Heroin: Hazy logic dictates a painful prohibition

Between moments of pungent humour, The Barbarian Invasions is a confronting movie. Facing a painful death to cancer, Remy, a self-described "socialist, hedonist lecher", accepts Montreal's crumbling, cramped public health system as his left-wing fate.

Until his estranged son, a rich investment banker - a "capitalist, ambitious prude", says Remy - jets in from London to make his father's last days more comfortable.

Sebastien learns from a doctor friend that heroin will be "800 per cent more powerful" than morphine - the standard fare dispensed by doctors to cancer patients. And so he seeks out the dealers and users necessary to secure heroin for Remy.

When it comes to helping those with painful terminal illness, the story will be sadly familiar to many in Australia. My father died of cancer, like more than 35,000 Australians each year. And like many others, he died in pain. It is hard to know what hurt him most. The pain that grew in his spine and, in the end, seemed to rack his entire body. The pain that he would never see his family again. Or the knowledge that we would watch his painful demise.

Like Remy, doctors only offered my father morphine to relieve his pain. Different sorts with different names, my family and I administered it to him in ever increasing doses, doubling, sometimes tripling what doctors advised. Morphine chased his pain. And sometimes caught it. When it didn't, it was dreadful. If minutes were like hours for us, I cannot imagine how it was for him. I know one thing: he needed more than what doctors offered him. Watching The Barbarian Invasions, I felt I had failed him for not traipsing the streets for heroin. If it could have relieved his physical pain or stoic mental suffering, that would have been a godsend.

Australia has an irrational history when it comes to using heroin for those dying in pain. In May 1953, the Menzies government prohibited its importation after pressure from the World Health Organisation, in turn under pressure from the US, where a burgeoning drug problem was emerging. Yet in Australia there was no drug problem to speak of; instead heroin was used to manage serious pain, especially for the terminally ill.

The ban went ahead despite objections from the director-general of health in NSW that "heroin ... is quite effectively controlled in this state and ... I see no justification to enforce absolute prohibition". And despite similar protests by the Royal Australasian College of Physicians and the predecessor to the Australian Medical Association, then the Australian Federal Council of the British Medical Association.

Ever since, heroin has been lost to the moral battlefield of illicit drugs.

Once banned, it was a drug with no legitimate role, one that junkies use and drug criminals deal in. What strikes me as more criminal is that, in 2004, the terminally ill still die in pain. Irrational responses get in the way of treating their pain. On the one hand, politicians parade their massive heroin hauls, piles of white bricks, as wins in the tough war on drugs. On the other, they help drug addicts on the street shoot up, providing them with clean needles and clean rooms. Those left out in the cold are the terminally ill.

It does not require much nuance to understand that allowing doctors to administer heroin to the dying is not a slippery slope to its legalisation. Nor will it lead to a nation of addicts. Doctors prescribe prohibited substances by the hundreds. Why is heroin different? A stubborn, unthinking abstinence lobby. That is the difference.

It does not require much compassion to understand that a fear that someone you love, dying of cancer, may become addicted to heroin is less important than ensuring they are relieved of terrible pain.

Why the irrational fear? Addiction as a moral evil has little resonance for those in pain.

It does not require much political courage to suggest that if British doctors can use heroin for those dying in pain, why shouldn't Australians facing a similar fate have the same choice? Granted, prominent doctors in both Australia and Britain point to doubts about whether heroin provides better pain relief than morphine. Nurses who have given heroin to the dying have fewer doubts. I am with the nurses. They are at the coalface of suffering.

It is true that morphine is a derivative of heroin, otherwise known as diacetyl-morphine. But heroin is more soluble, entering the body faster, absorbed quickly into fatty tissue like the brain. Heroin users talk about feeling a "rush". After that initial euphoria, heroin causes an alternately wakeful and drowsy state.

I don't want junkies determining drug policy but that they favour heroin over morphine suggests that the terminally ill might also prefer it. Euphoria is the wrong word for those dying of cancer, but if heroin can offer any kind of relief, mental or physical, why not offer it?

If we do more to ease the pain of the terminally ill, it may take much of the heat out of the euthanasia debate. That too is a good thing. In the end, Remy dies at home surrounded by those who love him most, and free from pain. My father was less fortunate. His family was there. But so was that unwelcome intruder, pain. With an ounce of common sense, compassion and political pluck, perhaps it need not have ended that way.

By JANET ALBRECHTSEN 16 June 04

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The Observer was allowed rare access to Styal and found it striving to change, with a scheme to help newly arrived drug users, and inmates, [prisoners], trained by the Samaritans to help women in despair. Report by Jane Mulkerrins.

At first sight, Styal prison is unrecognisable as the grim institution described in a report last January by the Prisons Ombudsman, Stephen Shaw. In the Cheshire countryside near Wilmslow, the official blue sign at the entrance to the drive spells out its purpose.

Yet instead of the vast Victorian corridors one might expect, most inmates, [prisoners], share individual two-storey red-brick houses in the complex, built as an orphanage. The houses have sitting-rooms with comfortable chairs, stereos, TV sets and pot plants, and are reached along small paths separated by grass.

Each inmate, [prisoner], has her own keys to her room, though the front doors of the houses are locked by staff at night. From a distance, it all seems very progressive.

Yet Styal has another side: beyond the neat houses on the other side of an ugly 20 metre-high fence is Waite wing, home to 160 of the most vulnerable women. Shaw called it 'isolating and forbidding'.

It was here that five of the six women who killed themselves at Styal in the year before last August died. All five were in their first month of custody, and four were in their first week.

Julie Walsh, 39, a mother of two, overdosed on drugs stolen from a medical trolley. Hayley Williams, 41, Jolene Willis, 24, Anna Baker, 31, and Nissa Ann Smith, 20, all hanged themselves with home-made 'ligs', nooses fashioned from material and fastened to furniture.

Sarah Campbell, 18, died of an overdose within 24 hours of starting a three-year sentence for the manslaughter of a man who collapsed after she hassled him for money in the street.

Five of the inquests have yet to take place, but Shaw's report identified drugs, mental health issues, administration of medicines and communications failures between staff as factors in the deaths. Four staff members, one a nurse, face disciplinary action.

The governor, Steve Hall, admits there are major problems, but vows: 'We are trying to address them.'

The number of women in prison in England and Wales has risen by 173 per cent in 10 years to more than 4,400. Between 1990 and 1995, seven women inmates, [prisoners], killed themselves, an average of 1.2 a year. In 2002, that increased to nine and last year it was 14. Women prisoners are three times more likely to commit suicide than their male counterparts.

More than 100 female inmates, [prisoners], were resuscitated after a suicide bid last year. There were a further 5,142 reported incidents of serious self-harm or attempted suicide not involving resuscitation.

Despite being only six per cent of the prison population, women account for half of all self-harm - one reason for the high pressure on staff in women's prisons where it is not unusual for 15 per cent of inmates, [prisoners], to be on the F2052 procedures for monitoring those deemed at risk.

Six deaths at Styal in a year was extreme, but there have been no suicides since last August mainly, say inmates, [prisoners], because women who use drugs in the outside world are now given methadone.

Styal is the second largest women's prison in England and Wales, housing 440 prisoners of all categories, from those on remand to murderers. Eighty per cent arrive with a drug problem. Most are heroin addicts but many are taking a combination of drugs, including amphetamines, cocaine and crack.

Until last September, newcomers had to go 'cold turkey', given only painkillers to ease the cramps, insomnia, vomiting, shaking and sweating of withdrawal - a system compared to giving an aspirin to an amputee.

Prisoner Sarah McKeever found this tough. 'I couldn't cope with the pain, so I stole my cellmate's painkillers and took 86 paracetamol tablets. All I wanted to do was end it,' she said.

McKeever has been in and out of prison three times since 1999 and been homeless after each release. This time she stole a purse to get money for accommodation. Although painfully thin, she is bright-eyed and chatty. 'Last time I came in,' she says, 'I had a straight rattle [cold turkey] and got really depressed. You've just been locked up and taken away from your family. Coming straight off heroin as well is just too hard - you can't cope and you just want to die.'

Methadone eases the pain of withdrawal. Daily doses are reduced over 15 days. The programme had been planned at Styal for three years, but money for it became available only six months ago. In March, three-quarters of the 230 new inmates, [prisoners], were on the drug.

'It's a different place here now,' says Sarah. 'Last time, there were three suicides in the nine months I was here. It was very edgy. Everyone wondered who would kill themselves next.'

Niall Clifford, who oversees women's prisons, said: 'Women have confidence in the detox programme, so they are not terrified of the process like they were before. That has made for a far calmer atmosphere.'

Waite wing itself is changing. The fence between it and the rest of the prison is coming down and what one inmate, [prisoner], saw as a battleship-grey, 'concentration camp' look has been transformed into a cheerfully painted environment with communal areas and cell furniture with fewer points for ligatures.

Suicide attempts may never be completely eliminated, however. 'Women will cut themselves with the tops from margarine tubs and bits of Biros, if that's all they can find,' said deputy governor Susan Howard.

Governor Hall believes this is why women's prisons should work to a different charter from the one that regulates men's jails. 'We are probably closer to being a hospital than a prison in many ways,' he said.

Statistics back this up. A Prison Reform Trust report showed that two-thirds of women prisoners suffer from a mental disorder, and 40 per cent have attempted suicide at some time.

'Detox is just a start and it only treats the symptoms of a much deeper problem,' says Hall. 'Drug use often masks serious mental health issues and depression. For many women coming off drugs, it is the first time they have had to face up to the realities of their lives. Once we treat the drug dependency, we often uncover sexual and physical abuse, issues with men and families, reasons for criminal activities and so on.

'Women would come in, detox over two weeks, then settle into a period of self-harm where they would think, "What have I done? Where are my kids?" Hall says. 'There is a sense of hopelessness they have avoided up to that point through drug use.'

In The Observer last month, Cherie Booth QC argued for reducing the number of women in prison. 'Everyone has a choice not to commit crime,' she wrote. 'But that choice is harder when, after years of being the victim of domestic violence or sexual abuse, you have lost all respect for yourself and others. It is harder still when you are addicted to drugs, or have stopped caring whether you live or die.'

Hall believes women feel the effects of prison more deeply than men. 'Men offend at a rate 16 times that of women, but the intensity of what women need is much higher,' he says.

'The expressions on their faces when they queue up to collect their methadone are very different from that of men. There is a different look in their eyes - more desperate.' Huge quantities of tranquillisers are dispensed in women's jails. In Styal fewer than 10 per cent of the inmates, [prisoners], are free of medication.

Dr Louisa Snow, a prison suicide prevention adviser, said: 'Women tend to be primary carers for their children, so the impact of leaving them behind is enormous. There are only 19 women's prisons, so they are usually much further from their families and have fewer visits.'

Hall believes women inmates, [prisoners], differ from men in positive ways too. 'You can harness peer support and responsibility more naturally - it is a natural thing for them to share emotions,' he said.

Peer support is evident in Styal's Listeners scheme, where a group of inmates, [prisoners], trained by the Samaritans is on call around the clock to listen to women who need support. Styal is also pushing art, sport, dance and education courses.

The Government too has a new approach. Prisons Minister Paul Goggins launched a Women's Offending Reduction Programme last month to tackle mental health and drugs problems.

Most Styal inmates, [prisoners], feel that on release they are replanted in environments that caused them problems before, with little or no support. In some cases, they feel even worse off. 'It's ridiculous that I stole a purse to get by last time I was released. This prison has really improved, but there is still no one to help keep us straight when we get out,' says McKeever.

My Sarah was smart and talented - Why did she die in jail?

LONDON: Sarah Campbell was just 18 when she killed herself [? committed suicide,] one of seven women to die in jail this year. Our correspondent asks why so many women kill themselves in prison [? commit suicide in prison.]

Posted 11 May 04 The Observer

ED: Actually some men are biologically women in that they are more women than men, that means men suffer the same if not similar problems and some are also primary carers for children and suffer from detox problems. The real answer is that we are all people and to solve any problem holistically one must go to the root and the root is a human being and not a women or a man. Therefore there is really not much difference with the way people suffer, prisoners' suffer, and prisons are barbaric in relation to punishment especially in the 21 century and they should be abolished.

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NSW Election 2003: VOTE 1 DEMOCRATS

The Democrats have watched with concern as both of the major parties support more and more legislation that puts more and more people in prisons. It is very easy for politicians to be tough on crime but it is harder to for them to explain to develop solutions to crime. Talkback radio and populist media driven opinion polls that show that the public approves of imprisonment.This comes from the notions that:

There is restitution of morality in that Criminals deserve punishment. After criminals have been punished they will not do it again as they will not want to go to gaol again and while they are in gaol, the rest of the public is safe.

Prison Policy

The Australian Democrats prison policy offers solutions that are both financially and socially responsible. Its aims are to:

Reduce the prison population, and Include community organizations in the formulations of initiatives to keep people out of prison

Use the money saved to improve education and rehabilitation of prisoners, by revitalising the Parole and Probation Section and in particular by increasing the Community Grants Program. (This last gets currently $1.17 million out of a budget of $433 million for Corrective Services) Change the perception of prisons as the solution to crime, to part of a problem that requires a more intelligent solution.

Investigate alternative methods of handling the problem of crime both at the level of behaviour change and the individuals and by social programs.

Use recidivism rates as an object of public discussion to assess the success of the criminal justice system. Maintain the vote for prisoners so that they retain a voice in their future as a right of citizenship.

Ensure that the Corrective Health Services remain separate from the Corrective Services Dept, and that availability for vaccination, drug and alcohol counselling be maintained.

Establish a Through-care model that:
a. Establishes a the needs of prisoners, ex-prisoners and their families
b. Acquires individual prisoner profiles on reception
c. Devises a through-care plan for each prisoner
d. Analyses prisoner profiles for broader programme development
e. Prioritises inmate development resources within Dept of Community Services. (DOCS)
f. Improves liaison between DOCS and Community Groups
g. Programmes for addressing offending behaviour must be part of the programmes.

Re-establishes remission and gives greater flexibility to sentencing judges and magistrates.

Strengthening Community Services Order administration and Periodic Detention administration to make these more viable options to prison.

Crime prevention will also occur by both attacking the causes of crime. This will involve:

Targeting of certain areas with positive community-based affirmative action programs including by building relationships in at risk populations.

Strengthening of ESL programs, school and other ethnic programs to lessen the racially based tensions especially in adolescents and newly arrived groups.

Provision of youth infrastructure and activities.

The Methods of reducing the prison population will include: Prison should not be used for low risk offenders, More effort to find alternatives to prisons.

Drugs use should be decriminalised for personal use, and there should be trials of heroin to addicts and decriminalisation of marijuana. This will reduce prison populations by reducing drug offences and also by reducing crime needed to feed drug habits.

Youth programs targeted at young offenders, such as restitution work and meetings with victims.

Until there is intelligent debate about prisons and their effects in Australian society, the fears and misconceptions will find their way into legislation and the problem will be perpetuated.

By Guy Ellicott The NSW Democrats Posted March 7 03

NSW ELECTION 2003: VOTE 1 GREENS

Drug law reform: The Greens are proud to have the most progressive policy of any party on drug law reform. Our Drugs and Harm Minimisation Policy is available in full from The NSW Greens, as are all our policies.

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Methadone addicts formed within: 'NSW Prisons'
The New South Wales Opposition has accused the State Government of turning jailed heroin users into Methadone addicts.

Murder charge first for DNA data bank link, but not the same as solving the murder Mass DNA testing of prisoners has [allegedly] led to the first NSW case of a person being charged with a previously unsolved murder as a result of a controversial gene-matching data bank.

Medical Records: Alex Mitchell's lost world
Perhaps we can get your medical report and spew it around publicly so you can see how it feels. But surely we do not have to go that far. And of course we are law-abiding citizens and I should think it would be enough to remind you of your ethics to report at all.

Prisoners can prove innocence for $20?
Les Kennedy Daily Telegraph reported today that" Prisoners who believe that DNA will prove they were wrongly convicted will have the chance to prove their innocence for a mere $20 administration fee. The move comes 20 months after NSW inmates were asked to provide DNA for comparison with a databank of DNA from unsolved crime scenes for possible convictions.

NSW opposition pledges review of detention laws
A spokesperson for Justice Action Ms Anal Advice said " NSW Prisons are a sex offence if you have been raped, bashed and squatted down to be strip searched. People should be diverted from going there at all material times".

Civil libertarians condemn planned changes to prisoners' privacy rights The New South Wales Government is using a recent case involving [framed] serial killer Ivan Milat to justify its decision to remove the privacy rights of prisoners. But really just another attack on Ivan Milat from Parliament House.

The punishment: Is the 'crime'
The punishment is the crime according to retired chief Justice of the Family Court of Australia Justice Alistair Nicholson. "Smacking a child ought to be seen as assault".

Mr. & Mrs. Mandatory Sentencing
Well congratulations to the bride and groom. Could you please be upstanding and raise your glasses for Mr. And Mrs. Mandatory.

Just wipe your arse on Ivan again Minister?
Mr Amery Minister for Corrective services has a problem with finding a toilet roll to wipe his bottom. Justice Action is appalled at the attacks by Amery and others in parliament on Ivan Milat's right to privacy and their attacks on the Privacy Commissioner and his office.

NSW Parliament Bitter Pills To Swallow?
One delusion pill: So people who investigate their own mistakes make sure there was no mistake or someone else made the mistake. Perhaps you're not biased and you will be honest about it.

NSW prisons - primary industry bailed up!
In many quiet regional centres around NSW there is a new primary industry shaping up. It has something to do with Bail but not with bales. The minister for Agriculture Richard Amery who also has the prisons portfolio is now committed to farming prisoners.

Black Nexus
The Separation of Powers Doctrine is nowcontaminated witharangeofcolours, now leaving us with a black shirt on a once blue bridge that crossed that thin blue line. The 'Amery and Woodham show'.

Prison Mind Games-Do they exist?
Directives are given inside the prison system that are not consistent with the law in NSW. And not in the good interests of the health and well being of the prisoners.

The Government is likely to abolish the Inspector General of Corrective Services position The Mulawa inspection report recommendations below strictly illustrate how important he is.

Drug rehabilitation: Threats, threats and more threats!

If you don't I will! The Australian dictator John Howard's drugs adviser calls for compulsory treatment.

'Yes Dad' [?]

Prime Minister John Howard's head adviser on drugs has called for the introduction of laws forcing users into treatment.

Major Brian Watters says it is often the case that drug users do not know what is best for them.

But a spokesperson for Citizens Against Being Forced Mr Ihave Amind Ofmyown said, "Major Watters is John Howard's adviser because he's a bully. Citizens make their own decisions about what is best for them and if you don't like that step down."

Major Watters heads the National Council on Drugs, established by the Government as part of its Tough on Drugs strategy in 1998.

He says drug users should not be given a choice as to whether they enter rehabilitation programs.

"It's a misunderstanding that people say quite often that somebody has got to want to stop before you can help them," he said.

Major Watters says he has not raised the idea with Mr Howard but hopes compulsory treatment will be a thing of the future.

However, the Federal Opposition's Justice spokesman, Daryl Melham, says the idea is a step back in time.

"It's the sort of thinking that will wipe out all the public health gains of the last 15 years," he said.

Justice Minister Chris Ellison says he does not believe drug users can be forced to seek treatment.

By Drac Onian 28 Feb 03

THE DUCK: Quack!