AN INJECTION OF GOOD SENSE

In December the US Senate passed a bill, signed into law by President
Barack Obama just before Christmas, allowing the federal government for
the first time since 1988 to allocate funding to needle syringe programs.

The bill also removed an earlier restriction preventing needle syringe
programs from operating within 300m of a school, playground or other
sensitive facility.

The US is slowly shedding the extremes of its long-standing war on drugs,
as are other countries in Europe and South America.

Australia cannot remain isolated from these powerful international trends.

Obama has announced that henceforth US drug policy will be determined on
the basis of the evidence. Sooner or later an Australian government will
not just say this, but also mean it.

The US ban was introduced at about the same time that scientists and
researchers started getting powerful evidence that needle syringe programs
- -- previously known as needle exchange programs -- slowed HIV infections
without increasing illicit drug use. Initially the US even banned
scientific research evaluating the benefits and costs of needle syringe
programs.

More recently, the US government or its agencies have commissioned eight
major reviews of this evidence. Each review, and an international review
of the evidence prepared for the World Health Organisation, concluded that
needle syringe programs reduced the spread of HIV without lowering the age
of initiation, prolonging the duration or increasing the frequency of
injecting drug use. Needle syringe programs are also cost effective.

Rejection of this evidence in favour of zero tolerance helped to ensure
that the US population has continued to have by far the highest rate of
HIV in the industrialised world. For decades, the US also strenuously
opposed needle syringe programs in other countries. US delegates at
official UN meetings have been harshly critical of Australia's support for
needle syringe programs.

Fortunately, the Hawke, Keating and Howard governments continued their
strong support for harm reduction, including needle syringe programs,
although the Howard government combined private support with public
hostility. An internal review of the strength of evidence for such
programs' effectiveness, conducted for the Howard government, resulted in
that government providing, from 1999, financial support for state and
territory needle syringe programs.

Australia's response to HIV has deservedly attracted considerable
international praise. But Australia has still not implemented a needle
syringe program in any prison in the country despite abundant evidence
that injecting drug use and HIV, linked to needle sharing, occur in our
prisons.

Ending the ban on federal funding was one of Obama's early campaign
promises. A commitment to federal funding of needle syringe programs
appeared on the presidential website within days of his inauguration. But
with federal and state governments in the US mired in debt, spending on
needle syringe programs for voiceless, poor minority drug users has a very
low priority.

Yet a recent Australian study found that every $1 spent on these programs
saved $5 in healthcare costs and $27 dollars overall.

While Australia provides 32 million sterile needles and syringes a year to
a total population of 22 million, the US provides just 25 million sterile
needles and syringes a year to a population of more than 300 million.
Adjusting for differences in population size, the US has about 15 times
more AIDS cases per head of population than Australia. Clearly this
nation, founded by pragmatic convicts, has managed its HIV epidemic more
effectively than a nation established by puritans.

One by one the dominoes of the war on drugs are slowly starting to fall.
Future US generations will wonder why it took 21 years to overturn this
important symbol of that war. The historically tokenistic needle syringe
program in the US will leave a huge health, social and economic legacy for
future generations to deal with. A major lesson of this experience has
been the high cost of allowing policy on a sensitive issue to be
determined by intuition rather than clear scientific research findings.

The dominoes are also falling in other countries. The parliament of the
Czech Republic passed legislation that became operational on January 1. As
with a half-dozen countries in Europe and a similar number in South
America, persons in the Czech Republic possessing illicit drugs below
specified quantities will no longer risk arrest.

Last week a senior Canadian court denied an appeal by the federal
government that aimed to close a medically supervised injecting centre in
Vancouver operated by the government of British Columbia. The majority
decision was based on views about federal-provisional government
responsibilities. But the original judgment also recognised that
government obligations to provide effective health services for persons
who used legal drugs injudiciously should extend to persons who use
illegal drugs injudiciously.

The Kevin Rudd government has been relatively quiet about illicit drugs.
Rudd has let it be known that he favours a hardline approach. While this
may have fewer short-term risks for a famously risk-averse politician, in
the longer term policy based on scientific evidence promises better
results at lower cost and with fewer nasty side effects such as police
corruption.

As the rest of the world adopts drug law reform, hardline approaches will
be harder to sustain.