Home | Issues | Guidelines | More... | Topics | Search

What messages of certainty did the Prime Minister and Cabinet send by extinguishing the heroin trial? Firstly, that the lucrative profits of illicit drug trafficking, the very engine of this problem, would not be threatened. Secondly, that this problem will continue to be dealt with predominantly by law enforcement, an approach now widely recognised to be prohibitively costly and hopelessly impractical.²

The decision also sends a powerful message to medical researchers throughout Australia. Six years of careful scientific work on a significant community problem, widespread consultation, publications in quality peer-reviewed journals, openness to scientific scrutiny,³ support by the Australian Medical Association, presidents of medical colleges, numerous leaders of the medical profession, police commissioners, directors of public prosecution and a royal commissioner are not enough. An important, but controversial, scientific research project will be brought down politically if opposed by 51% of respondents in a community opinion poll⁴ and if subjected to a relentless campaign of media vilification and misinformation (Media Watch, ABC Television, 9.30 pm, 1 September 1997). This makes a mockery of the present government's advocacy of evidence-based medicine.

Federal Cabinet's decision follows a long-standing tradition of basing policy in the illicit drug area on politics rather than science. Pharmacological fundamentalism even prevents doctors from recommending the option of smoking cannabis for palliating the intractable symptoms of terminal illnesses.⁵

The frequency of major inquiries into illicit drug use in Australia (at least 25, including Royal Commissions, in the past 25 years)⁶ suggests both considerable community anxiety as well as doubt about the effectiveness of current policy. Between 1979 and 1995, heroin-related overdose deaths increased from 10.7 per million population to 67 per million.⁷ Other illicit drug outcomes have also deteriorated alarmingly, while illicit drug law enforcement cost an estimated $1.7 billion in 1992.⁸ A Parliamentary Committee concluded that "all the evidence shows, however, not only that our law enforcement agencies have not succeeded in preventing the supply of illicit drugs to Australian markets but that it is unrealistic to expect them to do so".⁹

While generous funding continues for illicit drug law enforcement in the absence of demonstrable benefit, funding for treatment remains limited despite generally impressive outcomes. Methadone maintenance treatment is supported by overwhelming evidence of safety, effectiveness in improving health outcomes, reducing deaths, reducing crime and improving social functioning.¹⁰ The total cost of all methadone programs in Australia was estimated recently to be $40 million per annum,¹¹ met by Commonwealth, State and Territory governments and by patients.

An official decision to support a heroin trial became difficult to oppose on any logical grounds after the final results of the Swiss heroin trial were released recently.¹⁴ Health outcomes of this trial were extremely impressive. Among 1146 subjects treated for 18 months, there were no overdose deaths, only three new HIV infections, four new hepatitis B infections and five new hepatitis C infections. Reported income from illicit and semi-legal activities decreased from 69% to 10%, the number of offences dropped by 60%, court convictions declined significantly, employment increased from 14% to 32%, and there were net savings of approximately $A45 per patient per day. It is difficult to think of any new law enforcement, education or treatment approach in the illicit drug field in the past 30 years which can boast such promising results.

Why have the health, social and economic outcomes from illicit drugs in Australia continued to deteriorate for so many years? Firstly, there has been a systematic failure to collect relevant evidence (such as would be obtained from a heroin trial). Secondly, policy (including funding) has been based on ideology rather than evidence. If we want to help drug users lead normal and useful lives and offer some hope to their families and their communities, the first step is an unswerving commitment to evidence-based policy and practice without political interference. Tragically, in this country illicit drug policy has become inviolable while politicans remain terrified of losing an election lest rationality be misinterpreted as "being soft on drugs".

The 1997 MCDS support for a 40-participant pilot stage of the heroin trial undoubtedly marked a watershed for evidence-based policy -- not for legalisation. There is no reason to believe that a heroin trial would have led inevitably to drug legalisation. After all, Britain has permitted medically prescribed heroin for more than 70 years while retaining a similar illicit drug policy to the one in Australia. Legalisation, if it means indiscriminate provision of all classes and quantities of currently illicit drugs, defies common sense, will always remain a political impossibility and would contravene Australia's international treaty commitments.

The arguments for a heroin trial are as compelling now as they were before the prime ministerial intervention. As Justice Wood pointed out, "Without such a trial . . . its efficacy or otherwise will never be known. Until attempted, it is very difficult to move forward or to consider alternative strategies".¹⁵ The heroin trial was needed, and is still needed, as a circuit-breaker to move Australia from policies based on arbitrary historical decisions to a firm foundation on evidence. As far as the heroin trial is concerned, "the fat lady has not yet sung".

Alex D Wodak
Director, Alcohol and Drug Service St Vincent's Hospital, Sydney, NSW

1. Short J, Hawes R, Kerin J. Heroin trials not on says Howard. The Australian 1997 Aug 20: 1.
2. Flynn SE. The transnational drug challenge and the new world order. Washington, DC: The Center for Strategic and International Studies, 1993.
3. Bammer G, Douglas RM. The ACT heroin trial proposal: an overview. Med J Aust 1996; 164: 690-692.
4. Cockburn M. Nation's voters divided over ACT drug trial. Sydney Morning Herald 1997 Aug 19: 6.
5. Kassirer JP. Federal foolishness and marijuana. New Engl J Med 1997; 336: 366-367.
6. Australian Parliamentary Group for Drug Law Reform. Australian Drug Law Reform Foundation. Drug lore: the questioning of our current drug law. Canberra: The Foundation, 1997.
7. Hall W, Darke S. Trends in opiate overdose deaths in Australia, 1979-1995. National Drug and Alcohol Research Centre technical report No. 49. Sydney: The Centre, 1997.
8. Collins DJ, Lapsley HM. Social costs of drug abuse in Australia. National Drug Strategy Research Monograph No. 30. Canberra: Commonwealth Department of Community Services and Health, 1991.
9. Report by the Parliamentary Joint Committee on the National Crime Authority. "Drugs, crime and society". Canberra: AGPS, 1989.
10. Review of methadone treatment in Australia. Final report. October 1995. Canberra: Commonwealth Department of Human Services and Health, 1995.
11. Ward J, Mattick R, Hall W. Key issues in methadone maintenance treatment. Sydney: New South Wales University Press, 1992.
12. Swift W, Darke S, Hall W, Popple G. Who's who? A report on the characteristics of clients seen at We Help Ourselves 1985-1991. National Drug and Alcohol Research Centre technical report No. 14. Sydney: The Centre, 1993.
13. Drug and Alcohol Directorate. NSW methadone programme annual statistical report, 1995-1996. Sydney: NSW Health Department, 1997.
14. Uchtenhagen A, Gutzwiller F, Dobler-Mikola A. Programme for a medical prescription of narcotics. Summary of the synthesis report. Berne: Swiss Federal Office of Public Health, 1997.
15. Wood JRT. Royal commission into the New South Wales police service. Final report. Sydney: The Government of the State of New South Wales, 1997: 228.