WAGING A WAR ON DRUGS

[Ian Mathews says that harm minimisation is a far more effective approach
to substance abuse than the Government's 'get tough' measures to achieve
its zero-tolerance target.]

IT IS unlikely that the Prime Minister has had an opportunity to read Drug
Use in Australia, but even if he had it is doubtful he would change his
rigid views on how to tackle Australia's illicit and legal drug issue.

This latest compilation of research and comment on drugs has, as its
sub-title, A Harm Minimisation Approach, and, thus, is probably damned in
Howard's eyes on two grounds. The first is that Howard's view of harm
minimisation, despite allocating funds to its practitioners, is one of
zero-tolerance of illicit drugs. The second is that Howard has demonstrated
a marked reluctance to back research that might question his established
view.

Whatever our individual views on illicit drugs, we are all firm believers
in 'harm minimisation'. We teach our children to be careful with the hot
barbecue, to cross the road with caution, to swim where it is safe or with
a responsible adult - all exercises in harm minimisation.

Even when we suspect that our children may indulge in illegal or unwise
behaviour - riding bicycles in the dark without lights, mixing drinks at a
party, or being promiscuous - wise parents find ways of dropping cautionary
hints that might fall on fertile ground.

Harm minimisation, in the context of illicit and legal drugs, is the solid
foundation on which drug-abuse victims can build their future lives.
According to contributors to Drug Use in Australia harm minimisation
involves demand reduction, supply reduction, and, probably most
importantly, 'environmental responses that aim to assist people using drugs
to do so in the safest possible way'.

Demand reduction persuades people not to take drugs; supply reduction
simply aims at stopping the trafficking of drugs through regulation and law
enforcement - both of which the 'Get Tough of Drugs' policy seeks to
achieve. The third element, safety while using, is not an option in the
Government's new regime.

The authors of Drug Use in Australia: A Harm Minimisation Approach,
recognise that the 'Just say no' approach achieves nothing if the person is
unable to just say no. What the 24 contributors to this book have done in
their individual ways is to say, 'Well, if you are going to take drugs at
least take these precautions'.

Most of the authors and editors work at the Turning Point Alcohol and Drug
Centre, Fitzroy, which is affiliated with the University of Melbourne and
St Vincent's Hospital. For purist prohibitionists harm minimisation is
regarded as a cop-out at best and as an encouragement at worst.
Prohibitionists, however, refuse to recognise that their 'solution' of
harsher sentences, increased surveillance and law enforcement - the 'get
tough' approach - has not worked and cannot work. The elementary fact is
that prohibition makes the commodity being illegally traded increasingly
valuable.

Harsher prison terms, more police on the beat, more Customs on the wharves
and at airports merely increase the overheads. The price goes up, the
dependent user pays more and to do so, steals more or increases the rate of
prostitution.

Harm minimisation accepts, as Ernie Lang notes in the opening chapter, that
man has been taking drugs in one form or another for the past 9500 years,
according to archeological evidence. As a species, humans are hooked
whether it be on mushrooms, coffee or heroin, alcohol or tranquillisers.

We are, however, the only species to set (and change) behavioural rules.
Thus alcohol can be illegal in the US for years and then return to
legality. Similarly, opium, once legal in Australia has become outlawed.
Illicit drugs themselves flow in and out of fashion in much the same ways
as legal drugs. Fashion is dictated by availability, peer pressure, price.
While cannabis remains the most popular illicit drug, heroin, cocaine and
amphetamines move up and down the scale of popularity in much the same way
as riesling, chardonnay or light beer.

Harm minimisation has to be a constantly changing approach, unlike the
prohibitionist's 'thou shalt not'. For instance, patterns of alcohol abuse
have changed to make binge drinking and mixing alcohol with other drugs
greater problems than overall or chronic alcohol consumption. Thus harm
minimisation has to respond to such new patterns. Abuse of prescription
drugs tends to be concentrated among women and older people and so demands
a concentration of harm minimisation among those groups.

In monitoring harm, as opposed to criminal activity, contributors
Anne-Marie Laslett and Greg Rumbold note that the use of cannabis is no
greater in South Australia and the ACT where personal consumption has been
decriminalised, than in those states where use is still a criminal offence.

Bearing in mind that most drug-related deaths are caused by tobacco and
alcohol, the writers attempt also to define 'harm' caused by drugs in the
widest possible sense, including associated disease, the impact on
families, work, criminal activity and loss to the economy. Plainly 'harm'
has a much wider focus than the narrow law-and-order approach.

They conclude, 'tobacco, alcohol and pharmaceuticals are in fact associated
with greater mortality and morbidity, and more violence, accidents and
crime, than that which occurs with illicit drugs.'

The book examines how some drugs have social acceptance while others have
been demonised, the dividing line being their legality, not their intrinsic
properties or even the harm they do when abused. Illegal drug users are
categorised as sinners, sick or social victims with attendant theories of
why people turn to drugs. Few accept that most do so because they enjoy
their effect - just as smokers and social drinkers enjoy their drugs.

Michelle Keenan contributes the unexceptional idea that controlled use of a
drug changes with social environment. And if such control works for the
smoker and drinker (both of whom may abuse their drug use occasionally) why
shouldn't controlled use of currently illicit drugs also work?

A zero-tolerance regime, however, offers no hope for the user of any drug
and probably encourages abuse.

A new emphasis is to be placed on education under the Prime Minister's
policy. Keenan argues for peer-based education because it has been far more
effective than education programs that talk down, preach or theorise. In
her chapter on adolescents, Peta Odgers argues that peer-pressure
'reputation' militates against education programs extolling abstinence or
self-worth.

She notes that, far from the stereotype 'drug pusher', most young people
are introduced to drugs by friends of the same age. Their reasons are
direct pressure, modelling, social rewards or social approval,
opportunities for use and that drug taking is 'normal'.

The book has a valuable chapter on alcohol and Aboriginal society by Jenny
Davis. Nadine Ezard contributes a chapter on women's drug use and the need
to recognise gender in harm minimisation.

SADLY Trevor King's chapter on drug policy has been over-shadowed by the
Government's increased emphasis on law and order. King writes, 'Current
debate about illicit drug policy is also addressing the feasibility of
alternative strategies such as the decriminalisation or legalisation of
some, or all, illicit drugs.' Not in Howard's vision splendid.

In his chapter on limitations and possibilities, Nik Lintzeris makes the
point that harm minimisation is cost-effective. 'Some of the most telling
criticisms of the law-enforcement oriented 'war on drugs' approach are that
it is incredibly expensive, that it is not particularly effective with
regards to reducing the health costs or the social and economic costs of
drug use and, indeed, that it escalates overall expenditure through the
spiraling costs of an ever-growing criminal-justice system.'

Drug Use in Australia has been published at a time when its messages are
all the more necessary, given that harm minimisation - whatever financial
boost the policy has just been given - is now running a poor second to law
enforcement.

Prohibition, increased emphasis on zero tolerance, and added discriminatory
drug-law enforcement all ensure that the illicit market for drugs will
flourish. As long as it does, harm minimisation is probably the only way
many young drug users and abusers will stay alive.

Drug Use in Australia: A Harm Minimisation Approach, edited by Margaret
Hamilton, Allan Kellehear and Greg Rumbold, is published by Oxford
University Press. 330pp. paperback. rrp $34.95.

Ian Mathews is co-author with Russell Fox, of Drugs Policy: Fact, Fiction
and the Future, The Federation Press, 1992.