A leaked Queensland Health report has outlined the devastating potential fallout for patients struggling with opioid addiction, and the wider community, after a stalwart Brisbane GP closed his practice.
Aged in her 50s, Jane* is a survivor of the heroin wave that washed through Queensland in the 1990s.
A well-read and articulate former teacher, her "very heavy" heroin use was triggered by an abusive relationship, the death of a child and a long history of depression.
"I was living in an upmarket suburb … kids in private schools, that sort of stuff, you wouldn't have looked at me and thought: addict," Jane said.
Marnie* first took heroin when she was in her late 30s, muting the pain of trauma inflicted on her as a child and while her husband Steve* was away in prison.
"It made me numb, all the pain I was hiding … things that I'd been through in my life," she said.
For Steve, the drug had taken hold earlier. A young man with a troubled childhood, he first tried heroin in jail when he was in his early 20s.
It sparked a cycle of addiction, robbery and incarceration that would land him in and out of prison for almost half his life.
"I kept using it because it was a numbing agent for me because I was so damaged, I didn't know how to fix myself," he said.
But their stories are also ones of hope.
Like more than 53,000 people around Australia, according to 2020 numbers from the Australian Institute of Health and Welfare, all three are taking medication to help treat their opioid dependence and prevent relapse.
No longer gripped by heroin, Marnie and Steve both work full-time, Marnie is studying, they have a home and their children are healthy.
"We're not just surviving, but thriving," Steve said.
They say buprenorphine – a prescription drug which comes in formulations including suboxone and buvidal – is crucial to their stability.
It reduces the cravings for illicit opioid drugs and can be used in detoxification or as a maintenance treatment.
But the ability of hundreds of people to stay off illicit drugs has come under threat with the closure of a well-known GP practice sending shockwaves through south-east Queensland's marginalised community of opioid users.
Patients, doctors and advocates are warning of dire social consequences and their fears are reflected in a government document obtained by ABC News.
Internal report spells out systemic failures and cost of GP closure
A leaked Queensland Health report says more than 1,000 opioid dependent patients are at risk of overdose, death and criminality if they are unable to continue treatment after a Brisbane GP had conditions placed on his medical registration.
The nine-page internal document was sent by the Metro North Mental Health unit to senior health bureaucrats – including chief psychiatrist John Reilly – in late January.
It said state opioid substitution treatment (OST) teams have been operating "at or over capacity for many years" and an "emergent situation has now arisen with the displacement of approximately 1,100 clients seeking assistance from public OST clinics to urgently continue their medication, due to practice restrictions currently in place on an inner-city OST prescriber".
On December 21 last year, the Medical Board of Australia imposed restrictions on Highgate Hill GP Stuart Reece, who single-handedly treated an estimated 15 per cent of Queensland patients on OST.
Dr Reece has not had his medical registration suspended, but the watchdog's conditions include that he must not see more than four patients in one hour and that he be supervised by another doctor with experience in addiction medicine.
Dr Reece said he could not give an interview.
It is understood he was unable to meet the conditions because it was impossible to find a supervising doctor and he was forced to close his clinic.
Dr Reece has requested a review of the conditions in the Queensland Civil and Administrative Tribunal.
When asked why the conditions were imposed, a spokesperson for the Australian Health Practitioner Regulation Agency (AHPRA) and the National Boards said: "Under the National Law, conditions on a practitioner's registration are only applied where a National Board believes they are necessary to ensure public safety."
The statement said the conditions limit Dr Reece's "ability to see patients" and that he "requires supervision" but his ability to practice "is not otherwise affected".
The watchdog said the conditions were imposed "after considering all relevant circumstances including the previous tribunal decision in respect of Dr Albert Stuart Reece".
In late 2009 the Health Practitioners Tribunal imposed 11 conditions on Dr Reece after it found he had wrongly supplied morphine to some patients for methadone detoxification when "such treatment is not recognised in Australia".
The order said: "There is no evidence that there was harm actually done … although the potential for harm was there."
It said Dr Reece had "dedicated the last part of his working life to trying to help people conquer their addiction to illegal substances, particularly heroin, and is respected as a dedicated, intelligent and caring doctor who generally tries to improve the lot of others".
As part of the 2009 case, Dr Reece was suspended from practice for 12 months, but that was immediately suspended for three years on conditions.
Patients hard-pressed to find help in 'overwhelmed' system
Marnie, Steve and Jane are all patients of Dr Reece who credit him with saving their lives.
Jane described the closure of his bulk billing practice as "absolutely terrifying".
She said she got a spot in a state-run addiction clinic "by the skin of her teeth" after calling every day and jumping on a last-minute cancellation.
"I've got nothing bad to say about them, but they're overwhelmed," Jane said.
Steve and Marnie say they went through withdrawals for almost three weeks after Dr Reece closed and their prescribed medication wore off.
They live outside of Brisbane and are now being treated at a state clinic, but Steve said many others, including people coming out of jail who would usually turn to Dr Reece for an immediate appointment, have limited options.
"The reality is they're turning to drugs again, and what that does is it takes the crime rate back up," he said.
"You're going to have more robberies, more car-jackings, more armed robberies, more people getting mugged in the street."
January's leaked Queensland Health document said waiting lists at public addiction clinics are "exponentially increasing daily".
As scripts expire, staff are reporting "increasing incidents of abuse by people due to frustration at being unable to access OST".
The document said research showed opioid substitution treatment for dependent people halves "all-cause mortality" and the benefits are greatest where the program "is easily accessible, entry to treatment is prompt and retention is high".
It lists the risks to patients unable to continue their treatment as:
- Return to illicit substance use
- Contraction of blood borne viruses
- Return to criminality
- Overdose
- Death
- Significant risks to pregnancy
The report said impacts will be felt across the health system, including on ambulance services and emergency departments as patients seek alternative treatment "or utilise illicit substances to ameliorate their physical and mental distress due to the abrupt withdrawal of their OST medication".
It has made a series of recommendations including that "all available legislative mechanisms are immediately explored" to allow extension of [the] private prescribers' scripts and provide Metro North Health and Metro South Health more time to "safely transfer care of patients into their services".
Health Minister Yvette D'Ath and the chief psychiatrist declined an interview.
Queensland Health did not answer specific questions, but in a statement a spokesperson said a government plan "will strengthen capacity across a number of areas including the delivery of withdrawal management, opioid dependence treatment (ODT) and harm reduction."
'It's a catastrophe'
Geoff Manu is the acting CEO of peak body Australian Injecting and Illicit Drug Users League (AIVL) which aims to advance the human rights of people with experience of drug use.
He described the displacement of Dr Reece's patients as "catastrophic for people and their lives".
"It's a catastrophe, it's a time bomb that was waiting to happen," Mr Manu said.
He said some state-run clinics in Queensland have waiting lists up to six months' long and nationwide, not enough has been done to plan for when GP prescribers retire or leave.
"The likes of AHPRA need to really consider what will the impact be on the community and work more with the state … rather than just pulling the trigger and the community suffers," he said.
*Names have been changed to protect privacy.
Anyone who wants information on treatment options can call the 24/7 drug and alcohol service ADIS on 1800 177 833.
