PREVENT HARM IF WE CANNOT PREVENT USE

JAKARTA (JP): "This is a drug-free area." So shout the banners displayed in
many communities in Jakarta and around Indonesia. Paradoxically, banners
like this are most prominent in the areas where everyone knows that it
isn't true, in places where drug use has already become an epidemic.

There can be few who are not aware that drugs are an increasing threat to
the future of the nation, although not many are fully aware of the scale of
the threat. Even less clear is how to respond to it. Other banners exhort
us to "Just Say No" to drugs, even though many of us know how difficult it
is to say no to that most legal of drugs, tobacco.

Of course, the easy answer is prohibition. Eliminate the supply of drugs.
Would that it was that easy! Around the world, billions of dollars are
spent trying to reduce the supply of drugs, with little or no impact on
availability or price. Profits from supply of illegal drugs far exceed what
law enforcement authorities can afford anywhere in the world, let alone in
Indonesia. Here, these profits probably already exceed the combined budget
of the police and the armed forces. Huge sums of money are available for
traffickers to bribe their way out of problems.

Of course, we must try. But we must also be aware that our efforts are
almost certainly doomed to failure. And we must therefore find alternative
strategies.

The obvious choice is prevention. Encourage our children to say no to
drugs. But this is also by no means easy, especially if we leave the
problem to others. We cannot pass the responsibility to teachers or
preachers -- rarely do they know much about drugs, and they spend only a
very limited time with the children. In fact, research now shows that
school-based drug programs are more likely to increase drug use, and at
best make little difference.

Another mistake is to assume that our kids, being "good", will not be
tempted. A combination of peer pressure and curiosity, both very prevalent
among adolescents, will influence even the "best" children.

For prevention to be effective, it must start in the home, in the family,
and start early -- by the time the children reach the age of nine or ten
they are already becoming aware of drugs and beginning to ask questions --
usually to their peers who know no better than they do. Better they hear
the right answers from us before that occurs.

Even the best parental guidance will have little impact upon those who are
already addicted to drugs. Although patience and encouragement are crucial,
success in curing addiction must start with a real commitment by the
addict. Without this, relapse after treatment is almost inevitable.

Strangely to those of us who have never been under the influence of drugs
and who only see the harm which addicts do to themselves, few are ready to
make such a commitment. With all its problems, the world of addiction they
live in seems better than reality -- and as we know, reality in Indonesia
can be hard!

Sadly, few addicts are really aware or concerned about the harm they are
doing to themselves. Few consider the threat of death through overdose or
from AIDS or other conditions. The risk of these harms is greatest among
drug users who inject. In particular, HIV, the virus which causes AIDS, is
most efficiently spread through the sharing of needles -- once the virus
has infected one member of a group sharing needles, the rest of the group
can become infected within days. Experience around the world has shown that
once more than 10 percent of injecting drug users (IDUs) in any community
become infected by HIV, without extremely effective intervention that rate
has usually exceeded 50 percent within a year.

There are signs that we are almost too late to prevent this happening in
parts of Indonesia. Surveys have shown HIV rates already as high as 20
percent among IDUs in Jakarta. Extremely urgent action is needed to address
this. We are too late to prevent these people using drugs; we cannot expect
quick success in attempting to stop most of them using drugs. What we must
do quickly is to reduce the harmful effects, including the spread of HIV.
Again, experience around the world has shown that there are really only two
responses that are effective -- and these can be very effective, if
controversial. The first is to try to encourage IDUs to stop injecting,
usually by providing alternatives such as methadone, a cheap liquid drug
that is taken orally. For those not ready to change to methadone, providing
easy, cheap access to clean needles is really the only solution.

Neither of these approaches is ideal. But both work. Both will help ensure
that when users are finally ready to make the commitment to stop using
drugs (as most do sooner or later), they will still be healthy and able to
play a productive role in society.

As we consider our options and look for solutions on the International Day
against Drug Abuse and Illicit Trafficking on June 26, let us not ignore
the large number of our young people who will not be reached by strident
prevention messages. If these are to survive, they need our support to
avoid the harmful effects of their drug use.