Sunday, September 16, 2007

Bronwyn Bishop gets tough on harm minimisers

The Coalition’s ‘tough on drugs’ policy has been, in fact, a de facto harm-minimisation policy with a tough, external public persona. The years of being tough on drug users in Australia are, in fact, long since finished. With respect to heroin addictions, emphasis for a long time has been on treatment of the addiction by switching addicts to the use of commercially-acceptable opiates such as methadone or buprenorphine that are just as addictive as heroin. It is primarily a pessimistic viewpoint - the assumption is that we cannot eradicate illicit opiate use so let us learn to live with illicit drug use by 'medicalising' the problem.

A safe injecting room, use of needle exchanges and an increasing reluctance to use the force of the law against drug users, have all acted in unison to reduce the user costs of being a ‘dope fiend’ thereby encouraging use. So-called ‘harm-minimisation’ policies reduce the user costs of drug use creating more users.

With respect to heroin, usage fell in Australia after years of growing strongly (due partly to the support of our local harm-minimisation industry) because of the successful attack on heroin supplies by the Australian police in 2000/2001. This led to Australia’s so-called ‘heroin drought’. This has greatly reduced the number of new drug users and vastly reduced the number of heroin overdose deaths. I am completing a study of the 2001 drought, with Lee Smith, which I will release later this year, but the main conclusions are clear. Heroin demands and initiation rates are relatively price elastic (this is known from a myriad of studies including many not relating at all to the drought) so a reduction in supply will reduce demand. This, in simple terms, is what happened in Australia in 2001.

The industry of drug treatment officers and doctors with the thousands of their clients who they keep addicted to commercial-acceptable opiates have not contributed to reducing usage. They have transferred large numbers of users from illicit to licit opiates but have not primarily targeted the ending of drug addictions.

Partly I suspect the medicos hate the idea that supply restrictions and consequent price increases can reduce heroin demanded simply because they are ignorant of economics and fairly ignorant of anything outside their specific disciplines of study.

Doctors do very specific vocational degrees and don’t study social science disciplines. They don't have breadth in their approach to issues - you either support their line or you are a heartless fool who understands nothing. Their objective, as they see it, is simply to reduce harm to the patient in front of them and that is it. The notion that this might encourage costly continued usage by that patient or 'spill-over' effects on broader society does not cross their minds. The subversive notion that, by coming to the aid of junkies and making their life easier on every account, one might increase demand for the use of drugs is simply preposterous to them. It is preposterous because they are so ignorant of basic social science research.

At drug conferences, like the annual APSAD meetings, those addicted to drugs are keynote speakers and treated with hushed tones of reverence. I take a different view of these social parasites.

Partly too, any suggestion along the lines of an expanded role for the law cuts into the extent to which the addiction issue can be 'medicalised' and thereby limits the ability of 'harm-minimisation' oriented institutions to get more money and to ‘empire build’ on the basis of the expanded demands that their so-called harm-minimisation policies bring about.

The research groups like NDARC that draw in millions in research grants each year do really low standard work. If I marked most of it as an honours thesis it would get a fail grade. The researchers clearly don’t understand basic statistics or economics – most of their so-called analyses are based on bi-variate graphs where some sort of confused causality is asserted between two variables. Their Commonwealth Government-funded forecasts of current drug use trends are an absolute joke and an embarrassment to even others in their own professional groupings.

Senator Bronwyn Bishop’s Senate Committee report, The Impact of Illicit Drug Use on Families, is designed to challenge the harm-minimisation paradigm that we have de facto come to rely on by seeking to re-promote the virtues of drug use abstinence. The report involves a recommitment to a 'zero tolerance' approach to illicit drugs.

The Bishop Report has already aroused ire among the medical community and the spiteful army of ‘harm-minimisers’. This is hardly surprising as it is the most radical critique of the harm-minimisation policy for years. Of course, whether it will ever be translated into policy is doubtful given the Government’s current problems. A group of Labor Party pollies on the Committee did puit forward a minority report but they did agree with most of the core committee recommendations which is hopeful.

By throwing the ‘cat among the pigeons’ the report should provoke a community rethink. It is primarily an optimistic report that suggests we can reduce illicit drug usage to low levels. While it has been strongly criticised it has also gained support from groups such as Drug Free Australia.

Some of the main ideas in the Bishop Report:

· Constrain treatment options to be those that seek drug use abstinence rather than living with an addiction.

· Maintain a continued emphasis on policing for addressing drug issues.

· Minimise harm with respect to the children of addicts by removing children them from parents who are drug addicted into adoption. Expend increased resources for detecting illicit drug use by parents and promote contraception among addicts and manage the social security income of users to promote the provision of basic needs for kids.

· Fund only agencies promoting drug use abstinence. The primary objective of pharmacotherapy should be the cessation of an individual’s opioid use so Naltrexone implants – designed to end heroin addiction – are proposed to be listed on the PBS.

· Reassess the role of needle and syringe exchange programs to determine whether they are supported by the local communities and examine whether they direct users to treatment enabling them to be drug free.

· Have random testing for drivers affected by illicit drugs concurrently with random breath testing for alcohol and random workplace drug testing regime to improve safety for patients and other staff.

· Place child users aged up to 18 years in mandatory treatment for illicit drug addiction with an organisation seeking to make them drug free.

It is a ‘tough love’ approach to the issue of illicit drug use. But, in combination with policies that make heroin and other drugs expensive, these sorts of policies will help to minimise the extent of addiction and the harm that addicts inflict on communities.

18 comments:

conrad said...

I think coming to the aid of junkies acts as harm minimization to the community, which isn't a bad thing in my books (excluding personal self interest -- I wish the junkies near my train station would piss off). Having people spread HIV, hep C, commit crime etc. isn't fun for those that don't take heroin. Personally, if you don't care about the number of users (like me), then distributing free junk to all of them would solve these problems at a price much less than your war on drugs.

Also, what evidence have you got that it was _the Australian_ police were responsible for the reduction in supply, and what evidence have you got that their success wasn't just due to a bit of good luck that year? I'll bet you that in the next two years we'll see a marked pick-up in usage due to a drop in price thanks to the current Afghanistan situation.

Incidentally, it isn't just NDARC doing cruddy research. I'm surprised at the poor quality stuff released by some of the agencies. AIFS seems to produce random questions to answer unknown problems (who cares about psychometrics?), and some of the stuff the Department of education(s) releases is almost unbearable to read as are some of their responses to situations as they arise.

hc said...

Comnrad, I am in favour of HM in relation to the community - preventing damage by drug users on theitr children and the vrest of the community.

Spreading free junk would create a huge addiction problem that is socially undesirable.

It doesn't matter than much whether police effected the supply shock - the key issue is tyhayt a negative shock occurred which reduced addiction levels and overdose dealths. Hence a policy that effectively cuts supply will have these effects.

conrad said...

1) If the supply can only be restricted via international policing, there may be essentially no effective policy Australia can have to reduce supply. This is why you need to specify how the supply has been historically reduced. If the cost of that outweights the benefits obtainable in harm minization, its logical to choose the latter if you want to spend the money.

2) I don't see what the community harm in having large numbers of addicts is if the junk is essentially free (excluding the occasional OD). Its main harm now occurs because addicts can't get it easily and what they get is not controllable. Many people can function happily whilst addicted to heroin -- all addicts are not neccesarily dysfunctional. Its quite possible to work a productive 40 hour week addicted to heroin.

hc said...

Conrad, I am not in favour of a soma drug that keeps people happy but stupid. There is an optimal amount of pain in the world.

There are two issues (a) do supply interdictions work to increase price? - they do; (b) can Australia introduce effective interdictions? - I think they can.

andrewt said...

If you are focused on controlling illicit drug supply, I can't see why you go such lengths kicking the (ignorant narrow) medical profession - although you could go further. They clearly encourage unsafe driving by treating accident injuries and poor diet by treating cardio-vascular disease.

And if you want to come across as the rational economist (versus the woolly-headed medics) perhaps you shouldn't extol wine consumption and drug abstinence in consecutive blog posts.

Francis Xavier Holden said...

mmh that might explain why most doctors would prefer to treat a junkie than an economist. Most doctors have seen at least one reformed junkie get clean and contribute to society.

conrad - count yourself lucky you haven't got economists hanging around your station sneering at you.

hc said...

Andrewt, The moral harard implications of overeating can be captured by charging people more for health insurance if they are overweight. Denying people access to treatment does not neccesarily promote efficiency.

The supply restrictions that were associated with the heroin drought cut the number of overdose deaths in Victoria from over 1000, FXH, to a handful. Tell me honestly that is a bad outcome.

I am not saying that reducing harm is always a bad thing but ignoring totally its moral harard implications is.

conrad said...

HC,

you keep on talking about supply restrictions. However, as far as I'm aware there is no strong correlation between Australian law enforcement and the supply. All you have done is show price changes demand (no big deal), not that you can actually change demand without spending the Earth and having an authortiatrian state. Supply dropped all over the world, and Australian police were not all over the world. Your position is not based on logic, and you are falsely attributing success to the wrong people.

hc said...

Conrad, Not true the price hikes did not occur in other countries - just Australia. This suggests local interdiction effects were important.

That price changes demand is no big deal to economists but it is to the drug treatment industry.

If you are sayiong that if interdictions are infinitely expensive they will not be useful policies I agree. But I don't think they are infinitely expensive.

conrad said...

HC,

I'm not saying they are infintely expensive but I am saying that the benefit you get basically follows a log function, so the more you spend the less it affects the price.

I'm also saying that there is very little correlation between the amount spent on _local_ policing and price. This is because there is essentially no corrlation between the numbers of users and the amount spent on policing. The amount spent on policing is basically linear, but the number of ODs etc has been cyclical. Thus, for instance, what you often don't note is that policing didn't change much in the early 90s but we got heaps more addicts.

If you are saying that price didn't rise overseas, when (a) the Taliban started destroying the Afghani crops; and (b) the UN forces took over destroying it (now something that they sure about incidentally -- since it creates poor destitute farmers who join the Taliban), then all you have convinced me of is that the supply and price are not well correlated, which is really evidence against policing solutions.

Francis Xavier Holden said...

conrad - I might be wrong but my memory says the Taliban didn't destroy many crops but mainly withheld output from a market and stockpiled it for later sale at a higher price.

hc said...

Conrad, If your story was right then prices should have risen in all markets supplied by the Taliban. They did not. Whatever happened in Australia in early 2001 it was something Australian.

Anonymous said...

Australian Mr Big's made a strategic decision to move into methamphetamine importation and production. Or so the rumour goes.

The police were just spectators really.

Francis Xavier Holden said...

anon - the police are never "just spectators"

We will see in the ensuing months that they were players and indeed instigators on the Melb Gangland Killings as well as serious directors in drug profits. Deep corruption.

Another argument for decriminalisation.

Anonymous said...

Will we Francis? Interesting...

Did you see the spat in the Griffith Area News between Bob Bottom and Tony Reeves over who killed Donald Mackay?

Also, Harry just curious, can you explain what is "an optimal amount of pain"? I hadn't figured you to be interested in bondage, so thought it must be some economist in-joke.

hc said...

No i didn't see that spat.

It was a bit of a joke but it had a point. We all need to learn to live with some pain and unpleasantness - life was not intended to be a blissed-out 'soma'-like state.

Its a reason I have for not having a large slab ofr the population addicted to opiates even if they are benign.

JohnZ said...

Harry,

If you're so against the "soma" state, why promote mind altering drugs like wine on your blog?

Your hypocrisy is breathtaking.

hc said...

JohnZ, If enjoying wine is a breathtaking instance of hypocrisy then you need to have your lungs checked.

Alcohol does not induce a permanent soma state. Of course I am opposed to the abuse of alcohol.