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.