Dr Kerryn Phelps, AMA President, Parliament House, Canberra, Thursday 9 August 2001

If there is a trial and it doesn't work, it's not pursued. If the trial works, then we have another option for dealing with the illicit drug problem in Australia.

REPORTER: Realistically though you're going to have to wait for a change of Government before you see any move on this front.

DR PHELPS: Following the Prime Minister's comments yesterday, that would certainly seem to be the case. I would like to ask the Coalition and the Prime Minister to reconsider their position on prescribed heroin trials. We shouldn't be blocking off access to any option for something that might work. Australian families want solutions. They don't want a scaredy-cat approach to illicit drugs. And we really are at a stage in our history where we need to make some courageous decisions about illicit drugs and to look at things that might work. We know a lot about what doesn't work because that's where we're at right now.

REPORTER: Are you disappointed that the Prime Minister won't even consider a heroin trial?

DR PHELPS: The medical profession is very disappointed that the Prime Minister won't consider a prescribed heroin trial because we believe that in some people this just might work. And the more options we have for dealing with illicit drug dependence in people in Australia, the better chance we have of reducing the likelihood of people running into trouble with illicit drugs.

REPORTER: What kind of people do you think it will help?

DR PHELPS: I think it will help people who are unsuccessful in methadone management. And people who have tried all else and still keep going back to heroin. And what we believe that prescribed heroin trials will achieve is a reduction in the criminal justice implications of using heroin. And a reduction in the community damage caused by burglary, stealing of cars, violence related to drug crime.

REPORTER: Is the Government playing politics with addicts' lives?

DR PHELPS: I would like to, I would like to think that this matter should be above politics. Unfortunately it is not. We are talking about the lives, not only of the people who are unfortunately addicted to heroin, but we're talking about their families and their communities. Nobody is immune from the problems related to heroin dependency.

REPORTER: So that's a yes?

DR PHELPS: That is a yes.

REPORTER: In an election year, do you accept that it's virtually not a chance that anyone is really going to introduce heroin trials when out there in the community it's on the nose and any politician who introduce it would do so at their peril.

DR PHELPS: The time has come for political courage. Unfortunately that is a rare commodity in the lead up to an election. But I believe that our politicians really have a responsibility to listen to what the Crime Authority has to say, and to take the matter in hand and say, yes, we will try it. If the Crime Authority is saying that this is something that we should try, if the medical profession and the experts involved in drug dependence are saying, 'This is something we should try,' then I believe it is the responsibility of Government, both sides of Government, to take a look at this as an option and agree to give it a go.

REPORTER: Is this something you might bring up in an election campaign?

DR PHELPS: I think it's one of a range of public health issues that deserves attention in the lead up to an election campaign, absolutely.

REPORTER: What do you think of the ACT proposal and their referendum and do you think perhaps we should have a national one?

DR PHELPS: I think this is a - the issue of supervised injecting facilities is a State by State issue. And the fact is that we have a trial now going in NSW. We have yet to see the results of that. Once again, it's a trial. And I think that we must not be afraid of the word 'trial' because where would medicine and science be if we didn't ask questions and get answers. And sometimes they're not the answers we expected. That's what trials are all about. And that's what science is all about.

And if we can have a trial in the ACT, in NSW, in every other State which looks on a local level at what might work, then we have a better chance of finding solutions. It's not going to be a 'one size fits all' approach to heroin dependence. We are not going to answer this problem with one solution.

REPORTER: Have you had your meeting yet with Philip Ruddock about the Medicare cards for people in detention?

DR PHELPS: Yes, I met last night with Mr Ruddock.

REPORTER: And has he moved on that issue at all?

DR PHELPS: We had a very productive discussion with Mr Ruddock last night. He heard us out about the health concerns that have been expressed by the health professionals working, not only in detention centres, but with asylum seekers in the community and we raised a number of issues, particularly in relation to children who are in families in detention or who are in families of asylum seekers in the community awaiting appeal. And I think there is something that can be done, particularly to expedite their claims, and so that children are not in limbo for very critical parts of their developmental years.

We also discussed issues such as the provision of appropriate and culturally appropriate health care in the detention centres and who should be responsible for those. And we did have some undertakings that the Minister would look into a range of the issues that we raised.

I can't really give you - you'd have to ask the Minister how he was going to respond to those. But I was very satisfied that we'd got an appropriate hearing on the issues of concern to us.

(More journalists arrive)

REPORTER: What is a trial for? Is it simply to reduce the crime or is it to try and get people off it?

DR PHELPS: I might just start from the beginning. Since 1999 the AMA has been calling for the trials of prescribed heroin because we believe that heroin dependence is a health issue. It shouldn't be a criminal justice issue. The reason it's become a criminal issue is because the drug is illegal.

REPORTER: Yes.

DR PHELPS: If we had a prescribed heroin trial, we could look at what impact that had on the health of the addict, the communities around them, and on the criminal justice system. For example, how many people ended up in gaol; how many people committed crimes in order to get heroin. I think that the approach of the National Crime Authority is a very pragmatic and sensible one. It would take some political courage to get it through but that's I think what's needed in the Australian environment, some creativity, some vision and some courage because this is…

When we're talking about a heroin trial, the critical word is trial, not heroin. We're looking at a scientific trial and where would science and medicine be if we didn't ask questions and seek answers? And sometimes we don't expect the answers that we get. But when we do, we quite often find a cure. We quite often find a solution. And at the very worst, we find something that doesn't work and then we know not to pursue it again.

REPORTER: Do you think John Howard is capable of creativity and courage when it comes to drugs?

DR PHELPS: I think Governments in the wind up to an election can be very nervous about what might appear to be contentious issues. But when it comes to the problem of drugs in the community, we have to be creative and courageous and we have to listen to experts in the field. And the experts in the field have been telling us in the medical profession for a long time that what's happening now isn't working.

We welcome the comments by the National Crime Authority who acknowledge that, despite their best efforts - and many of those efforts have been successful - but they're not winning. And so we need to look at other options to increase our chances of success.

REPORTER: Dr Wooldridge said he might have supported a trial four years ago but there are better treatments now like LAM and Buprenorphine. What do you think about that?

DR PHELPS: I don't think we should close the door to any option. And while we do have these other options, they're not going to be the whole answer. And for some people, it doesn't matter how many methadone programs, Buprenorphine or whatever else is available, there are some people who cannot get off the heroin. And what we need is to look at a prescribed heroin trial but it needs a lot of medical and counselling support. And I think those are crucial features in any drug dependence program. And that takes resources.

And at the moment, I think that the vast majority of the resources are going into law enforcement and not nearly enough resources going into the health aspects, the medical aspects of drug dependence. And that's where I think we do need to look at much more emphasis.

REPORTER: In terms of ever making it really politically palatable though, I mean how do you sell the underlying philosophy behind it that, you know, heroin and illegal drugs are wrong, if the Government is handing it out? I mean don't you, isn't that, doesn't the Prime Minister have a point there? Explaining that to children or younger people?

DR PHELPS: Yeah, I think it's a really easy one. The problem is there and it needs to be dealt with. These people are getting heroin. It's the nature of their getting the heroin that is creating the problem. Now if we can demonstrate that in a certain population of drug dependent people that there is one way that will work for them… You know if heroin has failed; if other things have failed; if they are assessed that prescribing them appropriate levels of pharmaceutically developed heroin is the best way to get them off the heroin, then I think the public will accept that very well.

I think what we also need to look at is that heroin is very closely related to prescribed drugs like morphine and methadone. Now why is one such a big nasty and the others, which are prescribed and legal, not nasty? They all have side-effects. None of them are safe in large doses and certainly none of them will be safe if they come from an illicit supplier?

REPORTER: How would the AMA, that trial work?

DR PHELPS: Sorry?

REPORTER: How would your, the trial that you propose work?

DR PHELPS: Well we would have to look at the ethical ramifications. We would have to look at an appropriate scientific trial so that the questions - that we were asking the appropriate questions to get the answers that we were after. For example, what populations of people would it be appropriate to include in a trial? What dosage would be appropriate? How should they be supervised? What sort of follow up should they get? What sort of counselling should they get? Once those issues are discussed and agreed upon, then we would need to look at a pharmaceutical supply of heroin and appropriately trained doctors and nurses to administer the programs.

REPORTER: Run out of hospitals or pharmacies?

DR PHELPS: That would have to be also discussed but I think that really we need to look at how something like this might be constructed so that we get the best possible answers.

REPORTER: What do you think of your brother's performance in Blue Murder?

DR PHELPS: I thought it was sensational.

REPORTER: Yeah. Is that the first time you'd seen it?

DR PHELPS: No, no I actually saw an illicit tape which is the muscle pain and weakness and dark coloured urine and the other side-effects of adverse reaction to Lipobay, they should report it immediately and seek their doctor's advice.

REPORTER: Should it be removed from use here?

DR PHELPS: I think it should definitely be looked at in terms of its safety. If it's been removed in other countries, it should be a matter of urgency that it's looked at here in Australia.

ENDS