Responding to illicit drugs: a level playing field for evidence?
There were only six heroin overdose deaths in Australia in 1964. But by 1997, heroin overdose deaths in Australia had climbed to 1116. Just imagine the number of mothers and fathers, brothers and sisters who had suddenly lost a young loved one.
Australia’s first supervised injecting facility began operating in Sydney’s Kings Cross in 2001 in response to the epidemic of heroin overdose deaths in the 1990s.
One in 10 of all heroin overdose deaths in Australia occurred within a couple of kilometres of Kings Cross. So reducing the number of heroin overdose deaths in Australia required some sort of effective intervention in Kings Cross.
The 1997 Wood Royal Commission recommended the NSW parliament consider setting up a place where people who use drugs could inject under supervision. Although a parliamentary committee approved a very supportive report, a majority of the committee still voted against recommending a supervised injecting facility. The (then) NSW Premier Bob Carr was initially quite opposed to setting up a supervised injecting facility (SIF), but when he retired, Carr named the Kings Cross Medically Supervised Injecting Centre one of his ten proudest achievements.
The world’s first official SIF was established in Berne, the capital of Switzerland, in 1986. Many others have subsequently been established in Germany, the Netherlands and some other European countries. There are now almost 90 SIFs in nine countries with a number of other countries currently planning to establish SIFs.
By the time the Sydney centre began operating, European research on these facilities was still unclear. This environment ensured that not only was rigorous evaluation carried out, but also that it was of the highest standard. The second SIF in an English speaking country was established in Vancouver, Canada in 2003. This was also initially subjected to relentless attacks.
The reality is that the best independent evaluation and scientific research in the world on SIFs has been carried out in Sydney and Vancouver.
We now know that SIFs have many worthwhile benefits and no serious negatives. SIFs reduce deaths from drug overdose. Between 2001 and 2005, 89 drug overdose deaths occurred within 500 meters of Vancouver’s SIF, a third of all overdose deaths in that city. But after it began operating in 2003 fatal overdoses decreased by 35 per cent within 500 metres of the SIF.
SIFs also reduces the number of new HIV and hepatitis C infections, increase the number of drug users referred to drug treatment and health and social services, and reduce the number of people who have had a non-fatal drug overdose but required ambulance transport to a hospital. SIFs also reduce injecting and the numbers of needles and syringes discarded in public places.
A number of studies have found that SIFs save more funds than they cost to run. Recently, information collected from Sydney’s Medically Supervised Injecting Centre showed that heroin injecting started to increase after new forms of prescription painkillers were introduced which prevent them from being injected. So SIFs also help authorities to keep tabs on what is happening in the street.
It is now also clear that SIFs do not increase crime, drug injecting or delay entry to drug treatment.
But 15 years after Sydney’s MSIC began operating and despite the strong evidence of benefit, the lack of serious negatives and the impressive cost saving, it is still the only SIF in the country.
Despite the legitimate fear in the 1980s of severe health, social and economic costs of an HIV epidemic spreading from people who inject drugs, it required civil disobedience before needle syringe programs were first officially approved in Australia. This disobedience took the form of a number of dissident doctors, including Dr Alex Wodak, in November 1986 confronting authorities by illegally distributing clean needles in Victoria Street, Darlinghurst.
In a similar way, without the acute suffering of a 24-year-old man, Daniel Haslam, dying of bowel cancer in Tamworth, followed by the relentless campaigning of his politically well-connected mother, Australia would probably still be discussing whether or not to allow medicinal cannabis.
Despite the death of a number of young Australians in the last year after taking ecstasy at youth music dance events, authorities still claim that current policy of saturation policing and sniffer dogs is working and that there is no need to even trial pill testing. Authorities assert, wrongly, that saturation policing and sniffer dogs are effective, safe and cost effective. But who needs evidence for a “tough on drugs” approach?
The same pattern is true of every harm reduction and drug law reform initiative in this country. Advocates for harm reduction or drug law reform have to produce large quantities of high quality evidence for any initiative to be considered. But it’s a different story for any drug law enforcement initiative.
Drug courts in Australia first became established about the same time as our first SIF. Australia’s first drug court was established in NSW in 1998. Drug courts now also operate in Queensland, Victoria, South Australia and Western Australia. Although evaluation of Australia’s drug courts has shown some benefits and some cost-effectiveness compared to imprisonment, drug courts were adopted, implemented and expanded much more rapidly than SIFs despite much weaker evidence.
Drug driving laws enabling roadside testing for cannabis, amphetamines and ecstasy now exist in all states and territories in Australia. In 2004, Victoria introduced the first drug driving laws in the world. Yet the drugs tested are not the riskiest drugs for drivers. Proof of driver impairment is not necessary. Legislation says that roadside drug testing is random but the police admit that dodgy-looking cars and drivers are targeted. In fact, it’s by no means clear that drug-driving laws improve road safety.
Is it any wonder that Australia’s illicit drug problem has gone from bad to worse when evidence for health and social interventions and for law enforcement interventions are not judged on a level playing field?
Professor Ross Fitzgerald is the author of 38 books, including his memoir ‘My Name is Ross: An Alcoholic’s Journey.’
The Canberra Times, January 25, 2016. Also in WA Today & The Sydney Morning Herald, January 25, 2016.