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November 01st 2010 print

Gary Christian

Blinded by the Dominant Ideology

Immobilised by the internationally amplified glare of “the greatest moral, economic and social challenge of our time”, the often hidden nexus between science and ideology has been prised open for scrutiny once again by the Climatic Research Unit e-mail leaks which are currently informing the climate change debate. The manipulation of science for ideological ends was always one of postmodernism’s centrepieces, and there are numerous celebrated examples. But if climate science is the current star exhibit, the lowly field of illicit-drug policy provides diggings equally as rich in examples of objectivity taken captive and bent to a single ideological perspective.

The “scientific” evaluations of the Kings Cross Medically Supervised Injecting Centre (MSIC) in Sydney provide an excellent case study. A number of “independent” evaluations have been funded by the New South Wales government since 2002, and the latest by KPMG, costing $240,000, was due in July 2010. If voices in the media are to be believed, each has shown the success of the experiment, and each gives weight, they opine, to the argument that the injecting room should be made permanent.

The first extensive evaluation of the injecting room was released on July 9, 2003. As reported by Paola Totaro in the Sydney Morning Herald, the injecting room was responsible for saving six lives in its first eighteen months of operation, for self-reported reductions in public injections by MSIC clients, for avoiding any predicted “honey-pot” effect, and for referring a “conservative” estimate of 20 per cent of clients to other services. The later evaluations have been given equally enthusiastic receptions.

Yet any close analysis of the injecting room evaluations shows an almost diametrically opposite picture. Rather, the concerns expressed by many in the community are evidenced—increased illicit-drug use and increased drug trafficking. Fears of a “honey-pot” effect were indeed realised. And the 180-degree media spin of injecting room supporters is not entirely to blame for the dissonance between data and declared outcome, with the evaluators themselves often providing misleading or totally erroneous conclusions or otherwise failing to make the necessary conclusions from negative data.

Yet so large were the blind-spots of the various evaluation teams that they could not, or would not, countenance any troubling conclusions which failed to accord with Australia’s dominant drug policy orthodoxy of harm minimisation. This oddly occluded research optic, along with absurdly inflated claims about lives saved, has combined to snatch injecting room victory from the jaws of its inevitable demise, and so it continues today.

Sadly, this one-eyed approach is symptomatic of much of Australia’s evidence-based research in drug policy areas, where objective evidence is adduced to bolster a single subjective assumption at the expense of others. The injecting room evaluation is just the tip of an Australian drug policy iceberg which stands embedded in our social and political landscape, monolithic and uncompromised under the warm Australian sun. Australia’s illicit-drug use, the highest in the developed world, is very possibly a result.

Legislation giving permanent status to the Sydney injecting room was due to be debated during the week starting October 17, and Drug Free Australia submitted an analysis of the data in the latest 2010 KPMG evaluation to New South Wales parliamentarians the week before. Contributions to this analysis came from drug and alcohol experts from the United States, Sweden, the Netherlands, Scotland and Australia. This analysis, amongst other conclusions similar to those in this article, found that the injecting room had saved only four lives over the entire nine years of operation to date at a total cost of $23 million. This expenditure could have funded several thousand drug rehabilitation places.

Eyes Wide Shut on Lives Saved

In the 1999 Drug Summit which recommended the trial of an injecting room, saving lives was the first of three chief objectives for such a facility. Perhaps nothing better demonstrates the foibles of the injecting room evaluations than the “lives saved” calculations. The 2003 evaluation estimated that between six and thirteen lives had been saved by the injecting room over the eighteen-month evaluation period. These estimates, though, cannot stand up to even summary scrutiny.

The number of lives saved can be quickly, easily and more accurately calculated. It is a method of calculation used by the most comprehensive and sympathetic review of injecting rooms worldwide, the 2004 study by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on drug consumption rooms. It is almost certainly the same method used by the Expert Advisory Committee of the Canadian government, which in 2008 found that the Vancouver injecting room, Insite, with its 400 heroin injections per day, was statistically capable of saving just one life per year.

It is well established in journal studies that one in every 100 dependent heroin users dies in Australia each year from fatal overdose. It is also well known that dependent heroin users inject at least three times a day—this was a stated assumption used by the 2003 evaluators in their calculations. Taking these two together, it is also clear that 100 heroin users injecting three times daily will cumulatively inject 110,000 times per year, but also that only one of these 110,000 injections will end the life of the one in 100 who, on average, will die of fatal overdose annually. But because the injecting room hosts less than 55,000 opiate injections per year, it will take it two years to accumulate the 110,000 injections for which one fatal overdose is expected. What this means for the Sydney injecting room is that it takes, on this measure, two years to save just one life, at a cost of $2.7 million per year or $5.4 million for a single life saved.

The evaluators’ error was in calculating from the raw number of heroin overdoses in the Centre without taking the time to examine whether the rates of overdose accorded with overdose rates anywhere else, especially on the streets of Kings Cross where MSIC clients were injecting most of the time. The evaluators had all the data they needed to do such a comparison—ambulance callout numbers for the area, estimates of the percentage of non-fatal overdoses in the community to which an ambulance is not called, estimates of heroin user numbers and cumulative heroin injections in Kings Cross each day—but failed to do the obvious.

When Drug Free Australia did the required calculation, injecting room overdose rates were thirty-six times higher than on the streets immediately outside the Centre, with a rate forty-two times higher than the previous histories of overdose logged by clients in their MSIC registration surveys and forty-nine times higher than estimated overdose rates for the entire population of dependent heroin users in Australia. When the numbers of saved lives calculated by the evaluators were corrected for this vast over-representation of overdose in the Centre, the injecting room could only demonstrate a fraction of a life saved per year for its then $2.4 million of annual expenditure.

Statements in the media by the 2003 evaluation’s lead researcher, denigrating Drug Free Australia’s figures as “back of the envelope” calculations, failed to engage Drug Free Australia’s contention that they had used only data from the evaluation and used precisely the same assumptions and methodology as the evaluators.

How five competent researchers could overlook the required comparison of overdose rates in the service is difficult to comprehend, particularly when they would have known that their calculations of lives saved, derived from the raw numbers of injecting room overdoses, would be the most influential of all arguments for or against the injecting room, both for politicians and for the public. The fact that three of the evaluators were members of the same University of New South Wales Faculty of Medicine as the injecting room’s Medical Director, and that another evaluator was key to the promotion of an injecting room trial at the 1999 Drug Summit raises questions about the independence of the evaluation.

There are other silences and exclusions surrounding the saved-lives estimates that raise many questions. The glib handling of the massive over-representation of overdose in the room is another example. Injecting rooms in Europe have rates ranging from one to thirty-six overdoses for every 10,000 injections. Vancouver’s Insite experienced thirteen overdoses per 10,000 injections soon after its commencement and by 2008 had increased to twenty-seven. By contrast the Kings Cross injecting room had seventy-two overdoses per 10,000 injections for all drugs used in the Centre, but for heroin, the chief illicit-drug threat to lives in Australia, there were ninety-six overdoses per 10,000 injections, as correctly recorded on page 24 of the 2003 evaluation. Yet all the evaluators could say on page 62 was that:

In this study of the Sydney MSIC there were 9.2 [sic] heroin overdoses per 1000 heroin injections in the MSIC, and this rate of overdose is likely to be higher than among heroin injectors generally. The MSIC clients seem to have been a high-risk group with a higher rate of heroin injections than heroin injectors who did not use the MSIC, they were often injecting on the streets, and they may have taken more risks and used more heroin in the MSIC.

Not one other sentence in the evaluation addressed the high rates of overdose in the Centre. Nor did the evaluators take the time to check whether Kings Cross MSIC clients were indeed more at risk of overdose than other cohorts of heroin users studied elsewhere. Registration surveys indicated that 44 per cent of clients had previously overdosed, yet the 1999 Australian IDRS study found histories of 51 per cent, while a 1996 Sydney study had 68 per cent and a British study 58 per cent.

Another highly questionable silence was regarding the continual media claims by injecting room staff in its first eighteen months of operation that the Centre was saving hundreds of lives. Media report after media report emblazoned the growing number of saved lives on the public memory. On June 22, 2001, six weeks after the injecting room opened, the Sydney Morning Herald quoted Dr Ingrid van Beek, the room’s Medical Director, as claiming that the room had already saved four lives. At the nine-month mark, van Beek is quoted as claiming that more than a hundred lives had been saved. By May 2002, twelve months after it opened, Bryce Gaudry claimed in Hansard that it had saved 250 lives. Yet these claims were made by an addiction medical specialist who certainly would have known that only one in every twenty-five heroin overdoses is fatal—a statistic also used by the 2003 evaluators when calculating their estimates of lives saved. The failure of the evaluators to express concern regarding such highly influential misinformation, emanating from the injecting room itself, is extraordinary, particularly when community attitudes to the room were an object of study for the first evaluation.

While working in Mission Australia’s senior management in the mid-1990s, I was asked by the state Department of Community Services to complete evaluations of two funded community-based youth centres. A failure to make the hard calls where a service was not substantially meeting its objectives would never have been countenanced, but for the injecting room the standard of evaluation appears entirely otherwise.

Telescopic Vision on Ambulance Callouts

In June 2007 an evaluation was completed by the National Centre in HIV Epidemiology and Clinical Research (NCHECR) which studied the effect of the heroin drought on ambulance overdose callouts for the whole of New South Wales versus Kings Cross and Darlinghurst. Their finding that ambulance callouts had reduced by 80 per cent in the Kings Cross postcode over a five-year period, while the rest of New South Wales decreased by 61 per cent, was trumpeted as positive proof of the effectiveness of the injecting room in reducing street overdoses. Reductions in neighbouring Darlinghurst were a lowly 45 per cent.

The heroin drought had hit all Australian states six months before the injecting room opened in 2001, and continues to this day. So disentangling the effect of the heroin drought on Kings Cross against the effect of the injecting room is crucial to any analysis. An examination of New South Wales parliamentary Hansard at the time the injecting room trial renewal was discussed in 2007 reveals that this study was highly influential politically. Yet an epidemiological eye cast over these figures immediately suggests something quite other than the injecting room’s effectiveness.

What gives the epidemiological game away is the below average reductions in overdose callouts for neighbouring Darlinghurst. While Kings Cross reductions are 19 per cent greater than the rest of New South Wales, Darlinghurst is curiously 16 per cent less in terms of reductions against that average, and these two percentages together indicate a clear displacement effect of heroin users and their street overdoses from Kings Cross to Darlinghurst.

What could possibly cause such a displacement effect? The most celebrated Australian displacement effect back in 2001 saw heroin users hounded out of Cabramatta into neighbouring Fairfield. With sniffer dogs trained for the Olympics in 2000 at their disposal and new tougher legislation to back them, police cracked down on drug dealers and users in a New York-style zero-tolerance operation which yielded spectacular results—ambulance callouts of fifty-eight a month and trending higher, reduced to about ten per month in 2001 and 2002, an 83 per cent reduction.

In November 2001, six months after the injecting room opened, the New South Wales parliament enacted new laws which would allow use of the sniffer dogs and tougher policing in other drug hot-spots. On May 18, 2002, the ABC publicised tougher policing targeting dealers in the Cross, and on May 21 the Redfern Legal Centre’s website, which sent SMS messages to registered members with the precise movements of the sniffer dogs, crashed due to the demand for information. The previous weekend 2600 people had been stopped in Kings Cross and searched by police with sniffer dogs. Tougher policing continued throughout the five-year period to 2006 covered by the evaluation, as can be verified by internet search. The relative effort put into policing Kings Cross as against Darlinghurst could, of course, be answered by police.

That tougher law enforcement might be sufficient cause for markedly reduced ambulance callouts for overdose in Kings Cross would seem to be an obvious subject of further research by the evaluators, whose office lies just half a kilometre from the main street of Kings Cross, and whose knowledge of tougher policing measures could not be doubted. Study of the obvious displacement effect would also appear to be a given. The three NCHECR evaluators cannot claim ignorance of the phenomenon. One of the evaluators, Lisa Maher, was perhaps more responsible than any other for highlighting the tougher policing and displacement effect in Cabramatta, both objects of severe criticism in her co-authored 2001 article in the journal Current Issues in Criminal Justice.

In the June 2007 evaluation, the three researchers delivered a successful finding for the injecting room without giving any hint of looking for any alternative causal explanation. Telescopic vision greatly magnifies the subject of observation to the exclusion of all else. Drug Free Australia calculations can well demonstrate the real reductions the injecting room makes to ambulance callouts in Kings Cross. The 2003 injecting room evaluation used a study which found that there were twenty-four non-fatal overdoses for every fatal overdose in Australia—the injecting room consequently saves twelve to thirteen ambulance overdose callouts per year from an annual pre-heroin-drought average of 208 in the Kings Cross postcode.

Blindfolded on Reduced Needle Supply

The second of three objectives set for an injecting room trial by the 1999 Drug Summit was that the facility improve public amenity in Kings Cross with reduced public injection and discarded needles. Clover Moore said in May 2002 that “the hope is that amenity will improve”.

But public amenity did not improve. Amenity was judged by surveying local residents and businesses about public nuisance, approaches to buy drugs, public injections sighted and discarded syringes sighted. Additionally, counts of discarded syringes were recorded in a variety of locations around Kings Cross.

While the observations of local residents and businesses changed only to a small degree, despite the heroin drought markedly decreasing the amount of heroin available in Kings Cross during the evaluation period, decreases in syringe counts and public injections failed to maintain pace with the reduction in syringes being requested from local needle exchanges and pharmacies—a 19 to 20 per cent decrease.

Discarded needles on the street were counted and recorded in 2000, before the injecting room opened, and again in 2002, fourteen months after it opened. Data in the 2003 evaluation for clean-up teams from the KRC needle exchange in Kings Cross recorded a 9 per cent decrease in discarded needle counts, while South Sydney Council weekly counts for six drug hot-spots in Kings Cross actually increased by 1 per cent overall between July 2000 and July 2002, a situation the evaluators described as “stable”. The streets closest to the injecting room particularly failed to keep pace with reduced distributions of needles due to the drought. Darlinghurst Road, which the injecting room fronts, had 10 per cent decreases in council counts, while Bayswater Road, fifty metres around the corner, had 65 per cent increases and Kellett Street, at the back door of the facility, had 24 per cent increases. Two of the other hot-spots further from the injecting room had significant decreases, though, of 40 to 60 per cent.

Surveys of local residents in 2002 found that 58 per cent had observed discarded syringes in the last month compared to 67 per cent in 2000, with 64 per cent of local businesses affirming the same in 2002 versus 72 per cent in 2000. It is clear that public amenity, in terms of discarded needles, deteriorated in the immediate vicinity of the injecting room, while improving somewhat in other areas of Kings Cross and Darlinghurst, but still not in line with reductions in needle handouts due to the heroin drought.

For every discarded needle in a public place there is a public injector. The 2003 evaluation made much of the client surveys in which they self-reported reductions in public injection on the street from 57 per cent in 2001 to 46 per cent in 2002, and in a public toilet from 40 per cent in 2001 to 33 per cent in 2002. It is clear that the more objective measure of needle counts on the streets does not reflect the same reductions as the self-reported behaviours. This is all the more worrying when it is considered that 23 per cent of the 3810 clients who used the injecting room in the first eighteen months lived in the Kings Cross and Darlinghurst postcodes. Some measurable effect of the injecting room on public injection attitudes should have been observable beyond the 20 per cent reductions in needle distributions caused by the heroin drought. A June 2007 evaluation presented an unchanged picture—48 per cent reductions in needle counts for Kings Cross, and an 80 per cent reduction in ambulance callouts in the Cross. If the heroin users were being moved on from the hot-spots to rather inject in Darlinghurst, why not a far greater reduction in needle counts in the Cross to indicate injecting room effectiveness?

An examination of the 2003 and 2007 evaluations on public amenity shows an abject failure by the evaluators to make the required and obvious data comparisons. The 2003 evaluation, where needle counts were done in July 2000 and July 2002, could so easily have measured increases or reductions against needle distributions for the relevant months, but rather their efforts were expended on totally unrelated calculations on needle distributions, perhaps a smokescreen, and which certainly demonstrated nothing.

The conclusions of the evaluation teams make intriguing reading. The executive summary does not make any direct association between any reduced needle counts in Kings Cross and the heroin drought. It reads 1. “Kings Cross area local residents and business respondents reported sighting fewer episodes of public injection and syringes discarded in public places in 2002, compared to 2000.” 2. “Syringe counts in Kings Cross were generally lower after the MSIC opened than before.” 3. “There was a gradual increase in syringe counts in the period after the MSIC was established that may have reflected a return in the availability of heroin.” The 2007 evaluation, citing the 48 per cent reductions in needle counts, failed even to mention the heroin drought when discussing data or their conclusions from it, although the heroin drought continued to reduce the use of heroin and its associated injection paraphernalia throughout Australia by more than 60 per cent.

The failure of both evaluation teams to examine any correlation between needle distributions, as an indicator of the heroin drought’s reducing demand, and street needle counts appears selectively blindfolded on the indicators which mattered. Fortuitous blindfolding, too, because there was absolutely no case to be made that the injecting room was meeting this Drug Summit objective.

The failure of the evaluators to make objective conclusions has unfortunately become the springboard for drug law reform efforts overseas. In January 2004, Ben Wyld of the Sydney Morning Herald reported that “British health experts were calling for medically supervised injecting centres based on the success of Sydney’s controversial Kings Cross program.” It then records that “the report, headed by the director of the National Drug and Alcohol Research Centre, Professor Richard Mattick, found that there were fewer sightings of public injection and fewer discarded syringes in public places after the centre opened”.

Honey-pot Myopia

A prior concern of injecting room critics and of businesses in Kings Cross was that the siting of an injecting room in the midst of profitable businesses, and the drawing of drug users and dealers to its doors, would stifle trade. This is precisely what happened. Yet the myopia of the evaluators led them not to see what was plainly before them.

The 2003 evaluators conducted focus groups with police, railway workers (the main entrance to Kings Cross station is twenty-five metres opposite the MSIC on Darlinghurst Road) and other community key informants to determine whether there was a honey-pot effect.

Here is a selection of the canvassed comments recorded in the report. City-Rail worker: “We have a few more problems with drug activity out the front of the train station. You can tell some of them are drug-related. They run back and forth between the MSIC and the Tudor Hotel. You catch on that’s what it’s about.” Police: “What’s happening is a displacement effect. Our operations have been concentrated on activity at Springfield Mall … The dealing activity tends to move to a different area in response to our operations. The train station is a convenient location because it’s central to the area.” City-Rail worker: We’ve got problems at the entrance [of the train station] with people just hanging around. We’ve got members of the public complaining about drug users, homeless and drunks hanging around the entrance on Darlinghurst Road.” Evaluators: “They [City-Rail staff] noted that, while other factors such as police operations contributed to the increase in loitering outside the train station, there was a notable correlation between the loitering and the MSIC opening times.” And in case there is any question as to whether drug dealers had moved to the proximity of the MSIC, the Evaluators said: “The increase in loitering was considered to be a displacement of existing users and dealers from other locations.”

The evaluators’ conclusion? On page 193 of their report they summarise:

Loitering.

Quantitative evidence suggests that the number of loiterers in the vicinity of the MSIC was very low and there was no indication of an increase in drug-related loitering … There may have been a decrease in such loitering, possibly as a result of a security guard posted outside of the MSIC. Some evidence, on the other hand, suggested that there may have been an increase in drug-related loitering outside the front and back of the MSIC and at Kings Cross railway station. In all, the evidence indicating either an increase or a decrease in loitering is not compelling.

Drug dealing.

Police evidence indicated that the MSIC had very little impact on drug dealing in Kings Cross. On the other hand there appears to have been increased drug dealing activity at Kings Cross station, although it is difficult to determine whether this increase was causally linked to the operations of the MSIC.

A Failure of Nerve

The 2003 evaluators had noted what is in reality a staggering rate of overdose in the injecting room, and had coolly asserted that it was the result of clients who either were more at-risk of overdose in the facility, which has already been demonstrated not to be true, or who were using more heroin in the centre. The evaluators could easily have compared the overdose histories of injecting room clients with other cohorts, with injecting room client’s previous overdose histories and illicit-drug using careers already recorded in their own evaluation report’s tables. Of course, if their latter explanation is correct there is no other conclusion than that the injecting room was both increasing heroin use for clients and therefore helping the drug trade by increasing their sales, the very outcomes forecast by critics of the trial.

In 2007 Drug Free Australia located two ex-clients then in drug rehabilitation and asked them why the injecting room had had such staggering rates of overdose. Both replied as if it should be a matter of common knowledge. As recorded in the Legislative Council Hansard for June 26, 2007, the testimony of one of these clients was as follows:

DFA: Have you been a client of the injecting room?

Ex-client: I have, I have. To me I believe it has got a lot to do with the pills, people using pills in injecting rooms. They shouldn’t be allowed to inject pills in my opinion.

DFA: Is it the case that people would be experimenting with drugs in a way they wouldn’t on the street?

Ex-client: They feel a lot more safer, definitely because they know they can be brought back to life straight away. They know they can, like some people go to the extent of using even more. So in a way they feel it is a comfort zone, and no matter how much they use, if they drop they will be brought back. What users look for in heroin and pills is to get the most completely out of it as they can, like virtually be asleep. To get that you have to test your limits. And by testing your limits that is how you end up dropping.

Using more drugs appears to be part of the explanation, and mixing dangerous cocktails of drugs another. This kind of dangerous experimentation, with the complicit safety provided by the facility, appears to be supported by yet another client recorded on ABC’s PM program the same day the 2003 evaluation was launched.

Nicola: It’s saved my life quite a few times.

Nick Grimm: How so?

Nicola: Well, sometimes, you know, us junkies, so-called, we mix our drugs in ways. We don’t really care what happens to our bodies as long as we’re having our drugs, and cocktails, as you put it, can be lethal at times. And, yeah, I’ve quite a few times dropped in here and I’ve had Narcane to bring me back to life.

There is the possibility, of course, that injecting room staff are overly rushing to resuscitate clients to inflate the perception that many lives are saved in the centre, but the increased levels of drug use and dealing remains as the implication of the many overdoses. If the safety of the injecting room creates a party palace where users can go when they have enough money to test their limits, why is the state government funding it? And if the evaluators have inferred experimentation by clients in their previously cited statement on the rate of overdose, why did they not, as evaluation protocol demands, just come out and say it?

In the eye of the beholder

The third chief objective of the injecting room was that it should be a gateway to treatment. The 2003 evaluation recorded that 11 per cent of clients were referred to another drug intervention, 3.5 per cent were referred to detox and 1 per cent to rehabilitation. None of Sydney’s major rehabs—Odyssey House, WHOS or the Salvation Army—ever saw one of these referrals. A 2007 evaluation found that the injecting room was still referring just 11 per cent of clients to other drug interventions, but that the uptake rate to the referred services had moved from 20 per cent to 84 per cent. This improvement in uptake will save some lives. However, it leaves the question as to whether clients, many of whom may be there only to test their limits, would be motivated while in that frame of mind to consider treatment.

Of course, whether referrals for 11 per cent of clients is acceptable or not will be in the eye of the beholder.

Blind Spots of a Prevailing Paradigm

The injecting room evaluations, with their extensive evidence base, were unfortunately beset by evaluation teams with impaired vision. At those points where the data falsified the foreseen success of the injecting room intervention, the teams failed to join the dots.

The evidence had delivered very disappointing results for the injecting room and there has been little to commend. Virtually none of the touted benefits have eventuated. There were other disappointments. In the 2003 evaluation HIV and Hep C diagnoses had cumulatively worsened for the area, while there had been no improvement in Hep B transmissions. Clients in the injecting room, when surveyed, had not displayed better new needle uptake than other injectors in the same area. Tests taken for Hep B, Hep C and HIV showed no improvement.

Client safety had been the reason for establishing the injecting room but clients had displayed  little interest in their own safety, with infrequent visits to the room. At best, clients had had one in every thirty-five of their injections in the room, with the rest on the street, in a public toilet, a car, shooting gallery or at home. The concern of supporters that every injection could be their last was not matched by attitudes of self-preservation among the clients. There was much the injecting room had failed to realise, but so little declared. But why?

There may be other interests at stake. NDARC, the organisation which headed the 2003 evaluation, has a history of agitating for various drug legalisation agendas such as legal heroin on prescription, marijuana legalised for medical purposes, and of course legalised injecting rooms. Don Weatherburn, one of the five 2003 evaluators, has also been aligned with drug legalisation since 1992 with contributions, along with NDARC, to the push for a legal heroin prescription trial in the ACT. Perhaps there was too much personal investment in a positive outcome.

Those pressing for drug law reform, and for legalising interventions which are not now considered legal, are often driven by different assumptions from those driving community attitudes. The Australian 2007 Household Survey, which surveyed the attitudes of 25,000 Australians, found that 97 per cent did not want the regular use of drugs such as heroin, cocaine and speed accepted in our society. Very often, though, those pressing for drug law reform argue for an acceptance of not only the drug user, but also of their drug use. Many even go so far as to say that it is a human right to use drugs, more important than the right of the community to protect itself from it.

The associated belief that intoxicating drugs have always had an esteemed and universal recreational role in every human culture is bizarre, particularly as it applies to Western culture. It is a sweeping and exuberant a posteriori generalisation. But such a belief system drives much of Australia’s copious harm minimisation industry and its related research.

This ideological difference could be a factor driving the blind-spots and occlusions which afflict evidenced-based drug policy research. An inspection of the government-funded research conducted by NDARC indicates that almost every study reflects a harm minimisation assumption without any interest in drug prevention. Tens of millions of dollars in illicit-drug monographs have been spent bolstering a single ideological perspective, at the expense of alternative perspectives, so it is all too possible for research to become one-eyed. What Australian drug policy sorely lacks is research which compares the outcomes of harm minimisation interventions against drug prevention and rehabilitation interventions within a comparative cost-benefit framework. The $5.4 million that it takes to save a life in the injecting room would fund literally hundreds of rehab beds annually.

Such comparison of ideologically different interventions has rarely happened in Australia, and even when it has it has produced bizarre outcomes. The celebrated NEPOD study conducted by NDARC, completed in 2001, compared the effectiveness of methadone and other drug maintenance regimes against oral Naltrexone, an opioid antagonist which blocks the effect of heroin and prevents overdoses. The NEPOD Naltrexone trials had devastating results—against fifty-seven other Medline Naltrexone trials worldwide over the last twenty-five years with their average 34 per cent retention at six months NEPOD averaged a pitiful 4 per cent retention after six months. Regarding drug-free outcomes at six months, thirty-seven Medline studies averaged 52 per cent outcomes, but NEPOD 5.6 per cent. Failing to conduct the trial using practitioners already skilled in Naltrexone maintenance, and excluding the results of the one practitioner who was and who had 62 per cent drug-free outcomes at six months, NDARC went on to inform the public through an extensive media campaign that Naltrexone was a largely failed pharmacotherapy.

The selective blind-spots, silences, evasions, exclusions and overstatements can perhaps best be credited to a largely unquestioned paradigm that dominates the thinking of Australia’s drug policy regime. These academics and bureaucrats are univocally committed to objective evidence-based research as the basis for all drug policy decisions but are paradoxically almost universally guided by an overarching subjective belief—that illicit drugs are a normal and for some a thoroughly acceptable part of human reality.

Australian federal and state governments have perhaps unwittingly ploughed tens of millions of research dollars into reinforcing this subjective assumption, all the time being told that the research was objectively evidence-based. The multifaceted drug normalisation–harm minimisation edifice, so well crafted and shaped by this abundant partisan input, now blazes so bright that Australia’s drug policy luminaries have become so bedazzled by their own efforts that they can no longer distinguish any alternative. Overarching paradigms have the bewitching habit of somehow bending all objective observations to their own subjective agendas. The cost may be tens of thousands of drug users’ lives.

References:

1. Mattick RP, Kaldor J, Lapsley H, Weatherburn D, Wilson D. Final Report on the Evaluation of the Sydney Medically Supervised Injecting Centre. Sydney 2003.

2. NCHECR, 2007. Sydney Medically Supervised Injecting Centre Interim Evaluation Report 3: Evaluation of Client Referral and Health Issues. Sydney, UNew South Wales. p 7

3. NCHECR, 2007. Sydney Medically Supervised Injecting Centre Evaluation Report No. 4: Evaluation of service operation and overdose-related events. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, New South Wales.

4. Recent trends in property and drug-related crime in Kings Cross New South Wales Bureau of Crime Statistics and Research November 2006.

5. New South Wales Bureau of Crime Statistics and Research, Media Release: Recent Trends in Crime in Kings Cross, 12th November 2008. 

 

Gary Christian is the honorary secretary for Drug Free Australia and co-ordinates the work of DFA’s academic fellows. He is a welfare practitioner with seventeen years in welfare senior management—seven years with Mission Australia and ten years with ADRA Australia.