Australia's humane response by the drug companies

In this month 's Issuing Forth we examine the issue of safe injecting rooms, just one of the many controversial strategies that have been put forward to combat the 'heroin problem'. To discuss the pros and cons surrounding safe injecting rooms or 'shooting galleries', we have invited Dr Alex Wodak and Major Brian Watters, two of the major players in the media debate on the heroin trial, to provide arguments for and against the proposal.

By Dr Alex Wodak
St Vincent's Hospital

Injecting rooms reduce public nuisance and protect public health. They should be pad of a comprehensive response to illicit drugs in Australia.

Public Nuisance:

Some Australians these days are unintentionally exposed to individuals injecting drugs in public places. Others come across discarded used injection equipment littering public places such as parks, streets and beaches.

A recent unpublished literature review (A. Reynolds) did not find any published report of viral infection following injury from discarded used needle. This does not mean that infection is impossible but the risks are remote. Even so, negative reactions from the public about public injecting or discarded used equipment are very understandable. It is important to remember the relative risks. Children are at very high risk of contracting HIV (from their parents) in countries where HIV/AIDS is poorly controlled among injecting drug users (IDUs). Poor HIV control occurs in these countries because pharmacological fundamentalism prevents adequate provision of sterile injecting equipment. In contrast, children are at very low risk from a rare needle stick injury in pragmatic countries like Australia where sterile injecting equipment is provided to IDUs.

Injecting in public places generally only happens close to major drug markets. It involves a minority of IDUs, usually the most marginal members of an already marginalised population. Some are homeless, others have mental health problems. Most will have only recently purchased illicit drugs and then quickly obtained injecting equipment. Many will be desperate. Some will have little money. Most cannot tolerate any delay in finding a private place to inject. Some will have no private place to go to. About 80% of injections occur (far more safely) in IDUs' homes.

Used needles and syringes are mainly discarded close to major drug markets. Only a small percentage of the large numbers of needles and syringes used by IDUs are ever discarded in public places. Some used injecting equipment finds its way on to beaches through storm water drains because methods of dealing with storm water are still primitive. In some states, authorities have retained legislation which enables injecting equipment with traces of illicit drugs to be used as evidence of self administration. This legislation makes drug users fearful about responsible disposal of used injection equipment. States such as Queensland have managed to charge and arrest illicit drugs easily despite lacking equivalent legislation. The Clean Up Australia Campaign confirmed that discarded used injection equipment is a tiny fraction of street litter.

Nevertheless, public perceptions have been inflamed by some media dinosaurs who have temporarily escaped from their cages.

Even if the level of discarded used injection equipment is low, the public is entitled to see that authorities do what they can to further reduce the quantity of discarded used equipment. Injecting rooms would contribute to a reduction of discarded injecting equipment although they will never eliminate the problem.

Public Health:

Like many other western countries, Australia has experienced a steady increase in the number of reported 'drug overdose deaths' from 70 (10.7 per million) in 1979 to 550 (67 per million) in 1995. There are now more deaths from drug overdose each year than the number of Australian servicemen killed in action in all the years we had troops in Vietnam. Injecting in public places is far more hazardous as resuscitation is unavailable. Injecting rooms may help reduce drug overdose deaths, especially if located and run so that they are attractive to IDUs. Swiss authorities believe that injecting rooms have helped to reduce drug overdose deaths. There has not been a fatal overdose in a Swiss injecting room since they were established 10 years ago.

HIV infection among IDUs without other risk factors is under control in Australia. A decade ago, politicians from all parties put the interest of the community ahead of their own parties and allowed effective policies to be adopted. The health, social and economic benefits have been immense. Thousands of lives and many hundreds of millions of dollars have been saved.

But control of HIV infection among IDUs in Australia is very fragile. An epidemic could easily break out in prisons across the country. Indeed, a small HIV outbreak in an Australian prison system has already been detected (Dolan et al, submitted for publication). An epidemic of HIV infection could easily break out among indigenous Australian IDUs. Surveillance and prevention in this vulnerable population is more difficult. Such an outbreak could easily lead to the much feared further dissemination of HIV among indigenous Australians by sexual transmission.

Another major threat to continued control of HIV infection among IDUs is the current backlash against harm reduction measures such as needle exchange and methadone maintenance. Some senior members of this community have supported this short-sighted reaction. For the first time since an agreement to deal with HIV/AIDS in a bi-partisan spirit was forged in the early 1980s, there is a real possibility that HIV will become politicised. The dangers of this should not be underestimated.

Probably the most serious threats to the current control of HIV infection among IDUs in Australia is the continuing increase in cocaine use. This is probably occurring nationwide but the Kings Cross area is a particular focus. The Kings Cross area is possibly the major illicit drug market in the country. This area is also the national HIV epicentre. Cocaine use is a particular problem for HIV control because the number of injections per day is far greater than with heroin. This means that the needle exchange system has an even greater difficulty keeping up with demand. Also, many who inject cocaine go through a brief period of paranoia or chaotic behaviour during which their risk of infection is increased. We do not have now and may never have any pharmacological treatment for cocaine use equivalent to methadone maintenance for heroin use. Methadone treatment has undoubtedly made a major contribution to HIV control among heroin injectors. Powder cocaine epidemics overseas have often become crack cocaine epidemics after a few years. Crack cocaine use in many countries has led to a rapid increase in HIV transmission and other sexually transmitted infections probably because of sex for drugs and/or money. We can anticipate a continuing increase in cocaine importation and use in Australia as global cocaine production is trebling approximately every ten years. A very serious epidemic of HIV infection among injecting drug users, reaching an annual incidence of 19% per year, has been reported recently from Vancouver (Strathdee, et al, 1997) despite Vancouver having the largest needle exchange in North America. Increasing cocaine use in Vancouver, a shortage of facilities and treatment for drug users apart from needle exchange aid the poverty of the neighbourhood where the epidemic started, and the fact that Vancouver is a major entry point for cocaine into North America seem to be the most important factors in the epidemic.

Another major area of concern is the epidemic of hepatitis C among Australian IDUs. IDUs account for approximately 90% of old (prevalent) and new (incident) cases of hepatitis C in Australia. Clearly, control of the hepatitis C epidemic in Australia will not be achieved unless control is achieved in this population. The highly infectious nature of hepatitis C through blood-to-blood contact and the very high baseline prevalence levels means that authorities are unlikely to achieve a significant reduction in new cases of hepatitis C unless drug users are encouraged to adopt noninjecting routes of administration. Efforts to reduce the demand or supply of drugs, however attractive in principle, are supported by little evidence of success. Injecting rooms could provide an opportunity to influence drug users to administer drugs without injecting. Staff could assist by providing information about alternative routes of administration including sniffing, snorting, smoking or swallowing.

Injecting rooms were established in three cities in Switzerland a decade ago and later in cities in the Netherlands and Germany. Published evaluation is scant. Establishing and running injecting rooms has not been difficult. Although understandably initially treated with some suspicion in Switzerland, injecting rooms are now reasonably well accepted. Public nuisance of drug injecting in these cities has declined. Overdoses are promptly attended to in injecting rooms. The staff believe that they have influenced clients to inject less hazardously. Smaller gauge needles and syringes have been promoted and accepted. These cause less damage to veins and are less likely to transmit infections.

Establishing injecting rooms has increased referral to drug treatment. Government sanctioned injecting rooms would remove these facilities from their present association with criminals. Indeed, it could be argued that consideration of injecting rooms is really a matter of whether we want them to continue being run (sometimes badly) by criminals or run well by health departments.

Injecting rooms cost at least $300,000 to $400,000 a year to run. Vociferous community opposition is likely if these facilities are located where they are not welcome. The benefit to cost ratio, while still positive, is unlikely to be as high as needle exchange or methadone maintenance. The experience of Switzerland suggests they will still be very worthwhile.

Three decades of responding to illicit drugs in Australia has shown that alluring quick-fix solutions (such as Ultra-Rapid Opiate Detoxification) rarely justify their initial fervour Longer term, partial solutions like injecting rooms are almost always far more rewarding.

In most aspects of drug policy, details are far more important than overarching policy. The benefits and costs of safe injecting rooms in Australia are likely to be far more influenced by details like opening hours, conditions for clients, attitudes of authorities, communities and staff, than simply whether or not an injecting room has been established. It is likely that three or four safe injecting rooms throughout a state as large as New South Wales will probably be adequate.

Injecting rooms may be an unpalatable policy option. As in many other areas of drug policy, a continued lack of unsanctioned injecting rooms will in the long run be even more unpalatable.

Major Brian Watters
Salvation Army

Whilst one has to acknowledge the problems associated with the unsafe injecting practices associated with IV drug use, nevertheless 1 see the proposal to establish shooting galleries as being a cure potentially worse than the problem itself.

My concerns are broadly two fold:

Firstly, there is a values or philosophical question. Should we as a society be facilitating an illegal activity. Intravenous drug use is against the law and there is certainly an element of dichotomy in establishing a facility where one can legally do the illegal! Furthermore there is an implied, or tacit approval, for the use of illegal substances - heroin, cocaine, amphetamines and whatever else a person chooses to "shoot-up".

The question of "messages" is a great concern to me. 1 like to believe that all of us in this field are committed to preventing the spread of drug use. That (hopefully) being so, then we should recognise the mixed signals going out to the young in our society; namely If you want to try heroin, come along here to the 'Shooting gallery" where we can make it safe and comfortable for you!" There will be the further message "you don't have to worry about the police, its legal here!" Our society should be sending out a clear message that drug use is dangerous and unacceptable and that we as a society will do all in our power to prevent others becoming trapped in addiction.

My second concern and objection to the proposal, flows very logically from the philosophical debate. The pragmatics are, that the legal shooting galleries will increase the incidence of IV drug use. Obviously, to be successful these centres will need to be protected by the law and from the law. Thus, as with needle exchanges and methadone clinics, the police will be either officially or unofficially kept away from the centre.

Can it seriously be denied that the provision of legal facilities for the use of drugs and safe from police interference will not generate a supply to meet the demands for the substances? These places will become a Mecca for dealers and pushers. They will not only be supplying the existing demands, they will be stimulating and expanding their markets.

Consider this scenario: Joe and his mates from 'but west" are visiting Sydney and the Cross. Passing the shooting gallery, they linger out of curiosity. The stranger sidles up and says "go ahead boys, you should try it. Its all clean, safe and legal, just once won't hurt you". There is nothing too fanciful in that scenario! We know how persuasive drug dealers can be. Also, it is an ideal environment for extreme peer pressure with the addendum "... if its legal it can't be too bad!" It has long been a public health maxim that availability, accessibility and price are significant factors in consumption and in the growth of a market.

Those of us who work with drug addicted people, know the urgency - the immediacy - that overwhelms the addict when they have their drug in their hand. It has to be used now! This is clearly demonstrated at places like Cabramatta where these "customers" can't wait to get home, but are in the back alleys and shop doorways risking police attention. To truly impact on the problem of overdose there would have to be shooting galleries in every major suburb in Sydney. The addicts certainly won't travel from suburb to suburb. Furthermore there will have to be suppliers close by the galleries remember there can be no waiting!

All of us in this field are familiar with the N.I.M.B.Y. syndrome `not in my backyard". We encounter local hysteria when we try to open a treatment service, a needle exchange or a methadone clinic. Can we imagine the reaction at the proposal to open a shooting gallery! Although in this instance 1 have to admit I would join the cry "not in my backyard!"

I'm sure that all of us in the field are appalled at the waste of lives associated with the use of illicit drugs. Most of us have lost people we love, to overdose or a bad hit. But however much this proposal appeals to our immediate compassion and humane concern, it will very quickly generate more problems than it solves. If we believe that illicit drug use is a menace in our society - and 1 know that some readers may not agree with that proposition - then we need to be looking for longer term solutions not band-aids. We should be providing education, treatment and strong law enforcement against the dealers and suppliers. Sure, let's give narcan to the ambulances and make it available through pharmacies. Let's continue the needle exchange program. Let's provide properly supervised methadone reduction programs. But above all let us resist any measures that would give an appearance of even quasi-respectability to addictive drugs and the facilities for their use.

Wodak, A. 'Issuing forth', Centrelines Magazine 29 (1997) p. 2

Heroin Issues

Heroin use continues to cause community concern and with the recent statistics on heroin related deaths there is further mounting pressure for action. Numerous articles and newspaper reports reflect the range of opinions on the issue and the public debate that often appears divided on how best to address the heroin 'problem'. There are those that support increasing law enforcement and imposing more severe penalties for heroin offences, while others advocate for injecting facilities and decriminalisation/legalisation.

Harm minimisation is one approach that is widely accepted particularly by those working in this area. Harm reduction strategies stem from this approach and aim to reduce harm and prevent the problems associated with drug use. The needle/syringe exchange service that first became available in the mid 1980's is one example of a harm reduction strategy. The major goal of such a program is to prevent/reduce the spread of blood-borne viruses such as HIV and hepatitis C. Current approaches to address the problematic use of heroin (and other drugs) usually fall within three broad areas:

Supply and Control

The supply and control of heroin is considered by many to be an important factor when considering ways to reduce drug-related harm. Illegality of a substance will affect the demand and supply, and also the quality and strength of the drug sold on the market. Drug laws determine what constitutes an offence and law enforcement strategies are employed to assist in reducing the supply and demand for a drug. Legislation and drug policy also plays an important role by promoting debate about various models of control, including the proposing of harm minimisation strategies, such as decriminalisation and heroin trials.

Treatment

There are a number of different treatment options for drug users, which often vary in their aims and methods. Some programs aim exclusively for the user to achieve a drug-free lifestyle while others aim for the drug user to reduce the harms that are associated with their drug use. The latter case recognises that abstinence is not the only option and different strategies can be implemented that takes into account a range of goals to improve the health and wellbeing of the individual.

Modes of treatment include individual counselling, group therapy and drug maintenance therapy, e.g. methadone. Medical or non-medical withdrawal, or detoxification, programs aim to minimise symptoms that may present when a person stops using a drug. It is well recognised that no one single type of treatment is effective for every drug user and, often, a combination of interventions, e.g. drug withdrawal/maintenance in conjunction with counselling, is most effective.

There is continuing debate in Australia - as there is worldwide - on new treatment approaches for heroin use. New drugs or treatment programs are required to be well researched and then trialed before being implemented in the wider community. More recently, heroin trials and ultra rapid opiate detoxification have attracted a great deal of controversy in Australia on their efficacy as a treatment approach. New pharmacotherapies, such as naltrexone, LAAM and buprenorphine, are currently being trialed as potentially new or alternative maintenance treatments for heroin dependency in Australia. The methadone maintenance program is the most well established treatment in Australia for heroin dependency.

Education

Drug education has changed dramatically over the past 10 years. Previously, providing young people with information about drugs was regarded as being 'as culpable as supplying them with the drugs themselves'. Work achieved by drug educators/researchers has helped break down certain taboos about drug education. Harm minimisation is employed as a framework for Australian contemporary drug education and is currently being implemented in an increasing number of school curriculums. One significant aim of this is to promote informed decision making among young people through increasing factual knowledge and encouraging active exploration of drug-related issues. Peer education is another approach that is gaining popularity in the education of young people throughout the wider community.

Laws

The problems caused by illegal drugs

Drugs, both legal and illegal, can be responsible for a great many problems to individuals and society, including physical illness, dependency and psychological problems, social disruption, violence, family breakdown, economic loss, accidents and death.

In Australia, there were an estimated 22,700 drug-related deaths in 1997. Of these, 18,200 were due to tobacco, 3,700 attributed to alcohol and 800 to illegal drugs.

Source: AIHW, 1999. Media release: Drug use in Australia and its health impact. 31 March 1999. Canberra

There are some problems that are caused purely by the fact that a drug is illegal.

Many people have been imprisoned (even executed in some other countries) for dealing in or using illegal drugs. For many the stigma of a criminal record continues to burden them long after their drug use has stopped.
Restricting the supply of an illegal drug can make the drug more expensive. Many users of heroin are forced into criminal activities, such as theft and prostitution, in order to obtain sufficient money to support their drug use.
Because some drugs are illegal, they are not subject to any form of quality control. Drugs bought on the street are of unknown strength, which increases the risk of accidental overdose. While there is always a chance of overdose, this can be of particular risk to the one-off, inexperienced or occasional user. Street drugs can contain other unwanted or dangerous chemicals causing illness or death.

Drug laws

The Federal Customs Act covers the importing of drugs, while each state has laws governing the manufacture, possession, distribution and use of drugs, both legal and illegal. Drug laws in Australia distinguish between those who use drugs and those who supply or traffic drugs. Victoria Police recently introduced a cannabis cautionary scheme for those caught using cannabis for the first time. Under this scheme first-time offenders are formally cautioned by police then referred to a drug treatment centre. Police have also begun trialling a cautionary scheme for heroin and other illicit drugs.

The Drugs, Poisons and Controlled Substances Act (DPCSA) includes these major drug offences: use, possession, cultivation, and trafficking:

Use includes smoking, inhaling of fumes, or otherwise introducing a drug of dependence, into a person's body (including another person's body). (A drug is defined as a "drug of dependence" if listed as illegal except under prescribed conditions.) Generally there is a lesser penalty for the use of cannabis compared to other drugs.

Possession is the most common offence. Possession means having control or custody of a drug. Knowledge of such possession must be proven in court. Possession applies both to drugs found on the person or their property, unless it is proven the drugs do not belong to that person. In Victoria, those found in possession of a small quantity of cannabis (50g or less) for the first time are cautioned formally then referred to a drug treatment centre. The penalty for the possession of any drugs not related to trafficking is $3000, or one year imprisonment, or both.

Cultivation is the act of sowing, planting, growing, tending, nurturing or harvesting a narcotic plant. Any of these activities constitutes the offence of cultivation. If a person cultivates 'a trafficable quantity', or intends to sell even a small quantity, it is likely that charges for possession, cultivation and trafficking will be laid.

In Victoria if the court is satisfied that the cultivation is not related to trafficking, then the penalty is a fine not more than $2,000 and/or imprisonment not longer than one year. If the cultivation is related to trafficking, the penalty is a maximum of 15 years imprisonment, or $100,000 fine, or both.

Trafficking is a very serious offence. (The DPCSA defines trafficking to include: the preparing of a drug of dependence for trafficking; manufacturing a drug of dependence, or selling, exchanging, agreeing to sell, or offering for sale, or having in possession for sale, a drug of dependence.) If this is done in commercial quantities, the penalties are extremely severe. Bail may be refused unless there are exceptional circumstances. The criminal charge of murder is the only other offence that has a similar bail condition. In Victoria, the penalty for trafficking a commercial quantity of a drug of dependence is a maximum of 25 years imprisonment and up to a $250,000 fine.

Current responses to the drug problem

In Australia drug problems are dealt with in three main ways:

Reducing the supply of drugs

Law enforcement activities aim to prevent illegal drugs from entering the country, or being manufactured and distributed in Australia.

One result of restricting the supply of illegal drugs is to force up the street price, because users are forced to bid against each other for the limited quantity available.

There are also many laws restricting the supply of legal drugs. For example, making sure that alcohol is not sold to people under 18 years of age.

Reducing the demand for drugs

It is difficult to get accurate figures on how many people use illegal drugs, simply because they are illegal. However, a 1998 national survey showed that 39.3 per cent of the population had tried cannabis; 8.7 per cent amphetamines; 10 per cent hallucinogens; 2.2 per cent heroin and 3.9 per cent inhalants. Illegal drugs were used most often by people in the 20-34 year age range.

Source: AIHW, 1999. Media Release: Drug use in Australia and its health impact. 31 March 1999. www.aihw.gov.au. Canberra

Reducing the demand for drugs involves a range of activities including:

giving people the necessary information to make responsible choices about drug use;
working to ensure that people have an adequate standard of living and positive social and personal relationships so they are less likely to turn to drugs; and
helping people with drug problems reduce their drug use through access to treatment and rehabilitation programs.

Reducing the harm caused by drug use

Where drug use does occur, it is important that the harm caused to individuals and the community is minimised. This means concentrating on the specific harms and practical ways to reduce them.

For example, providing access to clean needles through needle exchange programs has reduced the spread of HIV/AIDS and hepatitis B and C. . Drink driving laws and random breath testing has reduced the harm caused by drink drivers.

Under the National Drug Strategy (NDS), Australia's approach to illegal drugs combines law enforcement with harm reduction.

The legislation debate

There is some concern that existing drug policies have failed and it is time to introduce a relaxation of drug laws. Opposing this is the concern that any softening of laws will lead to increased drug use and greater problems in society.

Some of the specific criticisms about existing drug policy are:

Existing drug laws fail to greatly reduce harms, and may actually increase them:

Some critics claim that current drug laws fail to reduce harm because they focus on the wrong drugs. Alcohol and tobacco account for around 97 per cent of drug-related deaths in Australia and 90 per cent of economic costs.

While there is medical evidence to indicate that some illegal drugs (such as heroin) are less harmful to the body than alcohol, the statistics above should be interpreted with caution. No one knows how much heroin or amphetamines or cocaine might be used, and how many deaths might result, if those drugs were made legal.

It is also clear that the illegal status of drugs, such as amphetamines and heroin, add greatly to the risk of overdose, poisoning and infection. Users may suffer legal sanctions and social stigma, be forced to associate with criminals to obtain drugs, or commit crimes to raise sufficient money to purchase drugs.

Drug laws are inconsistent, or even hypocritical:

Many of the distinctions between legal and illegal drugs are the result of historical factors and cultural bias rather than a rational assessment of the harms caused by those drugs.

While many people recognise that there are inconsistencies in our drug laws, only some see this as an argument for legalising all drugs. For others, it is an argument for making drugs, such as alcohol and tobacco, illegal. They point out that having alcohol and tobacco legal is bad enough. Why add cannabis or heroin to the list?

Drug use should not be seen as a moral issue:

Traditionally, our society has seen drug use in moral terms. However, since the appearance of the AIDS virus, the need to accept that people use, and will continue to use, drugs has become essential. Health workers now generally agree that it is more effective to work with drug users and provide them with information about safe use than to morally condemn them, and so drive them underground.

Many people have expressed opinions in the debate over legalisation of drugs: politicians, academics, police, doctors and others. Most of these opinions contain elements of practical and moral points of view. The questions remain: Should illegal drugs remain illegal? Should legal drugs remain legal? Are there other options available?

Options for drug policy reform

Various options for drug policy reform have surfaced over recent years:

Harsher penalties

This option is based on the logic that increased penalties for trafficking would act as a deterrent. The experience of other countries that have adopted this policy is not very encouraging. In 1989, President Bush committed $7.9 billion to the 'War on Drugs' in the United States, despite clear evidence that law enforcement was failing to restrict illegal drug availability and use.

Some reasons have been put forward as to why illegal drug use appears to be so unresponsive to harshness of law enforcement measures:

· Harsher penalties lead to increased drug prices. This increases the incentive for people to join the illegal trade because of the substantial profits to be made.

· Most drug traffickers do not consider the possible risks, and if they do it is usually in terms of whether or not they will get caught, rather than the possible penalties. Therefore, unless the risk of detection is high, the increased penalties are unlikely to deter drug traffickers.

Prescription Model

Some people argue that the main problems caused by illegal drugs (in particular, heroin) could be overcome by the establishment of a prescription system. The drug would be available to registered users on prescription. The drug user would have to periodically attend a doctor or clinic to get a renewal of their prescription.

Supporters of this model argue that the legalised supply of heroin by prescription would:

reduce the demand for illegal heroin;
undercut the illicit market;
increase the number of identified drug users who could then receive treatment and other help;
and reduce the need for users to commit theft and other crimes to support their addiction.

Opponents of this model argue that it supports drug use, and does not offer any encouragement for users to stop their drug taking. It is argued that drug users would be very well off, with cheap, clean heroin, subsidised by the taxpayer, available to them.

Not all drug users use regularly or are dependent. Recreational and irregular users would fall outside the guidelines of the program. They would either have to continue to obtain their drugs illegally, or would have to increase their habit so as to be eligible to obtain a prescription.

Decriminalisation

The term decriminalisation has been used in a number of different ways, to mean anything from reducing the penalties attached to drug offences, to completely removing all drug offences from legislation.

Decriminalisation can be dealt with in the manner of a fine. However, it is generally argued for in relation to minor drug offences such as possession. More serious drug offences, such as drug trafficking, remain major crimes and (consequently) incur harsh penalties.

Decriminalisation of cannabis use has occurred in South Australia and the ACT. An 'expiation notice' system has been introduced where a fine is imposed for possessing small quantities. So far, there has been no indication that the level of cannabis use in those states has significantly increased.

Decriminalisation would save on law enforcement efforts and on court costs. The major argument against decriminalisation is the concern that it would lead to a substantial increase in the use of those drugs that were decriminalised. (People can still be dealt with harshly under decriminalisation, however; fines can be difficult to meet, especially for some drug users whose financial assets may be limited.)

Public support

Any changes to drug policy require community support if they are to be effective. A recent survey showed that there is not general community support for a relaxation of drug laws. Over 91 per cent of people opposed proposals to legalise the personal use of heroin, amphetamines (92 per cent), cocaine (92 per cent), while 55 per cent opposed legalising cannabis. Increasing the penalties for the sale or supply of these illegal drugs was well supported (heroin 88 per cent, amphetamines 86 per cent, cocaine 86 per cent and cannabis/marijuana 63 per cent).

Source: NDS National Drug Strategy Survey 1995

Where to from here?

There are no simple solutions to the illegal drug problem. The debate surrounding illegal drug use, which is frequently controversial, is valuable to provide a greater understanding of the issues. This is vital if politicians, legislators and the public are to make the right decisions regarding illegal drugs.

It is clear that law enforcement strategies alone will not solve the 'drug problem'. A combination of strategies, including community education and development, and legal initiatives, are needed to reduce the harms associated with drug misuse.

There are many unanswered questions about what effects changes to drug policy would have. Only by carefully examining the options, carrying out research and investigating the impact that changes have had in other countries, will we be in a position to choose the best way to address illegal drug issues in our society.