Could pharmacists dispense heroin in injecting rooms?

Heroin in a syringe and powder

It’s time to put harm minimisation measures like prescription heroin back on the agenda, says one industry stakeholder

Pharmacists could dispense heroin to illicit drug users under very limited circumstances as part of a suite of harm minimisation efforts, says Public Health Association chief executive and World Federation of Public Health Associations president Michael Moore.

Mr Moore and other stakeholders, including Kings Cross injecting room medical director Dr Marianne Jauncey, are set to explore a range of options at a forum in Canberra this week.

He says that introducing an injecting room to Canberra, including the possibility of supplying heroin to users, should be a serious consideration, and pharmacists could have a key role.

“There are two issues really – the first is, do we administratively make the decision that we’ll proceed with opening an injection room, and the second is whether we should set about a process of being willing to provide the heroin to users,” Mr Moore says.

“What works in public health policy is almost always wide ranging,” Mr Moore told the AJP.

“So using tobacco as an example, pharmacists were involved heavily in nicotine replacement therapy and counselling, but at the same time we had restrictions on where you could smoke, price changes and so on.

“It’s the same for people involved in dependency on heroin. Already, the role played by so many pharmacies in providing methadone has always, in my view, been a major contribution to assisting people. From the first time I was involved in this, in the early ’90s, it became really clear to me that the contribution of pharmacy was fantastic.

“So when we talk about heroin prescription, in my mind, in terms of pharmacists we’re talking about a full range of alternatives. Buprenorphine is another possibility, and of course there have been some trials with morphine as well; and then there’s prescription of heroin.”

Any such heroin via prescription would be of an extremely limited nature, Mr Moore says, and would only be available to people who had already made serious efforts to manage their drug dependency.

“While the provision of heroin would be very limited, it would clearly still involve a pharmacist, within a supervised injecting centre or equivalent.

“It would still need to be provided by medical prescriber.”

He cited the example of Switzerland, where a doctor prescribes the drug, it is prepared by a pharmacist in a syringe “ready to go with the right dose”, and then provided via a drug and alcohol nurse to the user in a supervised facility.

Mr Moore also cited the recently updated National Drug Strategy, which focuses on three pillars of harm minimisation: demand reduction, supply reduction and harm reduction.

He told the AJP that while supply and demand reduction are important, the experience internationally from countries such as Portugal demonstrate a greater need for Australia to focus on harm reduction.

Mr Moore, a former Member of the Legislative Assembly of the ACT, also criticised the Territory’s previous Stanhope Labor Government for failing to implement an injecting room.

“In 2001 we did get legislation through the Assembly to make it legal to run a supervised injecting room,” he says.

“My understanding is that the legislation still exists. But when John Stanhope came into government they decided that it because the heroin supply had dried up at that time, and secondly because the user community had spread out, it wasn’t viable.

“However, with the increase in supply internationally, it’s time to look at this again and ask whether it is appropriate.”

Stakeholders are also calling for injecting rooms in other states: most recently, Brunswick pharmacist Angelo Pricolo joined calls for such a facility in Richmond, Melbourne.

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  1. Toby

    The drug is known as ‘Diamorphine’ in the UK, where it has always been prescribed for analgesia or cough suppression when appropriate, by GP’s, for people who have diseases such as cancer, especially lung cancer.

    • Andrew Tooms

      It’s arguably more useful than morphine as it’s more soluble in water. You can get a bigger dose in a smaller volume. Handy for palliative care.

  2. Ron Batagol

    As a matter of interest over many years here and elsewhere, until it became unavailable for therapeutic use some 20-25 years ago, Heroin ( Diamorphine) was widely given by injection during labour. I also worked in a clinical role in a terminal care centre where the experience was that Diamorphine was a very effective analgesic for terminal care, clinicians reporting less sedation than when using Morphine. One of the active metabolites of Diamorphine is 6- monoacetyl morphine (6-MAM), which readily crosses the blood-brain barrier.

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