Sunday, April 22, 2007

A stupid endorsement of harm-minimization

Dr Alex Wodak made a statement to the House of Representatives Standing Committee on Family and Human Services, as part of its inquiry into 'The impact of illicit drug use on families'. Wodak is Australia’s leading protagonist for increasing the role of harm minimization in illicit drug management policy. In my view he is being evasive in this statement and offering testimony to the Committee that is misleading in its implications and which would bring about disasterous policy outcomes for Australia.

We don’t want a community where large numbers of people use heroin, cocaine or amphetamines even if that usage can be made safe in very restricted terms. These drugs have damaging effects on people’s brains and generate many social evils. Harm reductionist defeatism won't help us deal with the drug problem and vthat is what Wodak's position amounts to.

Almost every part of Wodak’s statement I disagree with emphatically as did the Chair of the Committee Senator Bronwyn Bishop – she has been strongly criticized by those in the drug law reform movement for her rudeness. If I had been there I must admit that this type of nonsense would have got me annoyed too. I quote Wodak’s statement at length, bold bits that interest me and comment briefly on these bits as they occur. The complete unedited transcript of this part of the proceedings is here.

Wodak: ‘Harm reduction, a widely and possibly often willfully misunderstood term, is a simple concept. It means that we focus primarily on reducing the adverse consequences of drugs, such as deaths, disease, crime and corruption. The alternative to harm reduction is use reduction, as in the war against drugs. In use reduction, we focus primarily on reducing drug consumption, whatever the impact on deaths, disease, crime and corruption. The most important point about harm reduction is that the scientific debate about harm reduction is now over. Harm reduction is recognized widely to be effective, safe and cost effective’.

Response

Harm-minimization is not widely misunderstood. It means, as Wodak says, minimizing the costs of drug use. Legalizing drugs would reduce their prices while limiting the user costs of illicit drug use reduce non pecuniary costs of use. If you believe in the law of demand – that use depends negatively on price and other user costs – then demand would rise and a larger population would use drugs at a lower average level of risk. It is by no means clear that overall social damages would fall.

Use reduction as defined by Wodak is a straw man - note the use of the word 'whatever'. It is not practiced in pure form in any Western society. Huge amounts are spent trying to limit the availability of illegal drugs and huge amounts are spent dealing with the psychiatric and medical problems of the nitwits who use drugs.

There is no agreement on the value of harm-minimization as Wodak terms his policies. The scientific debate is not over. It is not clear at all that social damages would fall. The heroin drought in Australia of 2000 whereby interdictions substantially cut the supply of heroin and permanently reduced usage, overdose deaths and crime shows that Wodak is wrong. The long-term trends of decreased heroin and cannabis use show he is wrong. The attempts to reduce drug use by supply-side interdictions are proving successful.

Wodak: ‘Five Labor and three coalition governments, in Tasmania, Queensland and the Northern Territory, adopted harm minimization as our official national drug policy in April 1985. Every state and every territory government since then, whatever its political hue, has adopted and implemented harm minimization. The current federal government, despite its public stance, sensibly but unfortunately discreetly, continues harm reduction in several forms, including a $10 million a year enhancement of state-territory needle syringe programs, generous funding to support HIV prevention among injecting drug users in Asia, vigorously carrying the torch for harm reduction in debates within the UN system and by diverting drug-using offenders from the criminal justice to the drug treatment system. Needle syringe programs in Australia from 1988 to 2000, according to a Commonwealth department of health commissioned study, by 2000 prevented 25,000 HIV infections and saved up to $7.7 billion, while by 2010 needle syringe programs will prevent 4½ thousand deaths from AIDS. If this committee wants to scrap harm reduction in this country, you will have to take personal responsibility for the HIV epidemic that Australia then has to have’.

Response.

This is pure irresponsible political posturing. The Federal Government is, as Wodak notes, pursuing very much a harm-minimization-cum-supply-cum-suppression policy and it is a policy that makes much more sense than Wodak’s views. Why the word 'unfortunately' here? Is Wodak searching for a grizzle? It seems that what Wodak wants are the 'carrots' that support drug use without the 'stick' that seeks to limit it. Maybe the Government is rather discreet about this – it would not seek to give the public impression that it endorses dangerous illicit drug use and it is actively seeking to prevent illicit drug use. But it is spending a huge amount on treatment and other services for the druggie nitwits.

Who is suggesting scrapping needle syringe programs? Answer – nobody.

Wodak: 'There is growing realization that relying on drug law enforcement, Customs, police, courts and prisons to control illicit drugs in the last several decades has not worked, is not working and can never work. In the decades of global drug prohibition, drug production and consumption has soared around world. It is now a global $322 billion a year industry, of which 26 to 58 per cent may be profit. Drug problems have got worse and worse over the decades. Governments have spent more and more taxpayers’ money. This is a typically high-taxing, big government approach. Many fiscal conservatives, such as the Nobel prize winning economist Professor Milton Friedman, condemn these futile attempts to arrest and imprison our way out of our drug problems'.

Response

Just a series of false claims. The war on drugs is being successfully prosecuted in Australia and internationally. The difficulty is that Wodak does not seriously entertain the obvious counterfactual. What would usage levels be if drugs were legalized and how would overall levels of community harm be affected?

The heroin drought, recent experience in Australia and recent international experience (in particular the vast UN data bases) shows the War on Drugs is gradually winning. How would drug use problems improve if drug use was legalized and even greater attempts were made than at present to secure the health and safety of the nitwits who use illicit drugs?

Even Friedman acknowledges that the key difficulty with his reform proposals is that usage levels will rise. He is writing of a society where the main response to illicit drug use is imprisonment. Who is suggesting that for Australia?

Who says that drug abusers must be imprisoned? Most in Australia initially receive the option of treatment at public expense.

Wodak: What we have to do is redefine drugs as primarily a health and social issue, with funding for health and social interventions raised to the level enjoyed by drug law enforcement. Criticism of harm reduction and drug law reform may be clever politics in the short term, but the war against drugs has been an expensive way of making a bad problem worse. If drugs are treated primarily as a public health problem, as suggested recently by Justice Don Stewart, deaths, disease, crime and corruption will fall, and I expect that drug consumption will also fall once the huge profits of the industry are removed. In the current system, criminals and corrupt police control the drug market. Regulating this market mainly using public health measures is the least worst way of responding to these drugs’.

Response

The short-termism here is all Wodak's – not any Western government’s. The effect of legalizing drugs will be to reduce social costs in the very short-term. But a potentially huge new pool of users will almost certainly be generated whereas the current trend is for reduced numbers of users.

This is the myopia of a non-reflective doctor. Treat the problem that stands in front of you – not the reason for its existence. Wodak I am sure is a sound doctor but should stick to medicine and leave public policy to those who can take a broader view. Wodak wants what is best for the heath of his current cohort of patients. The policies he suggests will probably yield that outcome but at the expense of creating a larger drug-using pool and greater social damage.

Wodak is playing a cynical game. The Howard Government is pursuing harm minimisation as Wodak would want it but also pursues drug use suppression. Harms will be minimised if the minimum number of people use. But treating illicit drug users as misguided citizens who need to have every aspect of their behaviour mollycoddled rather than as the pimple-faced, sick nitwits that they are is wrong. So too is any suggestion that they should face no prohibitions but yet gain access to what is potentially a lifetime of support at community expense. The latter is foolish policy.

Bronwyn B got annoyed during Wodak's testimony, and quite justifiably. As I say, I would have got annoyed too.

4 comments:

conrad said...

That's interesting HC. However, I wouldn't use BB as a great endorsment of your position, even if you happen to agree with her. More importantly

1) I was under the impression that the heroin supply is very cyclical. Once the US pulls out of its current disastors, I presume supply will incrase again as it was in the 90s (and in the early 80s). In the 90s it was cheaper than alcohol for new users, and I presume that at that end of the spectrum, price isn't a big factor. However, whilst we saw a slight increase in usage, it was not thrilling (even more interesting would be the total users of ice + heroin versus just heroin in these two dates -- speed was exceptionally expensive back then).

2) Harm minimization = I don't care about junkies, harm minimization is mainly for me, not them.

3) There have been some international experiments with various drug legalization/decriminilization experiments. Marijuana is the obvious one. Do Melbournians smoke less than in Adealide? I'll assume the answer is no.

However, there are also vast differences in cocaine/heroin policy. I belive that the stance on these is very liberal in Spain and Italy (or at least was) -- i.e., decriminilized (possibly not much different to carrying small amounts in Australia). THere's no evidence there are huge amounts of users in those countries. Alterntively, in the US, where these drugs are much more seriously illegal, cocaine is, well, everywhere. I think that shows policy differences are not a thrillingly strong factor -- its just the price and supply that is important, which is going to basically be impossible to stop in certain situations (like Afghanistan become a major produce again, let alone adding Iraq), especially in places like Australia. In case that happens, then the relative cost of harminimization versus prohibition will look a lot better.

hc said...

I don't use BB as an endorsement of my position - I only understand her annoyance.

The evidence from the 2000 heroin drought is undeniable. Supply-side interventions dramatically reduced usage, overdose deaths and drug-related crime. I'll post on this soon - paper in preparation.

conrad said...

The evidence of the 2000 Heroin drought shows you that when weird international events occur at the same time (most of which are out of Australia's control), the price of heroin goes up and people use less or substitute other generally harmful substances. No doubt there is overall net benefit to that, since some people won't substitute other drugs.

However, we shouldn't be looking at Heroin in terms of the bottom of the cycle. The ability of the police to take it off the streets is basically the same at any given time -- the price *isn't* moving thanks to anything Australia is doing (what difference is there between enforment ability now and enforcement, say, in 2000 or 1997?), and thats going to be true when the price happens to fall again.

If it turns out that the price falls to a low level due to over supply for a very long time (say, because Afghanistan, Iraq etc.), which I think seems like a likely future outcome given the current political climbate, then extra policing is going to have very little effect. If this is the case the money would be better spent on harm minimization.

brett said...

I would laugh if it were not so sad. You talk about “dangerous drugs" but statistically there is a high probability that you use the second most dangerous recreational drug in our community. Alcohol is pharmacologically more damaging than all the drugs you have mentioned. I should make it clear here that i use no legal or illicit recreational drugs. Harm minimisation is not encouraging drug use it is acceptance that despite our good wishes people will use and if the do use we should reduce the harm to themselves and the wider community
Although the idea of prohibition sounds good the reality is it has never and will never work.
The current system is a dismal failure and who would argue that the prohibition of alcohol in the US was a spectacular failure. The legacy of alcohol prohibition in the US is the mafia as we now know it. A market was established enabling them to grow so powerful that even law enforcement agencies are afraid of them.
we need to put our petty prejudices aside and look at the big picture. there are people being maintained on opiate pharmacotherapy’s today and they are committing significantly less crime and prostituting themselves far less than their illicitly using counterparts. They are in many cases gainfully employed paying taxes and raising families. And they are as you call them " nitwit druggies" lets move forward not backward