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Towards a regulated market for illicit drugs: effects of the harm reduction model of controlled drug availability
International Journal of Drug Policy 16 (2005) 8–9
Response
Towards a regulated market for illicit drugs: effects of the harm reduction model of controlled drug availability Dave Burrows∗ AIDS Projects Management Group, PO Box 475 Mawson, ACT 2607, Australia Received 14 September 2004; received in revised form 13 October 2004; accepted 15 October 2004
Haden’s paper on public health tools that could be used to regulate illegal drugs (Haden, 2004) is a substantial and welcome step forward in the drug law reform debate. It reminded me that 9 years have passed since two colleagues (Steve Bolt and Timothy Moore) and I worked with a small group to promote similar ideas in Sydney, Australia. This work led to the publication of a Harm Reduction Model of Controlled Drug Availability (Burrows, 1995), followed by a report on the Drug Law Reform project in which we were engaged (Redfern Legal Centre, 1996). Both were widely circulated within Australia and, through the Internet, around the world. It is perhaps useful to briefly examine the impact of these works to see if there are lessons to be learned about the promulgation of such ideas and their acceptance or otherwise by policymakers. The Harm Reduction Model of Controlled Drug Availability began, after a preamble spelling out some of the problems with drug prohibition, by stating that “drug policy should: have realistic goals; take account of the different patterns and types of harms caused by specific drugs; be shown to be effective or be changed; separate arguments about the consequences of drug use from arguments about morals; be developed in the light of the costs of control as well as the benefits; ensure that the harms caused by the control regimes themselves do not outweigh the harms prevented by them; and recognise the existence of multiple goals, but ensure that contradictory goals are minimised.” It went on to suggest the following principles of controlled availability: (i) the use and possession of currently illicit drugs should be made legal, in an environment of controlled availability; (ii) the regulated manufacture, supply and sale of selected drugs should be allowed; (iii) the drugs selected for ∗
Tel.: +61 2 9558 9396; fax: +61 2 9559 2964. E-mail address: [email protected].
0955-3959/$ – see front matter © 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2004.10.005
controlled availability should include cannabis, heroin, amphetamine, ecstasy and anabolic steroids; (iv) the selected drugs should be made available either: (a) over the counter from licensed premises in specified (generally low) dosages of known purity, clearly labelled with ingredients shown; or (b) by prescription; (v) the age limit for the regulated supply of currently illicit drugs should be the same as it is for alcohol; (vi) advertising and marketing should be the minimum necessary (e.g., for brand identification) to ensure that non-users are not attracted into drug use by marketing; (vii) prices of regulated drugs should be set so that least harmful forms of the drug (usually lower dosages) are substantially less costly than more harmful forms of the drug; (viii) users must demonstrate adequate knowledge about the effects of the drug they intend to purchase, and about safe usage; (ix) profits earned from the commercial production or supply of drugs should be taxed. Revenues obtained from taxes and licence fees must be applied (in whole or in large part) to education and to treatment for those drug users who want it; and (x) controlled availability should operate in a framework of: (a) education in which doctors and other health professionals, licensed drug sellers and drug users all participate in baseline and follow-up education based on valid research; and (b) widespread, easily accessible treatment for drug-related problems, with funding to be provided to a wide variety of non-coercive options for positive change. Further thoughts were provided on a prescription system and how these various principles might be applied to different drugs. As the publication Beyond Prohibition (Redfern Legal Centre, 1996) pointed out, our small group at Redfern Legal Centre in Sydney circulated the Harm Reduction Model of Controlled Drug Availability and sought comments on it from a wide range of individuals and groups: these comments are summarised in Beyond Prohibition. We also established
D. Burrows / International Journal of Drug Policy 16 (2005) 8–9
some small steps that we believed were the most urgent and most likely to lead towards the introduction of this or some similar model in New South Wales (NSW), Australia’s most populous State. These steps were promoted through meetings with Parliamentarians from every political party, and through occasional public events. The five small steps (which look larger in hindsight) were to: (i) address personal use and possession of illegal drugs, through several options from abolishing these offences to varying enforcement practices (such as substituting fines for imprisonment, etc.); (ii) allow cannabis use for medical purposes; (iii) allow possession of drug equipment as well as needles and syringes (a particular issue pertaining to the way Australian laws are structured around injecting drug use); (iv) provide safe injecting spaces; and (v) allow use, possession and supply of Narcan without prescription (to assist drug users to help other drug users who have overdosed). Of these, only the second and fourth have come about by 2004. cannabis is available for medical purposes in NSW (though there remain legal issues related to State and Federal jurisdictions), and a medically supervised injecting centre has been operating in Kings Cross in Sydney since May 2001. In both cases, the Redfern Legal Centre group can hardly take credit for the decisions as many other processes and many other groups and individuals worked on the campaigns to bring about these changes. However, it is likely that the publications cited above and the work of our small group assisted in bringing these issues to public and political notice. What may be of greater interest is the way that the ideas in the Harm Reduction Model of Controlled Drug Availability have percolated through Australian society and beyond. These ideas continue to emerge in various contexts. Either or both Burrows (1995) and Redfern Legal Centre (1996) have been used in various ways in Australia. For example, they are cited in: The Illawarra Legal Centre’s submission to the Australian Senate’s Legal and Constitutional Committee inquiry into proposed changes to the Disability Discrimination Act as they affect drug users (Illawarra Legal Centre, 2004); a paper on the ethics of substance use policies by Dr Gregory Pike, Deputy Director of the Southern Cross Bioethics Institute in Adelaide, South Australia (Pike, 2001); Hemp South Australia’s submission to the Australian House of Representatives Select Committee On the Social & Economic Costs of “Drug Abuse” (Hemp, 2000); and the New South Wales Council on Civil Liberties website—at its May 1997 meeting, the Council adopted the “Redfern Model” as they called it (NSW Council on Civil Liberties, 1997). Further afield, South Africa’s Ravesafe group cited Beyond Prohibition in its submission to South Africa’s Drug Advisory Board related to the “Framework for a National Drug Master Plan” (Ravesafe, 1997). The Model has been used in discussions by the Green Party of Aotearoa (New Zealand) to formulate its drugs policy, which states in part: “The specific goals of this policy are to: Reduce the size and
9
profits of the illicit drug market by the greatest amount; and provide the greatest level of harm reduction for society and for users of legal and illegal drugs; and reduce alcohol, tobacco, cannabis and other drug abuse.” The policy states that the “Green Party proposes that the Government conduct a comprehensive and public review of all drug-related legislation, including the Sale of Liquor Act, the Smokefree Environments Act and Misuse of Drugs Act. The purpose of the review is to develop integrated, effective harm reduction legislation in order to: Reduce harm and cost to society and individuals from drug use and abuse; and enhance people’s capacity for informed choice” (Green Party of Aotearoa New Zealand, 2004). The lesson I take from this brief examination of the effects of our work in the mid-1990s is that the concept of controlled or regulated availability of illegal drugs will continue to be debated among professionals and, at least in the Green Party, among some politicians. But in general, the belief that controlled or regulated availability of drugs may have more benefits than prohibition appears to be one not shared by most Australians in 2004. Neither of the largest two political parties (Labor and Liberal) have adopted these ideas or anything similar to them. It will take a substantial, long-term advocacy campaign for these ideas ever to enter the mainstream of political thinking.
References Burrows, D. (1995). Harm reduction model of controlled drug availability Redfern Legal Centre Drug Law Reform Project. Sydney, May. Green Party of Aotearoa New Zealand. (2004). Drug law reform policy— Towards a harm reduction model for alcohol, tobacco, cannabis and other drugs. Adopted 19 May, available from: http://www.greens.org. nz/searchdocs/policy4749.html. Haden, M. (2004). Regulation of illegal drugs: An exploration of public health tools. International Journal of Drug Policy, 15, 225–230, Commentary. Hemp, S. A. (2000). Submission to the house of representatives select committee on the social & economic costs of “Drug Abuse”. Adelaide, June, available from: http://www.hemp.on.net/final folder/about us/ what weve done/submissions/hr00.html. Illawarra Legal Centre. (2004). Submission to senate legal and constitutional committee inquiry into proposed changes to the Disability Discrimination Act. Warrawong, February, available from: http://www. illawarralegalcentre.org.au/doc/DDA Submission.pdf. NSW Council on Civil Liberties. (1997). Drug policies 1970–1997. Sydney, available from: http://www.nswccl.org.au/issues/drug policies. php. Pike G. K. (2001). Substance abuse, ethics and public policy. Bioethics Research Notes, 13(3), September, available from: http://www. bioethics.org.au/BRN%201303.pdf. Ravesafe. (1997). Comments on the framework for a National Drug Master Plan as tabled by the Drug Advisory Board, October 1997. Johannesburg, December, available from: http://www.ravesafe.org/ submissions/ndp/submission 121297.htm. Redfern Legal Centre. (1996). Beyond prohibition: Report of the Redfern Legal Centre Drug Law Reform Project. Sydney, September, available from: http://www.druglibrary.org/schaffer/Library/studies/redfern/ rftoc.htm.
Response
Towards a regulated market for illicit drugs: effects of the harm reduction model of controlled drug availability Dave Burrows∗ AIDS Projects Management Group, PO Box 475 Mawson, ACT 2607, Australia Received 14 September 2004; received in revised form 13 October 2004; accepted 15 October 2004
Haden’s paper on public health tools that could be used to regulate illegal drugs (Haden, 2004) is a substantial and welcome step forward in the drug law reform debate. It reminded me that 9 years have passed since two colleagues (Steve Bolt and Timothy Moore) and I worked with a small group to promote similar ideas in Sydney, Australia. This work led to the publication of a Harm Reduction Model of Controlled Drug Availability (Burrows, 1995), followed by a report on the Drug Law Reform project in which we were engaged (Redfern Legal Centre, 1996). Both were widely circulated within Australia and, through the Internet, around the world. It is perhaps useful to briefly examine the impact of these works to see if there are lessons to be learned about the promulgation of such ideas and their acceptance or otherwise by policymakers. The Harm Reduction Model of Controlled Drug Availability began, after a preamble spelling out some of the problems with drug prohibition, by stating that “drug policy should: have realistic goals; take account of the different patterns and types of harms caused by specific drugs; be shown to be effective or be changed; separate arguments about the consequences of drug use from arguments about morals; be developed in the light of the costs of control as well as the benefits; ensure that the harms caused by the control regimes themselves do not outweigh the harms prevented by them; and recognise the existence of multiple goals, but ensure that contradictory goals are minimised.” It went on to suggest the following principles of controlled availability: (i) the use and possession of currently illicit drugs should be made legal, in an environment of controlled availability; (ii) the regulated manufacture, supply and sale of selected drugs should be allowed; (iii) the drugs selected for ∗
Tel.: +61 2 9558 9396; fax: +61 2 9559 2964. E-mail address: [email protected].
0955-3959/$ – see front matter © 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2004.10.005
controlled availability should include cannabis, heroin, amphetamine, ecstasy and anabolic steroids; (iv) the selected drugs should be made available either: (a) over the counter from licensed premises in specified (generally low) dosages of known purity, clearly labelled with ingredients shown; or (b) by prescription; (v) the age limit for the regulated supply of currently illicit drugs should be the same as it is for alcohol; (vi) advertising and marketing should be the minimum necessary (e.g., for brand identification) to ensure that non-users are not attracted into drug use by marketing; (vii) prices of regulated drugs should be set so that least harmful forms of the drug (usually lower dosages) are substantially less costly than more harmful forms of the drug; (viii) users must demonstrate adequate knowledge about the effects of the drug they intend to purchase, and about safe usage; (ix) profits earned from the commercial production or supply of drugs should be taxed. Revenues obtained from taxes and licence fees must be applied (in whole or in large part) to education and to treatment for those drug users who want it; and (x) controlled availability should operate in a framework of: (a) education in which doctors and other health professionals, licensed drug sellers and drug users all participate in baseline and follow-up education based on valid research; and (b) widespread, easily accessible treatment for drug-related problems, with funding to be provided to a wide variety of non-coercive options for positive change. Further thoughts were provided on a prescription system and how these various principles might be applied to different drugs. As the publication Beyond Prohibition (Redfern Legal Centre, 1996) pointed out, our small group at Redfern Legal Centre in Sydney circulated the Harm Reduction Model of Controlled Drug Availability and sought comments on it from a wide range of individuals and groups: these comments are summarised in Beyond Prohibition. We also established
D. Burrows / International Journal of Drug Policy 16 (2005) 8–9
some small steps that we believed were the most urgent and most likely to lead towards the introduction of this or some similar model in New South Wales (NSW), Australia’s most populous State. These steps were promoted through meetings with Parliamentarians from every political party, and through occasional public events. The five small steps (which look larger in hindsight) were to: (i) address personal use and possession of illegal drugs, through several options from abolishing these offences to varying enforcement practices (such as substituting fines for imprisonment, etc.); (ii) allow cannabis use for medical purposes; (iii) allow possession of drug equipment as well as needles and syringes (a particular issue pertaining to the way Australian laws are structured around injecting drug use); (iv) provide safe injecting spaces; and (v) allow use, possession and supply of Narcan without prescription (to assist drug users to help other drug users who have overdosed). Of these, only the second and fourth have come about by 2004. cannabis is available for medical purposes in NSW (though there remain legal issues related to State and Federal jurisdictions), and a medically supervised injecting centre has been operating in Kings Cross in Sydney since May 2001. In both cases, the Redfern Legal Centre group can hardly take credit for the decisions as many other processes and many other groups and individuals worked on the campaigns to bring about these changes. However, it is likely that the publications cited above and the work of our small group assisted in bringing these issues to public and political notice. What may be of greater interest is the way that the ideas in the Harm Reduction Model of Controlled Drug Availability have percolated through Australian society and beyond. These ideas continue to emerge in various contexts. Either or both Burrows (1995) and Redfern Legal Centre (1996) have been used in various ways in Australia. For example, they are cited in: The Illawarra Legal Centre’s submission to the Australian Senate’s Legal and Constitutional Committee inquiry into proposed changes to the Disability Discrimination Act as they affect drug users (Illawarra Legal Centre, 2004); a paper on the ethics of substance use policies by Dr Gregory Pike, Deputy Director of the Southern Cross Bioethics Institute in Adelaide, South Australia (Pike, 2001); Hemp South Australia’s submission to the Australian House of Representatives Select Committee On the Social & Economic Costs of “Drug Abuse” (Hemp, 2000); and the New South Wales Council on Civil Liberties website—at its May 1997 meeting, the Council adopted the “Redfern Model” as they called it (NSW Council on Civil Liberties, 1997). Further afield, South Africa’s Ravesafe group cited Beyond Prohibition in its submission to South Africa’s Drug Advisory Board related to the “Framework for a National Drug Master Plan” (Ravesafe, 1997). The Model has been used in discussions by the Green Party of Aotearoa (New Zealand) to formulate its drugs policy, which states in part: “The specific goals of this policy are to: Reduce the size and
9
profits of the illicit drug market by the greatest amount; and provide the greatest level of harm reduction for society and for users of legal and illegal drugs; and reduce alcohol, tobacco, cannabis and other drug abuse.” The policy states that the “Green Party proposes that the Government conduct a comprehensive and public review of all drug-related legislation, including the Sale of Liquor Act, the Smokefree Environments Act and Misuse of Drugs Act. The purpose of the review is to develop integrated, effective harm reduction legislation in order to: Reduce harm and cost to society and individuals from drug use and abuse; and enhance people’s capacity for informed choice” (Green Party of Aotearoa New Zealand, 2004). The lesson I take from this brief examination of the effects of our work in the mid-1990s is that the concept of controlled or regulated availability of illegal drugs will continue to be debated among professionals and, at least in the Green Party, among some politicians. But in general, the belief that controlled or regulated availability of drugs may have more benefits than prohibition appears to be one not shared by most Australians in 2004. Neither of the largest two political parties (Labor and Liberal) have adopted these ideas or anything similar to them. It will take a substantial, long-term advocacy campaign for these ideas ever to enter the mainstream of political thinking.
References Burrows, D. (1995). Harm reduction model of controlled drug availability Redfern Legal Centre Drug Law Reform Project. Sydney, May. Green Party of Aotearoa New Zealand. (2004). Drug law reform policy— Towards a harm reduction model for alcohol, tobacco, cannabis and other drugs. Adopted 19 May, available from: http://www.greens.org. nz/searchdocs/policy4749.html. Haden, M. (2004). Regulation of illegal drugs: An exploration of public health tools. International Journal of Drug Policy, 15, 225–230, Commentary. Hemp, S. A. (2000). Submission to the house of representatives select committee on the social & economic costs of “Drug Abuse”. Adelaide, June, available from: http://www.hemp.on.net/final folder/about us/ what weve done/submissions/hr00.html. Illawarra Legal Centre. (2004). Submission to senate legal and constitutional committee inquiry into proposed changes to the Disability Discrimination Act. Warrawong, February, available from: http://www. illawarralegalcentre.org.au/doc/DDA Submission.pdf. NSW Council on Civil Liberties. (1997). Drug policies 1970–1997. Sydney, available from: http://www.nswccl.org.au/issues/drug policies. php. Pike G. K. (2001). Substance abuse, ethics and public policy. Bioethics Research Notes, 13(3), September, available from: http://www. bioethics.org.au/BRN%201303.pdf. Ravesafe. (1997). Comments on the framework for a National Drug Master Plan as tabled by the Drug Advisory Board, October 1997. Johannesburg, December, available from: http://www.ravesafe.org/ submissions/ndp/submission 121297.htm. Redfern Legal Centre. (1996). Beyond prohibition: Report of the Redfern Legal Centre Drug Law Reform Project. Sydney, September, available from: http://www.druglibrary.org/schaffer/Library/studies/redfern/ rftoc.htm.