Robbie Mason started using heroin as a child.
His hands are dotted with scars that look like needle pricks. He had been using it for so long that he could no longer inject it into a vein in his arm, so he turned to his finger.
I got my first hit when I was 12 years old. His friends’ older brothers asked him to sell drugs for them while he was passed out at their home in Sydney’s west. They offered him some.
“The first contract sealed the deal. It helped me forget about everything,” he says.
He had been kicked out of his home two years ago on his 10th birthday.
Mason, now 44, said he injected heroin several times this year. Each time, he said, he thought, “What a bloody waste of money.”
Mason is articulate, open and warm. Although he is dedicated to drug reform advocacy, he says his heroin use was once his “full-time job.”
He spent 30 years figuring out his next fix and scraping together enough money to score. He was a sex worker for a long time. He spent three years in prison. He told himself he wasn’t going to beg on the street, and he actually did.
“I always said to myself, I never want to be the guy sitting in the corner begging. But that’s where I ended up,” he says.
“In my mind, I really wanted to give up. I just didn’t know how.”
Mr Mason says his life has done a “complete 180” since he and his partner took part in Australia’s first hydromorphone trial in Sydney.
This powerful synthetic opiate is used overseas as an opioid replacement therapy for chronic heroin addicts who have failed alternative drugs such as methadone and buprenorphine.
The Victorian government announced last week that it would fund its own hydromorphone trial to be conducted at a new “community health hub” in Melbourne’s CBD. But despite recommendations from former Police Commissioner Ken Lay, a second medically supervised injection center plan was withdrawn.
Experts and advocates have welcomed the decision to introduce hydromorphone in Victoria, but say it is not enough.
Mason strongly believes that this treatment should be widely available. But he said he had lost “probably over 50” friends to overdoses and that Melbourne needed a supervised injection center in the CBD.
Access to approved pharmaceutical grade medicines
The NSW hydromorphone trial is being carried out at St Vincent’s Hospital drug treatment services in Darlinghurst in partnership with Uniting, the organization that operates the supervised injection center in Sydney’s King’s Cross.
It is scheduled to start in April 2022 and end in August this year.
United NSW general manager of advocacy Emma Maiden said the feasibility study was testing whether hydromorphone could be delivered within existing drug treatment services.
Trial participants will participate twice a day. They administer methadone orally and then self-inject hydromorphone under supervision.
For Mason and his partner, access to hydromorphone meant “their lives changed dramatically.”
“We went from having no money in the bank to having hundreds of dollars when we got paid again,” Mason said.
“We went to the theater and saw Shen Yun at the Lyric Theater. My partner had never been to the theater before.”
The pair entered the trial in July 2022 and stopped it in January, when Mason said they reached a point where they were confident that methadone was sufficient. They are planning a cruise later this year, “possibly to the Great Barrier Reef.” They plan to quit methadone and visit Cambodia in 2025.
Methadone is designed to help manage withdrawal symptoms, while hydromorphone mimics some of the euphoric effects of heroin. The Sydney trial aims to help people transition to regular methadone or buprenorphine treatment.
Hydromorphone is given to some hospitalized patients as a powerful pain reliever. For those who are not tolerant, he may administer 2 mg at a time. People using it as a medication to quit heroin can take up to 200mg in a single dose.
Sydney’s hydromorphone trial is being overseen by Professor Nadine Ezzard, St Vincent’s Clinical Director of Drug and Alcohol Services.
Ezzard said the trial will allow people to access approved pharmaceutical-grade medicines without the risks associated with the unregulated illicit market.
“Heroin is short-lived, so it’s your life,” she says.
“People who engage in heroin use are constantly at risk of criminal justice consequences.”
Ezzard said there were 22 participants, but due to “natural attrition,” that number was reduced to about six. Some, like Mason and his partner, finished the job on their own terms. Others “dropped out”. One person died of natural causes.
Although participants have been interviewed, trial success is “undefined.” Ezzard expects the results to be announced next year.
The program, known as “Fopit,” demonstrates the feasibility of injectable opioid treatment.
In the room where people self-injected hydromorphone, laminated posters about healthy snacks and breathing techniques were taped to the walls, and next to them were photo boards of staff and participants’ “Four Pets.” A dog, a budgie, and “500 bugs.”
Dr Craig Rogers, a senior staff specialist in addiction treatment at the hospital, said participants were linked with primary care services and other social supports.
“It’s all about connection. That’s what our clients are receiving, rather than a standard treatment program,” Rogers says.
“I think the most difficult thing is getting people back to their normal lives. Everyone’s life is different, but many people don’t have anything.”
“There is no substitute for a safe injection room.”
Victoria’s hydromorphone trial is also small, limited to just 30 people a year. It will be postponed until 2026.
Debbie Brady, who lost her son Jay Vesey to a heroin overdose a year ago in Corio, Melbourne’s west, said the trial was “too little, too late”.
Brady said Vessie died on the floor of the disabled bathroom after going into the bathroom to inject herself with a kit she got from a nearby needle exchange. He was 34 years old.
Ms Brady has started a petition calling for a medically supervised injection room to be built in Geelong.
“As long as the government continues to pretend it doesn’t exist, we will continue to experience heartbreak and death,” she says.
In response to questions from Guardian Australia, a Barwon Health spokesperson said Geelong’s health care providers offer “a range of harm-minimizing programs, including a needle syringe program, a naloxone program to reverse opioid overdoses, and drug and alcohol counseling.” “We offer a wide range of services to help limit the number of people who are living in the United States,” and are “cooperative.” Evidence-based measures that can further reduce harm from drug and alcohol use:
Pennington Institute chief executive John Ryan believes Victoria’s hydromorphone trial should start “urgently” but is not a replacement for another supervised injection room.
“There are still a lot of people who are at high risk and don’t have access to hydromorphone,” he says.
Katrina Korver says her son Danial’s life could have been saved if there was a supervised injection room in Melbourne’s CBD.
She hailed the hydromorphone trial as “excellent” but said the government should not “ignore” people who do not have access to trials. She believes the facility should be modified to also be used by people who inject heroin.
Every week, she and her husband place fresh flowers in the alley where Danial overdosed two years ago. He would have turned 40 this year.
“We couldn’t stop him from using heroin,” Kober said. “But that didn’t stop us from loving him.”
