Pubdate: Thu, 9 Apr 1999 Source: Age, The (Australia) Copyright: 1999 David Syme & Co Ltd Contact: http://www.theage.com.au/ Author: Gay Alcorn and Nicole Brady PUBLIC AND POLITICIANS WRESTLE WITH DRUG OPTIONS JOHN Howard prides himself on his instinct for what the ``mainstream'' thinks. But the mainstream is changing. Even the Sydney shockjocks who viciously campaigned against the ACT's proposed heroin trial in 1997 are having a rethink. Detailed research by media monitoring company Rehame Australia provided to The Age compared the attitudes of talkback callers and radio commentators in 1997 and 1999. The results showed remarkable shifts in opinion about a heroin trial - a small thing in itself, but a symbol of whether Australia perseveres with its present drug policies (perhaps with a little tinkering) or decides that its stance is doing more harm than the heroin. It's not that talkback callers were in favor of a heroin trial, but they were no longer instinctively hostile - 42 per cent were now ``neutral''. The six radio commentators who dominated talk on heroin in Australia during the ACT proposal started to agonise early this year. ``I might have changed my view about that (a heroin trial),'' John Laws told his huge national audience recently. ``I think that Prime Minister John Howard is more concerned about the sensitivity of his constituents than he is about those people who are involved with heroin.'' Conservatives have been through a painful reeducation about heroin. There is now pressure from senior police, state leaders and those who work with drug users for a radical change in policy, away from what the director of Alcohol and Drug Service at St Vincent's hospital, Dr Alex Wodak, describes as Mr Howard's ``ideological prism'' and towards more evidencebased policy. A heroin trial, which noone pretends would ``solve'' the drug problem, is the flashpoint of the debate. Is Australia prepared to risk bold steps, or do we persist with familiar strategies until they start working? Yesterday, Mr Howard was firm: ``We're not trying to bob and weave on this ... we are against a heroin trial.'' Such a trial has been discussed in Australia as far back as 1979, but Mr Howard argues that it would send a message to the community that heroin is not as bad as people had been told. ``My Government is determined to prevent a new generation of users and addicts emerging,'' he said when launching his drugs strategy in late 1997. There might be slight shifts in emphasis, but the Howard Government's threepronged approach - law enforcement, education and rehabilitation - is essentially more of the same. The results of what has been called the longest war this century have been disappointing, to say the least. Globally, international prohibition on illicit drugs led by the US has failed to convince peasants in desperately poor countries such as Burma, Afghanistan and Colombia that they should switch to more unprofitable crops, and in the decade since 1985, land devoted to opium poppies has trebled. The profits are worth the risk to traffickers, with illicit drugs estimated to have an annual turnover of $US500 billion, or 10 per cent of world trade, making it a bigger global industry than oil and gas, food, and the textiles and clothing industries. Prohibition has failed because the profits - up to a 22,000 per cent markup - - are too great for all the police in all the world to stop. In Australia, an estimated $500million a year is spent on drug law enforcement, but has failed to stop heroin entering Australia - police estimate they seize about 10 per cent - and heroin is now more available and cheaper than ever before. Increased penalties for using and dealing in drugs have utterly failed to dampen demand. The economic costs are massive and increasing - an estimated $1119.7 million in 1992, a jump of 23per cent in four years. Apart from law enforcement, up to 80 per cent of prisoners are either convicted of drugrelated offences or are addicted when they enter jail, with police blaming the drug epidemic for around 70 per cent of all crime in Australia. The huge profits also means corruption. The NSW royal commissioner Justice James Woods stated that drug trafficking was ``destroying police on a state and federal level, and there is absolutely no reason to think it stops at NSW boundaries''. The reformers say ``enough''. Give up the moral judgments about heroin use and face the reality that the enemy has won the prohibition war. The key debate about where Australia should go with heroin now is between those who believe the drug itself is the problem, and those who believe heroin's illegality has caused much greater problems, physically, economically and socially. A heroin trial - useful only for small groups of intractable addicts at great risk of overdose or death - would be an acknowledgement that demonising heroin has been counterproductive. Both groups call themselves ``harm minimisers'', but the supporters of Australia's existing approach say drug use is the evil, and Australia's efforts, with more money and effort, will work in time. ``I believe we can change the culture and the acceptance of the attitude that it's inevitable that people are going to use drugs, because I don't think it is,'' said the Salvation Army's Major Brian Watters, Mr Howard's key drugs adviser. ``We have to engender in our society a clear message that we will not tolerate you using drugs (and) we will do everything in our power to stop you doing it.'' Major Watters has doubts about methadone maintenance - the linchpin to date of Australia's ``harm minimisation' approach to heroin treatment - because people are encouraged to stay on it as long as they want. While methadone reduces crime and slashes deaths, it doesn't get users off drugs. ``I know people who have been on methadone for 10 or 12 years and there's no attempt by anybody to encourage them from reducing their levels of use,'' says Major Watters. For similar reasons, he opposes giving heroin addicts heroin: ``There are worse things than death when it comes to addiction,'' he reportedly said of the ACT proposal. Dr Wodak, the president of the Australian Drug Law Reform Foundation, calls Major Watters' stance ``pharmacological fundamentalism''. Those pushing for change don't like drugs, but accept they are here to stay and believe we have to learn to live with them and reduce their harm, just as we are becoming more successful in reducing the harms of alcohol and tobacco. The reformers now include some big names, including the former US Secretary of State, Mr George Schultz, who said in 1990 that ``the conceptual base of current programs is flawed ... we need at least to consider and examine forms of controlled legalisation of drugs''. The reformers' aim is to keep addicted people healthy and alive until they decide to get off heroin by which ever harm minimisation approach is best - whether it be methadone, new treatments, multiple detox attempts or, if necessary, the prescription of heroin for maintenance. ``I would argue that the really critical issue is not whether there are 217,000 with heroin in their bloodstream or 210,000,'' says Dr Wodak. ``To me, the really critical issue is whether 600 die from heroin or whether 100 die from heroin. What's happened to the death rate in Switzerland (where a heroin prescription trial started in 1994) is a dramatic decline in deaths from heroin - 419 in 1992 to 209 in 1998 ... we've gone in the reverse direction.'' It is clear that heroin's illegality - rather than the drug itself - causes the majority of the harm. The purity of illicitly sold drugs is always unknown, education about safe use is limited, and crime and corruption is out of control because it is prohibited. Dr Gabriele Bammer, a researcher at the Australian National University and an internationally recognised heroin expert, was the key researcher in the defunct ACT heroin trial proposal and is a moderate in the debate. She is not in favor of legalisation of heroin - not that Australia could do it anyway - because the margin of error between a safe and an unsafe dose of heroin is too small and Australia already has two legal drugs that cause great damage. She says a key debate Australia has avoided is the basic one about why some drugs are legal and some are not, and accepting that those decisions are historical and cultural, and not necessarily rational. Medically prescribing heroin to some addicts - after a scientific trial - could break the criminal and corruption cycle and certainly save lives, she argues. ``People often raise the argument, well, why don't we give alcohol to alcoholics,'' Dr Bammer says. ``The reason is because alcohol is a very harmful drug (and) it would place doctors in a very difficult position to be doing harm. If a doctor prescribes heroin to a person who is already dependent they are not doing harm to that person. The only way they can go is up.'' What is more likely is that Australia might wait to see the results of other international trials. Switzerland is continuing to prescribe for some addicts and Dutch trial results will be known soon. ``(Waiting) would be a very Australian approach to take, I think,'' Dr Bammer says wryly. Australia could not legalise heroin, or even cannabis, and regulate them as we do legal drugs, because of a complex series of international conventions, backed by the United States, which take a hardline prohibitionist approach. The nation's ability to set its own illicit drug policies has been severely curtailed. But provisions in the UN conventions to ``limit exclusively to medical and scientific purposes'' the production, manufacture and use of illicit drugs, almost certainly would permit a heroin trial and medical prescription of heroin if the Federal Government backed it. ``The idea,'' says Dr Wodak, ``would be to see whether it is a greater evil for this drug to be prescribed by doctors than it is that these drugs be made available by the Mafia. I don't think it would be hard to work that out.'' One good thing about the heroin trial debate is that it has created a climate in which there is greater enthusiasm to try new treatments. Until naltrexone was approved earlier this year, Australia had just one drug to treat heroin addiction - methadone - and there was little interest in new ideas. There are now 10 trials under way across Australia of three other new treatments, some of which look promising for addicts for whom methadone is unsuitable, such as young people. Australia is also looking hard to try to divert heroin users away from the criminal justice system. It is believed that Mr Howard will put to the Premier's Conference tomorrow a national scheme to divert smalltime heroin users into alreadystretched treatment programs rather than the courts and jail. Australia could also take Victoria's lead to send firsttime users to compulsory counselling instead of court, an approach the chief commissioner of police, Mr Neil Comrie, believes has already saved lives. Also in Victoria, the Deputy Chief Magistrate, Ms Jelena Popovic, has been overseeing a $500,000 trial which offers nonviolent offenders treatment at the time of bail rather than waiting for sentence. Ms Popovic says that 85 per cent of court time is taken up with drugrelated offences and the trial was one way to break that cycle. ``It's not a soft option,'' she said. ``It's actually them agreeing to a much more rigorous time on bail than if they didn't agree.'' About 70 people are now on the program and Ms Popovic is ``cautiously euphoric'' about early results. ``(It's) not just that people look much healthier. They maintain their motivation. They're going regularly to their appointments. The rate of reoffending among this group is much lower than one would normally expect.'' - --- MAP posted-by: Keith Brilhart