[Opinion]

LET'S LEARN FROM THE SWISS ON DRUGS

LAW enforcement is an ineffective way of solving serious social
problems. Billions of dollars spent on police, courts and prisons have
failed to control Australia's illicit drug problem. We should have
known better. After all, the failure of all the king's horses and all
the king's men to control property crime in poverty-stricken England
200 years ago led directly to the establishment of a prison colony in
Australia.

But suddenly drug courts have emerged as the answer to Australia's
apparently intractable illicit drugs problems. Returning from a recent
visit to the United States to investigate drug courts, the Sydney
barrister Ross Goodrich spoke encouragingly of the new American
phenomenon. Impressive results are claimed from this attempt to
combine the pressure of the criminal justice system with the
behaviour-changing ability of drug treatment. The Premier, Bob Carr,
was sufficiently impressed to quickly announce that NSW would move
soon to establish drug courts.

Combining health and law-enforcement approaches to illicit drugs has
some appeal. If prisons are an expensive way of making offenders
worse, drug treatment is an inexpensive and relatively effective way
of helping many to abandon (drugs & crime).

The Rand research group in the US showed a $7.48 return for each
dollar spent on cocaine drug treat-compared to only 17 to 52 cents in
the dollar from different kinds of law enforcement. Also, it was the
understanding reached between health and law enforcement in Australia
in the l980s that allowed needle-exchange and methadone programs to
flourish, preventing an epidemic of HIV among injecting drug users
that would have spread to the general community. Since then, the two
sectors have quietly been collaborating much more, realising that
neither could achieve its aspirations acting alone. In response to
increasing drug-related crime and corruption, State police
commissioners recently recommended switching the emphasis on illicit
drugs from punishment to rehabilitation.

The community is, of course, very concerned about increasing numbers
of illicit drug-related deaths, crimes and corruption. Roughly half
the 700 drug overdose deaths in Australia each year occur in NSW. So
there is a strong case for NSW to consider seriously any new approach
which has a reasonable chance of working. Should drug courts be added
to the list of innovations we should consider along with injecting
rooms and prescribed heroin?

Dr Steven Belenko, of Columbia University, New York, concluded in a
recent review that "none of the drug court evaluations to date have
been comprehensive enough and of long enough duration to enable a full
calculation of the long-term costs and benefits of drug courts". Drug
courts may well be an advance. But we should keep an open mind on
their pros and cons until more independent research becomes available.

In the meantime, there are many warnings that drug courts may not turn
out to be the long-desired leap forward. There have been previous
attempts in Australia to blend drug treatment and law enforcement. The
NSW Drug and Alcohol Court Assessment Program (DACAP) in the 1980s was
one of many less than successful attempts. Any 'success" of the drug
courts in the United States is a direct result of closer supervision
of drug treatment and related services. We could provide this closer
supervision in Australia without the expense of setting up a new court
system. There is also the concern that drug courts are really an
attempt to reinvent failed law enforcement, disguising an ineffective

wolf in sheep's clothing. Drug users are not the only ones to have
difficulty kicking an unproductive habit

Another risk is the concern that treatment under coercion will crowd
out a chronically underfunded voluntary treatment sector. "Perverse
incentives" could develop so that young drug users seeking help to
regain control of their lives could be turned away unless they have
committed enough crimes to qualify for treatment. In Australia, drug
treatment including, detoxification, drug-free counselling and
methadone has never been funded adequately. Entry to detoxification
and methadone programs often requires repeated applications. Many drug
users give up in frustration after a few unsuccessful phone calls.
Most government and non-government agencies struggle to provide a
reasonable service. Although governments generate billions of dollars
from alcohol and tobacco excise, less than 1 per cent of health
expenditure is allocated to alcohol and drug treatment. Methadone
programs are subjected to relentless ill-informed attacks despite
compelling evidence of effectiveness, safety and cost-effectiveness
and despite having a singular ability to attract and retain large
numbers of drug users seeking help.

If drug courts are to be introduced in NSW, substantial new funding
will be needed for treatment programs. Our political leaders will have
to be prepared strongly to support and fund effective, evidence-based
treatments.

Where will the new funding come from? The most obvious source is the
criminal justice system. A million dollars will pay for the cost of
arresting, prosecuting and jailing 17 offenders for 12 months. The
same sum could pay for 133 offenders diverted for 12 months to
drug-free rehabilitation, or 625 treated in a methadone clinic or
1,425 pre-scribed methadone by a general practitioner.

One of the real benefits of the current voluntary treatment system is
an in-built flexibility. It takes time to correct a childhood of
sexual abuse or deprivation, deficient education or years of
self-neglect, prolonged unemployment and aimless living. The slow and
steady pace of the drug treatment tortoise is usually effective after
a while but impatient attempts to force quick, heroic results all too
often end in spectacular failure. Can drug courts be flexible enough
to accept and build on gains when they happen? If an offender before a
drug court has made great strides by getting a job, starting to pay
off debts and healing family rifts, but still has a few positive urine
tests, a wise drug court would allow extra time. Will that be possible?

There are sound reasons for diverting certain drug offenders from the
criminal justice system into supervised treatment. Drug courts may
have some role to play in a comprehensive and more effective approach
to illicit drugs in Australia. But it will not be easy and there are
real risks. If our aim is to reduce deaths, disease, crime and
corruption, why not use as a model Switzerland, where real progress is
being made; rather than the US, which spends tens of billions of
dollars but has increasing numbers of deaths, rampant HIV infection
and very high crime rates?

Illicit drug use needs to be treated primarily as a health rather than
a law-enforcement issue. Drug courts may encourage our decision makers
to further delay the inevitable.

Dr Alex Wodak is President of the Australian Drug Law Reform
Foundation

Checked-by: Rich O'Grady