HARM MINIMISATION

Sometimes called harm reduction, this concept was adopted as a policy for our national drug education programs at the national drug summit in Canberra in 1983. It is well expressed in a NSW secondary school program called 'Drug Sense', introduced earlier this decade. Its philosophy states:

"The notion of harm reduction is based on the belief that drug use is a common and normal part of our society. To try and prevent drug use from occurring is futile. Rather, the main focus of the harm reduction approach is to prevent or reduce the harms associated with drug use.

HARM REDUCTION This approach recognises that people use drugs in a variety of reasons and that drug use occurs along a continuum, between no drug use and harmful drug use. The aim of harm reduction is to reduce harmful an hazardous drug use, and promote responsible and safer use of drugs. In reaching this goal, the resource applies the model of public health (referred to as the drug use triangle) as a basis for determining what the potential harms are and how they can be reduced. The model of public health explains the reasons a person or group of people use a drug or a group of drugs. This model relates to · the characteristic of the group or individual (set) · the characteristics of the drug or drugs of choice, and (drug) · the environment in which drug use occurs " (setting)

It will be noted that the terms "set", "drug", and "setting" have been inserted by me to identify it with its source contained in a book named "Drug, Set, and Setting - the basis for controlled intoxicant use" written by former Harvard psychiatrist Dr. Norman E. Zinberg, M.D. who died in 1989. He states that in order to understand what impels someone to use an illicit drug and how that drug affects the user, three determinants must be considered:

The similarity to the Drug Sense philosophy is apparent. Zinberg argued that if set and setting are suitable then the use of most drugs can be controlled so that they can be used safely or responsibly such as to cause "minimal harm". It was this philosophy, coupled with belief that drug use is "normal human behaviour", promoted by the pro-marijuana lobby called NORML (National Organisation for Reform of Marijuana Laws) of which Zinberg was a former national director, that saw a dramatic rise in the daily use of marijuana in the US in the 1970's by young people.

The strategy by NORML was simple: to concentrate on those most vulnerable to their permissive philosophies namely young people for they grow up to be voting using adults who may force the hands of government through voting power. NORMLs founder, Washington DC lawyer Keith Stroup, said at their 10th Anniversary dinner in 1980, "An estimated 55 million Americans have used marijuana, and the average age of regular smokes in this country continues to rise. When we eventually enjoy the support of a clear majority of the American voters, we will outvote our opponents".

While strategies for harm reduction point to needle exchange and other more supposedly enlightened programs (e.g. legal heroin for addicts, shooting galleries) to lend credibility to harm reduction, the prevailing message is that use of illicit drugs can be controlled by learning to use them "responsibly" or "safely". That much is made clear in the philosophy of Drug Sense and in other educational programs for school students. The fact is that the drug itself, through tolerance and dependence, makes the user lose control. The "normality" message epitomised by NORMLs name is evident too in the Drug Sense philosophy. The link is clear.

The evidence of the failure of this policy is compelling and its manufacture by the so-called drug culture discredits it enormously. It is being promoted by the legalisation movement internationally at "harm reduction" conferences where it is equated with legalisation.

It is absurd to infer that people (particularly young people) will be deterred from using illicit drugs if they are told they can use them safely or responsibly. It cannot be justified because of the assertion that drug use is normal behaviour and to try and prevent it futile. It is equally absurd to suggest that in any drug treatment program that the primary aim must be not to stop drug use but to reduce the harm it causes. This, by equation, means that the primary aim is not to stop drug use. That could, at the best, be a secondary aim. The primary aim must be to stop use, the most effective harm reduction one could possibly aim for. Harm reduction therefore has no place as a primary policy in either prevention or treatment. It is permissive because it tolerates drug use. It is a give-in policy.

A NEW POLICY

It is ridiculous to believe that harm reduction will assist our drug problem. With just a little commonsense we can see that it must make it much worse. Users are urged to continue use in a supposed responsible manner (so their numbers do not diminish) while non users (particularly children) are being enticed to experiment in the belief they can do so safely. So while the number of users is not receded, the using population grows, and grows. Since it was introduced at the Australian national drug summit in Canberrain 1983, drug use (particularly marijuana) has increased alarmingly such that in 1997 the UN Narcotics Control Board made special mention of the fact that cannabis use and potency of cannabis in Australia is amongst the highest in the world now.

We urgently need a policy that will deter use and reduce the number of users, not maintain them. This has been achieved in Sweden where the objective is to attain a drug-free society. While not totally possible, it clearly indicates that the government will not tolerate use. It has embarked upon a restrictive program emphasising prohibition, education and rehabilitation. Massive education on the harmful effects of cannabis is available for parents and young people because it is regarded as a recruitment drug to heavier drug use.

That Sweden has the lowest using rate now is clear proof that such a program and policy is working and working exceedingly well. We could do well to closely examine their program and, like Sweden, adopt a policy that creates an attitude opposing use such as with tobacco's "Quit for Life" program. Does this not highly promote total abstinence and hence oppose harm reduction? And has not society been saturated with information about the harmful effects of tobacco? The result...a reduction of tobacco use from 70% in 1945 to 27% today. The answer is obvious. Why aren't we doing it? That is a question we may well ask. I suspect there will not be too many willing to give the answer.

Recommendation

Australia needs a model that has been proven to work successfully. One such model is the Swedish model.

The following are extracts from the "A model of success", a chapter of The Cruel Hoax, by Elaine Walters, pp. 25-36.

The Swedish Model has five founding principles:

Border protection

Stricter penal legislation

Preventative measures

Care and treatment

Disruption of street trading

The philosophy which underpins the Swedish policy:

"A drug-free society is a high objective expressing societies [sic] attitude to narcotic drugs. We do not accept the integration of narcotic drugs in society, and our aim is a society in which drug abuse remains a marginal phenomenon.

A drug-free society is a vision expressing optimism and a positive view of humanity: the onslaught of drugs can be restrained, and drug abusers can be rehabilitated.

Drug policy is a part of social policy, the aim of which is to give everybody in Sweden a basic measure of security through a system of general benefits. The restrictive focus of Swedish drug policy is a part of this general approach, of the idea that everybody is entitled to a decent life and that no groups are excluded from participation in society."

These sanctions are now among the strictest in western society. The Swedish government also implemented an uncompromising drug education programme in schools with emphasis on abstinence. One cannot always prove a casual relationship between certain actions and their effect, however it is interesting to note that in Australia approximately one in two 16-18 year olds have tried marijuana. In Sweden it is only one in twenty. This is a startling contrast!

...in Sweden today there is a consensus of community values concerning the focus of drug policy. Cutting across all boundaries of party politics and opinion there is agreement on the unacceptability of non-medical drug use. This message with the main emphasis on prevention combines to produce a cohesive drug policy, prevention, control, care and treatment.

Swedish strategies are very practical. Drug abuse is dependent on supply and demand. If drugs are readily available and society takes a permissive attitude the number of people trying drugs will increase. In other words even people who are well adjusted will eventually use drugs. If on the other hand they are difficult to come by and there is a danger of being arrested, the number of people trying drugs will be reduced to those who, for psychological and social reasons, are more at risk. If moreover society can bring measures of support and treatment to these vulnerable groups, it is very likely drug abuse can be reduced to an acceptable level. According to Swedish policy it is the duty of society to intervene against drug dealing, by supporting young people who are experimenting with drugs and by offering treatment to those who are drug dependent.

Health professionals, teachers and parents should not be expected to tell adolescents to use street drugs in a so-called controlled way.

The Queensland Justice Commission (CJC) quotes as the source NCADA 1985-1993.

"Between 1985 and 1993 the proportion of South Australian respondents in the 14 - 19 year olds who said that they had ever used cannabis increase 50%", "Since the introduction of expiation notices (on the spot fines) in 1987, there has been a substantial rise in South Australia in the proportion of survey respondents in the 14-19 and 20-39 year old brackets reporting that they have tried cannabis."

Variation of % of those ever used 14-19 year olds from 1985-1993

(South Australia introduced on the spot fines in 1987)

Variations of % of those ever used 20-39 year olds from 1985-1993

(South Australia introduced on the spot fines in 1987)