BY MICHAEL ARNOLD
Over recent years the "drug problem" has been regularly discussed in the corporate media. In the midst of this discussion, more than 1000 Australian heroin users have died as a result of overdoses between 1996 and 2000.
While drug forums and community consultations have been held in many localities across Australia, the federal and state governments refuse to consider alternatives to drug prohibition. This is despite the arguments of many doctors, law enforcement officers, health professionals, and drug users that this approach has resulted in an explosion of property crime, a crisis in public health and the systematic persecution of a large section of the population.
The federal government's National Drug Strategy enshrines a policy of "harm minimisation". Harm minimisation contains three pillars:
Most government resources are allocated to supply reduction. But supply reduction measures often negate harm reduction work. With less of the drug available, users often substitute another drug, causing damage to their health. As the price is driven up, petty property crime increases as users look for a way to obtain the money needed to purchase the amount of the drug that their body has become accustomed to.
This is what has happened in Australia during the last seven months, as the supply of heroin has dried up, partly as a result of police measures.
It is evident to many people that the current laws and policies surrounding drug use are bankrupt and need to be changed. What form change should take is a matter of heated debate.
There are three main options canvassed in the drug reform debate: medicalisation, decriminalisation and legalisation.
Medicalisation refers to making currently-prohibited drugs available through prescription by a medical professional. This system was trialed for heroin in Switzerland between 1996 and 2000, and is now a feature of Swiss medical practice for provision of both heroin and, in a more limited way, cocaine.
During the Swiss heroin trials, which involved around 1500 participants, participation in violent crime dropped to one-seventh of its pre-trial rate, with only one participant in every 100 committing violent acts.
Prior to participation in the trial around one user in every four suffered from symptoms of depression, schizophrenia and other forms of mental illness. After one year on prescription diacetylmorphine (heroin), only 5% were affected by these conditions. Drug user participation in property crime dropped by half and dealing dropped to one-third of its pre-trial rate.
Over the last five years a range of new pharmacotherapies (drugs used in the maintenance of or withdrawal from an opiate dependence) have been trialed in Australian capital cities. The most trialed, buprenorphine, will now be available through GPs.
When the pharmacotherapie trials were originally conceived, a diacetylmorphine provision trial was to have been included (known commonly as the "ACT heroin trial", although it would also have involved Melbourne, Sydney and Adelaide users). This was ultimately blocked by the Howard government, which refused to alter federal laws to allow for the importation or production of diacetylmorphine.
Supporters of medicalisation argue that it allows users of drugs that potentially have damaging effects to the body and/or mind access to continuous medical care. They argue that the process of obtaining a prescription may discourage young people from starting to use these substances, particularly in an ongoing way that could lead to dependence. And of course those users who are able to access prescriptions will receive affordable, medical-grade gear.
But under these programs, drugs users are reliant on medical practitioners for their drug supply. This has the potential to significantly reduce users' liberty. Methadone maintenance programs (MMP) are an example of the way in which medicalisation of a drug can be used as a form of social control.
Methadone is a synthetic opiate which prevents a user from feeling heroin withdrawal symptoms. Taking methadone regularly allows me to work without the daily stress and financial pressures associated with a heroin dependency. However, as a participant in a MMP I must report to my pharmacist five days a week. Having been a "very good boy" for five years, and having a constructive relationship with a very good doctor, I have the "luxury" of two take-away doses a week. I also have the more unusual privilege of being able to get dosed at another chemist while I am working in the city during the week.
However, in order to go away for work, pleasure, or protest I must apply weeks in advance for take-away doses or to use a different chemist. And I am not allowed to be away from a chemist for seven days. Users without good relationships with their doctor or chemist, who return "dirty" urine tests or who are hit by financial difficulties, stand to lose take-away privileges — denying them freedom of movement — or may lose access to methadone altogether. This can mean that they must satisfy a massive opiate dependence — often paid for by crime — or face a withdrawal potentially far worse than that associated with heroin use.
Participants in the Swiss program must attend three times a day to be dosed. This often causes massive lifestyle disruption and severe restrictions on travel.
So medicalisation can either benefit or control users' lives, depending on the conditions of the programs.
The second option is that currently supported in the Socialist Alliance platform, and also called for by the April 4 Green Left Weekly editorial: decriminalisation. This involves the removal of criminal penalties from the use of illicit drugs.
Where drugs have been decriminalised, possession, and production of these drugs for personal use, is often dealt with like a traffic law infringement. The obvious benefit from decriminalisation is that users do not receive a criminal record or face the threat of jail time if found with drugs.
However, in most decriminalised systems the state maintains the right to enter your premises or search your person, seize your stash, and you cop a fine for your troubles.
In South Australia and the ACT, possession and growth of small amounts of marijuana have been decriminalised. But the hassles associated with growing your own dope means that most users still rely on the black market.
It is unclear how decriminalisation of fully-synthetic drugs such as speed or ecstasy would work. They need to be produced by trained chemists, not in backyard laboratories. The amount of poppy required for making heroin, and the skill needed to turn opium into diacetylmorphine indicates that production and distribution of opiates is unlikely to be carried out by amateurs.
Decriminalisation supporters proceed from the premise that citizens need to be protected from currently-illicit drugs, but that drug use is primarily a medical issue, not a legal one. As Graeme Dunston was quoted as saying in the June 27 Green Left Weekly: "Decriminalisation is part of the prohibitionist approach".
In my opinion, it is unlikely to lead to a fundamental change in the treatment and well-being of drug users, as the black market will retain control of production, and the police will continue to engage in supply control measures.
My preferred option for drug law reform is full legalisation. This means the removal of all legal restrictions on access to drugs, with the possible exception of age limits (which are already applied to legal drugs). This could be supported by laws regarding the production, content and purity of different drugs, and the mechanism of sale. The most likely form of distribution under a legalised system would be over the counter at pharmacies, or through pubs or cafes.
Legalisation recognises the basic human right to control our own bodies and minds. Laws should be used to protect users' consumer and medical rights, not as instruments of social control.
In the June 27 Green Left Weekly, Nick Fredman reported that some marijuana reform activists in Nimbin oppose reform options for users of other drugs. This "pot-purism" is slowing the development of a united movement for law reform.
All drugs, including pot, can be used in ways that are harmful, or in ways that are of personal benefit — social, emotional, or physical. This is likely to be true regardless of the legal system controlling the use of drugs. Until legal barriers are removed, we will not know which harms are caused by prohibition. Thus we do not really know how to target harm reduction and other health messages for users.
There are yet to be many working examples of full legalisation of an illicit drug in the developed world. The International Narcotics Control Board usually acts quickly to stomp on any reform agenda. However, legal advice provided to the Swiss and to Australian policy reformers suggests that the Convention on Narcotics Control does allow nation-states the right to determine their policy on legality if they feel changes will benefit the health and well-being of their citizens.
I, and the majority of drug-user activists I know, support the full legalisation of illicit drugs used for recreation or self-medication. However, for speed, cocaine and heroin in particular, medically supervised trials that provide the drug to dependent people is likely to be a vital first step.
The Socialist Alliance supports safe injecting rooms, and this has been one of the main topics of public debate, particularly in Melbourne, Sydney and Canberra in recent years. These facilities, now being referred to as Medically Supervised Injecting Facilities, offer users a safe, sterile environment in which to use the drugs they have purchased.
Research, including extensive interviews with users conducted by VIVAIDS — the Victorian Drug Users Group — as part of the Drug Policy Expert Committee consultative process, suggests that injecting facilities will only ever cater for a very particular group of users — generally dependent, and often homeless, users or those who use away from their home.
For these users, facilities like the one recently established in Kings Cross (which have functioned in Europe for 10 years) offer a great opportunity to inject somewhere where the risk of virus transmission is minimal, where you can receive attention if you overdose, and access other services if needed.
These centres, however, would not be necessary if users could access controlled, regular and affordable doses of their drug of choice. Overdoses — one of the main harms the centres overcome — affect a majority of lone users taking drugs in their own home. They can be caused by a sudden rise in drug-purity or, more often, the combination of the drug with sleeping pills and/or alcohol (taken to reduce withdrawal symptoms or to supplement the effects of poor quality heroin).
Affordable heroin would free users from the poverty traps that result in homelessness, and allow users to take their drugs in a safe way in their preferred environment. Safe injecting rooms are an important step, but hopefully the need for them will be short-lived.
[Michael Arnold (<mibrane1@yahoo.com.au>) is a member of the Socialist Alliance and a peer education project coordinator at the Victorian Drug Users Group, and hosts the Drugtalk program on Melbourne radio station 3CR every Tuesday at 11am.]Medicalisation
Decriminalisation
Legalisation
Safe injecting rooms