the methods used and of the group itself. It is shown that the group, while very unconventional, exhibits social solidarity and organisation, in strong contrast to the images of anomie, disorganisation and pathology emphasised in conventional accounts of drug use. The article closes by discussing how St. Oswalds Day confronts the “sobriety” of modern society (an epitomisation of the Protestant Ethic) with an image of “carnival” (epitomising the Hedonist Ethic) and suggests that much conventional treatment of drug use is blind to questions of historical context and social structure.

Controlled heroin availability in Australia? How and to what end?

The general public, police, service providers, and users/ex-users were asked their views about options for trial design and trial outcomes with regard to a proposal for experimental controlled heroin availability. There was substantial agreement between the samples on issues concerning trial design. In general, the samples from the community, service providers and users/ex-users were more likely to report that a trial would result in positive outcomes, whereas the police sample was more likely to report that a trial would result in negative outcomes. This study illustrates the value of systematic consultation of key groups in exploring the options for change, raising potential difficulties, and highlighting different interests.

Is it Time for a Heroin Maintenance Program? Views of Users and Ex-Users

We investigated the feasibility of a trial to provide heroin to dependent users and as part of this sought the views of three groups of users and ex-users. While a majority of each group supported a trial, a greater proportion of people who were currently users of heroin or other illicit opioids were in favour than was the case either for people who had been dependent on heroin in the past or for people who currently used or had used illicit drugs, but who had never used heroin or other opioids. Where possible, we related views about trial outcomes to additional information provided by respondents. This information supported views that a trial might a) increase the number of dependent heroin users and. for trial participants, b) improve health, c) reduce criminal behaviour, especially drug dealing andd) increase the prevalence of driving under the influence of heroin, although this would not necessarily reduce road safety. Difficulties in measuring trial effects on some of these outcome measures are discu...

Early Life Predictors of Increased Body Mass Index among Indigenous Australian Children

Aboriginal and Torres Strait Islander Australians are more likely than non-Indigenous Australians to be obese and experience chronic disease in adulthood—conditions linked to being overweight in childhood. Birthweight and prenatal exposures are associated with increased Body Mass Index (BMI) in other populations, but the relationship is unclear for Indigenous children. The Longitudinal Study of Indigenous Children is an ongoing cohort study of up to 1,759 children across Australia. We used a multilevel model to examine the association between children’s birthweight and BMI z-score in 2011, at age 3-9 years, adjusted for sociodemographic and maternal factors. Complete data were available for 682 of the 1,264 children participating in the 2011 survey; we repeated the analyses in the full sample with BMI recorded (n=1,152) after multilevel multiple imputation. One in ten children were born large for gestational age, and 17% were born small for gestational age. Increasing birthweight predicted increasing BMI; a 1-unit increase in birthweight z-score was associated with a 0.22-unit (95% CI:0.13, 0.31) increase in childhood BMI z-score. Maternal smoking during pregnancy was associated with a significant increase (0.25; 95% CI:0.05, 0.45) in BMI z-score. The multiple imputation analysis indicated that our findings were not distorted by biases in the missing data. High birthweight may be a risk indicator for overweight and obesity among Indigenous children. National targets to reduce the incidence of low birthweight which measure progress by an increase in the population’s average birthweight may be ignoring a significant health risk; both ends of the spectrum must be considered. Interventions to improve maternal health during pregnancy are the first step to decreasing the prevalence of high BMI among the next generation of Indigenous children.

Police opinions of a proposal for controlled availability of heroin in Australia

Police attitudes have rarely been studied as part of law‐ or policy‐making, particularly in drug policy. We examined why the majority of a sample of Canberra‐based police were opposed to a proposal for a trial of controlled availability of heroin. Many police had negative attitudes towards heroin users with a sense that a trial was ‘giving in’ to them and that funds should be spent on more ‘deserving’ groups. Policing against illegal drugs was not seen to be effective and there was strong support for harsher laws and penalties against users and suppliers. While police attributed a high percentage of property and other crime to the use of heroin, they did not believe that a trial would reduce these crimes. Nevertheless a number of constructive suggestions about policing a trial were made, including a role for police in setting up a trial, selecting participants and monitoring outcomes and a role for police in ensuring the security of trial drugs, staff and participants. These results are discussed in light...