PUBLIC AND POLITICIANS WRESTLE WITH DRUG OPTIONS

JOHN Howard prides himself on his instinct for what the ``mainstream''
thinks. But the mainstream is changing. Even the Sydney shockjocks who
viciously campaigned against the ACT's proposed heroin trial in 1997 are
having a rethink.

Detailed research by media monitoring company Rehame Australia provided to
The Age compared the attitudes of talkback callers and radio commentators
in 1997 and 1999. The results showed remarkable shifts in opinion about a
heroin trial - a small thing in itself, but a symbol of whether Australia
perseveres with its present drug policies (perhaps with a little tinkering)
or decides that its stance is doing more harm than the heroin.

It's not that talkback callers were in favor of a heroin trial, but they
were no longer instinctively hostile - 42 per cent were now ``neutral''.
The six radio commentators who dominated talk on heroin in Australia during
the ACT proposal started to agonise early this year. ``I might have changed
my view about that (a heroin trial),'' John Laws told his huge national
audience recently. ``I think that Prime Minister John Howard is more
concerned about the sensitivity of his constituents than he is about those
people who are involved with heroin.''

Conservatives have been through a painful reeducation about heroin. There
is now pressure from senior police, state leaders and those who work with
drug users for a radical change in policy, away from what the director of
Alcohol and Drug Service at St Vincent's hospital, Dr Alex Wodak, describes
as Mr Howard's ``ideological prism'' and towards more evidencebased policy.

A heroin trial, which noone pretends would ``solve'' the drug problem, is
the flashpoint of the debate. Is Australia prepared to risk bold steps, or
do we persist with familiar strategies until they start working?

Yesterday, Mr Howard was firm: ``We're not trying to bob and weave on this
... we are against a heroin trial.'' Such a trial has been discussed in
Australia as far back as 1979, but Mr Howard argues that it would send a
message to the community that heroin is not as bad as people had been told.
``My Government is determined to prevent a new generation of users and
addicts emerging,'' he said when launching his drugs strategy in late 1997.

There might be slight shifts in emphasis, but the Howard Government's
threepronged approach - law enforcement, education and rehabilitation - is
essentially more of the same.

The results of what has been called the longest war this century have been
disappointing, to say the least. Globally, international prohibition on
illicit drugs led by the US has failed to convince peasants in desperately
poor countries such as Burma, Afghanistan and Colombia that they should
switch to more unprofitable crops, and in the decade since 1985, land
devoted to opium poppies has trebled.

The profits are worth the risk to traffickers, with illicit drugs estimated
to have an annual turnover of $US500 billion, or 10 per cent of world
trade, making it a bigger global industry than oil and gas, food, and the
textiles and clothing industries.

Prohibition has failed because the profits - up to a 22,000 per cent markup
- - are too great for all the police in all the world to stop.

In Australia, an estimated $500million a year is spent on drug law
enforcement, but has failed to stop heroin entering Australia - police
estimate they seize about 10 per cent - and heroin is now more available
and cheaper than ever before. Increased penalties for using and dealing in
drugs have utterly failed to dampen demand.

The economic costs are massive and increasing - an estimated $1119.7
million in 1992, a jump of 23per cent in four years. Apart from law
enforcement, up to 80 per cent of prisoners are either convicted of
drugrelated offences or are addicted when they enter jail, with police
blaming the drug epidemic for around 70 per cent of all crime in Australia.

The huge profits also means corruption. The NSW royal commissioner Justice
James Woods stated that drug trafficking was ``destroying police on a state
and federal level, and there is absolutely no reason to think it stops at
NSW boundaries''.

The reformers say ``enough''. Give up the moral judgments about heroin use
and face the reality that the enemy has won the prohibition war.

The key debate about where Australia should go with heroin now is between
those who believe the drug itself is the problem, and those who believe
heroin's illegality has caused much greater problems, physically,
economically and socially. A heroin trial - useful only for small groups of
intractable addicts at great risk of overdose or death - would be an
acknowledgement that demonising heroin has been counterproductive.

Both groups call themselves ``harm minimisers'', but the supporters of
Australia's existing approach say drug use is the evil, and Australia's
efforts, with more money and effort, will work in time. ``I believe we can
change the culture and the acceptance of the attitude that it's inevitable
that people are going to use drugs, because I don't think it is,'' said the
Salvation Army's Major Brian Watters, Mr Howard's key drugs adviser. ``We
have to engender in our society a clear message that we will not tolerate
you using drugs (and) we will do everything in our power to stop you doing
it.''

Major Watters has doubts about methadone maintenance - the linchpin to date
of Australia's ``harm minimisation' approach to heroin treatment - because
people are encouraged to stay on it as long as they want. While methadone
reduces crime and slashes deaths, it doesn't get users off drugs.

``I know people who have been on methadone for 10 or 12 years and there's
no attempt by anybody to encourage them from reducing their levels of
use,'' says Major Watters. For similar reasons, he opposes giving heroin
addicts heroin: ``There are worse things than death when it comes to
addiction,'' he reportedly said of the ACT proposal.

Dr Wodak, the president of the Australian Drug Law Reform Foundation, calls
Major Watters' stance ``pharmacological fundamentalism''.

Those pushing for change don't like drugs, but accept they are here to stay
and believe we have to learn to live with them and reduce their harm, just
as we are becoming more successful in reducing the harms of alcohol and
tobacco.

The reformers now include some big names, including the former US Secretary
of State, Mr George Schultz, who said in 1990 that ``the conceptual base of
current programs is flawed ... we need at least to consider and examine
forms of controlled legalisation of drugs''.

The reformers' aim is to keep addicted people healthy and alive until they
decide to get off heroin by which ever harm minimisation approach is best -
whether it be methadone, new treatments, multiple detox attempts or, if
necessary, the prescription of heroin for maintenance.

``I would argue that the really critical issue is not whether there are
217,000 with heroin in their bloodstream or 210,000,'' says Dr Wodak. ``To
me, the really critical issue is whether 600 die from heroin or whether 100
die from heroin. What's happened to the death rate in Switzerland (where a
heroin prescription trial started in 1994) is a dramatic decline in deaths
from heroin - 419 in 1992 to 209 in 1998 ... we've gone in the reverse
direction.''

It is clear that heroin's illegality - rather than the drug itself - causes
the majority of the harm. The purity of illicitly sold drugs is always
unknown, education about safe use is limited, and crime and corruption is
out of control because it is prohibited.

Dr Gabriele Bammer, a researcher at the Australian National University and
an internationally recognised heroin expert, was the key researcher in the
defunct ACT heroin trial proposal and is a moderate in the debate.

She is not in favor of legalisation of heroin - not that Australia could do
it anyway - because the margin of error between a safe and an unsafe dose
of heroin is too small and Australia already has two legal drugs that cause
great damage.

She says a key debate Australia has avoided is the basic one about why some
drugs are legal and some are not, and accepting that those decisions are
historical and cultural, and not necessarily rational.

Medically prescribing heroin to some addicts - after a scientific trial -
could break the criminal and corruption cycle and certainly save lives, she
argues. ``People often raise the argument, well, why don't we give alcohol
to alcoholics,'' Dr Bammer says.

``The reason is because alcohol is a very harmful drug (and) it would place
doctors in a very difficult position to be doing harm. If a doctor
prescribes heroin to a person who is already dependent they are not doing
harm to that person. The only way they can go is up.''

What is more likely is that Australia might wait to see the results of
other international trials. Switzerland is continuing to prescribe for some
addicts and Dutch trial results will be known soon. ``(Waiting) would be a
very Australian approach to take, I think,'' Dr Bammer says wryly.

Australia could not legalise heroin, or even cannabis, and regulate them as
we do legal drugs, because of a complex series of international
conventions, backed by the United States, which take a hardline
prohibitionist approach. The nation's ability to set its own illicit drug
policies has been severely curtailed.

But provisions in the UN conventions to ``limit exclusively to medical and
scientific purposes'' the production, manufacture and use of illicit drugs,
almost certainly would permit a heroin trial and medical prescription of
heroin if the Federal Government backed it.

``The idea,'' says Dr Wodak, ``would be to see whether it is a greater evil
for this drug to be prescribed by doctors than it is that these drugs be
made available by the Mafia. I don't think it would be hard to work that
out.''

One good thing about the heroin trial debate is that it has created a
climate in which there is greater enthusiasm to try new treatments. Until
naltrexone was approved earlier this year, Australia had just one drug to
treat heroin addiction - methadone - and there was little interest in new
ideas. There are now 10 trials under way across Australia of three other
new treatments, some of which look promising for addicts for whom methadone
is unsuitable, such as young people.

Australia is also looking hard to try to divert heroin users away from the
criminal justice system. It is believed that Mr Howard will put to the
Premier's Conference tomorrow a national scheme to divert smalltime heroin
users into alreadystretched treatment programs rather than the courts and
jail. Australia could also take Victoria's lead to send firsttime users to
compulsory counselling instead of court, an approach the chief commissioner
of police, Mr Neil Comrie, believes has already saved lives.

Also in Victoria, the Deputy Chief Magistrate, Ms Jelena Popovic, has been
overseeing a $500,000 trial which offers nonviolent offenders treatment at
the time of bail rather than waiting for sentence.

Ms Popovic says that 85 per cent of court time is taken up with drugrelated
offences and the trial was one way to break that cycle. ``It's not a soft
option,'' she said. ``It's actually them agreeing to a much more rigorous
time on bail than if they didn't agree.''

About 70 people are now on the program and Ms Popovic is ``cautiously
euphoric'' about early results. ``(It's) not just that people look much
healthier. They maintain their motivation. They're going regularly to their
appointments. The rate of reoffending among this group is much lower than
one would normally expect.''