Dr Michael Aufgang

Dr Michael Aufgang
MBBS, Monash 1987
Dip. R.A.C.O.G. 1991
FRACGP 2004

We Listen, We care, We Explain

Dr Aufgang has spent 8 years in the hospital system in various roles. He has been a GP since 1995 and practises in Altona Meadows. A major focus of his practice is drug and alcohol treatment, including inpatient and outpatient detoxification. He is a member of the drug and alcohol subcommittee of the RACGP. He is involved in medical education on many levels.

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Drug, Heroin Addiction Treatment.

There is no single 'magic bullet' cure for heroin addiction. As a result, there are several different approaches to treatment.

The user may need to be treated for an overdose, and they may need to 'dry out' (detoxify). They may need ongoing rehabilitation and counselling to help cope with the stresses that led them to use heroin, and they may need medical treatment for diseases caused by injecting heroin, like HIV or hepatitis. They may need to go on opiate substitution maintenance programs like the methadone program.

Almost all heroin users will need a combination of these treatments at different times. They may succeed at some and fail at others. Even if they are successful, relapse rates are high – going back to using is common. So is failure to seek treatment at all. Unfortunately, less than half – 45 per cent – of users are in treatment at any one time.

Treatment of an overdose

Heroin is a powerful respiratory suppressant. When someone takes too much heroin, it suppresses that person's breathing to the point where they stop breathing altogether. Usually, the heart continues to beat, but with not enough oxygen in the blood, the brain doesn't receive enough oxygen and it starts to die. This happens very quickly – within three to five minutes.

Whether the person survives often depends on whether there is someone else around who begins artificial respiration and calls an ambulance (tragically, the user is often alone and isn't revived). Ambulance officers routinely carry an antidote to heroin, called Narcan. This is a drug that blocks heroin from acting on opioid receptors and it revives the person almost instantaneously. However, the person will need to go to hospital. That's because the Narcan wears off faster than the heroin does. Someone who has had a big dose of heroin may become unconscious after a few hours as the Narcan wears off. Ambulance officers and hospital staff do not notify the police of heroin overdose cases.

Detoxing

When someone uses heroin regularly, that is, every day for more than a few weeks, they develop a physical dependence on the drug. When they stop using heroin, they experience withdrawal effects. These may include may include irritability, anxiety, muscle cramps, abdominal pains, chills, nausea, diarrhoea, sweating, sniffing, sneezing, weakness and insomnia. They begin within 12 hours of not using, peak after two to four days, and subside after about a week. Getting through this period, after which the body is no longer chemically dependent on heroin, is called detoxification, or 'detoxing'.

There are several ways a person can detox. People can stop using heroin and detox at home by themselves or with supervision (with a clinic staff member visiting the person at home) and/or seeing their GP during this period.

But it's more likely to be successful – that is, the person stops using heroin afterwards – if its done as an inpatient. Detoxing can take place in a private or public hospital, clinic or a therapeutic community, either with medications to help relive the withdrawal symptoms, (usually benzodiazepines) or without medications. The available number of beds in detox centres has grown in recent years, so that now it's usually possible to get onto a detox program at any time, although its more difficult in rural areas, and at certain times of the year when demand for detox services is highest (after Christmas for example).

Detoxification isn't the same thing as a cure. Even if they are no longer physically dependent on heroin, the person will still get psychological 'cravings'. Also, the stresses that caused them to take heroin in the first place will still be there. So as overseas studies have shown, detoxification by itself doesn't usually work in keeping the person off heroin. The average heroin addict will undergo detox between 10 to 25 times in their lifetime returning to using heroin each time, then detoxing then returning to using again.

Counselling and rehabilitation

People who are addicted to heroin take the drug because heroin relieves them of problems like low self-esteem, distrust and fear of abandonment. They may have poor communication skills, and poor relationship skills. They may have been sexually abused in the past, or have been involved in a violent or abusive relationship. They use heroin and other drugs to bring relief. Counselling and therapy, which should be conducted by qualified counsellors experienced in drug and alcohol treatment, aims to help them identify these issues, understand and overcome them, using techniques like behavioural modification, motivational programs, and self-help groups.

Counselling centres may be privately run, run by a State Health Department or Area Health Services, or run by non-profit charitable organisations like churches (often with government assistance). Counselling can take place on a regular basis as a day visitor to a rehabilitation centre, or in a residential rehabilitation centre (sometimes called a therapeutic community) for periods of up to three months. This involves the addict living in and entering a structured program – of group and individual therapy sessions, and training in life skills, work skills and people skills.

The live-in approach is often more successful because living-in removes a person from their usual heroin-using environment. Also a person who opts to give up their regular lifestyle to live-in is usually more motivated to become drug free.

If yourself or a loved one has an issue with any type of drug or alcohol abuse please visit Dr Aufgang at the Meadows Medical Clinic Altona Meadows
We are able to start yourself or your loved one on a program that is best suited to the user and slowly bring your usage to a minimum and stop.
Please also ask about treamtment options for Ultra Rapid Detox and Naltrexone Treatment/Implants

311 Queen Street
ALTONA MEADOWS
03- 9369 4266
Meadows Medical Centre

Dr Aufgang
MBBS, Monash 1987
Dip. R.A.C.O.G. 1991
FRACGP 2004
Specialist Substance Abuse.

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