DEAD FOOLISH, BUT STILL ALIVE

So precarious is the NSW Government's drug policy that it takes very little
to upset it, if only temporarily. The publication in The Sun-Herald on
Sunday of disturbing photographs included one of a child being helped to
"shoot up" with a needle supplied under the NSW needle exchange program.
This so unnerved the NSW Health Minister, Dr Refshauge, that he suspended
the program in the Redfern back street where the photographs were taken.

The needle exchange program generally has not been affected, and it is safe
to assume that it will soon resume in Caroline Lane, Redfern. The incident
has done little except panic Dr Refshauge and revive the painfully
inconclusive arguments over how to deal with the impossibly complicated
problem of drug abuse.

However shocking the images of children self-administering illegal drugs,
using State-supplied equipment, they provide no new insight into the social
problem they reflect.

No new policy direction is indicated.

And Dr Refshauge's action in suspending the needle exchange program in
Caroline Lane has been seen generally not as a sound, positive move but as
a negative reflex, bound to be overruled.

The hard fact is that there is no such thing as a workable drug policy,
simple and free from messy contradictions such as those so easily exposed
in Caroline Lane. It seems absurd that the State should on the one hand
strive to suppress the trade in illegal drugs yet on the other hand seem to
facilitate their use by supplying addicts with needle, spoon, water and
swabs under the needle exchange program.

The contradiction, of course, is not simple.

It is absolutely necessary that the importation and trafficking in illegal
drugs be prevented and that offenders be caught and punished with the full
weight of the law. Illegal drugs should remain illegal.

Experience shows that the illegality of, say, heroin, is often the first
lever that can be applied effectively to draw a user into effective
treatment for addiction and eventual rehabilitation.

The line between trafficker and user is not always clear.

But it is clear that users of illegal drugs taken intravenously not only
risk harm to themselves but present a potentially immense public health
problem.

The risk of life-threatening HIV or other serious infection through the use
of dirty needles is high and extends beyond the immediate intravenous drug
user. Needle exchange schemes are fully justified because they reduce the
immediate and potential risks of infection.

As the director of the Alcohol and Drug Service at St Vincent's Hospital,
Dr Alex Wodak, wrote in the Herald yesterday, there is "abundant evidence
of high quality, from different countries, using different research
designs, which has demonstrated convincingly that needle exchange programs
substantially reduce HIV infection among injecting drug users without
increasing drug use". Dr Wodak quotes the founder of the first needle
exchange program in the United States as saying: "We cannot stop them being
silly, but we can stop them being dead."

By now, there really should be no dispute about the need, regrettable but
compelling on broad public health grounds, for needle exchange programs.
Addicts will inject whether clean needles are supplied or not. A needle
exchange program ensures less infection and fewer deaths.

The related question of "shooting galleries" - designated rooms where
addicts can inject and be sure of prompt medical attention if they need it
- - is more controversial. But the idea should be tried, as the 1997 Wood
Royal Commission recommended, especially if it can be linked to treatment
and rehabilitation. The Opposition should not reject it out of hand.