September 12th 2015


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Articles from this issue:

COVER STORY Arab world must help fix Syria and Libya crises

FAMILY AND SOCIETY They don't want diversity but to impose conformity

CANBERRA OBSERVED Young Nats jump aboard generational juggernaut

TRADE UNIONS Why royal commissioner declined to step down

RESEARCH Spin on the contraceptive pill a bit hard to swallow

LIFE ISSUES Singer escapes Fisher's net in euthanasia debate

HISTORY OF INDONESIA Suharto's "New Order" a period of stability

CULTURE Academic centres turn on Western civilisation

FAMILY LIFE A father's presence in the home: part II

OBITUARY Historian Robert Conquest documented the horrors of Stalinism

PUBLIC HEALTH UN knows: harm reduction does not reduce harm

FAMILY AND SOCIETY Witness to Marriage Day, August 1

CINEMA On the rough road away from loneliness: Last Cab to Darwin

BOOK REVIEW Good science, specious argumentation

LETTERS

The coup against Tony Abbott

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PUBLIC HEALTH
UN knows: harm reduction does not reduce harm


by Ross Colquhoun

News Weekly, September 12, 2015

In early 2016 the United Nations General Assembly is to convene a special session on the world drug problem. Member states and non-government organisations (NGOs), through the Commission of Narcotic Drugs, were called upon to make submissions.

The United Nations General Assembly does

not favour “harm reduction” policies.

In 2009 the UN under-secretary-general and executive director of the United Nations Office on Drugs and Crime, and the Commission on Narcotic Drugs in 2014 have both reaffirmed their commitment to achieving the goals set out in the various declarations and plans of action on International Cooperation to Counter the World Drug Problem.

Difficulty is not the determinant

The reports confirm that worldwide addiction to illicit drugs has stabilised over the last few years. Drug use is falling for some types of drugs and in some parts of the world, but rising in others, while international controls have limited the number of people who take illicit drugs to a small fraction of the world’s adult population.

The underlying assumption of these declarations and action plans remains: it is not that drugs are harmful because they are controlled, but that they are controlled because they are harmful.

The reports affirm the position that because certain unlawful transactions are hard to control does not mean that they should be made legal. We pose the related question: should humanity accept paedophilia, human trafficking, and arms smuggling out of a naïve sense of market inevitability or intractability?

The reports also declare that lifting the controls on drugs would weaken the fight against organised crime and fail to protect the health of citizens.

Dalgarno Institute submission

The Drug Advisory Council of Australia and Drug Free Australia are concerned that the resolve to continue to counter the drug problem may be undermined as groups such as the International Drug Policy Consortium declare that they support decriminalising all drugs and are committed to harm-reduction policies.

In response the Dalgarno Institute has commissioned a report entitled “30 Years of Harm Minimisation: How Far Have We Come?” The report forms a major part of the Dalgarno Institute’s submission to the UN General Assembly Special Session (UNGASS) and critically evaluates the success or otherwise of the strategies to combat the harm associated with drug use in the Australian community between 1985 and the present. It also covers the prevalence of drug use, drug-related (overdose) death and transmission of infectious diseases.

The Australian strategy at present is a three-pronged approach to reduce supply, demand and harm to the community. The overall objective is to reduce the availability and accessibility of harmful drugs and to reduce the level of drug use.

However, over time this objective has increasingly been aimed at reducing harm to those who use drugs, irrespective of levels of drug use and harm to the broader community.

This shift in emphasis seems contrary to the UN declarations that have consistently emphasised supply-and-demand reduction as the principle means to combat drug abuse. The various UN statements do not promote harm-reduction approaches such as needle exchange and injecting rooms as effective ways to protect member states and their citizens.

The Dalgarno Institute submission provides the evidence that a focus on harm reduction has failed to reduce drug use and that Australia continues to be one the highest consumers of illicit drugs worldwide.

The belief of many who designed and implemented drug policy in Australia was that most people who use drugs, including those who injected them, experienced little or no harm; that to use drugs recreationally and for pleasure was a legitimate lifestyle choice and that society was obliged to minimise the harm associated with drug use. However, this view seemed to be mainly associated with the use of illicit drugs such as marijuana, heroin, ecstasy, cocaine and methamphetamines; and the emphasis was on reducing harm, not reducing drug use.

Disconnect in policy

On the other hand, the attitude of those who designed and implemented drug policy towards other, mostly legal drugs, such as tobacco and alcohol, was different. The strategy was designed to make these other drugs less available and to reduce the number of users.

For example:

  • Prescription drugs should be controlled by existing laws and medical authorities, and unauthorised and recreational use be prohibited.
  • Nicotine use is to be discouraged. Anyone smoking in public areas should be prosecuted, that the price should be increased to deter use, that confronting health warnings against use should be funded and so on.
  • Alcohol should be banned for those under 18, and sales and advertising strictly controlled. People drinking alcohol and driving, using machinery or in positions where public safety was compromised should be prosecuted. Trading hours should be restricted. Compulsory or random testing for alcohol impairment is accepted in many workplaces.

The evidence is clear that the use of nicotine and alcohol has declined and that the harm has been reduced in overall terms. The proportion of people over 14 who smoke daily had declined from 25 per cent in 1993 to 15.1 per cent by 2010 and to 12.5 per cent by 2014. More modest reductions in alcohol use and harm have been achieved, seemingly, as laws on alcohol supply have not been toughened due to the influence of the alcohol lobby.

The Dalgarno submission shows that even as authorities have cracked down on the use of legal drugs, they have pursued policies that have promoted greater permissibility and acceptance of illicit drug use and have curtailed supply-and-demand reduction strategies, and that such policies fail to reduce harm.

The evidence from 1998 to 2004, when a more stringent deterrent and supply-reduction approach to illicit drug use was enforced, shows a clear decline in drug use and drug-related harm compared with the periods preceding and following, when harm-reduction strategies dominated.

The emerging evidence is that harm-reduction policies, such as needle exchange, opiate-substitute treatment and injecting facilities, despite being heavily funded, have failed to reduce harm even as blood-borne virus infections have increased.

Moreover, the evidence shows the detrimental effect that illicit drug use has on families, including greater incidence of drug-fuelled domestic violence.

Recommendations

The report makes several recommen­dations based on the evidence. These include an increased emphasis on prevention, including education about harm, early detection, drug testing, mandatory treatment, monitoring of methadone programs to ensure some exit strategy is included, and the trialling of naltrexone as a treatment option.

Specifically the report makes several recommendations for drug policy based on the successful Swedish model.

  • First, that there be a continued strong emphasis on deterrents to drug use through law enforcement, to reduce drug availability, increase price and reduce the perception of permissibility.
  • It is recommended that governments actively discourage the production of materials that promote the drug liberalisation/legalisation agendas and instead encourage the use of anti-drug use materials in schools that accurately reflect the real harm associated with drug use.
  • The evidence indicates that needle exchange and methadone do not work. Indications are that they have most probably led to increased drug use for longer and to greater harm. It is known that neither of these programs will reduce usage or harm from use of methamphetamines. It is recommended that both programs be phased out and the funds redirected into treatment programs aiming to reduce overall drug use in the community.
  • The evidence, mainly from Sweden, also shows that early intervention before harm becomes serious should be the primary strategy for prevention among younger people. Young people often have very low motivation to quit drugs, especially when the message is that they are harmless and controllable. Many only seek help when they are incapacitated and unable to lead a normal life. Sometimes coercion to take up treatment and counselling programs is required.
  • Medical evidence shows that drug-induced brain damage hampers the cognitive function of drug users, reducing their ability to make decisions, such as self-protection, which would be the natural response to harmful behaviour for an average person. Research has found that the longer the drug use, the poorer the chance of complete recovery. The evidence is that the earlier the treatment can be given to the drug abuser, the better the result.
  • To facilitate early intervention, it is recommended that compulsory drug testing be introduced. Police should not be required to identify physical signs and presence of drugs as the prerequisites for drug testing. As with random roadside drug testing it should be seen as a preventative strategy to discourage drug use.
  • It is recommended that treatment facilities be better funded and that people who relapse be able more easily to re-enter recovery-based treatment programs.
  • Mandatory treatment is recommended for drug users who pose a danger to themselves, their families and society. Especially in respect of heroin and methamphetamine use, as retention in treatment is very poor, with high levels of criminal activity and harm to the community among these groups. Mandatory treatment is recommended when the individual and/or their families are being endangered by continued use of a drug that leads to morbidity and mortality, criminality, mental illness and loss of social functioning.

Dr Ross Colquhoun is an executive member of Drug Free Australia and research fellow, and a member of the Drug Advisory Council of Australia (daca.org.au).




























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