Harm Reduction: How Australia Stopped HIV

Posted in Anti-Drug Lobby, Drug Free Australia, Health, Human Rights, Illicit Drug Policy by Paul Gallagher

In 1985 before the introduction of needle and syringe programmes (NSP) 90% of Australian injection drug users reported sharing injection equipment. By 1994 following introduction of NSPs this figure had fallen to 20%. In 2009 this figure was around 15% possibly reflecting the constant number of distributions from NSP programmes over the previous decade.

One of the most powerful modes of resistance to the spread of HIV/AIDS is Harm Reduction (HR) measures.

In Australia, HR exists as one of three pillars of Harm Minimisation (HM) – our official illicit drug control policy. The other two pillars are Supply Reduction and Demand Reduction. Reduction in supply receiving the lions share of funding directs energy at reducing international and domestic supply. Reduction in demand receiving less funding delivers programmes and initiatives designed to reduce the demand for drugs within communities.

Harm Reduction receiving the least funding from the HM pile targets the harm to individuals that eventuates from behaviour. HR has always drawn condemnation from conservative groups because of the association with drug use and sex. Initially men who have sex with men (MSM). Then later through maximal exploitation of drug using pop culture. Nonetheless, study after study comparing countries and districts within countries to have implemented HR or not done so, show a stunning success in favour of HR.

This post will look almost exclusively at IV drug use. HR for Injection Drug Users (IDU) includes provision of clean needles and sterile water, swabs, sharps containers for disposal and specialised filters capable of removing bacteria. Opioid Substitution Therapy (OST) including methadone and buprenorphine and safe injecting facilities are pivotal aspects of HR. Heroin on prescription is not available in Australia but has shown unprecedented success as a HR measure where it has been implemented.

Despite the evidence supporting HM as an effective policy and the reality that Supply Reduction [law enforcement] is the most highly funded pillar, Aussies are still subject to notions such as “Tough on drugs” and code words such as Drug Free Australia’s Harm Prevention. Intuitively it sounds fine. Why minimise harm if you can prevent it?

Yet on examination “harm prevention” is the abandonment of HM for the reintroduction of Just Say No approaches. Known to have had deleterious effects on self esteem, no effect on lowering drug use and providing the field upon which drug use flourished, Just Say No quite simply failed, and failed Epically. Today of course, skeptics are well aware of how beliefs and behaviours are reinforced through attacking them. Harm Prevention even more so is code for punitive, custodial and forced behaviour control.

It is at times perplexing as to why so much energy is spent on attacking HM entirely. Supply Reduction however is based in part upon the reality that people want, seek, use and enjoy illicit drugs. Education to accompany this is open and honest – not promotion of illicit drug use . Yet to the conservative mind the idea that their children, friends or the community at large is the demographic from which drug demand comes, is morally untenable.

With HR it is aspects of this pillar that equally cannot be accepted. To the conservative mind, just as condoms cause AIDS and promote sexual promiscuity so too do clean needles, safe injecting facilities and safe injecting education encourage drug use. Drug Free Australia write:

We need to re-focus our drug policy and practice on an approach that prioritises primary prevention, if we are to see any real change in the health and wellbeing of our current and future generations of young people. We need to acknowledge that Australia has one of the highest rates of drug use, because of a priority on Harm Minimisation rather than Harm Prevention, and we now need to take a leaf out of the books of the policy makers in the UK and United States. Both these countries have given greater emphasis to prevention initiatives, while still aiming to help people who are drug dependent, to recover.

The towering dishonesty inherent in this nonsense is typical of the tactics used by DFA in what has become over just a few years, one of the most immoral lobbying groups on the illicit drug landscape. Australia has high levels of cannabis use and abuse. This is handy in arguing that we have high drug use generally. A synopsis of the above is simply: Harm Minimisation has caused Australia to have one of the highest drug use levels in the world. We should be doing what America and the UK do.

The UK get a mention because they reclassified cannabis to a Class B (like speed/other amphetamines) from a Class C drug and punish users accordingly. Of 2.3 million USA prisoners in 2010, over 65% or 1.5 million meet DSM IV medical criteria for substance abuse or addiction. On top of this another 458,000 have a history that meets DSM IV criteria for addiction, were under the influence when they committed their crime, committed a crime to finance the purchase of drugs or were incarcerated for a drug law violation.

Between 1960 and 1990 official crime rates in Finland, the USA and Germany were similar. Incarceration in Finland dropped 60%, remained stable in Germany and quadrupled in the USA, driven primarily by drug convictions.

Today around around 80% of USA prisoners are incarcerated due to illicit drugs. 11% are receiving some type of “treatment”. The last thing Aussies need is a dose of the USA nightmare.

What of the impact of changing our strategy on HIV and consequently other types of blood borne virus transmission? The graph below is from a TED talk by Sereen El-Feki, vice-chair of the Global Commission on HIV and the law:

HIV infection in Injection Drug Users

Whilst Thailand and Russia have ignored Harm Reduction and Australia and Switzerland have embraced it the USA and Malaysia employed only some Harm Reduction techniques. Should Australia embrace USA tactics our prison population will explode, HIV infection in IV drug users will increase by about eight times the present rate and treatment – presently some of the best in the world with plunge to 11%. The cost to the public health purse would simply gut present programmes and destroy any hope of improvement for say, dental, mental health, public hospital care, nursing home care etc.

There is a 4 minute out-take from Sereen El-Feki’s TED talk in April this year below. Or download MP3 here.

The first case of AIDS was reported in Australia in 1983. At that time morbidity rates to rival World War II were expected. Following the innovative approach of HR, levels of infection in all demographics fell from 2,500 per year to 500 in the decade following inception of HR. This infection rate has remained stable.

At the time, initiation of clean needle supply contravened the states Drug Offensive which, already highly criticised, had regrettably escalated drug use and criminalisation via the failed “Just Say No” approach. The pilot programme ran from St. Vincents Drug and Alcohol Service on November 13 1986. It was run in the suburb of Darlinghurst. An evaluation recommended they should be adminstered by social workers, drug agencies, pharmacies, medical professionals and urged:

The urgent widespread introduction of needle exchange programmes in all states and territories

There needed to be an amendment to the Drug Misuse and Trafficking Act following which NSW pharmacies sold “anti-AIDS kits”. By mid 1989 there were 40 public outlets run across Sydney. By 1994 there were 250 outlets run by NGOs, government agencies and pharmacists distributing 3.5 million syringes annually. For the year 1993-1994 10.3 million syringes were distributed across Australia. The USA with 15 times the population of Australia distributed 8 million syringes in 1994-1995.

More comprehensive analyses refuted the concerns of increasing drug use. No increase in drug use was seen in any country that had instigated needle exchange and more so, attendance at rehabilitation and abstinence programmes had increased. Australia’s Commonwealth Department of Health (now Dept. of Health and Ageing) estimated that 25,000 cases of HIV were averted in the 12 years from 1988 – 2000 due to needle exchange alone (page 10 – 3.5.3).

The infection rate among Aussie IDU sat at around 3%. Users who were also MSM had an infection rate of 27%. In Russia where HR for drug users was denied, the figure for IDU was between 75 and 90%. One study in 1997 looked at 81 European cities with and without needle exchange programmes. Seroprevalence (measured from the presence of HIV within blood taken from used syringes) increased 5.9% annually in cities without clean needle distribution, and decreased 5.8% in cities with needle exchange.

In an astonishing comparison, Edinburgh with no NSP experienced a 65% HIV infection rate amongst IDU. Glasgow, less than an hours drive away and with NSP experienced a 4.5% increase in HIV infection amongst IDU. The one issue Australia faced was return of used syringes. Users were placing them in sharps bins. Yet to return any syringes to Exchanges meant risking being questioned by police. A used syringe is evidence of illicit drug use and this acted as a disincentive to return items for safe disposal.

Of note however is that fears and front page headlines of beach goers and joggers stepping on syringes and undergoing “agonising waits” for blood tests to be cleared of HIV infection are out of proportion. HIV dies very quickly once outside the body and syringes on beaches have been discarded into drains, washed out to sea and then beached. Nonetheless despite the absence of actual transmission it is an unpleasant experience which can be lessened by removing all offences for possession of a used syringe.

Clearly, Australia’s decision to take the necessary steps and bring together members of drug using demographics, gay rights advocates and prostitutes collectives and allow them to consult upon and shape this programme was one of it’s greatest public health initiatives ever.

Between 2000-2009 NSPs have averted 32,050 new cases of HIV and 96,666 Hepatitis C infections. Needles distributed increased from approximately 27 million to 31 million in that decade. For every one dollar invested, four dollars have been saved. 140,000 Disability Adjusted Life Years were gained over the same decade.

Still, conservative biblical fundamentalist group Drug Free Australia boldly inform us that Return On Investment is quite wrong and should show an expense. In earlier posts you can access from the tag on the right, I highlight how they cherry pick phrases and select data out of context. At other times they simply dismiss WHO findings based solely on the reviews of just one Swedish researcher, Dr Kerstin Käll.

So to be very clear, Dr Kerstin Käll, working for the Swedish government who are dodging UN demands to establish more Needle Exchanges and accelerate HR or remain in breach of the international right to health, conducted no research but criticised methodology that was favourable of NSP success. Her own research argues regular testing for HIV is more of a prevention – yes prevention – than clean needle supply.

It’s easy to get confused because whilst Käll supports NSP programmes as reducing hepatitis C in prisons DFA refute any change in HCV attributable to NSP programmes… anywhere. They also lobby stridently against the establishment of needle exchange in Australian prisons. Of course, despite the evidence above they insist the impact of NSP on HIV is “inconclusive”.

Ultimately it’s irrefutable how successful Harm Reduction has been in controlling the spread of blood borne viruses. Paramount amongst these is HIV, Hepatitis C and Hepatitis B. The most significant and visionary measure to now apply would include steps to decriminalisation and regulation.

Today however, this is where Australia is falling behind.

8Jun2012

Australia still shirking drug policy discourse

Posted in Anti-Drug Lobby, Drug Free Australia, Illicit Drug Policy, Legal by Paul Gallagher

The prohibition of illicit drugs is killing and criminalising our children, and we are all letting it happen

Senator Bob Carr (Foreign Affairs Minister), Mick Palmer (former Federal Police Chief), Nicholas Cowdery (former Director: NSW Public Prosecutions), Geoff Gallop (ex W.A. Premier)

On April 3rd this year Aussies woke to news of “the most significant challenge to drug laws in decades”, as reported by Fairfax media below. Or download MP3 [41sec]:

Interesting then that Bronwyn Bishop looks set to sit on the Front Bench of Australia’s next Federal Government. In 2007 Bishop chaired a House of Representatives Senate Inquiry into the impact of illicit drug use on families. Dreamed up by John Winston Howard to give an airing to the extreme right wing anti-drug movement whilst simultaneously heaping shame upon the brilliant minds driving the policy of Harm Minimisation, it was an appalling example of a predetermined agenda.

For many years prior it was axiomatic to those involved with illicit drug policy and the impact of organised crime that prohibition was a failure. The War on Drugs is a war on people and it surprised no-one that Bishop entitled her all singing all dancing moral panic final report “The Winnable War”. It was rejected by every D&A policy, funding and health service of any standing. Indeed by many more with pretty much no standing.

Drug Free Australia (DFA) and a range of conservative anti-drug lobbyists held it in high regard. Ann Bressington, who squeezes anti-vaccination, anti-fluoride, anti-Harm Minimisation and Festival of Light fundamentalism into her day, was delighted. Then again, Ann verbally coached a witness through his submission to say he “escaped harm minimisation, not addiction”.

Bishop had given succor to one of their fundamentalist favourites, and on the same day attempted to batter one of their sworn enemies for his devotion to health policy, science and evidence. Perhaps I shall recount one exchange with the G.P. who used naltrexone, sedatives and the bible in bringing about the death of 25 of his heroin dependent patients in 20 months [summary]. Now an “expert” in naltrexone related fatality with Drug Free Australia (I kid you not) he said then:

I was interested to discover that the actual historical site of Sodom and Gomorrah has recently been found in Israel. On the bottom right of this slide are pictures of sulphur balls that have been found there. So consequences matter, and they can destroy a civilisation quickly, as we saw with yesterday’s tsunami and so on.

This slide shows a tree with snakes, which to my mind is a lot of the stories that you hear from harm minimisation. Methadone, syringe giveaways, injecting rooms, medical cannabis, heroin trials all those are catered for by the same people. But, on the other side of the tree, you have all the downsides, the side effects, which are not talked about in this culture.

It is of extreme concern to me that medical science which is known and understood overseas is not understood and not talked about and given no airplay whatsoever in this culture.
These are old slides I made several years ago, charting a lot of these behaviours: this is condoms and the AIDS risk, charting the parallel between condoms and AIDS deaths.

Ms GEORGE (Senate committee member): Sorry, I do not understand. What are you saying – condom protection and AIDS deaths are correlated?
Dr Reece: Yes, condom sales and AIDS deaths. I am saying that there is a statistical association between the two.

Under Keeping Up The War On Drugs Bishop wrote in her report:

A significant amount of damage to families and the community has been avoided by the government’s uncompromising approach to the trafficking and use of illicit drugs. Drug industry elites who have repeatedly claimed that the ‘war on drugs’ has failed are simply wrong. […]

The Australian Federal Police (AFP) and its partners have been highly successful in limiting the damage of illicit drugs in Australia. The number and weight of detections for selected illicit drugs are generally higher than before 2000…

Increasing drug seizures reflect increasing drug traffic. Increasing traffic reflects increasing and increasingly varied demand. Such demand indicates more use and we already knew more use was due to ineffective tactics globally. The snide term “drug industry elites” still has life in certain circles. Essentially it demeaned those who dealt in evidence alone and advised accordingly.

Australia endured the rejection of science by politicians for the very tenuous reason of hopefully securing votes. At the States and Territories health ministers’ conference in Cairns in 1997, the issue of a heroin trial – the latest step in Harm Reduction to show exciting success in Europe – was raised. Ultimately Michael Wooldridge, four states and the ACT voted for trials to begin. The result was 6-3 in favour.

Whilst credit is due for his continued funding of needle exchange programmes, Howard had not just a conservative eye but a retributive one. The success of Harm Minimisation under the previous government left him keen to change the essence of a policy that had seen Australia emerge as world leaders. Thus we copped his Tough On Drugs approach – a dismal failure. He immediately cancelled the trial on advice from his Evangelical adviser and first Chair of the ANCD, Major Brian Watters.

Watters was already making enemies in the ANCD itself, for merging his Salvation Army role with what should have been best practice. A Drug Free Australia Board member, Watters’ disdain for science and academics was manifest. He had spoken on an episode of Four Corners with John Howard:

WATTERS: I mean, the Salvation Army’s been doing it for 120 years. No good these academics telling us it doesn’t work.

HOWARD: And I feel in very safe hands, with the police on the one side and the Salvation Army on the other.

WATTERS: It’s the law and the prophets.

HOWARD: It’s the law and the prophets. That’s right.

So it continued. The “law and the prophets” looking after in-need Aussies. One of the most used phrases in the bible, it’s most significant aspect is that Jesus came to “fulfill” The Law and The Prophets. Then we got the faith healers and the purists. The Evangelists and the righteous. Anti-harm minimisation groups arose – DFA itself funded by [then] Health Minister, Tony Abbott. Others re-emerged keen to sink the conservative boot in to such sinful wickedness as clean needles, condoms and honest, open health education.

In 2007 The World Federation Against Drugs firmed it’s resolve in Sweden in striking mockery of the NGO Forum at the 50th Commission on Narcotic Drugs. Human Rights, Harm Reduction and Health Responses we heard from [then] UNODC Executive Director, Antonio Maria Costa, would be crucial to future global policy initiatives. Apparently not if conservatives could help it. Populated, perhaps unsurprisingly, by a number of biblical fundamentalists, evangelists and young earth creationists one might appreciate the uncompromising stance and anti-rights position that WFAD entertain.

On May 21st Mark Metherell reported:

DRUG Free Australia may not be a household name but its leaders claim a role in repelling further moves towards what they see as the evil of drug decriminalisation.

It fears the ”tough on drugs” regime of the Howard government is unravelling, with the abandonment of the school drug education strategy and declining use of community advertising campaigns. […]

‘Our view is that Australia’s illicit drug policy is too lenient, sending mixed messages to our youth,” [Jo Baxter] said.

Here’s a picture drawn by a child attending a DFA school education strategy (Hint: be drug free, go to heaven). Interestingly the Education Department in S.A. has a different view to Baxter on the matter. That article mentions a member of Youth for a Drug Free Australia, who is also head of The Recovered Drug Users League SA, Ryan Hidden.

He just happens to be the chap Ann Bressington coached to lie to the House of Representatives. But later Jo had him chatting to kiddies in school against Education Department instructions. A few weeks earlier he chose to dob in tobacconists the very day after Ann Bressington’s “bong ban” came into force.

Now… where did I read “mixed messages”?

Jo Baxter is Executive Officer of Drug Free Australia, Spokesperson for the S.A. “campus” of the evangelist driven Delgarno Institute is also vice-president of the World Federation Against Drugs. If you want an attack on human rights driven policy in Australia, Drug Free Australia is the group. If you want a “Heads Up People!” attack on the Global Commission on Drug Policy, whose main report also concludes prohibition has failed, the Delgaro Institute is the place.

But if you want to read an attack on the host of eminent Australians who produced the report raised in Parliament last April 3rd, Jo Baxter will even pop on her WFAD V.P. hat. So what do we get? Labelling the report compiled by 24 former senior state and federal politicians, experts in drug policy and public health, young people, a leading businessman, legal and former law enforcement officers, as “lacking substance” Jo begins:

The so-called ‘high level’ report on illicit drugs, suggesting that decriminalisation across the board, will solve Australia’s drug problems, lacks sound scientific basis and credibility and, as such should be discounted. The following a (sic) just some of the reasons:

First, it is not the ‘War on Drugs’ that has failed, but rather, it’s the failure of Australia’s Illicit Drugs Policy to satisfactorily address primary prevention.

For over 25 years Australians have endured a policy of Harm Minimisation, which has left a ‘train wreck’ in families and communities across the nation. […]

They have failed to recognised that, between 2000 and 2006, Australia had a ‘Tough on Drugs Strategy’ and our illicit drug use rates dropped significantly. The trend is now turning around. […]

Which is it I wonder? A Harm Minimisation train wreck or a Tough on Drugs victory? Harm Minimisation arrested the spread of HIV, Hepatitis B and harmful drug using practices. The surge in heroin use is well documented as due to immigration of a S.E. Asian demographic able to import large quantities and sell at reduced rates. If prohibition was working initially this would not have happened.

Instead criminal cartels blossomed and later shifted to manufacturing their own product indoors. If prohibition worked that would never have happened. It seems to me like Tough On Drugs actually oversaw the rise of many new classes of drugs and an actual shift in the drug using habits of our community more in line with criminal profit.

As always Harm Minimisation and Reduction have functioned to manage the fallout from prohibition’s failure.

Effectively Jo’s article is a repeat of what the Drug Free Australia mantra has been, no matter what the title, debate, paper or conference. A synopsis of what Bronwyn Bishop concocted in 2007. A reflection on their bogus research on Supervised Injecting Facilities, Needle Syringe Programmes, Medicinal Cannabinoid research and so on.

The global Drug Free movement is to illicit drug policy in the community, what creationism is to evolution in the science curriculum.

Given the demonstrable failures of prohibition, we are still reticent to discuss this issue vociferously. Clearly it is a topic that can be easily misinterpreted, accidentally misrepresented or used to cast mischievous accusations toward those who mount firm evidence backed arguments. Much of the confusion stems from the fear that drug use under relaxed laws will equate to greater use. Often this is expressed as if one believes use will be compulsory.

Yet needle provision did not lead to increased use. The return on investment is four dollars for every one dollar invested. As needles are returned potential virus reserves are removed from the community. Users reciprocate with services learning to manage health and exploit opportunity to cease using. New users are resourced and educated to develop the means to never risk cross infection. The entire community benefits and vital dollars are not spent dealing with preventable problems.

Still, the false belief that use is encouraged this way persists in the face of overwhelming evidence to the contrary. Similarly the notion of deregulation is seen as a “free for all”, quite bizarrely likened to alcohol. Perhaps understandably challenges to drug prohibition evoke images of the end of alcohol prohibition. With this comparison comes the assumption all drugs will be readily available and an integral part of culture. Businesses will provide and houses will be stocked. The roads will be full of talkative, super-horny, hallucinating, dozing, dancing, slurring and very hungry drivers heading for pizza.

No. The only relationship to alcohol prohibition will be the removal of the millions of Al Capone types and the violence, intimidation, corruption, ruined families and poisoned customers that inevitably evolve. The failure of prohibition can be seen in a top down, if not linear fashion. Yet the way in which it is finally dismantled is in my mind not completely predictable and remains a complex bottom up venture to be managed with flexibility.

Evidence across the world shows use drops or remains stable with relaxed laws. The Portuguese example has presented in over a decade, remarkable success. The advantages of removing extensive punitive measures and simple stigma become manifest in a few short years. Legal resources freed from the waste of hassling petty users are brought to bear on serious crime. Users, freed from the fear of severe prosecution and shame become proactive in seeking help.

Potential users become a smaller market as drugs become controlled by authorities and subject to medical oversight – not criminal endeavour. More so, the opportunity to get ones life back on track is a reality that provides huge motivation to avoid drug use and experimentation. Presently in Australia, by the time users need substantial help they may be alienated from society, ashamed, angry and overwhelmed by the prospect of “perhaps” getting a decent life back under way.

Options used to mange illicit drug use are well explained in the Australia 21 Report:

Decriminalisation means specified proscribed behaviour is removed from the criminal law and is dealt with under the civil law.
De-penalisation means reducing the severity of penalties.
Legalisation means that the specified forms of behaviour are no longer offenses dealt with by the law.
Regulation means establishing a strictly controlled legal market for drugs as is the case with pharmaceutical drugs, tobacco products and alcoholic beverages.

Deconstructing prohibition is not a licence to take drugs. It is a means to remove lucrative profits from criminals and steer in-need and at-risk Aussies toward a healthier and more hopeful future. Those able to see a way out of the present mess all hold a somewhat unique view. No one person holds the solution, but certainly as experts and visionaries, groups such as the Australia 21 Board are urgently needed to begin the process of improving Australian lives and saving tax payer dollars.

400 Aussies die from drug related causes annually and countless others suffer a range of related harm that varies from mild to severe interpersonal conflict, financial tragedy or horrific violence. Lives are cropped of potential and under the present system valuable, talented and vital community members slowly withdraw from society even years after they have ceased to use any drugs.

Stopping us from turning this mess around is the movement I opened this article with. Whether it’s same sex marriage, being an atheist or removing the stigma from elicit drugs a vocal and well organised minority conclude that they can do any and everything to impose their own moral values on the rest of the society. In effect however, knowing that they cannot successfully do this the outcome is merely to impede progress to equality and thus limit the freedom of others.

Hence we cannot really have this discussion without at some point acknowledging it isn’t resisted just on philosophical grounds. The continuance of the war on people and the fruitless prohibition of illicit drugs, regardless of means used, is the single aim of those who today are seen attacking Harm Minimisation and Harm Reduction.

Therein lies the problem. Whilst arguments are akin to anti-vaccination rhetoric: repetitive, evidence free, conspiratorial, personal and peppered with linking all related ills to the present policy, in this case conservatives do have political sway. Thus full and open discourse regarding the retrieval of control from organised crime must include the reality that the anti-drug movement is guilty in it’s own way of inflicting suffering, corruption and death on our nation.

More so, they know this well. The bulk of attacks on Harm Reduction revolve around creating the pseudoscience and pathological theories to argue HIV has not been controlled by reducing the personal exchange of blood and body fluids. Despite the exquisite correlation between Harm Reduction absence and HIV presence across the globe it is still argued that HR “enables” drug use, thus causes all negatives that go with it.

Discourse is poor because the reality is that no government would dream of even broaching the subject for fear of alienating the conservative vote. Dr. Reece states above that condom use parallels AIDS deaths and God’s wrath will follow Harm Reduction measures as a “consequence”. Rhetoric fed to parliamentarians about Injecting Facilities is nowhere near as absurd, looks genuine to the untrained eye and can influence decisions. We should expect the same polish in defence of prohibition.

Changes in equal rights now look set to take years. The public is well versed in who the bigots are in matters of marriage, abortion and euthanasia. For the public to be prepared to take on a gradual change in their world view as it pertains to drug use and abuse, those truly dedicated to abolishing prohibition need to expose the bigots and the saboteurs also. And yes, it may be that simply opening channels of discussion will be enough to do this.

The evidence is irrefutable. Prohibition has failed and it is killing Australians. We don’t just need discussion on the necessity for change. We need discussion on why there is as yet no change and instead a persistent silence. Every report on this issue and every report on Harm Minimisation success is attacked by anti-drug lobbyists such as Drug Free Australia.

When we do expand the discussion we must be prepared to lay the blame at their door.

16Jan2012

The problem with Margaret Court

Posted in Anti-Drug Lobby, Denialism, Drug Free Australia, Human Rights, Religion by Paul Gallagher

When God came to visit Margaret Court as she scrubbed the dishes one night and told her to “go forth” and set up a church one could guess it would all end in tears one day.

A woman of incredulous beliefs, hypocrisy, charlatanism and greed she preaches a destructive supernatural creed that is considered heresy by mainstream Christendom. It is quite true that Margaret Court persecutes minority groups with the God given “love” she has for them.

Single mothers, drug users, Muslims, non Liberal voters and homosexuals all cop a holy spray. It’s no secret that protestors are at the Australian Open today to peacefully voice what is really long overdue opposition to one of Australia’s most legendary bigots. Although the claim is being made that she doesn’t cash in on her past life in tennis the truth is that she does.

One of the creepiest is messing with young school kids minds by handing out imitation Wimbledon trophy trays to those judged by the group of which she is patron, Creationist lobbyists, Drug Free Australia to have the most biblical anti-drug message. That they are anti-equality, anti-safe sex and safe drug use hence a threat to public health is a message students aren’t told.

Margaret’s journey from tennis “legend”, to psychological wreck to auditory hallucination as Jesus’ private interlocutor had been striking. Plunged to the depths of depression when adoring cheers were finally silenced Margaret could see no way forward. As psychosis lapped at the edges of her consciousness and she lay bedridden with a broken mind, Margaret made a life changing decision. She found a bible and read it from front to back, believing every word.

At about the same time Margaret was claiming she had a torn heart valve. She got hold of an anatomy book, opened it at the page depicting a heart and laid it on the hallway table. Every time she passed she willed herself with the healing power of God that this was her “perfect heart”. Not long after she reported a miraculously repaired heart valve.

Clearly, no longer in Kansas so to speak, Margaret needed help. Proper, long term clinical help. It never came. Exactly what role was played by husband Barry in creating the new Margaret Court is not clear. I have every sympathy for a chap who believed his wife was spiritually touched after such a gruesome ordeal. However the quality of associates she now chose to further her “instructions” left much to be desired.

Margaret knocked over her bible “studies” in about a year at Rhema Bible College, thus becomming a pastor. Next a hefty payment to Oral Roberts University provided her with a dodgy doctorate as a Word of Faith adherent. Word of Faith attracts extreme condemnation from mainstream Christians as it teaches accumulation of material goods and wealth is itself a path to enlightenment: Economic Materialism. Kenneth Copeland and Kenneth Hagin are well known Word of Faith profiteers.

It’s a blend of Christian Science, New Age Mysticism, Christianity and Gnosticism. Its basic foundation is that it deifies humans and diminishes God. Word of Faith practitioners believe they wield the power of God through speech – hence the name – and that God must serve them:

And they believe that they have the same power as God, to create and destroy by speaking using “the Word of Faith.” And with their prosperity doctrine, they believe that their pleasures should be filled and they should be served by God on earth (making them gods on earth).

Court herself has dangled this threat of speaking destruction to punish Australia for failing to re-elect John Howard through united prayer in 2007. In a rare moment of lucidity, Court graciously admitted it was just a reminder and when it came to unleashing Divine Power through speech, “He (God) is Sovereign”.

Yet by this time Court was a fierce Christian Zionist, enemy of Islam and close friend of Danny Nalliah from Catch The Fire Ministries. Danny is well known for blaming the February 2009 Black Saturday bush fires on divine punishment for the decriminalisation of abortion in Victoria, and for his personal visit from Jesus to confirm Howard would win the 2007 election.

She wrote on his website in December 2007:

This man stood up for the Body of Christ^♠ against the vilification law; he was persecuted by many in the Body of Christ for his stand, but he pushed through for you and me so that we still have that freedom to openly share Jesus Christ.

From the Prophetic office^♣ he gave direction to the Church for our Nation, but the church did not take heed to what he had said – that the Body of Christ unite in prayer and action. (2 Chronicles 7:14)

I believe we are at a very pivotal time for our nation and for the church.

We had righteous leaders in Mr Howard and Mr Costello and how much easier it is for the church to fulfill the destiny spiritually when you have God fearing men at the top leading a Nation. Now you have a Prime Minister who says, “that public servants will advise me, not God” to lead our Nation. (Release: Southern Cross Broadcasting in Melbourne, Nov 30 2007)

I was praying and God showed me we have allowed a religious spirit to come back over our Nation. God always gives me Numbers 14 for this Nation where Moses repented on behalf of the people; we need to repent on behalf of the church. The government of this nation is on our shoulders (Isaiah 9:6) – we govern in the spirit; but a lot of the church is looking at man instead of God (Matthew 6:24-33)

I love the body of Christ; what a powerful army when we stand united together in prayer and Word. Let’s stand together for God to manifest Himself; believing and proclaiming that we are a righteous Nation, a God-fearing Nation and that His hand is on our Nation.

♠ – The “Body of Christ” is a term for collective Christians. ♣ – The “Prophetic Office” is the term used to describe a personal visit with Jesus or God.

Word of Faithers also deny a belief in The Trinity and the traditional story of Jesus’ crucifixion and resurrection. Probably finalised by Kenneth Hagin their story of Jesus’ demise is that he was crucified and died. From there he went to hell and was tortured by demons. A bit of a whimp he yelled and screamed for help until the arch–angel Gabriel swooped into hell, defeated the demons and saved Jesus’ skin.

All offences together have earned them the dubious honour of being known as heretics throughout Christendom. Their misinterpretation of the bible is legendary. Court recently said that same sex marriage would, “legitimise what God calls abominable sexual practices”.

This is utter nonsense. She is referring to Leviticus, chapter 18 verse 22:

You shall not lie with a male as one lies with a female; it is an abomination

We know that the book of Leviticus could not have been “written by Moses” as the defence goes. And as a defence it is demonstrably absurd noting that Moses was big on genocide, slavery and the kidnapping of virgins. Whilst the origin of some material is lost in antiquity the notion of the book as “written by Moses” began sometime in the 1st century. Leviticus itself continued to be modified up until around 540-330 BCE.

This is the Persian Era and may offer some insight into why the final book is a strict book of complex rules, much like Sharia law. I’m not suggesting it is Islamic, merely that the notion of rules instructing humans in the manner of living was popular in the middle east for centuries. Leviticus is 27 chapters of rules on festivals, eating, sacrifice, sexual behaviour, cleanliness, judgement and more.

Scholars are quick to point out that the tribes-people who wrote chapter 18 on sexual behaviour were known to use male anal rape as a means in war and of civilised punishment. Homosexuality was also accepted and legal. Not only is the meaning of Leviticus 18:22 lost in translation and time, a glaring absence is that of reference to gay women.

Thus it is not an instruction forbidding homosexuality. The most widely accepted definition is that it pertains to procreation. The word “abomination” in this sense relies upon it’s meaning as a violation of law. A violation of the tribal rule (necessity) to procreate. This was the explanation I heard, with references, in a lecture from a real biblical scholar and I give it credence over that of a megalomaniac and bigot like Margaret Court.

Today Court runs Victory Life Centre in Perth piping TVangelism to over 30 South East Asian locations, making the proverbial fortune. Still patron of Drug Free Australia she may be proud that they have caused enormous damage to children, families, education, public health and illicit drug policy. There are many reasons why this disturbed ex-tennis player should be called out for the antisocial opportunist that she is.

Giving a legitimate face to archaic homophobic views based on ignorance is something Australians should resist.

Drawing from a child indoctrinated by Drug Free Australia. The knife handle reads, “John 10:10” – The thief comes to steal, kill and destroy. I have come that they may have life and life to the full. Be Drug Free And You Will Be With Me, says God (top right).

30Dec2011

Dr. Stuart Reece: Drug Free Australia’s secret

Posted in Anti-Drug Lobby, Drug Free Australia, Health, Human Rights, Illicit Drug Policy, Legal, Media, Religion by Paul Gallagher

An interesting story sits hidden away in the June 2003 edition of Focus magazine – a QLD based fundamentalist Christian publication.

On page one we meet Graham Preston who was jailed back in June 2003 for pro-life antics. His sole direction was Proverbs 24, verse 11: “Rescue those being led away to death”.

The story on page two is about Drug Free Australia member, Dr. Stuart Reece (below). Thinking of the above proverb, it is disturbing to learn that over a period of twenty months, twenty five opioid dependent patients who sought his care, died following insertion of unregistered naltrexone implants.

Naltrexone is an opioid antagonist. In a 2013 position statement on naltrexone implants the Royal Australasian College of Physicians stated on page 6:

The World Health Organisation, UNODC (United Nations Office on Drugs and Crime) and UNAIDS (United Nations Program on AIDs/HIV) have endorsed treatment with methadone and buprenorphine. The World Health Organisation has included methadone and buprenorphine in its Essential Medicines List. Naltrexone has not been endorsed by any United Nations organisations nor is it included on the Essential Medicines List. […] The RACP does not support the routine use of sustained release naltrexone formulations (implants or depot injections) while the product is not registered with the TGA.

In 2003 when the Health Practitioners Tribunal adjourned Reece’s case indefinitely, such implants were available through the TGA Special Access Scheme. This 2008 article posing the question of safety, examines implications of the scheme and difficulty in securing sound data. The authors note:

The strong theoretical rationale for the usefulness of naltrexone in treating heroin dependence justifies further rigorous investigations. However, the uncontrolled use of unregistered products of uncertain quality hampers the development of proper clinical trials.

Above, we read that Reece was “deeply hurt” by the investigation that followed. The families of his dead patients are not considered. Incredibly, the above Focus article claims that the charges brought against Reece were “based on false reports by drug addicts”. No evidence is presented in support of this statement. No independent source has confirmed the existence of false reports. Brought by QLD Health, the charges were just and likely saved lives.

There’s a familiar, yet awkward tactic advanced in his defence. The type of logical fallacy that suggests if positive feedback is presented then to suggest otherwise is not only wrong but “false”. Someone has provided the Focus author with decontextualised data designed to be critical of methadone maintenance therapy. This argument is frequently used by the opponents of harm reduction and proponents of naltrexone. We read “590 patients died with methadone in their system”. It’s an underhanded attempt to suggest methadone was the cause of death. Note this doesn’t read, “died because of methadone overdose or complications”.

We don’t know the cause of death, but I’m certain if methadone was the cause this article would have made it abundantly clear. These figures are pulled from toxicity data in coronial reports. They include hospital patients receiving palliative care, out-patients receiving pain relief, road fatalities, suicides, homicides, poly-drug related deaths and so on. All opioids carry risks and fatalities do occur in the opioid maintenance demographic. Nonetheless, when prescribed by a GP and dispensed in a controlled environment as is the case in treatment of opioid addiction, methadone is a safe option.

I can’t comment much on a reference to a “recently published article” without the source, other than to note that rapid detoxification can pose a significant risk of overdose. Naltrexone has been used orally to block the effects of opioids. The National Drug and Alcohol Research Centre note in, Mortality related to naltrexone in the treatment of opioid dependence: A comparative analysis;

Because naltrexone blocks the actions of opioids, naltrexone rapidly removes a person’s tolerance to opioids so that a given dose of opioids would have more effect than previously. The lack of naltrexone, not its presence, exposes a naltrexone-maintained patient to risk of opioid overdose. If naltrexone treatment is ceased, individuals may be at risk of opioid overdose if they choose to return to opioid use.

Regarding the safety of naltrexone in comparison to the safety of methadone or buprenorphine in the management of opioid addiction, one reads:

When considering deaths per periods of high and low risk, the mortality related to naltrexone was approximately seven times that of methadone during the period of high risk and three times the rate during the period of low risk. […]

This study also found that the mortality related to oral naltrexone treatment was higher than that for buprenorphine and methadone… whether estimated as deaths per 1000 treatment episodes or per 100 person years of risk, the death rate for naltrexone was higher and we believe the estimate provided here is a conservative one. […]

The mortality rates suggest that oral naltrexone treatment, as it is provided in Australia, can place recipients at significant risk of death, and at higher risk than buprenorphine and methadone. However, it should be noted that naltrexone treatment is a useful option in some well-motivated patient subgroups that form a minority of the opioid-dependent population.

Regarding implant technology:

A number of potential issues also relate to this form of treatment, and rigorous research is certainly required to carefully examine the potential for this delivery system to represent a viable treatment option for opioid-dependent persons. Specifically, these issues are: the lack of randomised controlled trial evidence of naltrexone implant efficacy in the treatment of opioid dependence; considerable inter and intra-subject variability in the blood levels of naltrexone resulting from an implant (and so the level of opioid blockade); the lack of good monitoring of adverse events relating to the use of naltrexone implants; and the acceptability of the naltrexone implant preparation to patients and medical professionals.

The article also identified that an existing lack of systematic data reception by coronial databases, hinders accurate assessment of fatalities related to treatment with naltrexone. In 2008 The Medical Journal of Australia elucidated on this problem when it published a paper identifying twelve hospital admissions, related to implants, to two Sydney hospitals over a 12 month period beginning in August 2006. The Abstract conclusion read:

These severe adverse events challenge the notion that naltrexone implants are a safe procedure and suggest a need for careful case selection and clinical management, and for closer regulatory monitoring to protect this marginalised and vulnerable population.

Thus, in attacking methadone as a treatment modality, Reece raises concerns with this author about his impartiality. A read of Dr. Reece’s articles in the arguably biased Journal of Global Drug Policy and Practice is revealing. Also, purporting that methadone causes premature ageing and cell death, without presenting a mechanism and correcting for other variables such as smoking, nutrition and other lifestyle habits is poor science. In the above Focus article this is presented, without a source, as “new research suggests”.

The Focus article was in error to claim vindication. The QLD Health Practitioners Tribunal adjourned indefinitely over the twenty five deaths. It was beyond ambitious for Reece to claim, before a Parliamentary inquiry, to “hold the world safety record” in administering this very treatment. Such comments have little to do with supporting evidence, and more to do with misinformation.

By 1999 research indicated naltrexone was potentially unsafe despite seemingly miraculous stories of recovery. As an opiate blocker, it was emerging with the promise of a quick solution. Yet controlled trials were lacking. Wodak and Hall discussed the evidence in an editorial in the MJA, that also briefly noted the role of the media in confusing community attitudes. Under Parliamentary protection Dr. Reece accused Hall of “scientific fraud”.

In September 1999 the practice of Dr. Stuart Reece was raided following concerns with his approach to addiction treatment. Threatened with closure, he claimed that the QLD government would have blood on itʼs hands if he could not resume practise. Ultimately, he was not closed. Twenty months later, 25 of his patients were dead. ABC 7:30 reported on 4 June 2001.

KERRY O’BRIEN: When the anti-heroin addiction drug Naltrexone was introduced to Australia five years ago, it was hailed as a breakthrough.

Since then, thousands of addicts have been treated with Naltrexone, successfully breaking their deadly habit.

But despite initial expectations it hasn’t proved to be a universal remedy by any means.

Many addicts have lapsed back into heroin abuse and some have subsequently died from overdose.

In Queensland, an investigation is now under way into the practice of Naltrexone activist Dr Stuart Reece, after the deaths of 25 addicts who had undergone his program.

The investigation has already prompted a ban on the use of experimental Naltrexone implants, designed to take the place of tablets.

All had followed the Reece regimen. He was raided by the QLD Medical Board and again closed down. Rev. Fred Nile, speaking as leader of the Christian Democratic Party said at the time:

The action taken by Queensland Health is heavy handed intimidation against those who show true compassion toward heroin addicts. It would appear, by this move, that Queensland Health would prefer that addicts remain addicted to heroin. I fear that this is another step in the mounting campaign for government provided free heroin

Three months later he claimed twenty five “drug addicts” died as “part of a conspiracy”. In September 2003, The ABC featured Reece on their Sunday Nights programme:

Stuart Reece is a Brisbane doctor who finds himself in a bit of bother some of his fellow medico’s at the moment because of his conviction that faith can be instrumental in curing what ails one… The difference perhaps is that Stuart Reece is a born again Christian believer, and makes no apologies for his direct appeal to the Christian Gospel and the power of Christ.

Clearly, the largely untested naltrexone implants were in this case a problem. Had basic support, such as a contact or counselling been available, the recovering patients would have been more safely monitored. It is regrettable that there was undue faith in naltrexone combined with a moral objection to opiate replacement therapy. This is complicated further, in that had naltrexone been demonstrated as effective, financial rewards would have been significant.

In addition, the November 2009 Health Practitioners Tribunal transcript, Medical Board of QLD vs Albert Stuart Reece makes for compelling reading. An unrepentant critic of methadone Reece chose to illegally supply opioid dependent patients with morphine. The transcript includes:

It is clear from his evidence before the Tribunal that he is also very passionate about his practice and in strong disagreement about the continued use of Methadone as a treatment for heroin addiction. […]

Particulars of the referral notice in this matter are that the Registrant on 39 separate occasions supplied Morphine intended for use by drug dependent persons without obtaining approval from the Drugs of Dependence Unit in preparation either for Naltrexone treatment or other detoxification treatment. […]

He admits to doing so and to falsifying medical records when doing so and involving third parties in this conduct. […]

But it is also clear from his evidence, and as I’ve already said that he’s a man who has a somewhat evangelical approach to this area of medicine and because of that he does appear to lack a degree of insight and objectivity in relation to the treatment of his patients. Furthermore, he seems to feel that the ends justify the means in terms of treatment of patients.

In October 2005 Christian conservative MP Tony Abbott Liberal (then Federal Health Minister) funded Drug Free Australia to the tune of $600,000. They did not adhere to conditions under which they were awarded the funding, ultimately emerging as right wing lobbyists. They are followers of Swedenʼs zero tolerance policy and the USA hardliners [open letter]. Reece, a supporter of biblically driven abstinence and a Texas trained fundamentalist, was supported by Drug Free Australia.

By April 2007 Dr. Reece was testifying to the Standing Committee on Health and Human Services (see below) that the immoral policies that permitted condoms – the real cause behind AIDS – clean needles, opioid therapy for addicts, non-punitive cannabis laws, harm reduction and general tolerance for ill Aussies would be our doom. The Senate Standing Committee looked on as Reece introduced himself by saying, “I certainly know the science”. He then displayed a photo of “the archaeological site of Sodom” and a tree with snakes instead of branches. [Page 33/FHS 27]. He explained its relevance. “There will be consequences”.

Reece attempted to explain the moral consequences of policies such as Harm Minimisation, by blaming a tsunami on Divine punishment. He added:

I was interested to discover that the actual historical site of Sodom and Gomorrah has recently been found in Israel. On the bottom right of this slide are pictures of sulphur balls that have been found there. So consequences matter, and they can destroy a civilisation quickly, as we saw with yesterday’s tsunami and so on.

This slide shows a tree with snakes, which to my mind is a lot of the stories that you hear from harm minimisation. Methadone, syringe giveaways, injectingrooms, medical cannabis, heroin trials all those are catered for by the same people. But, on the other side of the tree, you have all the downsides, the side effects, which are not talked about in this culture. It is of extreme concern to me that medical science which is known and understood overseas is not understood and not talked about and given no airplay whatsoever in this culture.

These are old slides I made several years ago, charting a lot of these behaviours: this is condoms and the AIDS risk, charting the parallel between condoms and AIDS deaths.

Ms GEORGE (Senate committee member): Sorry, I do not understand. What are you saying – condom protection andAIDS deaths are correlated?

Dr Reece: Yes, condom sales and AIDS deaths. I am saying that there is a statistical association between the two.

As reported in Crikey by Ray Moynihan Reece decided the “disease drugs, sex and rock-n-roll” was the problem. Asked about the safety of naltrexone, Dr. Reece chose instead to attack internationally renowned scientist, Dr. Alex Wodak [Page 59/FHS54], who specialiseʼs in blood born viruses and epidemiology. Put differently, this means Wodak supports condoms, clean syringe access and used syringe collection: dire threats to our very civilisation, contended Reece. Yet Australian communities with dozens of dispensaries and hundreds of clients report no methadone deaths.

How did Committee Chairperson react to this? Bronwyn Bishop abused public health scientists (who had outlined the success of decriminalisation in Europe), yet she gushed in support of Dr. Reece. A pre-determined agenda in what was billed as the most important family-relevant inquiry of Howardʼs government spoke volumes. Bishop’s final report was rejected nationwide by all but religious fundamentalists and Christian lobbyists. Not one publically funded treatment or advocacy agency missed the opportunity to criticise the report. Bishop went on to call for the removal, and adopting out, of the children of parents struggling with addiction. Should parents conquer their addiction there would be no chance of reunion:

Their [Liberal-led House of Representatives] controversial plan – which also includes compulsory treatment for teenage addicts, restrictions on methadone programs and withdrawing funding from drug programs that promote harm minimisation – was dismissed as “a disgrace” and “frightening” by some anti-drug campaigners.

Gordon Moyes, the “Christian voice in politics” is also quoted on rumours in Drug Free Australia’s recent attack upon Lancet authors, of which Reece is a co-author. This involves quoting Moyes, who is quoting drug addicts he happened to speak to. Moyes also praised naltrexone despite the concerns of our medical community about it remaining unregulated. Regrettably, regulators have not prevented its use by the same people year in, year out.

When the Medical Journal of Australia exposed the fact these same prescribers were not reporting adverse reactions, despite TGA requirements under the Special Access Scheme, Drug Free Australia published a rebuttal. It made direct reference to Dr. Stuart Reece himself. Offensively, it reported that Reece “studies” death rates post naltrexone treatment. It was titled, Australia could be the biggest loser.

Dr. Reeceʼs motivation is arguably reflected in his obsession with teenage and childhood sex and sexual assault, murder, violence… all due to “the depraved advertising industry” which catalysed “the disease sex, drugs and rock-n-roll”. Advertising womenʼs nudity, outside of “a strictly medical context” is “incredibly powerful pornography”, he has observed.

Today, a decade plus since this evidence-free pursuit began, Reece is arguably a pin up boy for religious fundamentalism. Five or more years ago he promised Parliament that his results were “statistically powerful” and “revolutionary”. Of course, there are no results. Itʼs the same certainty that only faith can sustain. If prayer cures homosexuality, addiction is a certainty. His latest work “proves” naltrexone is safer than opioid therapy.

As reported on ABCʼs 7:30 Report, in 2006 multiple disciplinary teams have steadily found naltrexone has a fatality rate over four times that of opioid therapy. Dr. Reece, and others who seek funding and likely lucrative contracts seem to have a formula no others can find. More recent work with implants by his colleague, gynecologist George O’Neil, show ambiguous results, despite claims of success.

Regrettably this work is tainted with poor practice and again, Christian healing. Their biggest problem is the fraud published in the MJA surrounding suppression of negative outcomes – some almost fatal. Failure and coercion to boost sample numbers seems to be the norm. W.A.’s Freshstart clinic observes on its website chaplaincy page:

Our Christian Beliefs

The Nature and Character of God: we believe in one God, who has existed forever as Father, Son and Holy Spirit in a community of pure and eternal love.

The Fresh Start Statement of Belief embodies the second of the core commitments of the organisation:

The Creation of Humanity: men and women were created in God’s likeness with God-given dignity and worth in order to know, love and serve him forever.

Sin and Evil: sin came into existence through human rebellion against the good purposes of God. Sin is self-centred opposition to the love of God that separates humans from God and leads to death and eternal lostness.

Etc, etc….

There is no problem with having a strong faith. Yet there’s a difference between faith based welfare and faith based practices. When the supernatural impinges on your objective reasoning in managing the lives of others, no amount of friendly lobbyists can assuage this conflict of interest.

Today, Drug Free Australia bill Reece as “an expert in naltrexone” and in fatalities. Is this a joke? I honestly don’t know. What’s certain however is that his role in the recent DFA misleading outing to attack Vancouver’s Insite and the research backing it is not based upon any skill in harm reduction.

Drug Free Australia have many secrets. This one is quite shameful.

Comments posted online from a relative and a friend of Reeceʼs patients.

Just Jules says: June 5, 2010 at 6:01 am Ahhh there is none so blind as those who can not see .. Dr Reece in my eyes is a discusting (sic) human being .. I am the mother of a child he treated .. He also treated my daughter in law and the mother of my first grand child .. If you want to see what his methods leave you with, go see my daughter in law who for the last 11 years has been in a home for the severely brain damaged .. In is own words to me ” they are just reoffending drug addicts”. He is a wolf in sheeps clothing and should of been stopped before he started.

Vicki PS says: July 5, 2010 at 12:02 pm I came across this site looking for help for a friend of my daughterʼs. This young woman has been increasingly unhappy with her treatment under Dr Reece. He is treating her addiction with Suboxone, a subutex/naltrexone combination drug. Her big concern is that this unethical, immoral disgrace to the profession reduces her dosage if she has not been to church! This girl is now in early pregnancy and is scared that she could miscarry if this idiot messes around with her medication to suit his pathological world view. I find it frankly incredible that Dr Reece is still permitted to practice.

References:

MORTALITY RELATED TO NALTREXONE IN THE TREATMENT OF
OPIOID DEPENDENCE: A COMPARATIVE ANALYSIS – NDARC (HTML) (Download PDF)
Unplanned Admissions to two Sydney Public Hospitals after Naltrexone Implants – MJA. (HTML) (PDF)
IMPACT OF ILLICIT DRUG USE ON FAMILIES: HOUSE OF REPRESENTATIVES – Tuesday, 3 April 2007 (Download PDF)

Last update: 12 February 2023

♠︎ ♠︎ ♠︎ ♠︎

28Dec2011

Drug Free Australia’s attack on Insite really an attack on individual scientists

Posted in Anti-Drug Lobby, Drug Free Australia, Human Rights, Illicit Drug Policy, Legal, Religion by Paul Gallagher

A close look at Drug Free Australia’s recent attack on research supporting Vancouver’s Safe Injecting Facility, Insite, suggests a long planned attack on individual authors, not evidence.

Recently I wrote a piece on Drug Free Australia’s selective and misleading use of peer reviewed publications, government reports and pseudoscience to mislead readers with the claim of academic fraud and professional misconduct in the Lancet.

Their target was Insite, Vancouver’s Supervised Injecting Facility. Yet more specifically three authors of the Lancet piece, Evan Wood, Julio S G Montaner and Thomas Kerr have earned the retributive ire of Drug Free Australia’s parent body, Drug Free America Foundation. DFAF’s “division”, the Institute on Global Drug Policy fund the Journal of Global Drug Policy and Practice, which is not a journal but a vehicle for lobbying against progressive drug policy primarily that which targets HIV control. The JGDPP was initially funded by the US Department of Justice, presently under investigation for corruption.

One of the co-authors of the paper was Robert DuPont. Present DFAF board member, past White House Drug czar and former first director of NIDA, DuPont’s history is “impressive” but shamefully controversial. A champion of drug war tactics, the long debunked random drug testing of kids in schools and suppression of individual rights suggest he’d be better suited to the role of a cat-stroking super villain in a Bond movie.

The scale of human rights abuses and the litany of egregious conduct orchestrated by the ultra-conservatives drawn toward DFAF and the morally bankrupt satellite groups they inspire, is impressive indeed. DFAF was founded by Betty Sembler. Betty and husband Mel, both lacking any qualifications founded Straight Incorporated in 1976. Over 15 years this “coercive” rehabilitation programme, based upon the infamous and crime riddled Church of Synanon‘s approach, racked up hundreds of accounts of abuse of clients and their families. Synanon called it a day in 1989, by which time tax evasion, civil suits and attempted murder cases had eventually outshone their claims of Divine Detoxification.

Neither Drug Free America Foundation nor it’s pretend “Institute” on Global Drug Policy is a scientific organisation. The purpose of the IGDP is spelled out on the DFAF website:

The Institute is charged with creating and strengthening international laws that hold drug users and dealers criminally accountable for their actions. It will vigorously promote treaties and agreements that provide clear penalties to individuals who buy, sell or use harmful drugs. […] The institute supports efforts to oppose policies based on the concept of harm reduction.

Over recent years some rather spectacular junk science was produced by Dr. Colin Mangham, (then) president of the Drug Prevention Network of Canada. Whilst harm reduction initiatives save countless lives per year Mangham’s DPNC claims it “leads to terror, degradation and the eventual death of the addict”. Consequently Mangham writes accordingly and publishes in the discredited Journal of Global Drug Policy and Practice. In volume 1, issue 2; Summer 2007, Mangham wrote a critique of Insite’s “parent philosophy”.

In a stunning display of self sabotage he churned through 20 peer reviewed articles from journals including The New England Journal of Medicine, the Lancet and The British Medical Journal. All articles had published positively on Insite’s potential. Primarily Mangham used largely belief, irrelevance, moral outrage and assumption to mount his criticisms. The Royal Canadian Mounted Police (at that time opposed to Insite) had commissioned the review and later dismissed it themselves because it “did not meet conventional academic standards”.

It’s impossible to miss Mangham’s primary evaluation targets on his self-annointed meandering journey to Super Scientific Autonomy. Evan Wood, Julio S G Montaner and Thomas Kerr.

Conservative health minister, Tony Clement, desperate for even a hint of science to uphold the government’s case against Insite seized upon it as validation. In Canada’s National Review of Medicine, September 2007, Clement is quoted as saying to the Canadian Medical Association:

There has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite.

The article continued:

But extensive research has shown Insite is successful at reducing crime and overdoses, getting addicts into treatment and saving money.

Asked what research Mr Clement still needs to see in order to make his decision, Erik Waddell, a spokesman for Mr Clement, answers, “To see if Insite is getting people to programs to help them get off drugs.” However, the NEJM study, published June 9, 2006, concluded that Insite increased admissions into detoxification programs and addiction treatment.

The piece, written by Colin Mangham, PhD, argues that the studies carried out by researchers from the BC Centre for Excellence in HIV/AIDS and elsewhere have been flawed and misleading. Questions about the article’s trustworthiness have arisen. Dr Mangham is the president of the Drug Prevention Network of Canada, an organization run by former Conservative MP Randy White, and has previously written commentaries criticizing the philosophy of harm reduction….

Writing in Open Medicine on September 7th, 2007 Thomas Wood noted the unscientific nature and discredited status of Journal of Global Drug Policy and Practice. He further highlighted that the non scientific conservative lobby group Drug Free America Foundation and it’s ill disguised front shop (the so-called Institute on Global Drug Policy) were behind this ambitiously named “new research”. Wood calmly observed:

We stand by the published findings from the evaluation and believe that the limitations of the research are well described in these published reports. We agree with Colin Mangham, however, that there are many instances where media reports go beyond what is described in scientific studies. A colourful example of this is the large amount of media attention given to Mr. Mangham’s recent essay in the Journal of Global Drug Policy and Practice which was funded by the Royal Canadian Mounted Police.

As scientists, we are strongly in favour of scientific debate and academic critique, but we believe what is contained in Mr. Mangham’s essay falls well short of this. The paper is fraught with a host of outright factual inaccuracies and unsubstantiated claims, which we would be happy to list should the readers of Open Medicine wish. We strongly encourage the readers of Open Medicine to read Mr. Mangham’s essay alongside the various reports examining Insite’s impacts and to judge for themselves the state of the science in this area.

Yet Dr. Colin Mangham was beyond saving. None would come to his aid. From mountain top to valley floor, from deep blue sea to desert sand, from darkened ghetto to opulent penthouse from… okay, you get the idea – his demise was complete.

By September 30th, 2007 Wood, Montaner, Kerr and Mark Tyndall had submitted to The Global Journal on Drug Policy, an article questioning the conservative Canadian government’s treatment of the scientific process and evidence. The abstract includes [bold mine]:

Although the recommendations of scientific review bodies have traditionally been free of political interference in Canada, there have recently been growing concerns raised about Canada’s new federal government’s treatment of scientific processes and evidence. This concern is relevant to the scientific evaluation of Canada’s first medically supervised safer injecting facility… […]

This commentary describes what may be a serious breach of international scientific standards relating to the Canadian government’s handling of the SIF’s scientific evaluation, and the circumstances which eventually led to a moratorium on SIF trials in other Canadian cities.

The genesis of such striking criticism was the government’s observance of a single cancer in illicit drug policy. One that had metastasised into Colin Mangham’s Drug Prevention Network of Canada, DFAF’s unscientific Institute of Global Drug Policy and the dumping ground for all conspiracy pieces by those opposed to progressive HIV control and human rights observance, the Journal of Global Drug Policy and Practice. The Australian arm of DFAF is Drug Free Australia.

Added to this was a petition signed by over 130 physicians and scientists. Released the day after Clement’s speech noted above, it condemned the government’s “potentially deadly” misrepresentation of evidence for harm reduction programs. This misrepresentation encompassed “the overwhelmingly positive evidence” of Vancouver’s Insite safe-injection site.

In September 2008 The Lancet Infectious Diseases, published Illicit Drug Addiction, Infectious Disease Spread and the need for an evidence based response, by Wood, Montaner and Kerr. It included:

To our knowledge, this is the first time a lobby group such as the Drug Free America Foundation has created for itself a venue for the dissemination of opinion essays, which to the untrained eye could easily be mistaken for a scientific journal

There is no doubt that in just a couple of years, Montaner, Wood and Kerr continually exposed and dismantled a politically driven, pseudoscientific ideology and it’s masters simply by addressing the evidence at hand. One could be forgiven for thinking these chaps might be upsetting a certain group of fundamentalists.

By this time a suit had been filed with the BC Supreme Court arguing closure of Insite would violate the Charter right of Insite patrons regarding “security of the person.” As late as May 2011 the federal government was still claiming indecision of whether to keep Insite open or not. As this was in contrast to Clement’s previous statements everybody had heard enough from the government. On May 12th the Supreme Court reserved it’s decision on whether the government could close Insite or not. On September 29th, 2011 the Canadian Supreme Court ruled unanimously to uphold Insite’s exemption from the Controlled Drugs and Substances Act, allowing indefinite operation.

A win for human rights, humane disposition and indeed for evidence based public health.

Almost certainly planning revenge for months prior was a team under Drug Free Australia’s Secretary, Gary Christian. Consisting of three Aussies of biblical repute: Joe Santamaria, Stuart Reece and Gregory Pike. Also included was present DFAF board member yet past White House Drug czar and former first director of NIDA, Robert DuPont. Finally, none other than one disgraced PhD holder, Colin Mangham.

The Lancet report, Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study published in April 2011 was compelling evidence on reduced overdoses in a vicinity around Insite, and accepted by the Supreme Court. The problem for DFAF was that three of the five authors were Kerr, Montaner and Wood. The same three who had demolished so much of the amateur ideologists and DFAF’s non scientific lobby groups.

On September 13th hoping to besmirch the reputations of these men, the team struck. They released a collection of misleading claims cobbled together in a free range “analysis” enveloped in thunderously accusatory tone. It was designed to rebuke harm reduction in general and injecting facilities specifically. In this light it inexplicably republished many of Mangham’s already debunked criticisms as if new, misrepresented existing reputable studies by comparing unrelated data sets and publishing outright falsehoods.

If we dig up Clement referring to Mangham, from the National Review of Medicine September 2007, we can almost hear the echo:

There has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite

Fortunately history did not repeat. This re-choreographed material has been addressed more than once and found to be entirely baseless on each occasion. Despite the pollution of the material by Colin Mangham’s unprofessional accounts it becomes stranger when we note the “analysis” was conducted for Mangham’s Drug Prevention Network of Canada and REAL Women of Canada (the only supporting interveners for the government during the Supreme Court hearing).

Predictably published in the DFAF funded opinion rag Journal of Global Drug Policy and Practice, it’s accompanying media release included:

Three Australian doctors are part of an international team which has exposed major, inexcusable errors in a highly influential 2011 Lancet study on Vancouver’s Insite injecting facility, errors which nullify the study’s claim that it has demonstrably reduced overdoses in its immediate surrounding area. 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.

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.

A full two more paragraphs are spent attacking the individual researchers for acting dishonestly, much of which relies on the already debunked material from Mangham 2007. Using bitterly crude figures to inflate “overdose” deaths – including suicides and homicides – they maintain the authors “knew” they were acting dishonestly. They challenge the findings by increasing the sample area by a factor of 10, and hold this against the original sample area.

Christian’s team selectively quote the Lancet authors earlier work on displacement of users from the area due to an increase in policing. This would be a splendid point were it not that “this policing initiative ended within weeks of Insite’s opening and was not ongoing throughout the study period”. This claim was also a resurrection of Mangham’s still unpublished and disgraced 2007 academic corpse. The vicious “media release” finished:

Drug Free Australia’s Research Coordinator, Gary Christian, said, “…. Inexplicable errors and memory lapses is the price the Canadian government has paid for entrusting injecting facility lobbyists with its scientific evaluation. 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.”

A complaint was lodged with the University of British Columbia by Mr. Christian. This and the JGDPP piece were independently reviewed and found to be “without merit”.

Yet so many questions arise as to why this apparently devastating material was not presented in court. When I first asked Mr. Christian on December 2nd he took a superior tone claiming that they could not because they did not have it available until September 2011. “It would have been a good point but for you not checking your facts”, he replied. Let’s review these facts I supposedly failed to check.

On June 8th, 2011, the (new) President for Colin Mangham’s Drug Prevention Network of Canada, Gwendolyn Landolt insisted that data supporting Insite is flawed. In an extraordinary claim (for June) she asserted in a letter to Canada’s National Post that OD’s had actually increased around Insite in most years since it had opened and thus, Thomas Kerr was in error for accusing DPNC as presenting misinformation (as he had earlier done):

Mr. Kerr tried to discredit a report from the B.C. government — which stated that since the site opened, the area has seen an increase in drug-induced deaths every year — by claiming that it included deaths unrelated to drug use

I say! That claim seems to be lifted straight from Christian’s September debacle. The one they didn’t have… until, er… September. And what do we read on page 2 of Christian’s piece about “a report from the B.C. government”, also mentioned above?

The claims of this article are very curious from the outset, simply because a review of the statistics by the British Columbia Coroner’s Service, found at clearly indicates the contrary – since Insite commenced operations on 21 September 2003 illicit drug deaths have very clearly and unmistakably increased, not decreased.

Okay, the same claim. So they had access to this data 2 1/2 years before the Supreme Court sitting in May 2011. Every other accusation – the impact of policing, the supply of drugs, criticisms from Mangham go back to 2007. Other papers and studies used are also well before 2011. That the president of the Drug Prevention Network of Canada is shooting off unpublished material in response to a May 30th statement by Kerr suggests they were keeping their powder dry.

I put this to Mr. Christian on the same day he dismissed my poor fact checking (December 2nd). He replied on December 10th as follows:

I have received an e-mail back from Gwen Landolt of Real Women of Canada explaining that Colin Mangham’s work was not admissable to the Supreme Court because it was not available for lower court hearing. The truth, Paul, is that there were court-imposed limitations on evidence which have nothing to do with your fanciful fabrications here.

Okay. So the material was available (despite his earlier claims it wasn’t), but could not be submitted due to “court-imposed limitations on evidence”. My “inability to check facts” had disappeared in a puff of reality, but was now replaced with my “fanciful fabrications”. Oh dear!

Of course before the Court in May, the government was armed with the figures mentioned, but had stated it had “no evidence” to submit. So, a day later on December 11th, 2011 I replied in part to Mr. Christian:

The time to strike was in the Supreme Court. Exactly why information from 2007 (Mangham) and 2008 (BC report on OD’s) was not admissible for lower court hearing in 2011 is a question best answered by your colleagues, Mangham and Landolt. If there is a genuine technical reason I would be grateful if you could provide it.

Otherwise it must remain possible, indeed probable, that it was excluded due to a.) the paucity of evidence presented by Mangham in attempting to debunk 20 peer reviewed studies from esteemed journals, and b.) that the BC report on OD’s was irrelevant as a variable effecting the efficacy of Insite and thus the SC sitting itself.

If so, this renders Landolt’s comments to the media and your own use of both sources impotent.

Failing this, you must explain… exactly why it was unavailable given 4 and 3 years respectively to craft an effective rebuttal of Insite’s success with these figures.

What were those “court imposed limitations” and why were they not mentioned in your article or your media release which explicitly referred to the [Supreme Court] decision as influenced by the Lancet article and “harm reduction activists”?

As one may expect those points have never been addressed. No-one is any more the wiser as to why this apparently cutting edge demolition of the court accepted Lancet article, was not itself either in total or in substance, presented to the Supreme Court. Are we to believe an ambiguous and unmentioned “court imposed limitation” prevented the exposing of “research fraud and professional misconduct” by five authors in one of the world’s most prestigious journals, the Lancet? That these supposed academic crimes were overlooked by the Supreme Court of Canada, as they examined the material in question itself?

Or shall we accept the demonstrable trend and tone exercised throughout the ideological attempts to sabotage Insite, is now manifestly clear as an attempt to smear researchers and their work? As the media release claimed, “dozens of other Insite studies that must now be under a cloud as a result”.

The anti-drug brigade may be cruel but they are not stupid. I point this out to Mr. Christian very clearly above, and still await a cogent reply. An academic mirage supposedly good enough to undermine the work of five authors. But not offered in objection to their work. What then was it’s purpose?

It was clear any such opinion from known offenders would have no bearing against over 30 papers in 15 peer reviewed journals. The singular attack upon Kerr, Wood and Montaner is striking. Christian has never answered my queries, preferring to accuse me of “imaginations and suppositions” without facts. Exactly why this argument was not published anywhere until after the Supreme Court hearing has never been made clear.

Why it was not raised by DPNC or REAL Women of Canada (both for whom the final “analysis” was supposedly written) in court is unknown. “No evidence”, was the official position.

Yet Gary Christian gives the game away himself. On November 30th, 2011 I had written in response to his refusal to accept his ploy was found to be “without merit”:

You write as if Montaner and Kerr are under scrutiny. You had your chance. It and the complaint have been found to be without foundation.

He replied on December 19th suggesting conflicts of interest assumed on his part override the independent analysis of his attack. He offered two mundane sources and extraordinarily suggests intentional favouritism on the part of the University of British Columbia and independent reviewer, Dr. Mark Wainberg toward the Lancet authors:

Of course our complaint to the University of British Columbia was not progressed because Dr Mark Wainberg absolved Dr Montaner, Dr Kerr and Dr Wood of any errors in their Lancet article, claiming that it was exemplary science.

However, if you look at the relationship between Wainberg and Montaner, I think that you will find that the relationship breaches the most liberal guidelines in the corporate or political world as to who is qualified to conduct an independent inquiry. […]

Now tell me that the University of Britush Columbia’s ‘Independent Advice’ was absolutely according to the common understanding of independence.

More accusations of corruption. More suggestion of conspiracies. More of the same junk.

What were these devastating pieces of insight? At a meeting of the International AIDS society, 2009 Julio Montaner congratulates, “my friend and colleague, the esteemed Dr Mark Wainberg” on getting the conference to Durban in his capacity as IAS president. The other is a humdrum op-ed piece written with Stephen Lewis on urging the Canadian government to ensure HIV/AIDS therapies remain central topics.

To this day Gary Christian remains unapologetic and impervious to volumes of criticism and questions generated by his single opinion piece. There has been no apology, no explanation nor any correction of demonstrable falsehoods.

Attacks on Evan Wood, Julio S G Montaner and Thomas Kerr however, continue apace.

The “drug free” ideology is as free from compassion and evidence as it ever was.