by Dr Jane Hendtlass

Humans have always used drugs as medicinal agents to maintain or restore health or reduce the secondary symptoms of ill health such as pain or psychiatric or psychological illness, or as part of cultural or religious rituals or to facilitate social interaction. Alcohol was used as a health, religious, cultural and social adjunct by all indigenous people except the Australians and some North Americans. Although use of other drugs generally reflected the indigenous plants and the climate of the places in which each culture developed, increased international mobility and trade has gradually reduced these geographic and cultural distinctions beween races or cultures.

1. Caffeine was introduced to Europe as coffee by the Middle Eastern traders, tea from China, cola nuts from West Africa and cocoa from Mexico and the Carribean Islands.
2. Tobacco was introduced to Europe by Columbus and Drake from North America.
3. Cannabis was used in China as early as 2737 B.C. It spread from there to India, Africa and then to Europe.
4. Opium was imported from China and other parts of Asia into the Middle East and Europe.
5. Cocaine was imported into the United States from South America by traders and by the original manufacturers of Coca-Cola. The VCCL is particularly concerned about the individual and social harm which arises as the direct result of this selective legislative prohibition of some drugs.

This harm includes:
1. Selective drug law enforcement and sentencing practices associated with consequent corruption,
2. Economic consequences for individuals and for society including the health effects of malnutrition and the economic effects of diverting cash flow into the black market,
3. Inability to impose wholesale and retail taxes on drugs,
4. Criminal behaviour such as property crime,
5. The personal, legal and social implications of crimialization,
6. Dangerously uncontrolled quality of product, and
7. Inappropriate restrictions on choice of drug for medical and social use. The development of this selective, legislative proscription of drugs is attributable to important social changes in the 19th and early 20th centuries including:
8. Paternalistic sensitivity to and intolerance of racial and cultural difference resulting from colonialism;
9. Increased voting rights which changed the authority of the parliaments to reflect that of the democratic majority;
10. Intrusion of legislation into traditionally private areas of social life and culture;
11. Establishment of police forces within Government bureaucracies to enforce the legislation;
Increased influence of education and media which ensured dissemination of selective, biased information about the negative health effects of some drugs; and
A consequent shift toward reliance on legislation, criminal law enforcement and severe penalties as the principal method of imposing social control on the behaviour of minorities, including their use of culturally preferred drugs.


We know that prohibition of alcohol in the 1920's led to entrenched public and private corruption, black market supply, dangerously contaminated product and inappropriate expenditure on the criminal justice system. Alcohol prohibition was lifted because it did not and could not prevent alcohol consumption. Since then, controlled, legitimate availability of alcohol has reduced many of the social, criminal, economic and health problems which were seen under alcohol prohibition and provided a system where users can pay for the continuing unavoidable negative consequences of its abuse. However, in spite of these lessons, selective legislative prohibition of some other drugs has continued to expand in attempts to control the use of substances preferred by members of minority groups. Even the United Nations General Assembly has adopted prohibitive provisions which legitimise political and even military intervention in countries which have now become otherwise independent states under international law.

Therefore, drug control policies should be based on two fundamental criteria:
OBJECTIVE INFORMATION
HARM MINIMISATION

Three appropriate drug control measures can be identified using these criteria. These are:
1. Establishment of well-designed, accurate, community education programmes which aim to demythologise the stigma and fear which has developed in the community around currently illegal drugs and drug users;
2. Maintenance and, in some cases, increased availability and diversity of drug treatment programmes available to all drug users; and
3. A staged programme of controlled decriminalisation of all drugs in Victoria associated with objective evaluation of changes in drug excise collection and drug abuse indicators.

Community education programmes
Information about illegal drug use which is disseminated by the popular media and in some schools is strongly influenced by those with real but irrational fears and those with vested interests in maintaining the status quo. This information needs to be countered with accurate information which is delivered in a manner acceptable to the general population. Accurate information about drug is (and should be) fundamentally boring. For example:
a) Alcohol continues to cause more social problems than all other drugs combined. This effect is associated with the Australian culture which encourages alcohol intoxication and its pharmacology, which disinhibits usersí behaviour and leads to increased aggression in those who are otherwise keeping it under control.
b) Tobacco continues to cause more health problems than any other drug. This is because it is generally smoked, increasing the risk of lung cancer, and because nicotine is probably the most addictive drug available in Australia.
c) Historically, the factors which influenced criminalisation have been racist and politically motivated. An educational programme which emphasises the racial and cultural discrimination exercised in selecting drugs for prohibition could build on the lessons taught by the Aboriginal people.
d) Funding of some existing drug education programmes has continued despite negative evaluation. All educational campaigns must be sensitively delivered and objectively evaluated for their ability to increase accurate knowledge and reduce drug-related harmful behaviours without increasing abusive drug use.
e) At any one time, at least 80% of illegal drug users are not using drugs in an addictive or dependent manner. The exception to this generalisation is tobacco. Therefore, information which is based on the numbers and characteristics of users who come to notice does not provide a legitimate picture of the general population of drug users.
f) Surveys of drug use and sensational educational or media programmes can increase or legitimise existing use of drugs unless they are implemented in a sensitive manner. Therefore, all education programmes and surveys must be sensitive to the special problems associated with sensational reports.
g) Crime associated with illegal drug use is influenced by the criminal associations established by illegal drug users and by the artificially inflated price of illegal drugs. Therefore, the media should discuss drug-related crime in the context of the relationship between criminality of drug use and property or other crime rather than the relationship between use of a particular drug and the crime.
h) Health consequences of drug use are frequently caused by their method of use rather than by their pharmacology. Therefore, education programmes should ensure that distinctions are made between the pharmacological effects of drugs and the effects of their method of use.

The VCCL recommends that the Government of Victoria establish an education campaign which aims to provide objective, sophisticated information to the community about the positive and negative effects of all drugs and to demythologise the current inappropriate fear and anxiety associated with currently illicit drugs and drug users.

Availability and diversity of drug treatment programmes

At least 10% of all drug users are addicted to or dependent on drugs to the degree where professional intervention is required to minimise the harm which they impose on themselves and on society. These drug abusers are the legitimate responsibility of the health and social welfare professions. The Australian community accepts that the effectiveness of drug treatment programmes should be assessed in terms of harm minimisation rather than drug abstinence although, in some individual cases, the two criteria are not mutually exclusive.

The criminality of drug using and associated problem behaviour precludes the objective assessment of drug treatment programmes in terms of individual or community illegal drug use.

Nearly all drug abusers reduce their criminal activity and their drug intake while in treatment. This is sufficient reason to encourage and maintain their participation in treatment programmes.

Total abstinence is an impossible and irrelevant aim which is used to exclude many potential clients from drug treatment programmes, particularly those currently subject to court ordered urine screening. It is therefore not the most important appropriate criterion for assessing effectiveness of treatment programmes.
Different drug abusers respond to different treatment programmes differently. Sufficient programme diversity is required to cater for the wide spectrum of people who seek help with their abuse of currently illicit drugs.

Drug treatment options are still evolving. Scope for this experimentation should be encouraged by funding and accreditation criteria for treatment centres. For example, trials with heroin prescription in the ACT should be encouraged by the Victorian Government.

Many drug abusers mature out of inappropriate drug use. Therefore, it is important to maintain their health as well as attempt to reduce their drug abuse.

Free, unsupervised syringe exchanges need to be maintained to avoid transmission of AIDS and hepatitis B through shared needles. The VCCL recommends that the Government of Victoria maintain and, in some cases, increase the availability and diversity of treatment programmes available to all drug users.

Controlled decriminalisation of all drugs in Victoria
There is little doubt that legislative prohibition of drugs has many counterproductive effects including
Dissemination of inaccurate information about some drugs and drug users which leads to inappropriate fear in and discrimination by the criminal justice system and the community in general.
This leads to criminalising drug users merely because they use illegal drugs with implications for their employment, travel, therapy and social identity.
This misinformation leads to higher prices for drugs and associated crime associated with obtaining money, obtaining drugs, corruption of public officials and counterproductive linkages between criminal and otherwise legitimate activities.

The black market prevents taxation on drugs which could pay for some of the negative consequences of their abuse such as treatment for dependence.
Drug entrepreneurs develop new drugs to avoid the technicalities of the criminal law. Others develop more concentrated products or derivatives of existing drugs to avoid detection.

The high cost of drugs diverts frequent users from buying food or shelter which would otherwise help protect them from the consequences of their environment.
Illegal drug users who congregate learn to commit other crime to support their habit or because they learn to live in a criminal environment. In theory, there is no reason why drugs which are currently illegal should not be distributed in the same way as alcohol.

However, implementation of any quick radical changes will be blocked by the fear of drug use engendered in the community by 100 years of stigmatisation and the consequent political climate. Australia is ideally placed to trial and compare the effectiveness of different methods of drug decriminalisation in different States. However, drug policy makers should be selective when adopting international and Australian drug control measures which have been established under different and changing social and political conditions. For example, the Dutch system of cannabis supply and availability is excellent. Cannabis is available to anyone at registered coffee shops and is excised by the state. However, , in Holland, heroin supply remains in the black market. Although the methadone bus concept based on maintaining users' health until they mature out has promise because it does not require any commitment to withdrawal, it does not prevent their use and abuse of heroin.

Further, the Amsterdam authorities do not provide the resources required to adequately monitor methadone users' health so that it may not be any more useful than could be achieved by a minor policy change or the ACT trial here. Similarly, the so-called British system of heroin prescription has changed substantially under the Conservative government and bears little resemblance to that recommended by Rolleston in the 1960's and believed, then, to be a useful alternative to existing prohibition. Prescribed heroin and amphetamines for addicts will address some issues which relate to the health of addicts and nothing more (see above). However, these programmes could become self-fulfilling if they are implemented in isolation from general decriminalisation of use and possession of drugs because registration of addicts provides no incentive for them to reduce use and the requirement for addiction will, by definition, lead to an increase in their apparent or real number at the expense of currently casual users.

The black market will still supply the casual users. The newer Swiss model (which has been informally established in Kings Cross) of providing identified places where addicts can obtain and safely administer drugs and congregate has yet to be objectively evaluated. There have been problems with drug traffickers using the same areas and consequent law enforcement problems. Current American and Victorian policies which adopt the rubric and substance of The War on Drugs are counterproductive. They locate the illegal drug problem in the drug users rather than in drug control policies and in society. They create inappropriate fear and anxiety in the wider community. They emphasise the need to fight rather than co-operate. They encourage discrimination against and alienation of drug users and particular associated racial and social groups. They have been publicly acknowledged to accommodate the skills and services of those made otherwise redundant by the breakdown of the Cold War. Federally, Australia must withdraw from its harsh interpretation of its commitments under the international drug treaties to which it is party. She must also encourage international agencies to redraft all international instruments which inhibit amendment of domestic drug legislation. The South Australian expiation notice procedures for possession, use and cultivation of cannabis for personal use do not go far enough. They provide a useful indication that, at that level, decriminalisation is not associated with increased use. However, a large proportion of offenders still choose to go to court which leaves open the opportunity for police corruption and does not successfully reduce the drain of drug offences on Legal Aid funding. Therefore, all changes to current drug control measures need to be preceded by a planned education programme and a comprehensive, independent research programme to allow objective assessment of the effects of each change on drug related harm. The VCCL has recommended that the Victorian Government adopt a staged programme of controlled decriminalisation of drugs in co-operation, where possible with other States, based on the following presumptions:
If over 80% of drug users are not addicted or dependent on illegal drugs, then control of availability should be a social policy issue rather than a health or criminal justice issue.
If up to 20% of drug users will have disabling health, social or economic consequences, then availability of drugs should be associated with an excise to cover the community costs of use.
If use of some drugs, such as cannabis and heroin, is associated with reduced aggression and other social consequences, they should be legalised first.
If some methods of use, such as oral ingestion, are associated with less severe health consequences, they should be encouraged.
If alternative methods of drug control are proposed in other states, they should be supported by Victoria as long as they include objective evaluation on harm reduction principles. This paper is a summary of the Victorian Council for Civil Liberties submission to the Premier's Drug Advisory Council in January 1996.

This paper is a summary of the Victorian Council for Civil Liberties submission to the Premierís Drug Advisory Council in
January 1996.

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