Problems With Harm Minimisation, Part One

The general drift of both state and federal policy on the drug issue – as on a number of other social issues – is what is known as harm minimisation or harm reduction. Simply described, this approach says that social problems (in this case, drug use) cannot be eradicated, no matter how hard we try, and therefore government policy must contain the damage, and make the harmful practices somewhat safer, or less harmful.

This is the approach often taken to many social ills, including teen sexuality, pornography, and prostitution. In the area of drugs, this policy suggests that drug use will never be eradicated, that people will always use drugs, therefore we need to make drug taking safer or less harmful.

Often associated with the harm minimisation approach is the call for reduced penalties for drug use. Indeed, many would go the way of drug decriminalisation. These people argue that a “get tough” approach to drug use is not working. They claim that we should view drug use as a health issue, not a law enforcement issue. This, they argue, is the more humane approach.

Drug reformers such as Dr Alex Wodak frequently speak of the supposed failure of abstinence-based approaches and argue that strict policing and penalties are the wrong way to go on drug use. Indeed, he once made this remarkable claim: “heroin is dangerous because it is prohibited rather than prohibited because it is dangerous”.

However, are the champions of such drug reform right? I believe that the harm minimisation approach is misplaced and unhelpful. I do so for a number of reasons.

1. It is a counsel of despair.
This is the “throw your hands in the air” approach which admits defeat at the outset. Such a negative attitude is not the proper framework in which to be dealing with the drug problem. A positive, pro-active approach is needed, not one which declares surrender from the very outset.

At bottom, the drug problem is not so much a legal problem as a moral and cultural problem. (Indeed, some would argue that it is also a spiritual problem, a way of meeting deep-seated needs in a person’s life.) To throw up our hands and give up on our children is a sign of moral irresponsibility. As retired NSW District Court judge Kenneth Gee QC has said, “Legalisation is really a counsel of despair, almost irreversible once embarked upon. It should not be tried. It will not work.”

2. We don’t always take this approach in other areas of social policy.
We certainly do not use such a defeatist attitude in regard to many other social ills. Most governments do not argue that we must live with pollution, or that we will always have racism, or that we must accept rape. Indeed, in certain areas we take exactly the opposite approach.

A good example is in the area of tobacco use. It could be argued, and rightly so, that young people always have smoked and always will. A harm minimisation approach would suggest, therefore, that we teach people how to smoke safely, that we teach them about filters, low tar and nicotine levels, and so on. But no one is suggesting this. In fact, we are doing the exact opposite. We tell young people – and not so young people – to just say ‘no’. “Don’t do it.” “Don’t smoke.” We have quit campaigns. We have education campaigns. We ban tobacco advertising. We place very high taxes on tobacco products.

And what has been the result? Whereas 35 years ago over 60 per cent of the population smoked, today that figure has fallen to under 30 per cent. Harm prevention, in other words, works. Social trends are not irreversible. Problem social behaviours can be turned around if we have the determination and courage to see things through.

3. It tackles drug problems from the wrong end.
The harm minimisation model simply rejects the drug-free approach as unrealistic and unworkable. It asks us to manage the problem, instead of preventing the problem in the first place. However, as in so many other areas, prevention is always better than cure. It is more cost-effective and more compassionate to keep people off drugs in the first place, than to try to get them off drugs. The old fence parable is appropriate here: Better to invest in a good fence at the top of a cliff than to invest in a fleet of ambulances at the bottom of the cliff. Surely every dollar we spend on prevention and deterrence programs will save hundreds of dollars on treatment programs later on, as well as save many lives.

4. It sends out the wrong message.
To say that we must put up with drug abuse simply sends out the wrong message, especially to our young people. To say that people can use illegal drugs if they can be taught to safely do so, is to send out the message that it is OK to use such drugs. If we pass a law, for example, to allow heroin injecting rooms, the message is sent out that using heroin must be OK, because it is in a sense being legalised (in the injecting room). The educative effect of any law must be considered before legislation is changed or passed.

This raises the question of the normative effect of the law. Besides proscribing what we may and may not do, the law acts as an educator. By declaring certain things illegal, the law sends out a strong message that such activities are to be avoided. Correspondingly, to legalise a previously illegal activity sends the signal, especially to our young people, that such an activity is now morally and socially acceptable. What society was once seen to disapprove it is now seen to endorse.

5. It is a failed approach.
The truth is, programs which emphasise harm prevention are effective. The “get tough” approach, or the “just say no” approach has had measured success. As I mentioned in the case of cigarettes, a “get tough” approach can have real success. Of course it must include education campaigns and community involvement, but such approaches can and do work.

The “get tough” approach in Sweden in relation to drugs is a case in point. At one point Sweden took a harm minimisation approach to drugs. Indeed, it took a very liberal approach to drugs in the 60s and 70s. It ended up with the worst rate of drug use in all of Europe. In the late 70s it had a major rethink. It recognised that things had gotten out of control and must be turned around. And they did. Sweden decided to get tough on drugs. They introduced diversionary policies and mandatory treatment for some drug-related offences. They began to implement strict policing and stiff penalties for drug offences. They made extensive use of education and community involvement. And after 15 years of this approach, Sweden had the lowest rate of drug use in the Western world. “Get tough” policies on drugs work.

The following figures produced by the UN show the differences between Australia’s drug problems and Sweden’s. The two sets of data provide a remarkable contrast.

Lifetime prevalence of drug use among young people 9% 52%
Use in previous year 2% 33%
Est. dependent heroin users per million population 500 5000-16000
Percentage of dependent users aged under 20 1.5% 8.2%
Methadone patients per million population 50 940
Drug-related deaths per million population 23 46
Percentage of all deaths at age under 25 1.5% 3.7%
Average months in prison per drug offence 20 5
Drug offences per million population
(Sweden – arrests; Australia – convictions)
3100 1000

(Note: While this chart makes a telling contrast, it should be pointed out that it is very difficult to make accurate comparisons between one country and another. That is because there are no international criteria for measurement. There are no internationally agreed upon definitions on such issues as what a drug overdose is, or how one defines a drug-related death. For example, in Sweden, a “heavy drug user” includes someone who uses marijuana, while in Holland such a term would apply to heroin users, but not cannabis users. Thus we need to be careful here. As long as each country uses its own criteria on drug statistics, we must proceed with caution. However, with this qualification in mind, the above comparison does give us some idea of the differences between Australia and Sweden.)

More problems will be mentioned in Part Two of this article:

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5 Replies to “Problems With Harm Minimisation, Part One”

  1. Amen Bill – you are spot on again.

    Harm minimisation is the servant policy of every group looking to bring in every manner of immorality. Porn, drugs, prositution, abortion…you name it and The Greens and their ilk will be “harm minimising” it into society “for the good of the nation”.

    It is a dupe policy with a sheep facade and a ravenous wolf interior.

    But you have provided an excellent rationale that deals with the serious logical errors of it in a more beneficial way than my accurate but admittedly aggressive and merciless rhetoric, so thanks again Bill!

  2. The spiritual dimension of the drug problem was explained to me by a marijuana user who was a former schoolmate of mine – he said that, for him, the drug had become like the Holy Ghost. Next I heard of this man was he’d hung himself in gaol, an outflow of the psychotic disorder his drug use had given him. Hippocrates dictum was: “First of all, do no harm.”, not, “First of all, do a little harm.”!

  3. John, you have expressed something I believe to be profoundly true about drugs, and that is that they are an effective portal to hell, which is one huge reason to not allow use of them decriminalised. This I add to the scientific facts offered by Bill and others.

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