Jill Mellon-Robertson’s son was on the cusp of adulthood when he was diagnosed with schizophrenia. Soon after that he began smoking marijuana.
“For him, you’re 17, you’re wanting to be cool and it wasn’t cool to have a mental illness. It was cool to smoke a bit of dope,” his mother recounts.
“He was in the space – he was a musician and an artist. It’s all about the space and what’s cool.”
Over the next two decades, Jahn battled drug addiction. In his early 20s, he began using heroin, the drug that would ultimately kill him in 2015 at the age of 38.
“With heroin, he said [he] could just chill out and he felt very relaxed and the day would go quick – he didn’t have to think about it,” Mellon-Robertson says.
Former police officer Greg Denham remembers seeing Melbourne’s streets “awash with heroin”.
“It peaked in the mid-90s with a surge of heroin availability and a number of hotspots emerged,” he says.
“It’s been ingrained in the psyche of Melbourne ever since. It’s still relatively easy to access and probably cheaper here than anywhere else in Australia.”
Victoria accounts for 45% of the nation’s heroin consumption, according to wastewater analysis conducted by the Australian Criminal Intelligence Commission (ACIC), with Melbourne use per person approximately 70% higher than Sydney, and at least five times most other Australian capitals.
Yet as the city remains embroiled in heated debates over injecting rooms, crime and health responses – few are asking why Melbourne hasn’t been able to kick its heroin habit.
Treatment hard to come by in Victoria
Denham left Victoria police in the early 2000s and has since campaigned for harm reduction. He works for Cohealth, which is considered a frontrunner to operate a possible second safe injecting room in Melbourne’s CBD.
He suggests Victoria’s entrenched market is partly driven by Melbourne having the highest number of container shipments in Australia, leading to greater accessibility.
That’s something to which Shane Neilson, ACIC’s principal advisor on drugs, also refers. As heroin is exclusively imported, he points to the traditional routes – via Sydney and Melbourne – as entrenched supply markets that contribute to a stable user base.
Neilson says heroin users are typically an ageing cohort that tend to live in the same jurisdiction over many years, mostly in cities.
In Victoria, some of this group is struggling to get clean because of difficulties obtaining methadone or other opioid substitutes, according to several experts interviewed by Guardian Australia.
The latest data from the Australian Institute of Health and Welfare’s national opioid pharmacotherapy statistics shows Victoria has significantly less people receiving opioid replacement treatments (15,153) compared to NSW (24,783).
The Penington Institute chief executive, John Ryan, who led the independent review into the trial of the Richmond injecting room site, said Victoria’s higher per capita consumption of heroin could be influenced by the lower state government investment in opioid substitution treatment.
He pointed to the privatisation of opioid substitution treatment – under the Kennett government in the 1990s – which was designed to encourage GPs to prescribe the treatment.
“We’ve still got high caseload GPs and most doctors don’t prescribe opioid substitution treatment. It’s less of a problem in NSW, they have more state government-funded public clinics,” he says.
“There has been dogged determination to implement a model which has never been effectively implemented for nearly 30 years.
“It’s relied on too few GPs to do too much work and no back up services to support them.”
Denham says low availability of GPs who prescribe methadone means users are forced to make a decision between going “cold turkey”, which results in worse withdrawal symptoms; enrol in a treatment program, which often has long waiting lists; or continue to use heroin.
Dr Hester Wilson, an addiction medicine specialist at the Royal Australian College of General Practitioners (RACGP), says a lack of public clinics in Victoria meant private GPs were prescribing for a large number of people, but not all clinics did so.
“Across Australia, GPs are the majority of prescribers. But depending on where you are it can be as low as 5-10%,” she says.
“We need to look at the chronic, crushing financial burden that is impacting general practice.”
The commonwealth has reformed the Opioid Dependence Treatment Program (ODTP), meaning people will be able to buy treatments such as methadone or buprenorphine through the Pharmaceutical Benefits Scheme at some community pharmacies. But some private opioid treatment centres have warned they could be forced to close because their revenue will be reduced from next month.
The Cohealth chief executive, Nicole Bartholomeusz, says the service regularly sees clients who want to address their addiction but demand is too high for rehabilitation or detox services.
“Then the whole process has to start again,” she says. “We need more in-patient beds and more community-based treatment services like pharmacotherapy.”
‘People are dying in laneways, in cars’
Mellon-Robertson, a former Reason party candidate, is a member of the “Keep Our City Alive” campaign that is urging the Andrews government to set up a second safe injecting room in Melbourne’s city centre.
A report into the prospective location – penned by former Victoria police commissioner Ken Lay – is expected to be handed down by the state government in the coming weeks. It follows repeated delays during Covid and what the government said was changing drug use patterns.
The Richmond injecting room – made permanent last month – has been credited with saving an estimated 63 lives and managing more than 6,300 overdoses. But its location near a a primary school has sparked fierce backlash from the state opposition,some residents and businesses.
Data from the state’s coroners court shows heroin overdoses in the City of Melbourne now outstrip the rate in City of Yarra, where the first injecting room was established.
While Melbourne’s CBD is the current hotspot for overdose deaths, Denham knows its effect is not constrained to the city’s border. “People are dying in laneways, in cars, in squats if they’re sleeping rough and it’s touching so many people.”
Mellon-Robertson says safe injecting rooms not only keep people safe, they help connect users to wraparound services such as opioid substitution programs.
“They provide a non-judgmental space,” she says. “The wraparound services also give families breathing space because you know they’re getting the necessary support they need.”
A Victorian government spokesperson says Lay’s report has been provided to the minister for mental health, Gabrielle Williams, who is considering its recommendations and will release the report, and a government response, “in due course”.
They say the government funds a range of initiatives to help Victorians access pharmacotherapy and pointed to $313m in the budget for alcohol and drug services, including residential withdrawal and rehabilitation facilities, community-based services and crisis responses.
While most pharmacotherapy patients receive treatment from private GPs, a number of patients receive treatment at publicly-funded specialist addiction medicine clinics and from prescribers in community health services.
