Transcript Document

Thinking about drugs policy:
some core concepts that might underpin the next
stage of Australia’s National Drug Strategy
A presentation to the Families and Friends for Drug Law Reform,
Canberra, 22 May 2003
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David McDonald
Consultant in Social Research & Evaluation
PO Box 1355, Woden ACT 2606, Australia
Phone: (02) 6231 8904 (national); +61 2 6231 8904 (international)
Email: [email protected]
(remove the xxx from the email address; including it here it is an anti-spam measure)
Overview
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Origins of Australia’s harm minimisation policy
The prevention paradox
The prohibition paradox
Unpacking and refining the concept of ‘harm’
Feb 1985 DA:NA Workshop
Conclusion:
‘While there are still the traditional polarised views on the use of drugs,
there is now increasingly a common ground within the Australian
community on appropriate action on the abuse of drugs.’
Recommendation 1:
‘The objective of a national policy on drug use should be to minimise the
harmful consequences of the use of drugs to individuals, their families,
and the community as a whole including the needs of special groups.
Therefore a national, comprehensive approach will be needed.’
Distribution curve,
e.g. consumption of a drug
Number of people
Many
Few
Low
High
Level of
consumption
The prevention paradox
Geoffrey Rose 1981; 1992:
‘A large number of people exposed to a small risk may
generate many more cases than a small number exposed to
high risk.’
‘A preventive measure that brings large benefits to the
community offers little to each participating individual.’
The converse of the prevention paradox :
‘When many people each receive a little benefit, the total
benefit may be large.’
Contemporary challenges to the
prevention paradox (Ann Roche)
The shift away from measures of mean consumption, as the principal indicator of use and
problems, towards an incorporation of temporal patterns of use
•
alcohol may represent an exception to the population health models based on mean
distributions;
•
there is no prevention paradox if episodes of intoxication are examined instead of
mean consumption levels;
•
it is more useful to focus on at-risk drinking than attempt to locate groups of at-risk
drinkers;
•
harm minimisation offers a constructive conceptual vehicle by which to shift the
focus from consumption to consequences of use.
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Policy implication for drugs generally: we need to get the right mix of:
universal interventions (focusing on the whole community);
targetted interventions (focusing on at-risk population groups); and
indicated interventions (focusing on people already exhibiting risky behaviour)
The prohibition paradox
(John Marks)
Demand
Black market
gangsterism
Epidemic
intoxication
Social use
Supply
Prohibition
Control
Free market
The prohibition paradox
(Stephen Mugford)
Harm
Currently illegal
drugs
Currently
legal drugs
Optimal point
Supply
Low availability
High availability
The concept of harm in ‘harm
minimisation’ and ‘harm reduction’
• Harm is not proportional to use
• Total harm = prevalence x intensity x micro-harm
Taxonomy of drug-related harms/costs
Type of
harm/costs
Health
Social & economic
functioning
Safety & public order
Criminal justice system
Who bears the
harm/costs
Sources of
harm/costs
Users, dealers, intimates,
employers, neighbourhood, society
Drug use, legal status,
interventions
Our responses to drug-related
problems lack coherence
Responses are characterised by:• lack of information on how to develop and implement
interventions in particular contexts;
• lack of information on what is implemented and how;
• lack of information on the short-term outcomes and longer and
deeper impacts of interventions;
• lack of information on the cost-effectiveness, cost-benefit and
cost-utility of the interventions; and
• responding to problems after they have developed, rather than
anticipating them and giving primacy to prevention.
The ‘net harm’ approach
‘Policies have unwanted side effects. Taxes create
moonshining, regulation creates evasion and corruption,
prohibition creates black markets, programs cost money
and often create perverse incentives. Since all drugs are
dangerous and all policies are costly, we ought to consider,
for each drug and for all of them together, what set of
policies would create the least onerous overall problem,
adding together the damage done by drug abuse and the
damage done by attempts to control it.’
(Kleiman, MAR 1992, p. 386)
Sources and notes
Slide 3: The Drugs in Australia: National Action workshop was run by the Alcohol & Drug Foundation, Australia. See Brown, VA,
Manderson, D, O'Callaghan, M & Thompson, R 1986, Our daily fix: drugs in Australia, Australian National University Press,
Rushcutters Bay, N.S.W. Emphasis in original.
Slide 5: Rose, G 1981, 'Strategy of prevention: lessons from cardiovascular disease', British Medical Journal (Clinical Research Ed.), vol.
282, no. 6279, pp. 1847-51; Rose, G 1992, The Strategy of Preventive Medicine, OUP, Oxford.
Slide 6: Roche, AM 1997, 'The shifting sands of alcohol prevention: rethinking population control approaches', Australian and New Zealand
Journal of Public Health, vol. 21, no. 6, pp. 621-5. Mrazek, PJ & Haggerty, RJ (eds) 1994, Reducing risks for mental disorders:
frontiers for prevention intervention research, National Academy Press, Washington DC.
Slide 7: Marks, J 1990, 'The paradox of prohibition', in J Hando & J Carless (eds), Controlled availability - wisdom or disaster? Papers from
the National Drug and Alcohol Research Centre Annual Symposium, University of New South Wales, February 1989, National Drug
and Alcohol Research Centre, University of New South Wales, Kensington, NSW, pp. 7-10. Marks, J 1993, 'The paradox of
prohibition', in C Brewer (ed.), Treatment options in addiction: medical management of alcohol and opiate abuse, Gaskell, London.
Slide 8: Mugford, S. 1995, pers. com.
Slide 10: MacCoun, R, Reuter, P & Schelling, T 1996, 'Assessing alternative drug control regimes', Journal of Policy Analysis and
Management, vol. 15, no. 3, pp. 330-52. MacCoun, RJ & Reuter, P 2001, Drug war heresies: learning from other vices, times, and
places, Rand Studies in Policy Analysis, Cambridge University Press, Cambridge, UK. The authors list the sources of harm as drug use,
legal status and enforcement. Since drug education and other prevention programs, and drug treatment, are also potential sources of
harm/costs, the broader term ‘interventions’ is used here.
Slide 11: One response to this is the proposal by a small consortium of Australian researchers (with international advisers), to undertake a
major study titled ‘Responding to illicit drug problems in Australia - what is the best return on investment? The core research question
would be What is the optimal mix of interventions that will produce the minimum level of net illicit drug-related harm in Australia?
Slide 12: Kleiman, MAR 1992, Against excess: drug policy for results, Basic Books, New York, NY.