Saturday 23 February 2008

Jail For Treating A Medical Condition

In 1999, The ABC reported on Dr Philip Nitschke, the founder of the pro-euthanasia group Exit. Only it wasn't about one of his 'right to die' campaigns but about events in his previous life as a GP in Darwin.

Darwin in the 1990s had an usual drug scene in that heroin was hard to get and was subsequently very low quality. This led to most opiate addicts using morphine. The road to heroin often starts with someone addicted to an opiate who has to feed their addiction and the limited choices on the street means heroin is usually the only opiate available. In Darwin though, a lack of heroin created an unusually large morphine market. Morphine is only available via a prescription from a doctor unlike heroin which is made by organised crime with unknown quality and added contaminants from being cut down by dealers. The advantages to a user is that morphine is made by legitimate drug manufactures so it's clean and has a set strength, Users know exactly how much they are taking so overdoses are rare. The opiate addicts in Darwin were little trouble to the police or society, aided by the fact that some addicts received their morphine through a prescription from a doctor for pain management.

During the late 1990s, the Health Insurance Commission noticed that Darwin's doctors prescribed more morphine that the whole of NSW. Alarmed at the heavy prescribing of morphine, the HIC issued severe warnings to local doctors which ended the balance in Darwin's illegal heroin/morphine scene. Instead of studying why the overdose rate was virtually zero and why crime to obtain opiate based drugs was so low, the government dished out harsh penalties to doctors who treated addicted patients. 

It's worth noting that most countries have always been allowed to treat addiction with opiates or the actual drug they were addicted to ... until the US declared a 'War on Drugs' in 1971. This included modifying the UN resolution for the control of narcotics which most countries had signed back in 1962. Prior to the 'War on Drugs', robbery, assaults and fraud by opiate addicts to obtain their drugs was virtually unknown and police drug squads are a modern day development.

Penalties of $2,000 or two years imprisonment for any doctor who treats addiction as an illness where that addiction does not arise in the context of any other medical condition.

Basically, doctors could not treat patients for addiction alone -  doctor could only treat a medical condition. If a doctor treats addiction, they are committing a crime. The irony is that addiction is a recognised medical condition - the law doesn't actually make sense in the strictest terms. More alarming though, is the need to prohibit certain drugs to certain people for an agenda. The welfare of the patient was secondary to this agenda which is not based on medical or scientific facts. The agenda was political and moralistic. The ACT heroin trials had just been rejected by the government and Howard had made it clear that drug policy was a moral issue. No amount of medical science or research was going to change that.

Dr Philip Nitschke:

'I found myself in the situation time and time again where the choice was either to turn your back on an addicted patient or to prescribe morphine. It was far better medically to prescribe morphine for people like this than to turn them back out on the street. No way is it reasonable to legally challenge or threaten doctors who try to act in those very unsatisfactory circumstances.'

Now the crunch. NT is the only jurisdiction which doesn't have a fully comprehensive drug rehabilitation service - NO methadone maintenance program. Suddenly, all these addicts had no realistic treatment option except street supplied heroin. This of course lead to a huge increase in crime, overdoses and extra police to fight this new problem. Darwin has never recovered. The government had this bizarre explanation. 

Stephen Dunham, NT Health Minister:

'In analysing the decision, the Government was not of the view that any of the States with methadone maintenance programs could adequately demonstrate that they'd reduce things they'd set out to do, like lawlessness, drug overdoses, the criminal behaviour that often accompanies illicit drug use, so our belief was that while the policy end of it would say that it's a very good intervention, a quick analysis would show that often that's not the case.'

The ABC report had the last word:

Habits previously supervised by doctor's script and financed by public money will now be subject to the hazards and vagaries of the street. - Watch Darwin's crime statistics.

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