Zero tolerance vs harm minimisation for drug policy: there is another way

Recently, Prime Minister Howard and Opposition leader Mark Latham engaged in an incredibly unconstructive debate about illicit drugs. Howard reinforced the government’s commitment to a zero-tolerance approach, and attacked the ALP for taking an allegedly permissive approach to heroin injecting rooms. In reply, Latham backed down on the official ALP policy of supporting injecting rooms, suggesting that the existing Kings Cross trial could be a “one off”.

Neither Howard nor Latham seemed to understand that the illicit drugs debate goes well beyond the relatively marginal (albeit highly publicised) question of support for or opposition to injecting rooms or prescribed heroin. Rather, any solution to illicit drug use and abuse needs to consider its connection with broader social inequities and injustices.

Yet currently Australian illicit drugs policy is trapped into a simplistic divide of harm minimisation vs zero tolerance. Harm minimisation has been the philosophy underpinning Australia’s national drug strategy since 1985, and is generally taken to refer to policies and programs designed to prevent and reduce drug-related harm through the use of three “balanced” strategies: Supply-reduction is designed to disrupt the supply of illicit drugs through the use of law enforcement strategies; demand-reduction strategies are those designed to prevent the uptake of harmful drug use; and harm-reduction strategies are those designed to reduce drug-related harm for individuals and communities.

Harm reduction emphasises three core principles: First, drug use should be viewed as a public-health issue, rather than a criminal or legal issue. Second, harm reduction is morally neutral and accepts that illicit drugs are and will remain part of our society. And third, while harm reduction does not involve support for illicit drug use, governments acknowledge that as long as injecting-drug use continues to occur, they have a responsibility to develop and implement public-health measures designed to reduce drug-related harm both to individuals and the wider community.

However, Prime Minister Howard opposes many of the key components of harm reduction such as supervised injecting facilities or heroin trials, and instead favours a zero-tolerance approach. This model views drug use narrowly as a criminal and moral issue, rather than one of public health. Consequently, Howard favours law enforcement over public and social-health interventions, and prioritises abstinence rather than harm reduction. Most importantly, zero-tolerance approaches ignore the broader social and /or economic factors that may contribute to illicit drug use. They identify drugs and individual drug abuse as the problem per se, rather than seeing them as the symptom of broader social abuses and inequities.

While popular depictions of the drugs problem suggest that illicit drug users come from all walks of life, the reality is rather different. There is considerable evidence to suggest that most heroin addicts come from poor or socially disadvantaged backgrounds. There is also evidence to suggest that many of those users who do come from middle-class or affluent backgrounds have experienced significant personal trauma involving violence, abuse, and/or grief.

For example, the Swedish social work academic Ted Goldberg identified a number of factors that were likely to contribute to increased heroin use. These included high unemployment, limited access to education, segregated housing, racism towards newcomers, and traumatic refugee experiences. Other important psychosocial factors included parents who were alcoholics, experience of physical, sexual or emotional abuse, and poor family relations. Similarly, a number of local reports have identified illicit drug use with socio-economic disadvantage and emotional disorder. Thus heroin use can potentially be seen by users as a solution to deep-seated social, economic, and emotional problems.

These reports suggest that holistic policy responses must target both the personal and social causes of illicit drug use. Solutions would need to incorporate both structural supports around finances, health care, employment, and accommodation, and personal therapeutic support around trauma and relationship issues. Here’s a chance for Mark Latham to move beyond the tired old harm minimisation/zero tolerance divide, and introduce some new ideas into the illicit drugs debate.