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Robbie Mason started using heroin when he was a child.
His hands are dotted with puncture marks. He used for so long that he stopped being able to inject into the veins of his arms, so he turned to his fingers.
He was 12 when he got his first stroke. His friend’s older brothers asked him to sell the drugs for them while he crashed at their place in western Sydney. They offered him some.
“The first one sealed the deal for me. It helped me forget about everything,” he says.
He had been kicked out of the home two years earlier, on his 10th birthday.
Now 44, Mason says he has injected heroin several times this year. Every time he says he thought “what a waste of bloody money”.
Mason is articulate, open and warm. He has devoted himself to drug reform advocacy, but says heroin use has been his “full-time job.”
He spent 30 years thinking about his next decision and saved enough money to score. He was a sex worker for a long time. He spent three years in prison. He told himself he wouldn’t beg for money on the street, and he did.
“I always told myself that I would never be one of those people who sit on the corner and beg. But eventually I ended up there,” he says.
“Really, in my heart, I wanted to quit. I just didn’t know how.”
Mason says his life has done a “complete 180” after he and his partner took part in Australia’s first hydromorphone trial in Sydney.
The powerful synthetic opiate is used overseas as opioid replacement therapy for people suffering from chronic heroin addiction for whom alternatives such as methadone or buprenorphine may not have worked.
The The Victorian government last week announced it would fund its own hydromorphone trial, to be run out of a new ‘community health hub’ in Melbourne’s CBD. But scrapped plans for a second medically supervised injection centerdespite the recommendation of former police chief commissioner Ken Lay after deciding there was no site to balance the needs of drug users with the wider community.
While experts and advocates have welcomed the decision to introduce hydromorphone in Victoria, they say it is not enough.
Mason strongly believes that treatment should be widely available. But he says he has lost “probably more than 50” friends to overdoses and Melbourne needs a supervised injection center in its CBD.
Access to an approved pharmaceutical grade drug
The NSW trial of hydromorphone was conducted at the drug treatment service at St Vincent’s Hospital in Darlinghurst in partnership with Uniting, the organization that runs Sydney’s supervised injecting center in Kings Cross.
It started in April 2022 and is due to end in August this year.
Emma Maiden, general manager of advocacy for Uniting NSW, says the feasibility study is testing whether hydromorphone can be made available in existing drug treatment services.
Trial participants visit twice a day. They take an oral dose of methadone and then self-inject hydromorphone under supervision.
For Mason and his partner, access to hydromorphone meant their “lives changed dramatically”.
“We went from no money in the bank to hundreds of dollars when we got paid again,” Mason says.
“We went to the theater and saw Shen Yun … at the Lyric theater. My partner had never been to the theater before.
The two joined the trial in July 2022 and stopped in January, when Mason said they reached a point where they felt confident taking methadone was enough. They have plans to cruise later this year, “probably to the Great Barrier Reef.” They intend to get off methadone in 2025 and visit Cambodia.
While methadone is designed to help deal with withdrawal symptoms, hydromorphone mimics some of the euphoric effects of heroin. The Sydney trial aims to help people switch to regular methadone or buprenorphine treatment.
Hydromorphone is available as a strong form of pain relief for some hospital patients. Someone with no tolerance can get 2 mg at a time. People using it as pharmacotherapy to quit heroin can work their way up to taking 200mg at a time.
The hydromorphone trial in Sydney is being overseen by Prof Nadine Ezzard, the clinical director of the drug and alcohol service at St Vincent’s.
Ezzard says the trial allows people to access an approved pharmaceutical-grade drug that doesn’t carry the risks associated with an unregulated and illegal market.
“Heroin is short-acting, so it’s your life,” she says.
“People who use heroin are constantly at risk of … criminal justice consequences.”
Ezzard says there were 22 participants, but that number dwindled to about six due to “natural attrition.” Some, like Mason and his partner, graduated by choice. Others have “dropped out”. One person died of natural causes.
Participants have been interviewed, but the success of the process is “not determined”. Ezard expects the results to be published next year.
The program is known as ‘Fopit’: Feasibility of Injecting Opioid Treatment.
In the room where people are injected with hydromorphone, laminated posters of healthy snacks and breathing exercises are taped to the wall, next to a board with photos of staff and participants’ “Fo-pets”; dogs, budgies, “500 worms”.
Dr. Craig Rogers, senior specialist in addiction medicine at the hospital, says participants are connected to primary care services and other social services.
“It’s all about connections. That’s what clients get, as opposed to a standard treatment program,” says Rogers.
“The hardest part, I think, is bringing people back to life. Everyone’s life is different, but many of these people simply have nothing.
“There is no substitute for a safe injection room”
Victoria’s trial of hydromorphone will also be small, limited to just 30 people a year. It will be delayed until 2026.
Debbie Brady, whose son Jay Vesey died of a heroin overdose a year ago in Corio, west of Melbourne, says the trial is “too little, too late”.
Vesey died on the floor of a handicap restroom, Brady said, after he went in to inject himself with a kit he took from a nearby needle exchange. He was 34.
Brady has launched a petition to build a medically supervised injection room in Geelong.
“As long as the government continues to pretend it doesn’t exist, we will continue to have heartbreak and fatality,” she says.
In response to questions from Guardian Australia, a spokesperson for Barwon Hello said the Geelong health provider “offers a range of harm minimization services including a needle syringe program, an opioid overdose reversal naloxone program and drug and alcohol counselling” and “supports any community-based Evidence-based measures that could further reduce the harms of drug and alcohol use:
Pennington Institute chief executive John Ryan believes Victoria’s hydromorphone trial needs to start “urgently”, but it will not be a substitute for another supervised injection room.
“There are many people who are still at high risk and will not have access to hydromorphone,” he says.
Katrina Korver says a supervised injection room in Melbourne’s CBD would have saved her son Daniel’s life.
She hailed the hydromorphone trial as “amazing” but said the government should not “ignore” those who do not have access to it. She believes the facility needs to be adapted so it can also be used by people who inject heroin.
Every week, she and her husband lay fresh flowers in the driveway where Daniel overdosed two years ago. He would have turned 40 this year.
“We just couldn’t stop him from using heroin,” Korver says. “But that didn’t stop us from loving him.”
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