Drug Free Australia manipulate, misrepresent data to discredit Insite

In April 2011 the Lancet published an article written by authors from the British Columbia Centre for Excellence in HIV/AIDS, the UBC Faculty of Medicine, the UBC School of Population and Public Health and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

The title was Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study, by Brandon D L Marshall, M-J Milloy, Evan Wood, Julio S G Montaner, Thomas Kerr was followed by a media release from The University of British Columbia which included:

Researchers compared nearly 300 case reports from the British Columbia Coroners Service documenting all illicit drug overdose deaths in Vancouver between January 1, 2001 and December 31, 2005.

Compared to the 35 per cent reduction in overdose deaths in the immediate vicinity of Insite following its opening in September 2003, overdose deaths in the rest of Vancouver declined only nine per cent over the same period. No overdose deaths have been recorded at Insite since the facility’s opening. The researchers also noted that there was no evidence of significant changes in drug supply or purity during the study period.

“This study provides the first unequivocal scientific evidence of the benefits of supervised injection facilities, and clearly demonstrates that facilities such as Insite are saving lives and playing a vital role in reducing the harms associated with illicit drug use,” says co-author Dr. Julio Montaner, director of the BC-CfE and Chair of AIDS Research at the UBC Faculty of Medicine.

The Abstract can be read here. Insite which opened in September 2003 has also been the subject of more than 30 studies in 15 peer reviewed journals. These have cited a number of benefits including increased access to rehabilitation services, detoxification, reduced syringe litter, reduced public injecting and most importantly reduced needle sharing which serves to reduce blood borne virus spread.


In 2006 the new Conservative government which did not support the initiative threatened to let the site’s legal exemption lapse before the project was complete. On September 1st 2006, Health Minister Tony Clement cited a need for more research as he deferred his decision to extend the site’s legal exemption. On the same day the Government cut all funding for future research. In August 2007 two addicts and the Portland Hotel Society filed suit in the B.C. Supreme Court arguing violation of rights – “security to the person”. What followed was from a legal and human rights perspective remarkable including the May 2008 strike down of sections of the Canadian criminal code on drug trafficking and possession as a breach of the Canadian Charter of Rights and Freedoms.

The struggle between progression and conservatism continued with the federal government appealing this legal advance in human rights. The B.C. Court of Appeal dismissed this in a 2-1 ruling. The government announced a further appeal to the Supreme Court of Canada. There were nine interveners in the Supreme Court Case. Only one supported the stance of the conservative government to close Insite. That group was the socially conservative, anti-women’s rights lobby group REAL Women of Canada.

National vice president of REAL Women…, Gwen Landolt, argued against the Canadian Medical Association and other supporters. She claimed that Insite would allow users to get “worse and worse until they die” and that such facilities “are assisting in the suicide of drug addicts.” The government had to admit it had no credible research to show Insite was not working. There were no valid data to show Insite was not reducing drug related harm. In essence the government and REAL Women of Canada were mounting non evidence based claims.

The Supreme Court of Canada ruled unanimously on September 29th, 2011 to uphold Insite’s exemption from the Controlled Drugs and Substances Act. This allowed the site to stay open indefinitely. The ruling was highly critical of Health Minister Tony Clement’s application of the CDSA to Insite stating it was grossly disproportionate and undermined “the very purposes of the CDSA, which include public health and safety”.

Drug Free Australia’s Bogus Critique

Drug Free Australia (DFA) is a conservative right wing prohibitionist lobby group of loosely affiliated extremists masquerading as a quasi-official body critical of Australia’s illicit drug policy. Regarding Injecting Facilities they have a discredited history (indeed presence) in maintaining the highly flawed opinion piece Case For Closure attacking Sydney’s Medically Supervised Injecting Centre. The Drug Misuse and Trafficking Amendment (MSIC Bill) was passed in October 2010 with considerable support from then Premier Kristina Keneally, The Australia Medical Association and the Royal Australasian College of Physicians. All three along with countless other individuals, MPs and organisations rejected the efforts of Drug Free Australia under the auspices of Secretary Mr. Gary Christian to sabotage over a decade of trial success.

On September 17th 2011, perhaps in a final effort to sway the Supreme Court of Canada (at that time yet to hand down it’s decision) DFA presented a media release claiming to have “exposed major, inexcusable errors” alleging “research fraud and professional misconduct” in the Lancet paper by Marshall et al. They cited an article headed Analysis of the 2010 Lancet study on deaths from overdose in the vicinity of Vancouver’s Insite Supervised Injection Facility published in the Journal of Global Drug Policy and Practice (JGDPP).

The authors were familiar names. Dr. Greg Pike co-author of the Case for Closure, and already profiled here. Dr. Stuart Reece and Dr. Joe Santamaria, also both co-authors of the Case for Closure of the Sydney MSIC. Prohibitionist Robert DuPont, former “White House Drug War Czar” under Richard Nixon and present board member of Drug Free America Foundation and finally Dr Colin Mangham, Director of Research, Drug Prevention Network of Canada. Their coordinator was anti-Harm Reduction campaigner Gary Christian.

In a comprehensive response the Lancet authors note their methodology and data was subjected to extensive scientific peer review and that this independent process “confirmed the appropriateness of the data and methods that we employed”. They further note Mr. Christian’s source has not been subject to peer review nor published in any scientific journal.

Nevertheless this formed the basis of a complaint by “research coordinator”, DFA Secretary Mr. Gary Christian to the University of British Columbia. The media release included:

The international team’s analysis has been sent by the Drug Prevention Network of Canada to the Ethics Committee of the agency which funded the Lancet study with questions regarding research fraud and professional misconduct.

Mark Wainberg, professor of medicine and director of the McGill University AIDS Centre was called upon to independently review the matter. Wainberg reviewed DFA’s analysis, the Lancet paper and the author’s response. He concluded in part:

In my view, the allegations that have been made by ‘Drug Free Australia’ are without merit and are not based on scientific fact. In contrast, it is my view that the work that has been carried out by the team of Thomas Kerr et al is scientifically well-founded and has contributed to reducing the extent of mortality and morbidity in association with the existence of the safer injection facility. . . . The University of British Columbia should be proud of the contributions of its faculty members to the important goal of diminishing deaths due to intravenous drug abuse.

The JGDPP analysis and complaint were found to be entirely without merit and the complaint was dismissed.

Drug Free Dishonesty

Along with the Lancet author’s response and the independent review there are a number of elements which render this amateurish attack particularly offensive. As noted above the “analysis” is not peer reviewed nor published in any recognised scientific journal. It was published in the JGDPP which is a collection of non peer reviewed articles and opinion pieces. Described as a “glorified blog” by The Media Awareness Project, the JGDPP is run by DFA’s parent body Drug Free America Foundation (on whose board sits DuPont). It was initially funded by the US Department of Justice which is presently under investigation for corruption. It has an international reputation for hosting articles seeking to sabotage human rights oriented policy initiatives successful in controlling the spread of blood borne viruses. Many authors hold extreme and archaic religious and/or anti-science views.

Essentially the JGDPP piece argues that the 35% reduction in overdose deaths in a delineated area following the opening of Insite and documented in the Lancet by Marshall et al. is flawed. Tactics by which this is done obfuscate context and manipulate the import of data in such a way as to misrepresent it to the reader. By using flawed population analysis and failing to state the nature of deaths across a much larger area it seeks to claim overdose deaths increased. The JGDPP team also suggest the Lancet authors should have dismissed an entire year as irrelevant because doing so decreases the overall decline in mortality. Thus it was, in their minds, only included by Marshall et al. to skew results.

The Lancet authors note the JGDPP report:

[U]ses crude Vital Statistics data, which included all accidental poisonings to define its estimate of overdose deaths, and it did not exclude deaths unlikely to be affected by a supervised injecting facility (e.g., suicides, adverse effects of drugs in therapeutic use). We note that the REAL Women/DPNC (JGDPP) critique seeks to call into question the Lancet paper’s findings using these crude data, and then goes on to argue that the Lancet paper’s findings cannot be relied upon because they use similarly unrefined death counts. We would argue that you cannot have it both ways.

The JGDPP article also fails to admit it used crude death counts and not population-adjusted mortality rates. This fails to account the relevance of death rates in a changing population. The Lancet study used annual population estimates from Statistics Canada to conclude on overdose mortality. Most shocking however was the increase by the JGDPP authors in area consulted by around a factor of 10. The Lancet studied mortality in 41 city blocks. The JGDPP article refers to mortality in a 400 block area. This further obscures the fact that the greatest reduction in overdose is within 4 blocks of Insite and significantly decreases outside that area.

The area in green is that studied by the Lancet authors showing a 35% reduction in overdose mortality. The area in red is that used by the JGDPP authors to misrepresent the Lancet finding.

The JGDPP article was written as an analysis for REAL Women of Canada and the Drug Prevention Network of Canada (DPNC). It is demonstrably a collation of highly selective, misleading, out of context and academically discredited material. The “analysis” relies time and again on a 2007 “critique of [the Insite] parent philosophy” written by co-author Dr. Colin Mangham of the DPNC. The DPNC holds a highly partisan irrational anti Harm Reduction position claiming it “leads to terror, degradation and the eventual death of the addict”, refers to supporters of HR as “enablers” and presents a grossly distorted misrepresentation of HR on it’s website.

They are dedicated to:

…advance abstinence-based drug and alcohol treatment and recovery programs, to promoting a healthy lifestyle free of drugs and to opposing legalization of drugs in Canada.

Their Mission Statement freely includes, Lobbying in the media, at the community level and in government for the support of our stated principles. At no point does the DPNC propose to hold to an evidence based approach or accommodate advances in scientific consensus. Not surprisingly the previous 2007 article by Mangham is critical of research which supports harm reduction and Insite. Even less surprisingly it too is published in Journal of Global Drug Policy and Practice.

Along with accusations of fraud, professional misconduct and research errors directed at the Lancet authors, the media release From Gary Christian also expanded on the supposed impact of the work of Marshall et al:

The article was influential in the Canadian Supreme Court hearings of May 12 this year, where the court reserved its decision on whether the Canadian Government is rightfully able to close the facility. The Canadian government has been trying to close Insite since 2006, but has been hampered by court action by harm reduction activists.

This is extraordinary. The JGDPP analysis that has so emboldened Mr. Christian was written for REAL Women of Canada and the DPNC. REAL Women of Canada were interveners in the Supreme Court in favour of the Canadian Government. The JGDPP analysis relied significantly upon material critical of Insite produced by the DPNC in 2007. The same DPNC with a mission statement to lobby community and government. Surely the time for accusations and presentation of evidence was in the Supreme Court itself. Yet the reasons why the government could produce none of this flawed “evidence” are manifestly clear.

The JGDPP piece cites the 2007 critique of Mangham in formulating the claim that changes in policing, “could account for any possible shift in overdose deaths from the vicinity of Insite”, arguing this was intentionally ignored by Marshall et al. Mangham is also cited as refuting Insite as having any impact on public crime or public disorder. Yet the Royal Canadian Mounted Police who had commissioned Mangham’s 2007 report claimed it, “did not meet conventional academic standards”.

Although every injection within Insite is sterile and safe from contraction of blood borne viruses, Christian’s JGDPP analysis further cites Mangham 2007 in arguing:

Added to this [the impact of policing] are the spurious claims by Insite researchers that the facility has impacted HIV and HCV transmission, despite the claim being possible only if ALL injections by those HIV or HCV positive are hosted by Insite, which has rarely been the case.

Unsurprisingly Mangham’s 2007 report was ignored by Canada’s Expert Advisory Committee on Injecting Site in formulating their own report. This doesn’t stop the JGDPP piece from citing data from Canada’s Expert Advisory Committee on Injecting Site that Insite statistically saves only one life per year. It’s argued that “this would not be detectable at the population level. This estimate is backed by the European Monitoring Centre’s methodology and avoids the error of naively assuming overdose rates in the facility match overdose rates in the community.”

At first blush this sounds compelling but is in fact a rogue construct manipulating entirely different methodologies, which yield entirely unrelated data sets, to imply naivety on behalf on Marshall et al. Regardless of what is “detectable at the population level”, neither study is relevant to the other. Citing the European Monitoring Centre’s methodology is simple weasel wording applied to distract the reader from the straw man of “one life per year”.

In truth the “one life per year” comes from person to person intervention in a clinical facility. It actually underscores the safety of the Insite environment in averting dynamics which may predicate a potentially fatal overdose. Community overdose rates considered by Marshall et al. cover 41 blocks surrounding Insite. The Lancet authors seek to quantify the impact of Insite’s presence on these rates.

Canada’s Expert Advisory Committee on Injecting Site is in no way at all dismissive of the “one life per year”. They write plainly [bold mine]:

INSITE staff have successfully intervened in over 336 overdose events since 2006 and no overdose deaths have occurred at the service. Mathematical modelling (see caution about validity below) suggests that INSITE saves about one life a year as a result of intervening in overdose events.

Marshall et al. write in their abstract [bold mine]:

We examined population-based overdose mortality rates for the period before (Jan 1, 2001, to Sept 20, 2003) and after (Sept 21, 2003, to Dec 31, 2005) the opening of the Vancouver SIF. The location of death was determined from provincial coroner records. We compared overdose fatality rates within an a priori specified 500 m radius of the SIF and for the rest of the city.

Furthermore it is interesting that the EMCDDA 2004 report notes such rooms can be expected to reduce high-risk behaviour beyond the consumption room setting itself and reduce exposure to and transmission of drug-related infectious diseases [p.25]. On public order and crime the same report lists two main objectives of 1.) to reduce public drug use and associated nuisance and 2.) to avoid increases in crime in and around the rooms [p. 61].

It should be noted each of these four points is in dissonance to the position of the JGDPP authors and every point they cite from Mangham 2007. More so, as noted during the Supreme Court Case the Canadian Government and the government’s only supporting intervener REAL Women of Canada, chose not to produce Dr. Mangham’s 2007 report. They effectively admitted they had no evidence to support their case to close Insite. As such it is remarkable Mr. Christian relied so heavily on Mangham to argue there were, “questions regarding research fraud and professional misconduct.”

Mr. Christian’s problem is not that the Canadian Government, “has been hampered by court action by harm reduction activists” since 2006. It is the simple reality that despite having had five years in which to produce convincing evidence in a court of law to close Insite, the Canadian Government has been unable to do so all the way to the Supreme Court of Canada. Apart from criticising Clement for undermining the purpose of the Controlled Drugs and Substances Act the ruling also acknowledged the dysfunctional nature of the prohibitionist mindset, stating:

…the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises.

Other shonky tactics employed by Christian’s team include intentionally misrepresenting the findings and recommendations of other research. In attacking cost effectiveness of sterile injecting the JGDPP report states:

The 2009 Andresen and Boyd cost-benefit study calculated savings to government from 35 supposed HIV/AIDS transmissions averted by Insite annually, despite the most authoritative international review to date not finding any demonstrated effectiveness of clean needle provision reducing HIV transmission via needle exchanges.

This is a misrepresentation of the cited IOM review. Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence, states:

The report provides evidence-based recommendations regarding drug dependence treatment, sterile needle and syringe access, and outreach and education. The report urges high-risk countries to take immediate steps to make effective HIV prevention strategies widely available.

Page 2 of the report brief includes [bold mine]:

Avenues for making clean injecting equipment more widely available—and thus reducing drug-related HIV risk—include needle and syringe exchange; the legal and economical sale of needles and syringes through pharmacies, voucher schemes, physician prescription programs, and vending machines; supervised injecting facilities; and disinfection programs….. Multi-component HIV prevention programs that include sterile needle and syringe access are effective in reducing drug related HIV risks such as the sharing of needles and syringes.

Gary Christian also claimed in his media release as part of the allusion that policing, not Insite had caused a reduction in mortality:

These researchers cannot truthfully claim they knew of no policing changes in the immediate area around Insite when some of their number produced an indignant study condemning the changed policing.

Yet in their response the authors indicate that the police initiative referred to ended “within weeks” of Insite opening. It was not ongoing during the study – which is what Christian’s team had falsely suggested. More so if the crackdown was the cause of a reduction in mortality after Insite opened then it was the cause of an increase in overdose deaths in the area prior to Insite opening. Even more crushing for Gary Christian, is that this means the decline in drug related overdose clearly demonstrated in the Lancet occurred because the policing initiative ended.

Perhaps most scurrilous as mentioned above is the suggestion by Gary Christian’s JGDPP team that the Lancet authors included 2001 in their methodology in order to skew results in favour of overdose reductions. The JGDPP report suggests a review from 2002 onwards would show an increase. Yet the Lancet authors had written an earlier report in 2009 showing stable use from 2001 to 2005:

As shown in a figure from that report (below), although the proportion of IDU reporting daily heroin use declined from 1998 to 2001, the proportion of IDU reporting daily heroin injecting remained stable from 2001 to 2005 (i.e., the period considered in our Lancet study).

Figure showing that daily heroin use from 2001 to 2005 remained stable

Whilst this is a look at the most prominent manipulations and misrepresentations authored by Gary Christian’s team a quick reading of the Lancet author’s response – below – reveals a more comprehensive overview. Accusations of careless assessment are put to rest and a read of the original paper shows the lengths gone to in the Discussion to acknowledge other factors that may contribute to a reduction in drug induced mortality. There are also many other absurdities presented in the JGDPP article (such as “recommended reading” and citing a speech by “Christian voice in politics”, Gordon Moyes) that must condemn Christian and his team even further.

Of course like an antivaccination lobbyist Christian has not budged an inch, still insisting he is completely correct and that peer review and science itself is flawed. Now, in the shadow of their complete demolition we can review the hypocrisy and misplaced confidence of Mr. Christian in his ability to scam the public and academics alike.

 Activists are never likely to provide objective science and there are dozens of other Insite studies that must now be under a cloud as a result.

Drug Free Australia has never produced any science and peer reviewed research. This shows their inhumane prohibitionist world view as without merit, and data supporting Insite as entirely safe.


Bad politics vs good drug policy and prison health

Australia’s National Drug Strategy consists of the three pillars of Harm Minimisation

To hear major parties speak of Australia’s national drug strategy one may be forgiven for assuming it is a competition of muscle. To be sure, we’ve come a long way since the great stupor of the Howard years, as then federal Health Minister, Tony Abbott taunted Opposition leader, Kim Beasley for being “soft on drugs”. Translation? Taking the evidence based advice of global drug strategists.

Terrified of losing votes, Beasley all too readily took the bait. In this way successive debates and policy changes had a ratcheting effect on absurd non evidence based and wasteful attempts to be seen to be “tough” on drugs. Manfully tearing up cannabis plants and thrashing them against rocky outcrops or cursing at bags of cocaine aside, it follows quite logically that “tough on drugs” is nothing less than tough on people.

Should Abbott become PM we will quickly find that there is more to Aussie politics than just carbon taxes, boat arrivals and the odd NBN slur. It wasn’t just Howard’s homophobia, weapons of mass destruction lies and black and white 1950’s relativism we’d woken up from. Howard’s skill as a politician is rivalled very well by his inability to understand the 21st century. Indeed, perhaps the last third of the one before.

I’m not suggesting drug policy should become a national focus to the exclusion of any other policy. It never will. Yet, the list of human rights abuses ushered in by stealth and without reason under Howard is a long one. It was Tony Abbott himself who funded the extreme right evangelical lobbyists, Drug Free Australia with the explicit aim of destroying Neal Blewett’s 20 year old successful policy of Harm Minimisation. Howard’s sabotage of our role as world leaders in Harm Reduction is legendary.

Even in 1997 going against the advice of then health minister Michael Wooldridge, and taking that of (later) DFA board member, evangelist and disgraced Salvation Army Major, Brian Watters (initial Chair of the ANCD) to dump the heroin on prescription trial. From The Politics Of Heroin – ABC 4 Corners:

KATE CARNELL: The approach that we put, or I put, to that meeting, was that this was a small trial, only 20 people or so in the first instance. That the trial would be a medical trial with appropriate science backup.

ANDREW FOWLER: The vote came as a huge surprise. The Federal Health Minister, four States and the ACT voted for the trials to go ahead.

A 6-3 result. The decision marked a radical shift in policy.

KATE CARNELL: This is not just a heroin trial. It’s an integrated, national approach that brings in the majority of States in this country. I think it shows a huge amount of maturity and it really is a mammoth step forward.

ANDREW FOWLER: The Federal Health Minister, Michael Wooldridge, telephoned the Prime Minister to tell him the news. But a few minutes later, as he made his way back into the meeting, observers say he looked shaken.

Nothing to this day has beaten Bronwyn Bishop’s 2007 Parliamentary Committee Inquiry. A despicable abuse of our parliament and the role of standing committees, the final report was rejected by every D&A body in Australia. All except our installed enemies of humane policy, lobbyists Drug Free Australia. As Chair and at John Howard’s urging she intoned to field experts that, “the PM says he doesn’t want that” (Harm Minimisation), sounding much like an Inquisitor instructed to reject reference to heliocentrism. That this was her governments policy was entirely lost on her. It was a predetermined farce to attack progressive successes, and demonstrably so.

Her attacks upon Alex Wodak‘s internationally respected skill and evidence in favour of biblical stories from fundamentalist zealot Dr. Stuart Reece, left jaws agape. A bastard baptising, bible wielding, Jesus summoning fruit cake who’d knocked off 25 of his patients in 20 months with reckless naltrexone treatment. The investigation into which he described as “a conspiracy”. “They’re only drug addicts anyway”, he informed a grieving parent who later wrote to me.

As reported in Crikey by Ray Moynihan in Naltrexone II: no trials, just the power of prayer:

In lengthy evidence to a current parliamentary committee inquiry into illicit drugs, being run by Bronwyn Bishop, Reece suggested one of the biggest problems at the moment was a disease called “drugs, s-x and rock and roll.” As part of his evidence, Stuart Reece cited Sodom and Gomorrah, the Biblical cities destroyed by God for their immorality.

Reece’s testimony then suggested Australia’s civilisation was under threat of being destroyed by the scourge of injecting rooms, give-away syringes, and methadone. These of course are the well-established strategies of “harm minimisation”, the approach that underpins the way Australia deals with the dangers of illicit drug use. In contrast to his attacks on harm minimisation, Stuart Reece spoke reverentially of the work of Dr George O’Neil, and the immense value of the still unproven naltrexone implant.

Asked during an interview whether he currently prescribed naltrexone implants to heroin addicts, Dr Reece answered cryptically, “Yes and No”.

Suffice it to say, Reece as a member of Drug Free Australia still marches front and centre with the most dangerous and most irrational opponents to Harm Minimisation. Our National Drug Strategy. What they call “the noramlisation of illicit drug taking”.

However, the Public Health Association report below on the proposed Needle, Syringe Program (NSP) trial at the Alexander Maconoche Centre is clear:

The Australian government web page on the National Drug Strategy (NDS) identifies that

“the National Drug Strategy, a cooperative venture between Australian, state and territory governments and the non-government sector, is aimed at improving health, social and economic outcomes for Australians by preventing the uptake of harmful drug use and reducing the harmful effects of licit and illicit drugs in our society”. (Australian Government Department of Health and Ageing-DoHA, 2011)

The NDS is based on three inter-related strategic approaches to dealing with drugs in our community – the NDS refers to them as the “three pillars” of the overall approach of harm minimisation.
Harm minimisation, therefore, is our agreed national approach to drug policy which encompasses the three pillars of:

Demand Reduction

Demand reduction to prevent the uptake and/or delay the onset of use of alcohol, tobacco and other drugs; reduce the misuse of alcohol and the use of tobacco and other drugs in the community; and support people to recover from dependence and reintegrate with the community. To achieve this requires effort to:

  • prevent uptake and delay onset of drug use
  • reduce use of drugs in the community
  • support people to recover from dependence and reconnect with the community
  • support efforts to promote social inclusion and resilient individuals, families and

Supply Reduction

Supply reduction to prevent, stop, disrupt or otherwise reduce the production and supply of illegal drugs; and control, manage and/or regulate the availability of legal drugs. To achieve this requires effort to:

  • reduce the supply of illegal drugs (both current and emerging)
  • control and manage the supply of alcohol, tobacco and other legal drugs

Harm Reduction

Harm reduction to reduce the adverse health, social and economic consequences of the use of alcohol, tobacco and other drugs. To achieve this requires effort to:

  • reduce harms to community safety and amenity
  • reduce harms to families
  • reduce harms to individuals

Our NDS does not simply limit its scope to the broad community but states categorically:
“The approaches in the three pillars will be applied with sensitivity to age and stage of life, disadvantaged populations, and settings of use and intervention”. (DoHA 2011)

Over the years we’ve had the rants of Alan Jones and John Laws. The rubbish of Piers Akermann and Andrew Bolt. The fear mongering of the anti-science mob. Still many fail to appreciate not just good policy but the responsibility under human rights which (as I’ll get to in time) is exactly what Alexander Maconochie is about. Right down to using the name of the great penal reformer himself.

This Lateline segment from October 2009 gives excellent insight. On October 2nd 2009 they reported, “The Australian drugs conference in Melbourne has today called for a trial of needle and syringe programs in Australian prisons. One in three Australian inmates has hepatitis C, and it is thought that a needle and syringe program could reduce the incidence of blood-borne viruses in jail.

Resistance born of political will, not evidence, continues today. It will be a great shame if ignorance prevails.


Public Health Association Report on NSP Trial at the Alexander Maconochie Centre

Needle, Syringe Programs needed in Aussie prisons

Needle Syringe Programs in prisons have proven successful across the globe, including in Iran.
Gains are directly transferred to
individuals, family members, community members, custodial officers, law enforcement officers and health professionals.

Australia once led the world in Harm Reduction initiatives, a number of which pertain to safe injecting of illicit drugs.

Because of the illegality, potential for tragedy and high risk associated with IV drug use it is very easy to be led astray from the evidence base supporting harm reduction initiatives. Primary amongst these is the funding of over 1,000 Needle, Syringe Programs (NSPs) across Australia. Although introduced against considerable opposition, community acceptance is now very high. More to the point, similar misinformation and conservative opposition was raised against another harm reduction initiative when introduced. Condom use amongst men having sex with men (MSM).

Harm Reduction measures were introduced by then federal health minister, Neal Blewett in 1985, ushering in unprecedented acceptance, understanding and management of high risk behaviour leading to the spread of HIV in Australia.

Led by the Minister for Health under the Hawke government, Neal Blewett, Australia undertook several unprecedented and pragmatic steps: it introduced a needle exchange program for intravenous drug users, encouraged open discussion of safe sex, and created the famous Grim Reaper advertising campaign.

There was fierce opposition from the religious right, but 25 years after the initial AIDS outbreak, Australia’s decision to accept human nature in policy making has saved thousands of lives – especially when compared to the USA where ‘morality’ has outweighed practicality in dealing with the illness.

Harm Reduction (HR) is one of the three major prongs of Australia’s illicit drug policy. The policy is called Harm Minimisation. Not “tough on drugs”, not “zero tolerance”. Harm Minimisation includes Supply Reduction, Demand Reduction and Harm Reduction. Over the years the gay lobby and LGBTQ community has forged itself a formidable legal and social identity. I pity the conservative zealot who would insult their ontology. Not so for IV drug users. This is due to many reasons, the more obvious being the transient nature of drug use (experimentation), the social, professional and personal cost of outing oneself as a chronic addict, the complete lack of intention to politically mobilise and the volume of comorbid mental health problems.

To be rather crude whilst it is demonstrably bigoted to discriminate against Australia’s disabled population they are not a force of reckoning. Our communities remain poorly suited to accommodate disabilities. Stigma persists leading to discrimination and inequality.

Similarly whilst we clinically accept the disease model of addiction, many community members still remain blinded to this very real health problem in favour of pop culture “bad guy” stereotypes. This is sheer manna for those with political interests to be seen to be “tough on drugs” or who seek to exploit individuals with a range of disabilities, including drug dependence.

Most Aussie addicts are alcoholics and cigarette smokers. The bulk of public health money dealing with drug induced harm is spent here. Illicit drug addiction consumes under 5% of the total expense. Writing in, Redefining Addiction in MJA Insight Paul Haber noted:

The American Society of Addiction Medicine (ASAM) grappled with this problem for 5 years before releasing its new definition of addiction, which has stimulated interest from around the world with commentaries in The Lancet, Time and elsewhere. ASAM proposes that addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. It is a chronic relapsing and remitting disorder that manifests in continuing use of substances or alcohol despite accumulating harm to the individual and to others. [….]

This addiction disease concept facilitates a medical approach to management, including the need for quality evidence to support clinical interventions and it encourages engagement of medical professionals in this field. Acceptance of the disease model can also reduce the stigma of the disorders. Specific neurobiological abnormalities have been identified such as certain dopamine receptors in the reward system and these are targets for therapeutic intervention.

The funding pittance that is dealt to illicit drug harm reduction in part reflects the dwarfing of this demographic alongside drinkers, smokers and gamblers. The rest is explained in that the lions share is consumed by futile supply reduction efforts in the endless cycle of importation, distribution, dealing and administration. Demand reduction – fighting the demand for drugs through education, rehabilitation and disincentives also receives more money than harm reduction. It remains far, far too easy to raise a voice of ignorance and accuse HR initiatives of “allowing” or “encouraging” drug use.

The ABC news items below discuss the need for needle exchange programs in Australian prisons and the potential for a trial beginning in Canberra’s Alaxander Maconochie prison. It’s probable an HIV epidemic beginning in injecting drug users, and placing the wider Australian community at risk, would begin in Australian prisons. Questions are also raised as to the “shameful” state of Australia’s Harm Reduction initiatives that have fallen behind what is considered effective evidence based practice for prison population health. This is further evidenced by successful programs in other countries around the world. Needle Syringe Programs are strongly supported by a large global evidence base. Significantly, one public health success story is Australia.

Indeed return on investment research in 2009 [PDF] show that “investments in needle and syringe programs were yielding a twenty seven fold return in health, productivity and other gains.” Gino Vumbaca, Executive Director of the Australian National Council on Drugs wrote at the time:

What is striking is the level of public support for the program. The largest regular survey on drug use issues we have, the National Household Survey on Drugs, now records public opposition to the program at less than 20%. The Hawke, Keating, Howard and now Rudd Governments, as well as a myriad of state and territory governments of varying hues over the past 20 years have all lent their support to the program. For some this was in the face of strident opposition. A truly admirable achievement based on evidence, common sense and humanitarian grounds

Discussing the 2009 report findings Anex wrote:

The World Health Organization commissioned a review of evidence of the effectiveness of Needle and Syringe Programs to reduce HIV which concluded:

There is compelling evidence that increasing the availability and utilisation of sterile injecting equipment for both out-of-treatment and in-treatment injecting drug users contributes substantially to reductions in the rate of HIV transmission. Research from around the world clearly indicates that NSPs make a significant contribution to preventing the spread of HIV/AIDS and hepatitis C.

Between 2000 and 2009, the Australian Government invested $243 million in Needle and Syringe Programs. This resulted in the prevention of an estimated 32,050 new HIV infections and 96,667 cases of hepatitis C. $1.28 billion dollars were saved in direct healthcare costs. [….] The report states: “If NSPs were to decrease in size and number, then relatively large increases in both HIV and hepatitis C could be expected with associated losses of health and life and reduced returns on investment. Significant public health benefits can be attained with further expansion of sterile injecting equipment distribution.”

Countries, like Australia, that have implemented NSPs have averted HIV epidemics among injecting drug users and, therefore, the community at large.  Those countries that have not implemented these measures have often experienced uncontrolled HIV epidemics. There is strong evidence to suggest that when HIV becomes endemic among the injecting drug user community it can then spread to their sexual partners and children, resulting in high mortality rates and large social and economic costs to the entire community.

Conservative ideologues and those with vested interests in punitive measures, have attempted to discredit NSP efficacy. Nations without proper NSPs, such as Sweden are deemed in breach of the UN International Right to Health. See page 3, item D. Religious fundamentalists & other totalitarian belief systems frequently reference Sweden’s “war on people” mentality, obfuscating the human rights abuse. As revealed by WIKILEAKS, the USA work actively to sabotage Harm Reduction initiatives as part of their War On Drugs policy, citing Stockholm as a reliable ally. An excellent discussion of this matter is to be found at Neurobonkers. The Global Commission on Drug Policy has demonstrated the failure of the Drug War. [CNN News]

With respect to needle exchange, rather than advance challenges to NSP efficacy with new research the tactic of a small minority is to attack existing methodology in an out of context, subjective fashion creating the illusion of an argument. An analogue today might be “pertussis diagnoses have increased, therefore the vaccine is ineffective” – a claim advanced by comparison of unrelated data sets.

In May 2010 Norah Palmateer et al. produced a meta-analysis using what they called “Critical appraisal criteria” to challenge the methodology of NSP research. However, even whilst selecting particular modes of distribution and leaving out others, a conclusion that “New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission”, was delivered. This is scarcely revolutionary, yet is falsely cited as discrediting NSP efficacy by fundamentalist conservative groups. In truth Palmateer et al actually argue for a shift in analytical focus to biological rather than behavioural data. More so, they write:

The findings of this review should not be used as a justification to close NSPs or hinder their introduction, given that the evidence remains strong regarding self-reported IRB and given that there is no evidence of negative consequences from the reviews examined here. [….] We recommend a step change in evaluations of harm reduction interventions so that future evaluations: (i) focus on biological outcomes rather than behavioural outcomes and are powered to detect changes in HCV incidence; (ii) consider complete packages of harm reduction interventions rather than single interventions; (iii) are randomized where possible (preferably at the community level); and (iv) compare additional interventions or increased coverage/intensity of interventions with current availability.

“The findings of this review should not be used as a justification to close NSPs or hinder their introduction”. Yet this is exactly what the enemies of reason have done, misquoting Palmateer at every turn. The “AVN” of Blood Borne Virus control is a group of far right evangelical lobbyists known as Drug Free Australia. Their “Meryl Dorey”, as it were is their “secretary”, young earth creationist and climate change denialist, Gary Christian. The similarities between Dorey and Christian are striking. No medical or health qualifications, citing of global conspiracies, “social experiments” – not evidence based public health, saving Australians, provision of “truth”, attacking certain research identities, cherry picking of data and outright lies.

When a 27 fold return on investment for NSPs was claculated after years of research, Mr. Christian promptly dismissed this claiming NSPs actually serve to promote drug use and spread viruses. WHO data would prove this if properly adjusted he cried, mimicking Dorey’s claims to “properly read research”. Thus he was able to immediately dismiss what is absolute proof opposition to NSPs is baseless. Indeed, Christian went further.

Harm Reduction is the “normalisation of illicit drug use” not just correlating to, but causing a rise in drug use. Hands up if knowing about NSPs motivates you to experiment with IV drugs. This new take on “condoms cause AIDS” is demonstrably flawed. Just as abstinence, not condoms will prevent STD’s, Christian claims “free HIV testing” not NSPs or harm reduction will control HIV, citing discredited non peer reviewed sources.

Thus arguments raised against the value of exchange program efficacy in cutting blood borne virus spread are emotive, supposedly backed by misrepresented, spurious and/or biased “research” and driven by discredited, conservative fringe lobby groups.

Unsurprisingly the opposition to NSPs in Aussie prisons is based on misinformation and a lack of evidence.

ABC TV News October 15th

ABC AM Program October 15th

NSP Information, Q&A. Australian Government

Progressive policy and fundamentalist resistence

A close look at the rejection of evidence and application of religious belief as guiding principles for members of the Negative team, in debating if drugs should be legalised. Jade Lewis, Greg Pike and Paul Sheehan.
Last post we looked at the debate All drugs should be legalised held by Intelligence Squared. One of the greatest moral, social and human rights based questions today is: Should illicit drugs be legalised?
We ask this question because the harm caused at the community and personal level by prohibition is irrefutable. To this we can add the devastating effects of The War On Drugs – crafted initially by Nixon on the back of the Vietnam war. Few realise the first head of the US Drug Enforcement Administration had his office in Saigon. Returning veterans had to produce clean urine to show they were not using heroin.
Once begun, this foreign policy bonanza worked much like Dr. Whoʼs “psychic paper” pass. Flash it at a sentry and they read whatever convinces them of ones legitimacy. But more so was the USAʼs powerful control over the UNODCP and hence, UN drug policy. Most in the Western world have knowledge of Harm Reduction. The acceptance that punitive measures for drug users ultimately inflicts personal, monetary and social cost on the wider community, and accepting use whilst minimising harm reaps benefits for all.
For this reason nations who focus on evidence and the international right to health provide clean needles through NSPʼs – needle and syringe programmeʼs. Safe injecting facilities are provided increasingly in Europe and elsewhere. Australia has over 1,000 NSPʼs and one Medically Supervised Injecting Facility – MSIC – in Kings Cross, Sydney.
These programmeʼs and facilities serve to manage high risk behaviour, control the spread of blood borne viruses, motivate/provide for users to seek treatment, and they meet community discontent arising from obvious illicit drug use. Most users can return to work, pay taxes, raise a family and remain healthy. But what of intractable addiction? More recently several heroin on prescription schemes in Europe have shown dramatic results in reducing crime, death/illness, uptake of heroin use and length of heroin addiction. Portugal has full decriminalisation and demonstrates a resounding success to date.
Once world leaders in harm reduction, Australia was ready to be the first nation since the War On Drugs began to introduce a heroin on prescription trial in 1997. Despite State government sanction of 6-3, John Howard personally intervened to stop this, and weʼve been backsliding ever since. The rise of Christian Evangelical lobbyists has caused bemusement, angst and disgust.
Australiaʼs full policy is Harm Minimisation – HM. Supply reduction, demand reduction and harm reduction. Zero Tolerance has only ever been rhetoric. Harm reduction is the least funded, with the struggle to repel supply and the education and (usually failed) advertisements thrust at young Australianʼs taking the two highest shares respectively.
Those who resist drug legalisation seek to distort the argument by misrepresenting the success of harm minimisation. Indeed despite overall reduction in drug use they fraudulently and falsely argue that HM encourages, condones, increases or has no positive effect on use. Attacks on successful initiatives with peacock terminology and weasel worded opinion pieces are common. Published as “research” these are brought up time and again.
In the case of Drug Free Australiaʼs Case For Closure [PDF] against the MSIC, written during itʼs trial status, it is simply rehashed, republished and recirculated. One speaker, Greg Pike is co-author and “statistical analyst”. Greg is best known from his role as Director of the Southern Cross Bioethics Institute, which presently promotes his part in the upcoming debate. Another co-author is the infamous “naltrexone fatality” doctor, Stuart Reece. Embattled DFA secretary Gary Christian is another.
You may wonder why, if supply and demand reduction are funded more than harm reduction, that such groups attack harm reduction – HR. My psychological profiling days may be behind me, but this is clear. HR already attracts right wing condemnation and is easy to misrepresent. The evil druggie and his/her filthy lifestyle is a false pop culture phenomenon. However, conservative Christians cast HR in pop culture format usually in the context of blaming HM. Enter the suggestion of why we need demand reduction. Young Aussies take drugs. Kids from all walks of life. From all faith backgrounds.
For the religiously conservative mind this is an affront. An insult to parenting skills, the instillation of Christian values and indeed, Godʼs work. God “cures” addiction. He does not leave vacuums of vulnerability, in the mind of the fundamentalist. Thus HM in totality is an affront to conservative Christians. Overlaying this is the fear of the success of HR education. An analogue of sex education and condom availability, no proper child would fail to just say no to sex and drugs – or rock n roll for that matter. With two down, supply reduction must be increased along with punitive measures for users. And DFA are adamant they speak for “all Australians”, promoting behaviour control: Harm Prevention.
Another speaker and DFA identity – whose intentions I kind of understand – Jade Lewis wants a drug free Australia, [surprise!] through application of biblical values and the never ending sale of her “story” on DVD. Not your story, or the story of drug policy, or evidence based material – her amazing religious conversion. Jade is ruthlessly exploited by DFA. The excessively priced, only-seen-if-you-buy-it DVD, “Golden Haze” earned Jade the title “The goose that laid the golden haze” – (more on Jade later).

Greg Pike
Greg is co-author of the Case for Closure and a crusader against humane or progressive policy and free choice. His “bioethics institute” gig is a misleading peacock in some of today’s most pressing health issues. Abortion to him is of course, murder and at one time he claimed – as a research outcome – most women do not want choice. His argument against euthanasia once included the appalling claim that a patient travelled to Switzerland – with others – to die with dignity, as “… a case of someone wanting to pursue death under activist like circumstances.” [ABC 7:30 Report Feb. 2007].

Greg Pike

The right to die for the terminally ill is supported by as many as 85% of Aussies according to some polls. The reluctance of politicians shows the grip of the Australian Christian Lobby on vote wary parties. Prior to the above debacle, Pike wrote “Once the killing starts, there’s no stopping it” in January 2007. It included;

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All Drugs Should Be Legalised – Intelligence Squared Debate

On May 10th this year Intelligence Squared – the forum for live debate – hosted All Drugs Should Be Legalised in Sydney Australia.
You can watch the video alone here, or check out the audio here. They note on their website.
In most cases, prohibition has failed to curb demand and the provision of illicit drugs has become the lucrative trade of organised crime – with the associated ills of corruption, violence and health risks.
Some people urge tighter restrictions on all recreational drugs as the cure for social ills linked to their use and abuse. Others argue that all drugs should be legal – subject only to prudent regulation.
Below are the pre and post debate audience figures for All drugs should be legalised.
Question Pre-debate poll Post-debate poll
For: 46.8% 69%
Undecided: 32.3% 8%
Against: 20.9% 23%
Well prior to this debate, I was struck (to put it mildly) at the makeup of the negative team. Decorated veterans from The Enemies of Reason army, I felt more disappointment than the outrage I expected would engulf me. It was clear those bastions of moral evangelism and anti-drug hysteria, Drug Free Australia had quite likely been called upon to muster a good riposte to the ever expanding evidence supporting a change in policy. Like calling upon conspiracy theorist and anti-vaccination lobbyist Meryl Dorey of the AVN for “balance” one can rest assured DFA, enamored with pseudoscience, could fill the anti-drug niche. For “balance” if you like.
My next post will be my own biography of the negative team. These guys have a lot in common and I feel it’s only just to point out the “incestuous” relationship that manifests as informed opinion, but is in fact a superstitious, narrow and morality based attack on secular Australia, progressive policy, free thought, free choice, human rights and individuality. Yet my disappointment in “releasing the hounds”, so to speak stems from the fact I myself can argue against legalisation for reasons never mentioned here. Yet they tend to be reasons on variations of legality and access. Or concerns over black markets. Or solutions proffered by other pro legalisation movements. Australia is unique. Great arguments come from Norm Stamper and his colleagues at LEAP – Law Enforcement Against Prohibition. But we don’t have shoot outs in suburban streets and thankfully, haven’t tortured and jailed our civilians at the rate the USA has. We already have Harm Reduction – we just need more. Period.
The negative team is:
Jade Lewis is a former drug addict who now campaigns and educates against use of illegal drugs. As a young teenager she was a champion junior athlete who competed internationally, and won the WA Doug Hancy Award, Athlete of the Year and Junior Sportswoman of the Year. Her records remain unbeaten in Western Australia. Her later heroin addiction, criminal behaviour and volatile relationships are recorded in her book, Golden Haze. She now educates at schools on positive relationships and runs a program for women prisoners.
Dr Greg Pike is the Director of the Southern Cross Bioethics Institute in Adelaide, South Australia where he focuses primarily on the influence of bioethics on public policy development. He trained as a physiologist with a PhD in muscle electrophysiology, becoming Hospital Research Scientist at the Royal Adelaide Hospital in the Department of Surgery. He is the Chairman of the Board of the Australian Drug Treatment and Rehabilitation Program and a member of the Institute on Global Drug Policy, has served as a Deputy Member on the SA Council on Reproductive Technology and was a member of the Australian Health Ethics Committee for the 2006-09 triennium.
Paul Sheehan is one of the most thought-provoking commentators in Australia today. A columnist for The Sydney Morning Herald, Sheehan is a prominent writer and has written on the bigger debate about the politics of cultural diversity in contemporary Australia. He is one of Australia’s best-selling authors with three best-selling books including, most recently, the number-one best-seller, Girls Like You.
The positive team is:
Nicholas Cowdery AM QC BA LLB was the NSW Director of Public Prosecutions running the largest prosecuting agency in Australia from 1994 to 2011. He became a Barrister in 1971 and was Public Defender in Papua New Guinea for four years. As a Barrister in private practice in Sydney, he specialised in criminal law appearing in many high profile cases including the prosecutions of the late Justice Lionel Murphy (of the High Court of Australia) and of the late Sir Joh Bjelke-Petersen (former Premier of the State of Queensland). He is a member of the NSW Sentencing Council and the Advisory Committee, Sydney Institute of Criminology and the National Advisory Committee, Centre for Transnational Crime Prevention, University of Wollongong. He is the author of Getting Justice Wrong: myths, media and crime.
Wendy Harmer is a prominent Australian broadcaster, entertainer and veteran of countless international comedy festivals. She has presented top-rating morning radio and has hosted, written and appeared in a wide variety of TV shows including ABC’s Big Gig and In Harmer’s Way. Harmer is the author of several books for adults, two plays and a series of children’s books. She has also hosted the television Logie Awards and has been a regular newspaper and magazine contributor.
Dr Alex Wodak AM is a physician and has been Director of the Alcohol and Drug Service, St Vincent’s Hospital since 1982. His major interests include prevention of HIV among injecting drug users, treatment of drug users and drug policy reform. Dr Wodak is President of the Australian Drug Law Reform Foundation and was President of the International Harm Reduction Association (1996-2004). He helped establish the first needle syringe program (1986) and the first medically supervised injecting centre (1999) in Australia when both were pre-legal. Dr Wodak helped establish the National Drug and Alcohol Research Centre (1987) and the Australian needle syringe program annual survey (1995).
It’s clear drug law reform has manifest merit. This by no means suggests a simple reverse of policy or free for all is justified. Managing existing problems through evidence based approaches is the avenue needed. This is not the “handouts to children’ moral panic we’re often misled with. Whilst it’s true alcohol is far more damaging to individuals and society – something we ignore handing out ever more lenient licences – I don’t think the “my buzz vs your buzz” argument applies here, either. Prohibition is an abysmal failure to be sure. Indeed the sole cause of illicit drug induced tragedy. However because this can be demonstrated in a crisp top down, if not straight linear fashion doesn’t assuaged the reality that reversing this insult to our species is a complicated bottom up process that will have set backs, loud opposition and unforeseen hurdles and successes. Fortunately other nations have taken the step. Portugal is finding great success after a decade and now Poland is moving toward legalisation.
Today we struggle with drugs unheard of when this open door to profit was gifted to organised crime. Not only is there fantasy, ecstasy, mephadrone and a repulsive mix in between of these amphetamine type stimulants, but so much profit ensues that clandestine production is the norm. This has given us crystal methamphetamine and hydroponic cannabis. Our media and politicians score an E and an F for Epic Failure and in the main deserve our disgust and derision. That newspapers can be sold with articles gloating over and baying for blood for problems they themselves have in no small way contributed to beggars belief. That elected politicians pander to Christian Lobbies or their own retarded opinions, rather than serve the community that placed them in office is undemocratic.
Along the way, police have fallen to corruption and far, far worse. Prominent informers in cases of police involvement in production, selling and underworld murders have themselves been murdered. Far from a case of “they deserved it”, as crown witnesses under police and custodial maximal protection their deaths signify an attack on the very heart of our justice system. As I write the head of Barwon prison, David Prideaux is missing on a hunting trip in the Victorian Alps. This report came in a few minutes ago.
I can confirm Prideaux is a high profile witness in the murder of Carl Williams who was bashed to death in the most secure section of the most secure jail in the state whilst under 24 hour watch. Williams in turn was preparing to give evidence into the murder of informant Terry Hodgson. Hodgson was preparing to give information into the theft of pseudo-ephedrine allegedly by himself and Drug Squad officer Paul Dale. In the case of the two informers, police had leaked documents to underworld figures outlining their intentions. Hodgson was under police guard in a safe house, with all security details – alarms, lights, locks etc, known only to police. Investigations showed he and his wife were shot in the back of the head, kneeling, after letting someone in to the safe house.

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