The recent fatal overdose of American actor Philip Seymour Hoffman was marked with an obituary in TIME magazine by scriptwriter and former heroin user Aaron Sorkin. “[Hoffman] said to me once: ‘If one of us dies of an overdose, probably ten people who were about to won’t.’ He meant that our deaths would make news and maybe scare someone clean.” A highly publicised, drug-related death seems as good a reason as any for society at large to re-examine heroin use. But I wondered whether there really was any hope for a celebrity effect on drug users. What does it take to ‘scare someone clean’?
Someone I thought worth asking was Melbourne community drug worker Donna, now aged 46. Living in a Queensland housing commission in her late adolescence, Donna experimented with drugs⎯mostly alcohol and cannabis. In her twenties, she lost several friends to overdoses. After working in Australian prisons for over a decade, she is now part of an outreach team walking a regular route through Melbourne’s laneways. Donna and her team look like ordinary people, but emblazoned on each of their backpacks is a patch⎯two feet in laced red boots. This is the logo of Foot Patrol, a Needle and Syringe Program (NSP) bringing clean equipment to the injecting drug user community of inner Melbourne.
When Foot Patrol was launched in 1996, Melbourne’s heroin supply was abundant⎯twice as pure and half the price of today’s product. Donna first started working her CBD beat in 2003. “Back then, on Russell Street, you couldn’t walk five steps without someone asking if you were chasing [looking to buy].” In spite of a forceful undercover police presence, very few dealers were arrested. “They would use runners…while they remained in their hotel rooms.” Donna tells me. “They all had legitimate fronts to their operations. They never sampled their own product.” The glut tapered off in the early 2000s, which saw a decreased incidence of overdoses and drug-related ambulance call-outs. It took the 2006 Commonwealth Games for a serious crackdown⎯there was a forty per cent decrease in active street-based markets in Melbourne. For a brief moment, it looked as though the city was going to get clean.
Instead, Melbourne’s drug trade simply became seasonal. In June, Foot Patrol sees a spike in heroin use. “We call heroin a ‘chemical blanket’. It gives you a warm feeling that makes it easier to go to sleep on the street in winter.” In August, there’s a trend towards steroids. “People want to get in shape and bulk up for summer,” Donna explains. Melbourne’s amorphous drug culture forces Foot Patrol’s community outreach workers to keep their ear to the ground. Today, they face new challenges: a surge in synthetic opiates, a breakout of Hepatitis C, and an ageing user demographic.
As heroin became scarce in the early 2000s, the reach of pure product shrank. These days, most street products coming through Melbourne⎯whether it’s heroin, hormones or psychostimulants⎯are of poor quality. “When [users] can’t get heroin, they get creative,” Donna warns. “Either it’s been cut with something else, or someone has decided to whip up a batch at home.” Has there been a Breaking Bad effect? I ask. “Something like that,” Donna laughs. “Everyone thinks they can cook.”
Melbourne’s outer suburbs have seen a surge in black market prescription pain medication, such as Fentanyl and Oxycodone. A batch of ‘hillbilly heroin’⎯cut with Fentanyl⎯saw a spike in overdoses around the time of Philip Seymour Hoffman’s death. (Toxicologists have been unable to confirm whether the heroin that killed Hoffman came from the same supply.) These synthetic opiates are stronger and cheaper than pure heroin. The only advice Foot Patrol can give to users is to test every drug in half measures. “We say two holes in the arm is better than one in the ground. That seems to resonate.”
Transforming prescription opiates into an injectable fluid for an intensified rush isn’t safe or sanitary. Fentanyl is only available in pill form, which is difficult to crush and forms a gel in contact with water. “Most users end up injecting the pills’ chalk and binding agents,” Donna says. Oxycodone is manufactured in ‘tamper-resistant’ patches, but it seems users will take the risk anyway. To extract the drug from its patch, you must soak it in water, lemon and vinegar. Once you heat the liquid and skim off its waxy coating, Oxycodone is supposedly ready to inject.
While the rate of AIDS infection among Melbourne’s drug users is relatively small, Foot Patrol faces a new threat: the growing incidence of Hepatitis C. “Users think it’s like the old days with AIDS,” Donna explains. “They say, ‘well, I’ve got it and my girlfriend’s got it, so we share needles and that’s fine’. But what they don’t realise is that there are multiple strains to this virus. They can continue to spread Hep C without knowing it.” Without an education campaign specifically targeting Hepatitis C or a more comprehensive NSP presence in Melbourne, it will be difficult to curb the rate of infection.
One woman struggling with Hepatitis C is 41-year-old reformed heroin user Jacky*. I meet Jacky at an open Narcotics Anonymous weekly meeting in North Fitzroy. She graciously agrees to a short phone interview. With a small, wiry frame and a tangle of shoulder tattoos, she has the look of a seasoned user. In Melbourne’s heat she wears a singlet⎯track marks still visible in the mottled skin of her arm. Jacky first fell into heroin use as a way of coping with an abusive foster mother. “It masks the pain,” she says.
As a young woman working in Melbourne’s CBD, Jacky quickly grew dependent on the drug. Jacky had no need for NSPs like Foot Patrol because she could afford to buy her own equipment. But all it took was one shared needle among friends. “The nurse in Parkville gave me a call saying, ‘you need to come down to get your results in person.’ That’s always bad news.” For Jacky, the Hepatitis C diagnosis was something of a wake-up call. To wean herself off heroin, Jacky tried several unsuccessful rounds of pharmacotherapy, combining Methadone with prescription pain relief. Eventually, she checked herself into a recovery unit in St Kilda and went cold turkey. On the day I call her, it has been nearly five months since she last used any drug, including alcohol and methadone. “I get a special key-ring in a week or so for cracking 150 [days].”
Foot Patrol is concerned for Melbourne’s increasing number of ageing injecting drug users. Jacky’s habit began in the late ’80s, as did the bulk of Melbourne’s current injecting drug user population. Her long-term or “service” use placed her at an even greater risk of cancer, cardiovascular disease and vascular damage than overdose. Adding to these concerns is the State Government’s refusal to fund a complete set of clean equipment. Foot Patrol has a good supply of syringes⎯1mL insulin needles for heroin, bigger ‘barrel’ needles for methamphetamines—but there’s more to injecting than the needle. Tourniquets are essential, regardless of age. “I’ve seen a lot of first-timers really butcher their arms trying to find a vein,” says Donna. Wheel filters are crucial for removing any foreign matter from the drug itself before injection. Donna has to warn her clients against a common street substitute: cigarette filters. “They tend to have fibreglass residue, which⎯when injected⎯can go straight to through the system and cause endocarditis [infection in the heart’s right ventricle]. Older users can die of heart failure.” Without sterile water, users inject tap water boiled in on a stovetop. These unsanitary alternatives risk abscess and infection.
Much more than an NSP, Foot Patrol takes responsibility for the safety of the wider community. A recent study conducted by the Burnet Institute in Richmond found that users break open safe disposal bins to scavenge for equipment, meaning that on a Monday morning, joggers have to skip around needles and injecting paraphernalia around the parks. Every week, a dozen or so Clean Up Crew volunteers from Foot Patrol’s parent company Youth Projects scour the laneways, stormwater drains and rivers of Melbourne’s CBD for used injecting equipment. At the moment, the crew are looking to sequester vans and expand their reach, as Donna finds that Melbourne’s drug centres have moved further out. “There are only a few dealers still kicking on in the city,” she says. “But if you go to Footscray or Richmond, you get on pretty easily.”
Foot Patrol offers wound care, informal counselling, legal advice, referrals to drop-in centres, condoms and lubricant. But, most importantly, they offer non-judgemental compassion and dignity to their clients. For regular users, the risk of being ‘outed’ as a drug user and its resulting social ostracism are powerful deterrents to purchasing clean needles. “In rural and suburban communities where everyone knows each other, they might be afraid of going into the chemist and being recognised by someone when they’re buying needles,” says Donna. Older users remain suspicious of authority. “We’ve still got to remind people that it’s not like the old days where if you called an ambulance and tell them it’s an overdose, they call the police.” Some of Donna’s clients took upwards of five years to build up sufficient trust with Foot Patrol.
Donna works with users from all walks of life. “We get people in business suits and policemen knocking off for the weekend. We see security guards, doctors, lawyers.” Most of Foot Patrol’s clients will admit to being drug users, but reject the ‘junkie’ label. There remains a great deal of stigma attached to injecting drug use. Nonetheless, Donna tries to foster a supportive community to minimise the risks of shooting up. She even gives her regular clients Christmas presents. Jacky derives similar support from Narcotics Anonymous. “It’s funny,” she says. “I don’t know any of these people’s last names, but I feel like that they know me better than anyone of my friends of family can at this point.”
When I ask Donna if she’s ever found herself personally in danger, she rises to defend her clients. “These aren’t people who are going to fuck you over. Most of them would rather beg than burgle to get money for their next fix.” She recalls a near-overdose on Russell Street. Two users known to Donna helped her haul the middle-aged man out of his car. He exhibited shallow breathing and a coloured tinge to his lips and fingernails, so Donna called an ambulance. As she administered CPR, a group of onlookers gathered. None of them offered help, and a few pulled out mobile phones to record the incident. “I think that’s an indictment on our society more than anything,” Donna mutters.
So what does it take to scare someone sober? “Sometimes they’ll have a friend overdose, a relationship break-up or a brush with the law,” Donna suggests. “Maybe they’ve just done time in jail or they want to get off the streets. They always have the best intentions.” But determination doesn’t always cut it. Jacky doesn’t mince words when describing her first serious withdrawal. “It’s excruciating pain. I don’t want to be crude, but the diarrhoea is so bad, you could probably birth a child through your arse. Your body is wracked with cramps. You can’t sleep. After the first few days, most people think to themselves⎯I need to get some ‘medicine’. And they relapse.” Donna believes that motivation to stay sober must come from within. For Jacky, this has a literal significance. “It took a pregnancy to get me clean,” she says. “I ended up losing the baby, but I got my life back. That’s how it goes, doesn’t it?”
Donna thinks that the celebrity effect can still count for something. “The wider community sees that the stereotype of the drug user doesn’t exist. When Ben Cousins was in the paper for his substance abuse, a lot of people were like, ‘oh, wow. He’s a footballer, you know, admired by young Australians.’ This can affect anyone.” And as for Philip Seymour Hoffman, “most of our clients didn’t even know who he was,” Donna says. “But you never know. If someone’s a social user, it might cause them to think twice.” Jacky hasn’t a great deal of faith in Hoffman’s death as a wake-up call to any long-term users. “Even when River Phoenix died back in the nineties⎯and he was a bigger deal than Philip Seymour Hoffman⎯it made fuck all difference.”
Hoffman’s overdose, like every drug-related death, was a preventable, lamentable waste of human talent and potential. His death might not have scared addicts clean, but it has given us cause to reconsider how we see drug users. We should start by acknowledging that they are, and always will be here. Donna thinks the most important message we can take from Hoffman’s overdose is this: we should not reduce users like Jacky to their habit. We should recognise the strength they exert to endure and survive.
For now, Donna is just a single foot soldier on the front line of Melbourne’s ever-changing drug scene. She has braved the laneways at all hours and pressed life back into a user’s ailing heart with her bare hands. We could to take these actions out of context to call them heroism. But for Donna and her fellow Foot Patrol volunteers, they simply do what is necessary. We must embrace what it has taken Foot Patrol years to understand: every drug-related death deserves a write-up, and every user deserves dignity.
*Jacky’s name has been changed.
Should you need to contact Foot Patrol, they are can be reached on 0412 155 491 and toll-free on 1800 700 102.