Content warning: This story contains the name and image of an Aboriginal man who has died. He has been identified with the permission of his family.
Finding a pathway out of heroin addiction was an issue that Nathan Booth had struggled with for most of his adult life.
But as "regular as clockwork", an inquest was told, the Canberra father - a "loveable larrikin", as he was often described - turned up at Building 7 at Canberra Health's Drug and Alcohol Services to receive his dose of methadone. He was fighting addiction the best way he knew how.
He was one of 223 people in the ACT regularly prescribed the drug, some after spending time in jail.
It is not known how many of these 223 are former detainees at the Alexander Maconochie Centre, which has an opiate maintenance therapy program, dispensing both methadone and another substitute, Bivudal.
Justice Health has a poor record on managing its methadone program, according to a whistleblower. In 2021, a former senior director at the prison told The Canberra Times "prisoners are not weaned off methadone in prison which any good methadone program should do to allow prisoners to lead clean lives outside, which means they still have a habit when they leave".
When people on the opiate substitution program are released from jail, they receive a script for one month which allows them to connect with another provider outside.
Mr Booth was receiving a very large dose of the liquid opioid, around 120 milligrams a day. But according to friends and family, he had self-managed his dependence well with no cognitive issues.
Methadone is a powerful, slow release, synthetic, long-acting analgesic drug. It works by blocking pain signals to the brain and for those striving to break heroin addiction, it is a proven method.
Forensic toxicologist Professor Olaf Drummond said regular methadone users develop a tolerance for the drug and need higher dosages to achieve the desired effect.
But equally, as the body develops tolerance, the effect produced by the drug diminishes. Professor Drummond had speculated that this was most likely the case with Mr Booth who also took other drugs, such as small amounts of methamphetamine, to counter the sedative effect.
But like heroin, methadone is also a full blown drug of dependence. Julie Tongs, head of the Winnunga Nimmityjah Aboriginal Health and Community Services, describes it as "liquid handcuffs" and has been sharply critical of how freely it is dispensed inside the jail.
"It makes them [detainees] drowsy and compliant, which suits the people who run the jail," she said.
At 3.08pm on June 27, 2019, Nathan Booth took his regular dose of methadone at the hospital clinic.
It was the last time he was seen alive.
Five long months passed until his body was found in a lonely, remote part of the Murrumbidgee River with a badly broken ankle. No-one who knew Mr Booth could offer any clue as to why he had gone to so such an isolated location and experts were all but certain the body had not been carried downstream by the river flow.
After hearing three days of evidence last month, the ACT coroner, Ken Archer, is yet to deliver his finding into the cause of Mr Booth's death.
From the post-mortem, forensic pathologist Professor Johan Duflou could not definitively establish a cause of death.
Mr Booth's out-of-character non-appearance at the methadone clinic in the critical days following June 27, where presumably the staff knew him and held his dispensing records, was not raised at the inquest.
While the program is voluntary, those on it are among the Canberra community's most vulnerable. These patients are people who fall between the cracks of society.
When Mr Booth failed to return to the clinic the next day, there were no records of phone calls to family nor welfare checks. He was effectively a missing person, but no alarm was raised. Not for weeks afterward. CCTV footage at the hospital runs on a loop, and was over-written after 30 days.
Nathan's sister, Deeanne, said the health service failed in its duty of care and that one phone call from the cllinic - "someone who cared" - may have saved her brother's life.
"All it would have taken is one phone call to Winnunga [health service], or whoever, just one," she said.
Canberra Health Services confirmed patients at the clinic are not assigned case managers.
In its response, a spokesperson for Canberra Health Services stated "there have been instances of welfare checks made or referrals to other services, i.e. mental health if necessary".
"However, this is a voluntary program that clients choose to participate in, and they can leave the program or choose to miss a dose without follow up".
