Echo Issue Outline: copyright Echo Education Services
First published in The Echo news digest and newspaper sources index.
Issue outline by J M McInerney
Should heroin addicts in the Northern Territory have to travel interstate for a methadone program?
In September, 1995, the Northern Territory Government introduced its Patient Assisted Travel Scheme. Under the scheme, heroin addicts wishing to receive methadone treatment interstate were to have been given free bus travel, one-way, in order to do so.
Prescribing methadone as a treatment for heroin addiction is a crime in the Northern Territory.
The Patient Assisted Travel Scheme concerned the Greyhound Pioneer bus company which claimed not to have been consulted about it. The company offered a bus which was to carry heroin addicts exclusively and take them interstate on a non-profit basis.
The Northern Territory Government decided instead to give free one-way air tickets to addicts wishing to leave for treatment interstate.
These developments have met with opposition from a number of other states and have been opposed by the Australian Medical Association.
Background
Methadone is a synthetic narcotic which has been used in Australia as a substitute for heroin since the 1970s.
As a legally sanctioned heroin substitute methadone is administered on a regular basis to registered heroin addicts in controlled doses usually through treatment centres.
The Northern Territory was the first Australian jurisdiction to introduce a methadone program; now, it is the only jurisdiction in Australia without such a program.
Within the Northern Territory it is a crime to prescribe methadone for the pain caused by heroin withdrawal. To do so is punishable by two years jail or a $2000 fine.
Methadone can, however, be legally prescribed in the Northern Territory for pain relief in the treatment of conditions such as cancer.
The Northern Territory claims that it does not have a serious heroin addiction problem, claiming to have between 200 and 500 users, only 100 of whom are said to be heavy users.
Arguments in favour of the Northern Territory's ban on methadone programs
There are three main arguments offered by the Northern Territory government in support of its ban on methadone programs.
The first would appear to be its belief that methadone programs do not work.
The Northern Territory's acting Minister for Health, Mr Palmer, has stated that there is no evidence that methadone assists the treatment of heroin addiction.
Mr Palmer has also suggested that the most effective treatment for heroin addiction is that addicts should `simply stop' taking the drug.
The same view has been put by the Northern Territory's Health Minister, Mr Finch.
Mr Finch has stated, `There are plenty of alternative treatments available in the Territory - for a start, they can get off the stuff.'
According to this line of argument methadone merely replaces one addiction with another. Thus, those who hold this view maintain that the only effective way to stop being a heroin addict is to cease taking any form of heroin.
A second argument offered in support of the methadone ban, and an extension of the first, is the Northern Territory's contention that governments have no obligation to support addicts in any form of addiction.
The Northern Territory Chief Minister, Mr Stone, has claimed, `It's easy for doctors to dress up this issue in a medical way. But this is a self-inflicted problem and taxpayers should not be called upon to support and prop-up these people.'
This line of argument suggests that governments have no ethical responsibility to remedy the problems of those whose particular affliction has been deliberately chosen and then persisted in.
Behind this line of argument there seems to be the belief that individuals, in their dealings with government, should be as responsible as possible for themselves.
A third argument offered in support of the Northern Territory's position on this issue is that to offer a methadone program would be to encourage addicts to come to the Northern Territory.
The Northern Territory appears to believe that much of its heroin addiction problem is imported from other states. It further seems to believe that offering a methadone program would merely be an encouragement to heroin addicts to come to the Territory.
Mr Stone has stated, `I am not going to accommodate Mr Beattie (the Queensland Minister for Health) by making it easier for heroin addicts to come to the Northern Territory.'
Mr Stone has further stated that the law banning the use of methadone would remain to discourage heroin addicts from heading north for a life of `lying in the sun and living off the taxpayer.'
It would appear to be as a consequence of its belief that it has no obligation to assist heroin addicts and its further claim that most of the addicts in the Territory have come from elsewhere in Australia that the Northern Territory has adopted the policy of encouraging heroin addicts to go interstate.
Initially the Northern Territory supplied a one-way bus ticket out of the Northern Territory for heroin addicts wishing to access a methadone program interstate.
After objections from the Greyhound bus company and the government's failure to take up the bus company's offer of a cost price bus that would transport only addicts, the Government decided to supply one-way air tickets.
The Northern Territory Health Minister, Mr Finch, has stated, `This is basically a repatriation scheme for addicts to go interstate, back to their homes, get methadone and get support from their friends.'
Mr Finch has further stated, `If these people are part of the heroin sub-culture then we do not want them back.'
According to this line of argument many addicts come to the Northern Territory as itinerant workers believing there will be easy access to heroin.
Such people, the Northern Territory Government claims, should be returned to their state of origin, and given whatever treatment that state deems appropriate.
Arguments opposing the Northern Territory's ban on methadone programs
Those who oppose the Northern Territory's ban on methadone programs usually begin by stressing the supposed importance of such programs to heroin addicts who are attempting to rehabilitate themselves.
Dr John Jagoda, who works at Moreland Hall Drug and Alcohol Rehabilitation Centre in Coburg, Melbourne, has claimed, `It (methadone) gives them (heroin addicts) a chance to stop this vicious cycle of always looking for drugs, using drugs, looking for more funds to pay for drugs, like a dog chasing its tail.'
According to this line of argument, methadone is not only important because it can help an addict break his or her dependence on heroin, but because the certainty of supply makes it possible for the addict to change his or her lifestyle, thus avoiding having to deal with criminals and possibly having to commit crimes to pay for a supply of heroin.
On the question of the importance of methadone as a means of dealing with withdrawal symptoms, a current heroin addict, one of the first to leave the Northern Territory for a methadone program interstate, has been quoted as claiming, `You're either stoned or you're sick, simple. It's a bad sickness. It (withdrawal;) is diarrhoea, very bad cramps, sweats, can't sleep, a runny nose and just very painful ... Methadone is the only option for me. I just can't do it cold turkey.'
Critics of the Northern Territory's ban on methadone programs maintain that it is unreasonable to suggest that all heroin addicts can simply give up their addiction.
According to this line of argument, part of the nature of addiction is that the addicted person has a physical and psychological dependency upon a particular substance.
Such critics further claim that all governments have an obligation to help meet the needs of their citizens and that this obligation continues to exist even should the citizen be a heroin addict.
There have also been numerous criticisms not simply of the Northern Territory's ban on methadone, but also of the apparent consequence - the Territory's paying of the air-fares of addicts who seek treatment interstate.
Those who criticise the Northern Territory's current practice of encouraging addicts to leave the Territory, maintain that the majority of addicts in the Territory are long-term residents, not recent arrivals from other states.
Dr Philip Nitschke, who runs a clinic in Darwin which treats many addicts, claims that most of the Northern Territory's addicts are Territorians.
Critics have also claimed that in attempting to transport it heroin addiction problem the Northern Territory has reneged on its obligations to the citizens affected.
Dr Nitschke has stated, `I don't think there's any parallel in the civilised world for a Government acting in this way against its citizens.'
This action of encouraging relocation interstate has been further condemned on humanitarian grounds.
The executive director of Moreland Hall, Ms Colleen Pearce has stated that it is unsatisfactory to send addicts on long interstate bus trips, away from their family and community, for treatment.
Dr Benny Monheit, a consultant medical officer at Moreland Hall, has claimed that such actions by the Northern Territory Government are an `abrogation of human rights.'
The Australian Medical Association has condemned the policy as `barbaric' and `neanderthal'.
The bus company, Greyhound Pioneer, originally involved in having to transport heroin addicts interstate at Government expense has claimed that it was never consulted about the policy.
The company has expressed concern that possible safety issues were not addressed, both in terms of the addicts' comfort and safety and that of their fellow passengers.
The company has also maintained that the majority of the travelling public would not wish to `sit next to a heroin addict'.
It was for these reasons that the company suggested running a bus that only carried addicts.
Finally, other states have objected on the basis that they should not be expected to bear the cost of a problem which has been deliberately exported to them from another state.
The Queensland Minister for Health, Mr Beatie, has stated, `It is a callous way to deal with people with a disease and at the end of the day, we (the other States) ought to be sending the Territory Government a bill.'
Further implications
This is clearly an issue that will not go away.
A Northern Territory doctor, Dr Phillip Nitschke, has attempted to have six of his patients, all heroin addicts, treated with methadone by having their prescriptions written out by an Adelaide doctor, Dr Lynton Stephens, via a teleconference link between Adelaide and Darwin.
Unlike the Northern Territory, it is legal to prescribe methadone as a treatment for heroin addicts in South Australia.
On September 28, 1995, the Darwin pharmacists to whom the scripts were presented refused to fill them. This was on the advice of the Northern Territory's chief medical officer.
Dr Nitschke may now face criminal prosecution. The Northern Territory's acting Minister for Health has referred the matter to the Director of Public Prosecutions.
It has also been suggested that the Northern Territory may take legal action against the Adelaide doctor, Dr Lynton Stephens, who took part in the teleconference and who faxed the six prescriptions.
Should these legal actions proceed they are likely to galvanise opposition to the Northern Territory Government's position on methadone programs.
In Adelaide, Dr Stephens has expressed the hope that the controversy surrounding the action taken by he and Dr Nitschke may lead to a review of Northern Territory law on methadone treatment.
Dr Nitschke has also indicated his intention to set up a mobile methadone clinic in suburban Parap to administer methadone to 40 patients who are heroin addicts.
One newspaper report has stated that the first two addicts to travel interstate under the Patient Assisted Travel Scheme were given methadone to keep their condition stable during the trip.
If this is the case, then the doctor or doctors who prescribed the methadone may also face prosecution as it has been further reported that the Northern Territory police drug squad has been sent in pursuit of doctors attempting to prescribe methadone for their patients while they make the trip interstate.
Finally there have been suggestions that the Northern Territory's standing with the rest of Australia may be seriously damaged by this policy.
David Nason, The Australian's Darwin correspondent, has claimed that the Northern Territory's chief minister, Mr Stone, needs to be aware that such policies will only perpetuate the `hicksville' perception of the Territory commonly held in other states.
Sources
The Age
23/9/95 page 2 news item by Gay Alcorn, `Addicts on a ticket to ride'
25/9/95 page 7 news item by Gay Alcorn, `Addicts given air tickets'
18/10/95 page 9 news item by David Saunders, `NT's one-way drug trip under fire'
2/11/95 page 15 analysis by Gay Alcorn, `Methadone madness'
The Australian
15/9/95 page 3 news item by David Nason, `Heroin addicts face repatriation'
25/9/95 page 4 news item by John Kerin, `Stone plan to export heroin addicts comes under fire'
28/9/95 page 5 news item by Andrew Ramsey, `Legal threat to methadone scripts by fax'
29/9/95 page 5 news item by David Nason and Andrew Ramsay, `Medics may be charged over methadone scripts'
3/10/95 page 3 news item by David Nason, `Methadone ban to keep addicts out'
6/10/95 page 13 comment by David Nason, `Stone must beat ministers' redneck addiction'
What they said ...
`Methadone is the only option for me, I just can't do it (give up heroin) cold turkey'
John, one of the first heroin addicts to be transported from the Northern Territory for methadone treatment interstate
`There are plenty of alternative treatments available in the Territory - for a start, they (heroin addicts) can get off the stuff'
Mr Finch, the Northern Territory's Health Minister