Effective care, not criminalisation

THE drug war policy wonks are in retreat. The UN’s World Drug Report makes this clear.

Released last month in Washington by the head of the UN Office on Drugs and war-on-drugsCrime, with new US government drug tsar Gil Kerlikowske, the report has direct implications for all countries.

The report reveals that a significant shift is occurring in the way the world controls drugs. The ambition of ending drug use through law enforcement is giving way to a sobering realisation that we need to reduce demand for drugs, decrease incarceration of drug users and increase drug treatment programs.

The report warns against using law enforcement as a blunt instrument and calls for “universal access to drug treatment to save lives and reduce demand”. Kerlikowske, newly appointed head of the White House Office of National Drug Control Policy, has recently said we should “completely and forever end the war analogy, the war on drugs”. Based on 100-year-old policy architecture, it has failed to eradicate the illicit drug trade, conservatively estimated to be worth more than $320 billion a year.

As a result, we are confronted with regional and national HIV epidemics driven by illicit injecting drug use. The UNODC report records injecting drug use in 148 countries, covering 95 per cent of the world’s population.

Just as we live in a global economy, so we live in a global illicit economy. While Australia doesn’t have the crack cocaine problems found in the US or Britain, it does have different drug problems, particularly with opiates and amphetamines.

In Australia, we had a clever government approach to drugs. Officially called Tough on Drugs, tabloid-style drug war rhetoric was matched with investment in treatment programs. The government sensibly invested resources in the diversion of drug users away from the criminal justice system and into the drug treatment system.

The public machismo of drug war rhetoric was matched with the quiet national funding of evidence-based and sensible interventions, such as opioid substitution treatments and needle and syringe programs.

Australia’s Howard government spending was built on a solid policy foundation. Since 1985 Australia has relied on a strategy with three key elements to address illicit drugs: demand reduction, supply reduction and interventions to reduce the harm when drug use does occur, commonly known as harm reduction.

A Howard government-funded study showed that during a decade harm reduction programs significantly reduced the need for health services, saving $7.7 million. Here lies the reason the Howard government’s investment in harm reduction, based on needle and syringe programs, existed under the banner of Tough on Drugs.

While a drug strategy based on supply, demand and harm reduction sounds balanced, the devil is in the detail. Nearly 50 per cent of all drug strategy funding is still spent on law enforcement and only 3 per cent on harm reduction. Most of the demand and harm reduction budget for drugs is dispersed through the Council of Australian Governments’ new National Health Care Agreement. The quantum of money to health generally has increased to record high levels under the Rudd government, to be dispersed by the states and territories under broad agreements with the federal government.

The problem with these new agreements is they do not have key performance indicators for demand and harm reduction programs or for communicable diseases such as HIV. They also do not insist that specific funds be attributed to programs that meet nationally agreed targets for our illicit drugs strategy.

The risk to our drug control efforts is therefore twofold: John Howard didn’t have the spending balance right between supply, demand and harm reduction, and specific accountabilities are not enshrined in the new healthcare agreements.

There is little political glory in funding drug addiction services and HIV prevention.

Weak political constituencies in these areas make funding a constant vulnerability. This encourages state treasuries to take a reactive approach to spending, moving further away from funding the drugs area proactively andadequately, pending another HIV or drug crisis.

At the local level, police and drug treatment and social welfare programs will often work together to reduce harm associated with drug use. However, the lack of key performance indicators in healthcare agreements, poor access to training and workforce development, and high levels of workforce attrition mean that cross disciplinary collaboration on a long-term basis is at risk.

By John Ryan. Source.

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