SMALL DOSE OF HUMANITY A BIG PART OF THE CURE FOR OUR DRUG ILLS

OUR drug policies are inhuman, ineffective in achieving their stated goals,
damaging in uncountable ways to the health of individuals and of society.
They are enormously costly and corrupting. They don't work.

So why do we not only continue with these policies but even extend them? Why
do we attack strategies of proven effectiveness and humanity, including
methadone maintenance and needle and syringe distribution? Simple. We do not
care.

Prohibition rests on a view of drug users as subhuman and outside society.
The practice of prohibition reinforces these views. Internationally, drug
users suffer human rights abuses from the most severe _ torture and death _
to daily irritations. They are discriminated against on every level and lack
access to services we take for granted. The first and most fundamental step
needed to tackle the problems around illicit drug use is to re-admit drug
users to the human race. If we can refocus attention away from the demon
heroin and on to the lives and desires of the people concerned _ and if we
can look for what works rather than what is electorally popular _ then we
will be devising very different approaches that will help.

So where do we go? Programs of heroin replacement or opiate substitution
have been tried in England, Italy, the Netherlands and Austria through the
middle years of this century. All suffered from a lack of evaluation; all
died as a result of political factors rather than any demonstrated
ineffectiveness. Anecdotal information suggests those programs were probably
effective. Proper clinical trials are under way with alternatives to
methadone, including buprenorphine, long-acting oral morphine and a variety
of longer-acting methadone. The aim is not to replace methadone, but to
supplement it _ methadone is not appropriate for everyone, and having a
range of options broadens the potential client group.

The results of the Swiss trial of heroin prescription are well known _ large
decreases in infections with blood-borne viruses and involvement in crime
and violence, and major increases in socialisation, as measured by the
ability to find and maintain employment. Following the Swiss lead, the
Netherlands and Germany are beginning trials of heroin on prescription.

Substitution or replacement therapies for other illicit drugs have not
received nearly as much attention. Prescription of oral dexamphetamine as a
replacement for amphetamines has been used for several years by a number of
British programs, chief among them a program run in Portsmouth. This program
has found that of clients receiving oral dexamphetamine, more than half
stopped injecting, all decreased sharing, and most decreased the amount of
amphetamines used.

A trial is being started in Australia. This should not obscure the fact that
in relation to treatment for people who have problems with illicit
stimulants, we have little to offer them that works.

It is possible to eradicate consumption of a drug from a society. In 1949
China had 20 million opiate-dependent people; by 1952 it had none. But the
costs of the necessary strategies are too high for any humane society to
contemplate. The lesson is, therefore, we must learn to live with drugs.

Most of what is done in the field of illicit drugs has never been properly
evaluated in terms of effectiveness. The main exceptions almost all come
from the harm reduction approach _ in particular, methadone maintenance and
needle exchange. Almost all law enforcement approaches have either never
been demonstrated to achieve their goals, or have been demonstrated not to.

It is vital to have a clear definition of our goals. If we accept the
international and historical evidence that drugs are here to stay, then our
goal must be to ensure that the use of those drugs causes the least possible
harm. If we state this clearly, we can move away from harmful approaches to
drug use towards that which has been demonstrated to work.

We are now in a nightmare mess of opinion, little of it based on fact. The
international experience shows us the importance of evaluation and
monitoring; but it also shows us the limited usefulness of scientific
evidence in the face of political ideology. I arrived in the US in 1988 to
work on AIDS among drug users to find two states with successful compulsory
seat-belt legislation repealing those laws on the grounds of interference
with private liberty.

A similar situation exists in the US with methadone maintenance and needle
exchange, and we are headed in the same direction. Overseas experience shows
us that humanistic harm reduction approaches do work.

The international experience also shows us that the drug war and ``zero
tolerance'' approach not only does not work, it causes enormous damage to
individuals and society.

We must concentrate on stopping or decreasing the damage associated with the
use of illicit drugs. The use of the drugs is a secondary concern, for two
reasons; the drugs won't go away and if the use of a particular drug is
causing no harm to the individual or society, or a level of harm which
society judges to be acceptable, then it is not of concern.

We must canvass all possible strategies towards a solution. The
incarceration and ruination of the lives of young Australians, and the
continuing death from so-called heroin overdoses, should remain on
everyone's conscience _ especially that of John Howard.

We know what to do. We just lack the heart, and the will, to care for our
young people.

Checked-by: Melodi Cornett