Fighting the wrong battle in the War on Drugs
Supporters of the ‘War on Drugs’ love to quote former drug users who have now become avid supporters of drug prohibition. But it is just as easy to find former drug users who have now become unambiguous critics of the ‘War on Drugs’.
One of these is now the President of the USA. President Obama said in the US Senate that the ‘War on Drugs is an utter failure’. Opinion on drug policy is clearly changing around the world.
On May 14, the new US Drug Czar, Gil Kerlikowske, called for an end to the ‘War on Drugs’ in an interview in the Wall Street Journal. The limited benefits, high costs and serious unintended consequences of the ‘War on Drugs’ are now being increasingly recognised.
Drug war supporters also like to suggest that Australia is somehow unique in accepting harm minimisation. The Prime Minister, all six Premiers and the Chief Minister of the Northern Territory adopted harm minimisation as our official national drug policy on 2 April 1985.
Harm minimisation received bipartisan political support for the next 12 years. It has since been re-endorsed as our official national drug policy by meetings of all our Health and Police Ministers on several occasions, each time following a thorough independent evaluation.
While the Federal Coalition Government opposed harm minimisation from 1997 as a political strategy, it discretely supported harm minimisation as a public policy by generously funding state and territory needle syringe programmes and HIV prevention among injecting drug users in Asia.
Seventy other countries have also explicitly adopted harm reduction. Sixty two other countries now provide methadone treatment while 76 other countries now provide needle syringe programmes.
Although drug war supporters are very critical of methadone and needle syringe programmes, methadone and buprenorphine treatment was supported by 68% of the community and needle syringe programmes by 67% in the National Drug Strategy Household Survey in 2007.
Methadone treatment has also been endorsed by the World Health Organisation, the United Nations Office on Drugs and Crime and UNAIDS, was included on the Essential Drugs List by the World Health Organisation and is supported by copious high quality research. Virtually all the major United Nations organisations responsible for drug policy now strongly support harm reduction. Many international organisations also support harm reduction including the Red Cross, the World Bank and the Global Fund for AIDS, TB and Malaria.
Some drug war supporters strongly support treatment of heroin users with naltrexone and naltrexone implants. Naltrexone has not been endorsed by WHO, UNODC or UNAIDS. It is not included in the Essential Drugs List. Scientific evidence to support naltrexone and naltrexone implants is very weak. Most clinics providing naltrexone treatment in Australia became bankrupt and had to be closed.
After reviewing the evidence on effectiveness and safety of naltrexone, a high level Australian committee recommended against including the drug in the Pharmaceutical Benefits Scheme. Treatment with oral naltrexone carries an increased risk of death. No country in the world has yet approved naltrexone implants for the treatment of heroin dependence.
Ms Jane Halton, the Secretary of the Department of Health and Ageing complained to the Senate Standing Committee on Community Affairs in October 2008 that naltrexone implants have been produced in Australia for 8 years but have never achieved ‘Good Manufacturing Practice’ standards. This means that they have never met the minimum safety standards required to be inserted permanently into the human body.
This state of affairs would never be tolerated for any other patient group. It should not be tolerated for injecting drug users. Some lay commentators express strong views about the relative merits of different medications and approaches to the medical management of heroin dependence. While they are entitled to hold and express these views, these are technical medical matters. Why should lay views, however well intended and heartfelt, carry more weight when considering medications used for heroin detoxification than they are given for medication used in cardiology or cancer chemotherapy?
In 2008 the Medical Journal of Australia published a paper describing a number of patients presenting to major Sydney hospitals with complications following rapid detoxification with naltrexone or the insertion of naltrexone implants.
The failure of naltrexone supporters to include any reference to the undoubted complications of naltrexone shows a serious lack of balance in their approach to this subject. Though not approved by Australian regulatory authorities, clinicians have inserted naltrexone implants into thousands of patients in this country by exploiting a loophole expressly intended only for patients with a terminal condition and likely to die in the next few months. It is quite inappropriate to use this scheme for injecting drug users.
These days, we have a pretty good idea about what works and what does not work to prevent and treat drug problems. Unfortunately, what works is often not politically attractive and what is politically attractive often does not work. The things that really work are basing policy and practice on evidence and respecting the human rights of drug users.
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