Discuss the concept of harm reduction and compare it to the notion of zero tolerance (or total abstinence): evaluate both as approaches to either.
1. Public policy approaches to drug use
When dealing with the concept of illicit drug use on its different levels (manufacturing, distribution and consumption), government legislation has always had to make the innate decision between the notion of harm minimization, versus total prohibition when deciding it policy direction.
The foundations of Australia’s drug policy dates back to a rationale of xenophobia and maternal ties to Great Britain and wartime allies. Laws governing the distribution and use of cannabis, and later heroin, were based on the compliance to international convention (Moore & Wodak, 2002).
From this questionable establishment, Australia’s stance of prohibition was created against any problematic evidence. This has been the primary policy fuelling the ‘war on drugs’, which is commonly referenced today.
The concept of harm reduction however is far more recent, and has been a more prevalent topic since the birth of the National Campaign against Drug Abuse in 1985 (Wellbourne-Wood, 1999).
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This was brought about in the effort to limit the spread of blood born viruses via needle exchange programs and safe sex education (McConnel, 2002), which was further legitimized by the threat of HIV/AIDS, which remains a public health success story. Both policies share similarities in their views on supply and demand reduction, but where harm minimisation differs is its focus to a holistic approach to harm reduction (Mendes, 2004).
This introduces the ideas that drug use should be viewed as a public health issue, rather than criminal affair, as well as being a morally neutral stance accepting that drugs will remain part of society, and that while they exist the government has a responsibility to develop and implement public-health measures designed to reduce drug-related harm, both to individuals and the wider community (Mendes, 2004).
Politically there are arguments for and against either policy. This suggests that, instead of debating whether to invest public money in drug law enforcement or treatment measures, policy makers should concentrate on determining the optimal mix of enforcement and treatment. (Lind & Weatherburn, 1999).
In 1992, the figures indicating this balance show that Commonwealth and state governments spending for drug enforcement was 84% ($A600 million), while only 6% went towards treatment, and 10% on research and prevention (Moore et al, 2002).
This obviously presenting a vast distribution of resources to the prohibition of illicit drugs.
One such argument for zero tolerance claims that with such a heavy focus on enforcement, there is a much higher perceived risk amongst potential drug users, serving as a deterrent for mostly youths, claiming the “the risk wasn’t worth it” (Lind et al,1999).
Further arguments are that the two most common, leagalised drugs being alcohol and tobacco account for a far more prevalent exposure amongst Australians, with 80% consuming alcohol, 20% being tobacco users, and approximately 16% being illicit drug users(NDS household data survey, 2007).
The inference from these figures being that the legalisation and regulation of alcohol and tobacco has not faired well in decreasing their burden of disease (Cancer Council of Australia, 2009), while the illicit drugs under prohibitive laws represent a much smaller prevalence, and therefore expenditure. This knowledge is often also shown in conjunction with using the 2001 Heroin drought as a case study. This was an example of how the supply control of heroin lead to significant falls in consumption, expenditure, and a decrease in the rate of overdoses in NSW (Marlatt, 2002).
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It is these impressive acute figures, the variety most valuable to a politician, that account for the lopsided expenditure. Using this, an evaluation can be drawn that the prohibition of illicit drugs has made them far less common in society when compared to legalised substances, and are therefore a lesser burden on society, making it a positive and appropriate policy approach. This is a very traditional, simplistic and numerical way of observing the effect of drugs on the wider community. Testament to this is that while the heroin drought did in fact reduce burden in Australia, it also drove both a cocaine, and crystal methamphetamine epidemic that is widely seen today. It is this very argument that plays into the hands of a harm minimisation approach when performing a comparison.
First and foremostly, harm minimisation is an evidence based approach. The number of injecting drug users has been doubling every ten years since the 1960’s (Moore et al, 2002), and drug overdose deaths have risen from 6 in 1964, to 958 in 1999 (Moore et al, 2002).
The evidence shows that in light of prohibitive laws, drug use has risen exponentially, and is becoming more prevalent in younger demographics. Compared with the harm minimisation approach towards the HIV/AIDS outbreak in the mid 80’s, it is difficult to comprehend why the concept is not given greater contemplation. A $10 million expenditure was shown to have prevented 2,900 HIV infections, and saved $280 million (Moore et al, 2002), through education and syringe exchange programs. As mentioned, only 16% of expenditure towards illicit drugs was for harm minimisation, with the rest for law enforcement. This also introduces the most differentiating principle between the policies of a holistic approach, by not only recognizing the individual, but the wider community as well. It does not follow the public moral condemnation of drug use as encouraged by a prohibitive approach, but takes a morally neutral stance by offering a pragmatic solution benefiting the user, and the community. This to many may seem to take the form of facilitation, such as a safe injection site or methadone programs, but it is this neutral stance that allows it to work. In areas where needle syringe programs were introduced, HIV prevalence decreased 18.6%, compared to an increase of 8.1% in areas that did not (McConnel, 2002).
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Similar can be said about hepatitis C, in that by 2000, 90% of hepatitis C infections were attributed to the sharing of needles. The incidence and prevalence of this has now begun to see a decrease since the establishment of harm reduction programs (Moore et al, 2002).
In both cases, prevalence decreased without taking a criminalising standpoint on drug use, increasing the potential engagement of safe practices by drug users, by making such precautions as easily accessible as possible. It is pragmatic in the sense that it deals with the reality that illicit drugs will always exist, where a zero tolerance policy’s outcome is that it will one day be cured. To deny this is denying the most gravitational economic force of supply and demand. If the heroin drought was to demonstrate the stem of supply, it also shows how demand is met elsewhere with other drugs, and has been the case for the entire lifespan of prohibitive laws. This is why alternate means of dealing with the situation is needed. If legalisation contains a moral bias, and criminalization has been empirically shown to be ineffective, then a third means of regulation needs to be introduced (Moore et al, 2002).
It deals with the practicality that the epidemic cannot be properly policed, and focuses on the neutral stance of reducing unnecessary secondary burdens, such as crime or spread of disease, to be experienced by both the users and community in increasing overall health outcomes, as it has been shown by evidence
We today are fortunate to have the hindsight of a century’s worth of prohibitive drug policies. They were originally introduced for the wrong reasons, and present times do not show a need for them either. A zero tolerance policy is yet to produce evidence pertaining to its outcomes of eradication. A harm minimization approach allows for a morally neutral standpoint, putting forward pragmatic solutions, for both the individual and the community showing evidence of decreased prevalence, and the easing of its financial burden.
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Cancer Council of Australia (2009) retrieved from http://www.cancercouncil.com.au/editorial.asp?pageid=371 on 20/4/10
Lind, B. Weatherburn, D. (1999) NSW Bureau of Crime Statistics and Research. Heroin harm minimisation: Do we really have to choose between law enforcement and treatment? Retrieved from on 20/4/10
Marlatt, G. (2002). Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors. Guilford Press
McConnel, B. (2002) One policy Australia cannot afford to abandon. Retrieved from http://www.ffdlr.org.au/commentary/docs/HarmMinimisation.htm on 20/4/2010.
Mendes, P. (2004) Zero tolerance vs harm minimisation for drug policy: there is another way. Retrieved from http://www.onlineopinion.com.au/view.asp?article=2026, on 20/4/10
Moore, T. Wodak, A. (2002) Modernising Australia’s drug policy, UNSW Press
NDS Household Data Survey. (2007) retrieved from on the 20/4/10
Wellbourne-Wood, D. (1999) Harm reduction in Australia: some problems putting policy into practice. International Journal of Drug Policy, Volume 10, Issue 5, Pages 403-413