THE DOPE ON DRUGS

SENSATIONAL as the Oswaldian revelations are, they should not be allowed to
obscure the powerful messages contained in Dr Phyll Dance's decade of research.

The rigour of the work is not in dispute. It is a clear and powerful
exposure of an important element of Canberra's drug scene.

In two volumes totalling almost 1000 pages, it provides an understanding of
the important factors at work in the process of addiction and the dangers
of our present approach to drug control and harm minimisation.

For example, it gives the lie to those who say heroin can be used sparingly
as a "recreational" drug.

It explodes the myth that prohibition is itself an effective control.
Indeed, it is clear that to the Oswaldians and many others like them
prohibition only adds a false glamour, to a substance that has a role in
society only within a medical regime at a time of terminal illness.

Dance herself makes a series of recommendations to minimise harm to illegal
drug users. They include

* Intravenous drug users need even better access to sterile needles and
syringes. As other researchers have indicated, this could be accomplished
through vending machines.

* Peer outreach workers could attempt to access those not currently in
contact with service providers. Special efforts should be made to contact
homeless youth.

* Education about ways of avoiding accidental needle sharing could be
included in programs that educate intravenous drug users about safer drug
use and it could also be included in peer magazines.

* More stringent efforts are required to persuade intravenous drug users
and their sexual partners to be immunised against Hepatitis B.

* Some deaths from heroin-related overdoses might be prevented if users
were given access to Narcan. Consideration should be given to this proposal.

* The exclusion of intravenous drug users from Interferon treatment is
inequitable. More effort needs to be made to attend to the physical and
psychological health needs of users with hepatitis C, including
non-judgmental ways to help them stop injecting.

* Consideration should be given to reinstating a feasibility study into the
controlled availability of opioids that is, the "heroin trial" should be
reconsidered.

* Tertiary institutions should be targeted as venues for teaching safer
drug use.

* Gender specific education strategies regarding genital and sexual health
are needed. This education must cover the complete armoury of the potential
hazards of unsafe sexual behaviours.

Since so many women have been concerned enough about their genital health
to have a Pap smear, this concern could be utilised by health professionals
who, at time of testing, could spend some time educating women about the
need to use condoms and to also teach them ways of negotiating safe sex.

* In order to bring about periods of prolonged or total abstinence for
those who wish to maintain the reduction in their drug use, and to assist
those who choose to continue to use drugs, more stringent efforts should be
put into providing them with worthwhile paid employment.

Dance says that in order to best implement the suggestions she has made as
well as those made by other people that she has endorsed, and to continue
with existing harm minimisation strategies, there needs to be increased
funding to user organisations.

"People stop using drugs for a great variety of reasons," she says. "One of
the most important themes to emerge from my findings was the reduction, or
non-use, of a drug due to detrimental health effects.

"A secondary theme was a concern for the health of significant others. This
shows that people who use illegal drugs can reflect on the impact drug use
has on their own lives as well as the lives of other people.

"One harm-minimisation approach may be to give drug users access to the
voices of people who have reported problems in studies such as this.

"It is my intention to make this report available as widely as possible to
the people I interviewed, as well as to other people who use illegal drugs."

All but one of her interview subjects spoke of negative effects in their
increased heroin use.

One man said, "It just comes to dominate your life. We got to where we were
using so much we weren't paying rent, we weren't buying much food.

"We borrowed $1000 to buy a truck; we sold it and we used all that money to
buy heroin and we still owed $1000.

"A bit after that I was just so distraught about it really.

"Even then, I think, my libido started going and with that great use, it
just sort of petered out.

"We got to the doctor about that time and he got us on methadone."

Dance is also concerned with the sexual transmission of disease by illegal
drug users. Australia has been very successful in preventing an epidemic of
human immunodeficiency virus among intravenous drug users, she says.

However, a major problem is complacency. "We have now reached the stage
where both hepatitis B and C have become serious public health problems in
the (intravenous drug user) community. "Future education programs aimed at
people who use illegal drugs in particular, and also the wider community,
should incorporate the complete armoury of potential hazards of unsafe
behaviour.

"Generally the potential consequences of Hep B and C and STDs such as
chlamydia are poorly understood.

"Educating everyone about these consequences and, therefore, the need to
protect themselves against the transmission of such diseases as well as HIV
and unplanned pregnancies may help overcome future problems of complacency."

She also found that the Oswaldians indulged in a similar level of criminal
behaviour to the rest of the drug-using community.

However, she says, most crimes committed by those she interviewed were
either because of the illegality of the drug or were minor such as shoplifting.

"Very few had been involved in more serious crime, bringing into question
the stereotypical image of people who use drugs."

She says there was a possibility of under-reporting. However, her findings
were consistent with other researchers who have reported that most crimes
by intravenous drug users are generally not serious.

Dance says. "On the sort of information I obtained in 1989 [when she first
interviewed the Oswaldians and others], I could not predict which of the
Oswaldians were going to have problems with their heroin use.

"Much of my reason for hypothesising that they would be different from
other drug users I studied was based on my close contact with a group of
people who were mostly in the early stage of their drug using careers and
also on their idiosyncratic invention of a 'Patron Saint' of drug use. When
comparing the Oswaldians with other people who use illegal drugs over time,
and at a later stage in their careers, there was little evidence to support
my hypothesis.

"My research with the Oswaldians began at a time when they associated drug
use with pleasure. I would like to have been able to report no changes in
this, but, as I have shown throughout the thesis, a variety of transitions
in drug use have occurred since my first contact with the group.

"Very few Oswaldians were able to maintain all their drug use, particularly
their heroin use, at a non-dependent level.

"For some Oswaldians, the problems associated with their increase in heroin
use led them to seek their first treatment. Oswaldian group-members who
stopped their heroin use, the few who managed to maintain their use at a
non-dependent level, and those who reduced their illegal drug consumption
demonstrate a concern for friends who have experienced problems with their
heroin use.

"Many Oswaldians have entered into long-term relationships, have become
parents for the first time or re-entered tertiary education.

"Despite the substantial changes in these realms, most Oswaldians, whatever
their level of drug use, still interact at social occasions.

"Increasingly, Oswaldian gatherings are becoming more mainstream, being
occasions such as dinner parties, weddings, engagement or birthday parties.

Thus, though the reasons for celebrations have changed, the friendship
links within the group have largely been maintained during the 10 years
since I first made contact with these people, who invited me into their
everyday lives."