|
Personal Perspective
The New South Wales Drug Summit: a view from a local foreign observer
Jeffrey H Samet
MJA 2000; 173: 264-265
1. "The Drug Summit was just a political exhibition" -
2. "All agree on one thing" -
3. "I hope that this forum does not end up as some sort of factionalised debate" -
Acknowledgements -
References -
Authors' details
-
-
More articles on Drugs and alcohol
| |
In December 1998, on sabbatical leave from Boston University School
of Medicine, I spent time at the University of Sydney's Faculty of
Medicine, because I thought that the Australian experience had
something special to teach those of us in the United States working on
the "drug problem". The timing was remarkable -- illicit drug policy
became a captivating major news topic, culminating in the Drug Summit
in Sydney in May 1999.1 Drug abuse, despite its
importance from personal, public health, public safety and economic
perspectives, has not received comparable concerted public
attention within the United States in a generation or more.
The dynamics of the Australian discussion were fascinating, but
certain opinions expressed seemed in need of
reconsideration.
|
1. "The Drug Summit was just a political exhibition -- nothing useful
will come of it." | |
This point of view, prevalent before and during much of the Drug
Summit, was extremely cynical and not constructive. Not
acknowledging the existence of a problem is a very well known practice
in the world of drugs and alcohol. In fact, the first goal in the
treatment of patients who misuse drugs is getting them to acknowledge
that a problem exists.2 No one expects to fix the problem the first few times it is addressed.
The same perspective should frame the discussion about activities
that recently took place in the New South Wales Parliament. Firstly,
it was significant that the drug issue was widely acknowledged as a
major societal problem. Secondly, it was remarkable that
politicians joined together with the most experienced
professionals and affected individuals to search for understanding
and common ground on how to address the issue. This phenomenon should
be recognised for what it was: major progress. The summit enabled
politicians to gain, at minimum, a basic understanding of the issues
of addiction and substance misuse. Politicians will in future
be better able to assess drug policy proposals.
The extensive media coverage educated Australia's citizens, both
adults and young people, about the realities of falling victim to
mind-altering substances. It reminded members of society that drug
abuse is a scourge and the reality of drug addiction is painful and sad.
History teaches us that this lesson is all too quickly forgotten, and
such refresher lessons play a valuable role.3 The Drug Summit's very
existence was a very important and useful event. Cynicism was
inappropriate.
|
2. "All agree on one thing, nothing in the past has been successful." | |
One early conclusion, announced after the first day of the Summit, was
a condemnation of past efforts. Australian newspaper headlines
echoed the theme of past failures. This summary critique was not an
appropriate keynote to an Australian drug summit. Absence of either a
cure or a recipe for prevention does not equate with a past record of
failure. Clearly, the drug problem is huge and ever in need of
innovative approaches to combat it; nonetheless, Australia has much
about which to be proud in its approach to illicit drug use. One in four
injecting drug users in the United States are infected with
HIV.4
As a consequence, the individual suffering, high costs of medical
care, and transmission to non-injecting partners and newborns are
immense burdens on society. This scenario has been largely avoided in
Australia, where fewer than 3 in 100 injecting drug users are infected
with HIV.5,6 This is success,
incredible success, and hopefully not ephemeral success.
The existence of a treatment system in which thousands of individuals
each year in Australia get help in their struggle to deal with their
addiction is progress. Of course, striving to expand and improve the
quality of those services and the institution of trials to find
innovative new approaches are required, but there has been
unequivocal progress in this field.
Research successes are also notable. The best data in the world on
heroin overdose have been collected and analysed by the Australian
National Drug and Alcohol Research Centre.7,8 As a result, approaches to
intervention have been developed and this "silent epidemic" is no
longer silent in Australia. HIV prevention, extensive treatment
(even if insufficient), and innovative practical research are
recognised Australian successes in this field.
|
3. "I hope that this forum does not end up as some sort of factionalised
debate ... -- a war on drugs versus legalisation; zero tolerance
versus harm reduction." | |
The discourse at the Drug Summit covered important issues, but the
terms used in the illicit drug policy discussion often got confused.
Consequently, some messages were at risk of misinterpretation.
"Harm reduction" is not synonymous with "legalisation". The goals
are different. The message is different. Equating these terms does
injustice to both issues. There are data to support the effectiveness
of some harm reduction efforts and there is a desire to collect data for
other proposed harm reduction efforts.9,10 This situation is quite
different from a theoretical discussion of the harms and benefits of
legalisation of certain aspects of illicit drug use. The latter is a
public policy question with enormous potential consequences
unlikely to be subjected to the rigours of scientific testing to
assess efficacy. On the other hand, it is very useful to subject novel
approaches to harm reduction to the careful scrutiny of clinical
trials before broader dissemination. The inappropriate equating of
these terms is detrimental and should be strongly resisted.
It is important to realise that drug problems are an area where
agreement on desirable outcomes is possible. The path to those
outcomes has been hampered by a disturbing and remarkable amount of
factional debate. In this most useful public health discussion,
absence of cynicism, recognition of past success, and clarity of
terms will serve to remove impediments from a struggle that will
continue long after the wonderfully focused efforts of the NSW Drug
Summit have become a fading memory. We in the United States can
learn from Australia's willingness to publicly confront these
issues.
|
Acknowledgements | |
I am indebted to Drs James Rankin, Paul Haber, Alex Wodak and Wayne
Hall, who were so kind to me during my sabbatical term in Australia and
who provided feedback about this manuscript. Without their openness
and generosity of spirit I would not have had the opportunity to see
what I saw or write what I wrote.
|
| |
References |
- Swan N. Drug doings down under. JAMA 1999; 281: 1782-1783.
-
Samet JH, Rollnick S, Barnes H. Beyond CAGE: a brief clinical
approach after detection of substance abuse. Arch Intern Med
1996; 156: 2287-2293.
-
Musto D. The American disease: origins of narcotic control. New
York: Oxford University Press, 1987.
-
Centers for Disease Control and Prevention. HIV/AIDS
surveillance report. 1997; 9(2): 1-44.
-
Kaldor JM, Elford J, Wodak AD, et al. HIV prevalence among IDUs in
Australia: a methodological review. Drug Alcohol Rev 1993;
12: 175-184.
-
MacDonald M, Wodak AD, Ali R, et al. HIV prevalence and risk
behaviour in needle exchange attenders: a national study. Med J
Aust 1997; 166: 237-240.
-
Darke S, Ross J, Hall W. Overdose among heroin users in Sydney,
Australia I. Prevalence and correlates of non-fatal overdose.
Addiction 1996; 91: 405-411.
-
Darke S, Ross J, Hall W. Overdose among heroin users in Sydney,
Australia I. Responses to overdose. Addiction 1996; 91:
413-417.
-
Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange
programmes for prevention of HIV infection. Lancet 1997;
349: 1797-1800.
-
Drucker E, Lurie P, Wodak A, Alcabes P. Measuring harm reduction:
the effects of needle and syringe exchange programs and methadone
maintenance on the ecology of HIV. AIDS 1998; 12(Suppl A):
S217-S230.
|
Authors' details | |
Section of General Internal Medicine and the Clinical Addiction
Research and Education (CARE) Unit, Departments of Medicine and
Social and Behavioral Sciences, Boston University Schools of
Medicine and Public Health, Boston, MA.
Jeffrey H Samet, MD, MPH, Associate Professor of Medicine and
Public Health.
Reprints: Associate Professor J H Samet, Section of General
Internal Medicine, Research Unit, 91 East Concord Street, Suite 200,
Boston Medical Center, Boston, Massachusetts, 02118 USA.
jsametATbu.edu
Make a
comment
|
|
