MINDS WIDE SHUT ON DRUGS

If Australia is serious about harm reduction, illicit drug use needs
to be redefined as a health and social issue, writes Alex Wodak.

It is 15 years since Australia officially adopted harm minimisation as
its national drug policy. On April 2, 1985, Prime Minister Bob Hawke,
all State premiers and both chief ministers gathered in Canberra to
discuss Australia's response to illicit drugs.

The meeting was prompted by Hawke's campaign promise to act after the
1984 election. This in turn followed the revelation that the Prime
Minister's daughter had been injecting heroin. An official commitment
to harm minimisation formed part of the National Campaign Against Drug
Abuse (later retitled the National Drug Strategy).

What is harm minimisation? Has harm minimisation been effective in
Australia?

Harm minimisation originally meant focusing primarily on attempts to
reduce the adverse health, social and economic problems resulting from
drugs. Worrying about drug consumption was considered an important,
but secondary, issue.

Experience over several decades has shown that attempts to reduce the
adverse consequences of illicit drugs have generally been highly
successful (and inexpensive), while attempts to reduce consumption
have usually turned out to be ineffective and costly.

Rather than setting our sights on the utopian target of becoming a
drug-free nation, harm minimisation allowed Australia in the 1980s to
aim for and achieve HIV control. We went after and achieved a very
valuable silver medal rather than risking all chasing an impossible
gold medal.

In contrast, Congress passed legislation in 1988 requiring the United
States to become drug-free by 1995. Not only are illicit drugs in the
US now cheaper and more concentrated than ever before, almost half the
40,000 new HIV infections in the country each year involve the sharing
of injecting equipment.

Harm minimisation fits in well with the traditional public health
notion of never letting the best become the enemy of the good.

In May 1998, Prime Minister John Howard extravagantly praised zero
tolerance. Consumption itself, rather than the consequences of
consumption, became the new focus of concern.

Harm minimisation was redefined to include attempts to reduce the
demand and the supply of drugs as well as attempts to avoid harmful
complications of drug use.

This new definition confuses the situation. It equates two
fundamentally different but complementary approaches. The primary
intention of supply and demand reduction is to reduce consumption
(whatever the effect on consequences), whereas the primary intention
of harm minimisation is to reduce harm (whatever the effect on
consumption).

How does Australia respond to illicit drugs? According to a 1997
report of the UN International Drug Control Program, Commonwealth and
State governments in Australia spent about $640 million in response to
illicit drugs in 1992, of which 84 per cent was allocated to law
enforcement, 6 per cent to treatment and 10 per cent to prevention and
research.

It demonstrates that harm minimisation is not where governments have
been allocating funding. Hundreds of millions of dollars are spent on
customs, police, courts and prisons, while only tens of millions of
dollars are spent on needle syringe and methadone programs. Australia
has been funding a solid core of supply reduction with a thin veneer
of harm reduction.

Despite the generous funding for measures to restrict supply, the
availability of illicit drugs continues to increase. The purity of
street drugs increased from 57 per cent to 65 per cent in the last
financial year. Illicit drugs are now also cheaper than ever before.
The number of first-time heroin users jumped 50 per cent in the past
three years.

By any criteria, outcomes have been appalling and getting worse. The
six dea ths from drug overdose in 1964 increased to 737 deaths in
1998. This 1998 figure represents a 23 per cent increase on the 1997
figure. Drug overdose deaths represented 0.1 per cent of all deaths in
the 15- to 44-year age group in 1964 and 7.3 per cent of such deaths
by 1997. Drug-related crime is also growing rapidly.

The only bright spot has been the performance of harm reduction.
Commonwealth and State governments spend about $20 million a year on
needle syringe programs and about $30 million a year on methadone
programs. These harm reduction programs have kept HIV under control.

There is increasing evidence that the number of new hepatitis C
infections is starting to decline.

In a national survey of injecting drug users, 50 per cent were
infected with hepatitis C in 1997 compared with 63 per cent in 1995,
while the proportion injecting with shared equipment halved (from 31
per cent to 15 per cent) over the same period.

Overseas, 71 per cent of Swiss voters supported extending the heroin
trial in a 1997 national referendum. Switzerland was able to halve the
number of drug overdose deaths in the country between 1992 and 1998.
Crime has been reduced, HIV among injecting drug users is now under
control and public nuisance in the streets has declined.

These results were achieved by a comprehensive package of policies
including a dramatic expansion of the range, capacity and quality of
drug treatment, injecting rooms, a heroin trial and well-funded law
enforcement. But conservative Switzerland did not have a recalcitrant
prime minister to contend with. Prevention and treatment receives 50
per cent of total Swiss Government funding in response to illicit
drugs, with the other 50 per cent allocated to supply control.

Until it is easier to get help than it is to buy illicit drugs,
Australia is going to have a great and growing problem. Despite harsh
rhetoric and the expenditure of hundreds of millions of dollars a
year, we have been unable to make much impact on the drug trade with
punitive measures. But we have never tried making quality drug
treatment readily available, possibly shrinking the illicit drug
industry to a size which enables law enforcement to be effective. If
we are going to be serious about harm reduction in Australia, illicit
drug use will have to be redefined as primarily a health and social
issue.