DRUGS: by Richard EganNews Weekly
Parliamentary Committee recommends dumping Harm Minimisation
, December 13, 2003
After an inquiry into substance abuse in Australian communities that has taken almost three and a half years the House of Representatives Standing Committee on Family and Community Affairs has issued its final report.
The key recommendation (122) is that the Commonwealth, State and Territory governments replace the current focus of the National Drug Strategy on harm minimisation with a new focus on harm prevention and treatment of substance dependent people.
Harm minimisation has been one of the key principles of Australia's drug strategy since 1985.
It has been used to justify a range of measures that tolerate the use of illicit drugs while attempting to minimise particular harms to drug users, such as overdosing, contracting infectious diseases and other adverse side-effects.
Many of the supporters of harm minimisation stress the impossibility of significantly reducing the level of illicit drug use and often tend to ascribe harm to the illicit nature of the drugs consumed rather than to the substances themselves.
Harm minimisation measures implemented or proposed in Australia include needle and syringe exchanges, injecting rooms, heroin prescription, methadone substitution, liberal cannabis laws and testing kits for ecstasy.
The Committee's recommendation, if implemented, would refocus our drug strategy towards preventing new users from taking up illicit drugs and providing effective treatments aimed at cessation of substance abuse for those who are chronic substance abusers.
In regard to treatment for heroin addicts, the Committee recommended (52) that the ultimate objective of methadone maintenance must be to assist users to become abstinent from all opioids and that priority be given to treatments, including naltrexone, that focus on abstinence at the ultimate outcome (54).
The committee also recommended that, as a matter of urgency, the Commonwealth fund a trial of naltrexone implants, coupled with the support services required for efficacy, and that naltrexone be placed on the Pharmaceutical Benefit Scheme for the treatment of opioid dependence.
The Committee was impressed with the beneficial results from therapeutic communities, such as those run by Teen Challenge.
It recommended (56) funding to establish such communities throughout urban and rural areas in every State.
The Committee recommended that heroin prescription trials not proceed (57).
The myth, often propagated by advocates of liberal drug laws, that cannabis use is relatively harmless was seen as a major problem, and as one factor in the widespread use of cannabis, especially by young people.
The Committee accepted the weight of evidence that there are serious dangers to physical and mental health associated with regular cannabis use and called for urgent development and dissemination of cannabis cessation strategies. (61-63)
Labor MPs Graham Edwards, Julia Irwin and Harry Quick dissented from the Committee's report on key recommendations, defending the longstanding focus on harm minimisation, supporting injecting rooms, prescription heroin trials and methadone maintenance without any abstinence goal, and opposing the Committee's support for naltrexone and therapeutic communities.
Significantly, Labor MP and former ACTU head, Jennie George not only refused to join her colleagues in their dissent but in her own dissenting remarks strongly endorsed the view that "prevention and treatment of substance abuse should be enhanced".
She stressed "the urgent need for further research into the use of naltrexone given that many people are now 'parked' on methadone maintenance programs."
She accurately described opioid dependency as a "chronic, relapsing disease" that cannot be wished away. Society has an "obligation to provide the necessary support for people seeking to break their dependency".
Her remarks point the way to what should be a bipartisan drug policy as adopted in Sweden as opposed to the partisan support of harm minimisation and drug liberalisation by the ALP, especially in New South Wales, with the Kings Cross injecting room, and Western Australia with its liberalised cannabis law.Needle exchange
One disappointing aspect of the Report is its partial endorsement of needle and syringe distribution programs.
At a cost of over $20 million to taxpayers, nearly 32 million needles were distributed in the year 1999/2000.
The Committee noted the claim in the Evaluation of Council of Australian Government's initiatives on illicit drugs: final report
that needle distribution programs had resulted in the prevention of 25,000 cases of HIV and 21,000 cases of hepatitis C over the ten years from 1991.
Nonetheless the Committee did recommend (66) that the Australian National Audit Office undertake a complete evaluation of needle and syringe programs assessing distribution, inadequate exchange, accountability and the impact on both HIV and hepatitis C.
The Committee expressed particular concern that the incidence of HIV and hepatitis C was escalating despite the quantity of syringes distributed.
The Committee did not seem to be aware of the body of evidence which demonstrates that needle exchanges actually increase the rate of needle sharing and that hepatitis C is spread among users of needle exchanges even when they refrain from sharing needles but share drug ampoules, water, cotton swabs, and other paraphernalia.
The Federal Government's Tough on Drugs Policy has already achieved a drop in the last twelve months' use of illicit drugs from 22% in 1998 to 17% in 2001.
If all Australian governments adopted the Report's key recommendations then we could expect this downward trend to continue.