Source: Sydney Morning Herald (Australia) Contact: http://www.smh.com.au/ Pubdate: Tue, 8 Sep 1998 Author: Dr Alex Wodak [Opinion] LET'S LEARN FROM THE SWISS ON DRUGS LAW enforcement is an ineffective way of solving serious social problems. Billions of dollars spent on police, courts and prisons have failed to control Australia's illicit drug problem. We should have known better. After all, the failure of all the king's horses and all the king's men to control property crime in poverty-stricken England 200 years ago led directly to the establishment of a prison colony in Australia. But suddenly drug courts have emerged as the answer to Australia's apparently intractable illicit drugs problems. Returning from a recent visit to the United States to investigate drug courts, the Sydney barrister Ross Goodrich spoke encouragingly of the new American phenomenon. Impressive results are claimed from this attempt to combine the pressure of the criminal justice system with the behaviour-changing ability of drug treatment. The Premier, Bob Carr, was sufficiently impressed to quickly announce that NSW would move soon to establish drug courts. Combining health and law-enforcement approaches to illicit drugs has some appeal. If prisons are an expensive way of making offenders worse, drug treatment is an inexpensive and relatively effective way of helping many to abandon (drugs & crime). The Rand research group in the US showed a $7.48 return for each dollar spent on cocaine drug treat-compared to only 17 to 52 cents in the dollar from different kinds of law enforcement. Also, it was the understanding reached between health and law enforcement in Australia in the l980s that allowed needle-exchange and methadone programs to flourish, preventing an epidemic of HIV among injecting drug users that would have spread to the general community. Since then, the two sectors have quietly been collaborating much more, realising that neither could achieve its aspirations acting alone. In response to increasing drug-related crime and corruption, State police commissioners recently recommended switching the emphasis on illicit drugs from punishment to rehabilitation. The community is, of course, very concerned about increasing numbers of illicit drug-related deaths, crimes and corruption. Roughly half the 700 drug overdose deaths in Australia each year occur in NSW. So there is a strong case for NSW to consider seriously any new approach which has a reasonable chance of working. Should drug courts be added to the list of innovations we should consider along with injecting rooms and prescribed heroin? Dr Steven Belenko, of Columbia University, New York, concluded in a recent review that "none of the drug court evaluations to date have been comprehensive enough and of long enough duration to enable a full calculation of the long-term costs and benefits of drug courts". Drug courts may well be an advance. But we should keep an open mind on their pros and cons until more independent research becomes available. In the meantime, there are many warnings that drug courts may not turn out to be the long-desired leap forward. There have been previous attempts in Australia to blend drug treatment and law enforcement. The NSW Drug and Alcohol Court Assessment Program (DACAP) in the 1980s was one of many less than successful attempts. Any 'success" of the drug courts in the United States is a direct result of closer supervision of drug treatment and related services. We could provide this closer supervision in Australia without the expense of setting up a new court system. There is also the concern that drug courts are really an attempt to reinvent failed law enforcement, disguising an ineffective wolf in sheep's clothing. Drug users are not the only ones to have difficulty kicking an unproductive habit Another risk is the concern that treatment under coercion will crowd out a chronically underfunded voluntary treatment sector. "Perverse incentives" could develop so that young drug users seeking help to regain control of their lives could be turned away unless they have committed enough crimes to qualify for treatment. In Australia, drug treatment including, detoxification, drug-free counselling and methadone has never been funded adequately. Entry to detoxification and methadone programs often requires repeated applications. Many drug users give up in frustration after a few unsuccessful phone calls. Most government and non-government agencies struggle to provide a reasonable service. Although governments generate billions of dollars from alcohol and tobacco excise, less than 1 per cent of health expenditure is allocated to alcohol and drug treatment. Methadone programs are subjected to relentless ill-informed attacks despite compelling evidence of effectiveness, safety and cost-effectiveness and despite having a singular ability to attract and retain large numbers of drug users seeking help. If drug courts are to be introduced in NSW, substantial new funding will be needed for treatment programs. Our political leaders will have to be prepared strongly to support and fund effective, evidence-based treatments. Where will the new funding come from? The most obvious source is the criminal justice system. A million dollars will pay for the cost of arresting, prosecuting and jailing 17 offenders for 12 months. The same sum could pay for 133 offenders diverted for 12 months to drug-free rehabilitation, or 625 treated in a methadone clinic or 1,425 pre-scribed methadone by a general practitioner. One of the real benefits of the current voluntary treatment system is an in-built flexibility. It takes time to correct a childhood of sexual abuse or deprivation, deficient education or years of self-neglect, prolonged unemployment and aimless living. The slow and steady pace of the drug treatment tortoise is usually effective after a while but impatient attempts to force quick, heroic results all too often end in spectacular failure. Can drug courts be flexible enough to accept and build on gains when they happen? If an offender before a drug court has made great strides by getting a job, starting to pay off debts and healing family rifts, but still has a few positive urine tests, a wise drug court would allow extra time. Will that be possible? There are sound reasons for diverting certain drug offenders from the criminal justice system into supervised treatment. Drug courts may have some role to play in a comprehensive and more effective approach to illicit drugs in Australia. But it will not be easy and there are real risks. If our aim is to reduce deaths, disease, crime and corruption, why not use as a model Switzerland, where real progress is being made; rather than the US, which spends tens of billions of dollars but has increasing numbers of deaths, rampant HIV infection and very high crime rates? Illicit drug use needs to be treated primarily as a health rather than a law-enforcement issue. Drug courts may encourage our decision makers to further delay the inevitable. Dr Alex Wodak is President of the Australian Drug Law Reform Foundation - --- Checked-by: Rich O'Grady