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;

Continue reading

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.

Continue reading