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Overdoses - A Kitbag of Solutions by Brian McConnell, Families and Friends for Drug Law Reform (ACT) Inc. (Australia) The most significant contributing factor to overdose deaths from heroin is our current punitive prohibition laws. In the ten years preceding introduction of prohibition of heroin in 1954 there were no recorded deaths despite there being a number of people who were dependent on heroin. Some 41 years later in 1995 the death rate had risen to 550 (Australia) and from all evidence available is continuing to rise. This article explores a range of measures to be included in a kitbag of solutions. It concludes that the most significant contributing factor to overcoming the problem in the future will be families. Prohibition has failed A great many people throughout Australia agree that prohibition has failed. In the words of Nicholas Cowdery, the Director of Public Prosecution in NSW, "it has been proven beyond a reasonable doubt that prohibition has failed." The United Nations body responsible for controlling narcotic drugs also concedes that it has not succeeded. What you will find is that although there is an acceptance that prohibition of drugs has failed there is disagreement on what should come after prohibition. Most fear that if anything is changed then more young people will use drugs and thus they conclude that more will die. What they do not acknowledge is that prohibition concentrates the harms in an unintended and inhumane way on a certain group of people. Prohibition contributes to poor or inefficient drug education, unknown quality or purity of the drug; overdose, marginalisation of members of society to the extent that in many cases help is not forthcoming or given reluctantly or given with conditions, increasing profit in trade of illegal drugs, increasing crime (both organised crime and robberies), increasing corruption and the list goes on. Prohibition policies have imposed the greatest obstacles to reducing overdoses by the fear and prejudice to which society has been conditioned over the years. Prohibition was supposed to protect our young, our children - provide an impermeable barrier through which no drug can ever pass. The majority of the people who die are young people, in Australia half are under 30 years of age and can be as young as 13. Some as young as 11 are using heroin. We have poured money into the problem but the problem has become worse not better. We have tried surveillance cameras in shopping centres. The dealers and the users have simply moved ten paces to the left. We have tried surveillance cameras in school toilets and we have expelled students caught with drugs in school (mostly marijuana but rarely alcohol or tobacco). What is the answer? But what is the answer? What is the magic bullet that will prevent overdoses once and for all? There is of course no one magic solution. This is not an engineering problem. It is not like solving a problem of how to store sufficient water from the local river to last through the dry season. You cannot build a dam to hold back the drugs. A Kitbag At a drug debate forum recently on a TV program, I listened closely to the many views and opinions. One thing that struck me was that most seemed to be pushing their own particular solution to the exclusion of all others. None recognised that there was no one simple solution. It occurred to me then that a kitbag of solutions is required. Kitbag is a canvass bag in which soldiers carry their belongings. Used here as a metaphor for things that a "soldier" fighting against "the war on drugs" might have. I present here some suggestions for items to be included and a process for selecting what will go in. Criteria for Inclusion in Kitbag From a parent's perspective the criteria for selecting what should be included as important. I was impressed by Dr Robert Haemmig's response to people who asked him "how can you prescribe an illegal drug such as heroin to a dependant user?" He replied by saying he applies the following four ethical steps: Does it reduce mortality? Does it reduce morbidity? Does it ease suffering? Does it do no harm to the person concerned? Quite clearly as demonstrated by the results of the Swiss trials he said he was able to answer "yes" to all four ethical tests. We should adopt these criteria for items that might be put into my kitbag, no matter that it be a medical treatment or a change in the law. This implies however, rigorous and scientific testing or demonstration by objective evidence. The First Items I propose including the following in my kitbag: A policy that police not attend overdoses. The police can often exacerbated the situation when the ambulance is called for an overdose. A normally law abiding citizen when confronted by the law at a time when he or she is particularly vulnerable can make a difference between life and death. In the ACT, the police now have an official policy of not attending ambulance calls for overdoses. This goes a long way toward reducing the harm to the individual drug user whom for whatever reason accidentally overdoses. A no penalty policy that would encourage a call for help. On Monday October 23 1995 Sydneysiders woke to find a picture of a young girl plastered across the early morning papers. She and her three friends had taken ecstasy to enjoy a night of dancing. Within a short time she felt unwell. She started to vomit and was taken to the toilets where her friends took turns in looking after her for up to 6 hours according to some media reports. The young girl was obviously not getting any better. She had a high fever and was by this time almost incoherent. Her friends did not want to call an ambulance to take her to a hospital, for fear of the consequences - both legal and parental. She was finally taken to one of her friend's homes. At 10 am, some ten hours after becoming sick, the young girl now in a seriously dehydrated state, was found by the friend's mother who instantly raised the alarm. But it was too late. Consider for a moment what the outcome might have been if the law had been such that the young girls friends had not been afraid of repercussions from the law. Would they have raised the alarm? Yes I think so. And they might not have been afraid of parental repercussions because of a more enlightened attitude on the parents' part. A policy that police not become involved in personal use of illegal drugs unless there is a greater risk to the community. We can adopt the enlightened approach of the Netherlands where, although the sale and use of certain drugs are illegal, the police do not intervene at the user level unless it is in the greater good of the community to do so. What good does it do for police to chase ambulances when there is a drug overdose? What good does it do to give a young man a criminal record and ruin his future life chances because he had a roach in his car? What good does it do to apprehend a young man for possession when he is doing the right thing and returning his used syringes to the needle exchange? Earlier this year I was in Netherlands and I saw people in a bar having a drink talking to friends or reading a newspaper. In the café next door I saw people drinking coffee, talking to friends or reading a newspaper. I walked on and I saw people in a coffee shop smoking marijuana, talking to friends or reading a newspaper. I saw paternalistic police on duty outside talking pleasantly to any who approached them. I saw them helping a young man who was unsteady on his feet, steering him away from the canal so that he would not fall in. He obviously had drunk too much coffee! Drug related deaths in the Netherlands in 1994 was 2.4 per million of population whereas in Australia it is over ten times that rate at 28.3 (and Sweden which I mention in parenthesis because their system is often held up as an example has 23.5 deaths per million of population). A policy of truth in drug education and education for the whole community and in particular for families. Careless handling of the truth can have an effect opposite to that expected once exposed as a lie. Our young people are not empty vessels to be filled with propaganda; they do think and make decisions for themselves. Once a young person sees the lie, any other valid message can be lost. In 1937 the US made a film called Reefer Madness. It grossly exaggerated how people turned into homicidal maniacs, totally losing control by smoking marijuana. In the ACT this film now has a cult following and by popular request the film is shown regularly. Patrons get stoned and go and watch the film. The proposed ACT heroin trial would certainly be included as a very positive addition to the kitbag. The proposed ACT Heroin Trial which has now been postponed by Australia's Prime Minister, John Howard, promises to be a treatment method with the greatest promise for severely dependent users. The outcomes of the Swiss trials gives very positive indications of how successful this treatment might be. After three years participants' health was improved, homeless reduced and criminal activity reduced substantially. While critics might say that few became abstinent one must remember that this was not the purpose of the trial. The trial was to determine whether provision of medically supervised clinical grade diacetylmorphine would improve health and to reduce deaths and crime. There were no overdose deaths for those on the trial. For me, that last point would be sufficient to include the trial in my kitbag. Families and friends are important ingredients Many dependent users who now have their drug use under control state that the support of family or friends has been a significant factor. To the kitbag I would then add courage, strength, compassion and love. Courage and strength for families to go through what is or will be a most difficult time. From the time they find out their son or daughter is using illegal drugs they will need the courage to educate and inform themselves. They will need the courage to listen to their instincts and reject the well-meaning but often ill-informed advice that they will be given. They will need the courage and strength to stand by their child in very difficult times. Some of which they may not wish to acknowledge but will be there nevertheless. I would give them courage and strength also to speak out. To call for a change because their child, relies for survival on a daily injection of heroin but unlike a person with a normal problem that can be dealt with by simple prescription, has to deal with the black market to obtain a drug of unknown strength and composition. To have the strength and courage to call for change, to speak out about these things and demand that things be different. It will be too late to help a dead child. In a whimsical moment I would also add some leadership and courage to the kitbag so that our political and community leaders may use it to give them the leadership and courage to fight for the lives of our young. Conclusion In conclusion I would have to say that the most important ingredient must be the families and their courage in speaking out. When middle Australia calls out for a change, whether it be to stop the overdose deaths of our young people or from concern about the crime and corruption, then our leaders will have no choice but to listen. Then we might make some real progress! Families and Friends for Drug Law Reform (Australia) Inc. is committed to preventing tragedy that arises from illicit drug use. FFDLR was formed as a direct result of heroin related deaths in the Australian Capital Territory. It believes that prohibition laws are more the problem than the solution. It seeks laws and policies which will eliminate the deaths and minimise the health and social harm. Its members include parents, siblings, friends, past and present illicit drug users and other concerned members of the community. For more information write: FFDLR · PO Box 36 · HIGGINS · ACT · 2615

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