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Legislative Assembly for the ACT: 1997 Week 9 Hansard (2 September) . . Page.. 2774 ..

MRS CARNELL (continuing):

capital city mayors, Justice Wood, Professor Penington, and other high-profile people who called for a properly controlled national heroin trial for people who may have failed other programs. But, as I said, the option is now closed to us, at least for the time being, because of the Commonwealth's decision.

This does not mean, however, that this Government will renege on its commitment to ensuring that a range of treatment options are available here in the ACT for opioid-dependent people. Now that we are unable to proceed with the heroin trial, we will be working with Victorian authorities to test two other treatment options - buprenorphine withdrawal treatment and naltrexone relapse prevention treatment. Mr Berry, if he ever bothered to read the actual documentation, would know that we were always planning to be part of other trials as well. This has meant that we have expanded that approach. In addition, as I said earlier, the methadone program has now been expanded by 30 places to 430 places in the ACT. As members know, that is a significant increase since we came to government just over two years ago.

Buprenorphine is a heroin substitute that is to be trialled as both a maintenance drug and a withdrawal treatment. The ACT trial will test buprenorphine as a withdrawal treatment to assist heroin or methadone users to become completely drug free. The trial will test whether buprenorphine allows for quicker and easier withdrawal than other options. Buprenorphine has been shown in some studies to be as effective as methadone in reducing illicit opioid use, retaining clients in treatment and reducing withdrawal symptoms. It is acceptable to heroin users, has few side effects and is safe at high doses, enabling alternate day dosing. It is associated with a low level of physical dependence and a relatively mild withdrawal syndrome - features which may make it a useful drug in the facilitation of withdrawal from opioids. It is currently able to be prescribed in both Switzerland and the UK.

Naltrexone is a heroin antagonist, which means it blocks the effects of heroin. It is long-acting, with few side effects, but patients need to become opioid free before it is used or it induces withdrawal symptoms. It is most successful with highly motivated individuals who wish to cease opiate use completely. At any one time, this group, as I think Mr Moore has already said, is likely to be small; but that does not mean that the group is not important. There is currently some interest overseas in the use of naltrexone as an agent in a very rapid opioid detoxification approach, and I think Mr Moore went through that issue very well. It is something that we are certainly willing to look at; but again, it is one of those issues, one of those many things, that probably do need to be trialled to assess just what group of people or how big the group of people is that it affects. Whatever happens, the Commonwealth is undertaking research into naltrexone as we speak.

The intensive nature of the treatment makes it very expensive - we understand somewhere between $7,000 and possibly as much as $10,000 - and its effectiveness is yet to be independently demonstrated. Initial results have been claimed to be very good; but, as Mr Moore says, there still needs to be appropriate work done. There has also been a death reported in Britain which is under investigation. So again, Mr Temporary Deputy Speaker, as Mr Moore said, there is no simple answer here. The only way we are going to know is if we have proper clinical trials of all of these drugs that may be useful.

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