Before the youth overdoses in the lane, he registers an unconscious cry for help. It is a disguised plea, made in a flurry of visits to doctors. But it's not recognised. As a report reveals, most GPs don't know how to deal with drug abusers and are not told that multiple visits, or ``doctor shopping", is linked to a risk of overdose death.
A report for the Melbourne division of general practice, which represents most inner Melbourne GPs, has found that monitoring those visits by drug users - which, on average for young overdose victims, rises from 12 to 36 times a year - could pinpoint those at risk, and potentially reduce the number of drug deaths among young people.
The report, which surveyed drug users, and 202 heroin-related deaths reported to the Coroner, also found that, rather than being criminals, most young people who die from drug overdoses suffer from mental illness. More than half the drug users questioned had a psychiatric disorder, usually anxiety or major depression.
``The underlying problem is increased mental illness among young people, not drugs," the report's research consultant, Dr Danielle Clode, says.
She argues that drug abuse should be treated as a mental health symptom, not as a breach of the law.
In common with other studies, the report links drug abuse with mental illness, abuse in childhood and poverty. But while up to 25per cent of young people who see GPs are said to have ``significant psychiatric problems", the report claims that GPs seem reluctant to identify and manage drug abusers, a high-risk group. It says this could be because GPs feel ill-equipped to deal with mental illness.
The research director for the Melbourne division, Dr Raymond Martyres, who oversaw the report, says the health system does not allow GPs to deal effectively with patients making an unconscious cry for help.
``That cry is drug abuse and some GPs just don't have the time or skills to handle it," he says. ``Drug abuse is not only drug addiction. It takes time and resources to deal with, and GPs don't have that."
Dr Martyres wants the Health Insurance Commission to use its data bank to monitor and isolate those at risk of overdose death. The idea is for GPs to access visitation rates, and thus identify those at risk of overdose.
The HIC will consider the plan, which already has the backing of Beyond Blue, the Jeff Kennett-inspired depression initiative. Its chief executive, Professor Ian Hickie, says the report challenges doctors' common response to drug users.
``Doctors often think, `It's just another drug addict.' But there is a link between drug use, emotional distress and more frequent visits," he says. ``And it can lead to overdose or suicide."
The warning signal is doctor shopping. As the report found by matching coroner's reports with Medical Benefits (MBS) and Pharmaceutical Benefits (PBS) data, the mainly male, 15 to 24-year-olds likely to fatally overdose make multiple visits to GPs to obtain drugs before they die.
``This pattern of behaviour may reflect the increasingly chaotic lives of heroin addicts in the months prior to overdose, an increased need for prescription drugs," the report says. It dismisses the idea that doctor shopping is just a cost to the health system, and says it must be seen as a ``critical opportunity for intervention and prevention of heroin-related deaths".
Attempts to obtain a comment from the Royal Australian College of General Practitioners were not successful.
A National Drug Research Institute study has found the number of Aborigines injecting drugs in Western Australia has jumped an estimated 50per cent since 1994.
It found that up to 4per cent of Aborigines aged 15 or more who live in cities and towns had injected drugs in the past year. Amphetamines were by far the most widely used drug, with little recorded use of heroin.
Research team head Dennis Gray said there was a tendency for Aborigines to share needles, because of a lack of access to fresh needles, and a lack of awareness about health risks.