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CHAPTER 7 - HARM MINIMISATION : CONCLUSIONS

Introduction

7.1 No approach to the use of drugs of dependence and psychotropic substances will ever achieve a drug free community. The current preoccupation in the United States with achieving a drug free community has been supported by substantial financial resources but the results have fallen far short of what was hoped. Risk elimination rarely works.

7.2 Conversely, policies which give priority to the minimisation of harm generally have been successful. The most impressive success of harm reduction has been control of the spread of HIV, mainly through the introduction of needle exchange. Similar models have been adopted with similar health, social and economic benefits in the Netherlands, Switzerland, England and Australia. Although caution is appropriate when extrapolating from one country to another because of cultural differences, Australia can certainly still learn much from other countries.

Expansion of methadone programs and needle exchanges

7.3 Expansion of needle exchange programs and the introduction and expansion of broad based methadone programs throughout Australia are the most urgent harm reduction steps which Australia needs to consider. Access and choice needs to be increased. Methadone programs should also be extended in prisons and needle exchanges provided for inmates notwithstanding the likely problems of initial acceptance. The Hepatitis C epidemic rages beyond control. A future generation will inherit substantial health and cost problems from this epidemic. This epidemic and increasing deaths from drug overdose seem part of a world wide trend.

Rehabilitation

7.4 The number of places in rehabilitation programs in Australia is still limited; this needs to change dramatically. Furthermore, the continual availability of places for those who seek abstinence based programs is vital. Support of healthy lifestyle choices should not be denied.

7.5 Maintenance based rehabilitation programs also need to be considered and evaluated as pilot programs. Harm may be reduced by decreasing the quantity of drugs taken, ensuring safer methods of administration and by encouraging healthy living skills.

7.6 Adequate access to methods of rehabilitation preferred by an individual drug user should be available. This will enable real choices to be made by drug users about their own health, consistent with the approach adopted by the World Health Organisation in the Ottawa Charter of 1986.

Education

7.7 The health discourse on illicit drugs is in competition with an approach dominated by law enforcement. For decades, the law enforcement approach has dominated.

7.8 A sustained effort to communicate with, and educate the community objectively about illicit drugs is a prerequisite to long term and meaningful harm reduction. Community and school education programs achieve modest gains slowly rather than heroic gains rapidly. Education programs probably do impact on those who are least at risk but have less impact on those who are most at risk.

7.9 Some features make such programs more effective. There is no single response to addressing illicit drug problems through campaign information and education activities. Strategic responses must be multi faceted, integrated, coordinated and sustained. They must be based on truth, not myths. If they are untruthful, young people quickly ascertain this and do not believe nor heed the advice. Programs should not only emphasise individual aspects of health but also be based on respect for young people, public order and safety.

7.10 In the Netherlands, education programs are presented in ways to appeal to the young. One of their successful innovations has been to conduct preventive activities in places that youngsters visit when they go out, such as rave parties. In partnership with local government, police, health agencies and the nightclub owners, the activities include giving accurate information about drugs, advice on how to reduce the risk of using drugs and testing the purity of street drugs. Parallel to these activities are those aimed at the parents of these youngsters, often held in the same nightclubs.

Scientific research

7.11 It is critical to the success of harm reduction that a long term commitment be made to adequately support rigorous scientific studies into the treatment of drug users and the misuse of drugs of dependence and psychotropic substances, including alcohol and tobacco.

7.12 A consistent theme of most of the Parliamentary Inquiries and Royal Commissions including Marriott (1971), Baume (1977), Sackville (1979), Williams (1980), Rankin and Kerr (1981), Cleeland (1989) and now Penington (1996) has been a concern about the quality of much of the data available. Properly evaluated scientific data is needed upon which to base good policy decisions and to design effective eduction programs.

7.13 A trial of controlled availability of heroin was first mooted by the ACT Legislative Assembly Select Committee on HIV, Illegal Drugs and Prostitution in 1991. The National Centre for Epidemiology and Population Health at the Australian National University has been conducting research on the feasibility of a study since then and concluded that a formal research study is justified, could be implemented and would produce valuable information. Approval to begin this study is still awaited although a number of other countries have commenced similar projects or are intending to do so.

Abolition of criminal sanctions for personal drug use

7.14 Sending people to prison because they have been found in possession of a quantity of illicit drugs consistent with personal use or self administered banned substances, is an expensive way of making a difficult problem worse. Prisons are often the place where they learn how to commit income generating crime with less risk of detection. At the heart of the problem is the definition of drug use as a law enforcement matter rather than a health concern. Criminal sanctions require considerable financial resources. Apart from police time, the court, legal services and corrective service costs are formidable. If this approach was effective despite these costs, communities and political leaders could rest more easily. But even worse, while evidence of effectiveness is hard to identify, unwanted complications such as police corruption are all too obvious.

7.15 Why do we prosecute someone for what is after all a victimless crime? Criminal sanctions reduce opportunities for future employment, stability in life and do not appear to reduce dangerous drug use. They seem to make drug use more dangerous without deterring would be users from initiating or continuing drug use. In fact, prisons push many young people into further and often more dangerous drug use.

7.16 In Australia today, charges for drug use and possession are more common than those for trafficking. In Victoria there are five times as many people who face charges where possession or use of cannabis is the most serious offence than those whose most serious charge relates to trafficking. Although it is not current policy to pursue drug users by preference, this policy is not uniformly carried out in the community and drug users may be easier to apprehend than drug traffickers.

7.17 In the Australian Capital Territory, South Australia and the Northern Territory, personal use and possession of small amounts of cannabis can be expiated through an on the spot fine. Although this was implemented in order to redirect personal users away from the courts and avoid criminal records, the net effect has been an increase in targeting by police of the more visibly disadvantaged. A disproportionate number of unemployed, young, homeless, migrant and aboriginal people are fined, often more than once and then find themselves in trouble when they cannot or do not pay the fine.

7.18 The Victorian Premier's Drug Advisory Council has recommended that personal use of small amounts of cannabis should not be regarded as an offence. The police have much more important tasks to perform than pursuing individuals because of their personal drug use.

Undermining the black market

7.19 The debate on drug law reform too often gets bogged down on a false choice between prohibition versus decriminalisation or legalisation. The truth of the matter is that there are many more choices than this even if people could agree on the meaning of these terms. A more constructive debate is one that focuses on alternatives which recognise that drug use is not going to go away. Perhaps we can learn from the system that operated in Australia until 1953. That was a system of controlled availability. Australia has changed a lot in those 40 years and we simply cannot wind the clock back as though nothing has happened. We need schemes which are properly researched and evaluated at every step.

7.20 One of the most attractive features of a controlled availability scheme is that it would undermine the black market. The immense profits of the black market not only contribute to the death and illness of many people and promote corruption in our police forces, they are also the main incentive for expanding the supply and distribution of illicit drugs and the search for new consumers. As Mr Raymond Kendall, Secretary-General of Interpol and Commissioner Johnson, Tasmanian Commissioner of Police, stated earlier in this report, the money to be made on the black market can make people "rich beyond their wildest dreams." No amount of interdiction, threat or punishment will deter those who know they can make enormous amounts of money from producing, supplying and distributing. The only effective way to destroy this network is to undermine their profits.

7.21 If some users have the opportunity of obtaining drugs at a clinic, it is probable that the price in the black market will fall. The need to raise large sums of money for those left in the black market will decline. They may even feed themselves and their children better. They will know the purity of the drugs they consume, will be better educated about safer methods of administration, will be less persuaded to try other drugs and they will have regular contact with an agency that will offer them real choices and assistance when they are ready to stop using drugs. And they will be alive and well enough to make that choice worthwhile.

7.22 Under prohibition, there are no controls on the black market. Our policies have handed over control of the illegal drugs market to the suppliers and dealers.

International Treaties

7.23 The International Treaties were designed to deal with drug trafficking. In the short term, Australia can achieve a great deal of harm minimisation through its policies and still remain consistent with these Treaties. In the long term, however, Australia will need to re-assess its commitment to the Treaties. While it is logical to have international treaties dealing with international drug trafficking, there is clearly a need for a diverse range of policies within each country to deal with their own drug problems.

A new approach

7.24 Just as Australia showed great foresight in adopting innovative policies, such as needle and syringe exchange programs, to deal with the enormous problems of the HIV/AIDS epidemic, the time is coming for us to show the innovative determination in developing policies that address the burgeoning increase in illicit drug use and associated health problems, corruption, crime rates and expenditure blow outs. Illegal supply meets a demand we have been unable to suppress. The time has arrived for a new approach.
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