Unpacking+the+effects+of+drugs+from+the+effects+of+prohibition

=Unpacking the effects of drugs… = = …from the effects of prohibition = Student no: n4728742 Name: Mikael Almond Tutor: Jey Rodgers Three stills from Stuart McMillen’s comic // WAR ON DRUGS // [] ||
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The Artefact
This artefact depicts a set of three stills from a web comic called //WAR ON DRUGS// by Stuart McMillen. These stills summarises the theme of his web comic; that many of the problems surrounding drugs developed as a result of the prohibition and abstinence policies rather than as a result of the drugs themselves. In his comic, Stuart McMillen explores the parallels between the 1920s prohibition of alcohol in the United States of America and the current prohibition and abstinence policies and challenges that there is intelligent debate to be had on the topic.

The Public Health Issue
In his comic, Stuart McMillen draws parallels between the current war on drugs and the 1920s prohibition of alcohol in America. Like the prohibition of alcohol, current abstinence policies designed to stem the supply and use of drugs has done little to extinguish the desire to partake in drug use nor their availability and access. Instead it has led to a rise in gangs and violence, a thriving black market, dubious quality with extreme health risks, corruption, crime, homelessness and a variety of mental disorders. Using the work by free market economist and Nobel laureate Milton Friedman who in 1971 predicted all of these outcomes, Stuart proposes to

//“understand which of our problems come from the drugs themselves… // //…and which problems come from the drugs being illegal.” //

He recognises that drugs can consume and ruin lives, but can also provide fun, positive experiences.

Literature Review
Harm minimisation policies and programmes are intended to decrease the adverse health, social and economic consequences of drug use. Wodak (1999) explains such policies and programmes view illicit drug use as a health and social issue rather than the traditional view of a criminal justice problem. Similarly Brook and Stringer (2005) describe it as a competition between ‘science’, serving a harm minimisation approach, and ‘politics’, serving the abstinence and prohibition approach. They argue that prohibition strategies are crime-based and view the users as criminals, reinforcing and promoting anti-social behaviour and crime. A view echoed by Gupta, Parkhurst, Ogden, Aggleton, & Mahal, (2008, p766) who suggest drug control policies that stigmatise and marginalise drug users can act as barriers to medical and social services and foster high risk behaviours such as sharing equipment and sex work.

Despite international evidence that rates of drug use are not directly affected by harsher punishments of drug users, there mains concern that harm minimisation approaches could cause an inevitable increase in the prevalence of drug use with the assumption that this would increase the extent of drug-related harms. (Reuter & Stevens 2007). This was put to the test in 2001 when Portugal lifted all criminal sanction on the //personal// use of illicit drugs and committed substantial resources to dissuade use of drugs. The evaluation of the program has been positive both with respect to the health and social effects on users and the Portuguese civil society. In addition to finding no signs of significant expansion of the drug market in Portugal as feared, Hughes and Stevens (2010, p1001) linked the following developments in Portugal to the decriminalisation:
 * Small increases in reported illicit drug use amongst adults
 * <span style="font-family: Calibri,sans-serif;">Reduced illicit drug use among problematic drug users and adolescents
 * <span style="font-family: Calibri,sans-serif;">Reduced burden of drug offenders on the criminal justice system
 * <span style="font-family: Calibri,sans-serif;">Increase uptake of drug treatment
 * <span style="font-family: Calibri,sans-serif;">Reduction in opiate-related deaths and infectious diseases
 * <span style="font-family: Calibri,sans-serif;">Increases in the amounts of drugs seized by authorities
 * <span style="font-family: Calibri,sans-serif;">Reduction in the retail prices of drugs

<span style="font-family: Calibri,sans-serif;">Over the last decade there has been a significant policy shift in many parts of the world, recognising the importance of harm minimisation policies in controlling the health, social and economic impact of continued drug use. Australia’s harm minimisation approaches placed the country at the forefront of international efforts to constrain the harms resulting from these substances. Two decades ago Australia introduced the needle and syringe programs (NSPs) along with widespread methadone maintenance treatment (MMT) services. These have formed an integral part of Australia’s harm reduction strategy. The evidence supporting this approach to controlling the spread of blood borne viruses among injecting drug users is substantial.

<span style="font-family: Calibri,sans-serif;">MacDonald (1997) found HIV prevalence among injecting drug users using these programs has remained low at under 2%. These results have been replicated overseas for similar programs. The New York City syringe-exchange programs reported HIV incidence rate of 1.5/100 person-years at risk, less than one-third of the rate of 5.3/100 person-years at risk among drug injectors in the city who did not participate in the syringe exchanges (Des Jarlais et al., 1996). These findings are supported by Wodak & Cooney (2005).

(Mathers et al, 2008, p1742) || <span style="font-family: Calibri,sans-serif;">Both Mathers et al, 2008 and Stoové, Dietze, Aitken & Jolley, 2008 found mortality among injecting drug users in Australia to be far lower than it is in both the US and Europe. Studies in the US and Europe have reported considerable AIDS related deaths. Mathers et al, 2008 found HIV infections detected in less than 5% of the injecting drug user population in Australia supporting the results described earlier by MacDonald (1997). This is compared to 12% for China, 16% for America, 37% in Russia and higher elsewhere. The low prevalence of HIV infection among Australian injecting drug users is a testament to the effectiveness of Australia’s harm minimisation strategies in reducing the instances of blood born disease transmissions among injecting drug users.
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<span style="font-family: Calibri,sans-serif;">Despite success in reducing instances of HIV, prevalence of Hepatitis C virus remains high among injecting drug users who participate in needle exchange programs (Falster, et al., 2009, p109). The Australian Needle and Syringe Program (NSP) Survey, a cross-sectional study that has been conducted annually over a 1-week period since 1995, found little indication that transmission of HCV among participants changed between the period 1995 and 2005. Epidemiologically, duration of injecting was most strongly associated with instances of HCV in this study. However needle and syringe sharing along with imprisonment were independently associated with higher HCV prevalence regardless of duration of injecting (Falster, et al., 2009, p115).

<span style="font-family: Calibri,sans-serif;">The failure of zero tolerance and abstinence base treatment is none more obvious than in the prison system. Australia’s more recent toughening of drug policy is directing a disproportionate burden of drug-related illness into the prison system. Despite the efforts of correctional officers, illicit drug use in prison remains high. Levy, Treloar, McDonald & Booker, 2007 found 43% of women and 24% of men in 2001 reported injecting illicit drugs while incarcerated. The lack of sterile syringes for injecting means syringe sharing is unavoidable among incarcerated injecting drug users. The sharing of injection equipment within Australian prisons has led to outbreaks of HIV and HCV infection on a number of occasions (Dolan and Wodak, 1999). The prevalence of hepatitis C is extremely high among prisoners posing a significant risk to themselves, their family, prison staff and the wider community. Dolan, 2000 found on average one third of male prisoners and two thirds of female prisoners are infected with hepatitis C. Among injecting drug users both male and female, the rate is as high as 80%.

<span style="font-family: Calibri,sans-serif;">A significant limitation of many of these studies, including the Australian Needle and Syringe Program Survey, is that they rely heavily on self-reported usage and usage patterns. The Australian Needle and Syringe Program Survey sample only those participants in the Needle and Syringe program who volunteer. There is no coverage of users who do not participate in the program in addition to the potential for sample bias in that those with healthier habits may be more willing to volunteer their information leading to underestimation of the prevalence of disease. Likewise Mathers et al. (2009) found many a wide variance of the self-reported drug use and infection status of many countries.

<span style="font-family: Calibri,sans-serif;">Cultural and Social Analysis
<span style="font-family: Calibri,sans-serif;">In 2010, some 1,705 deaths were attributable to illicit drug use and thousands more suffered the short and long term health consequences of drug dependence, unsafe injecting practices and infections (Australian Institute of Health and Welfare, 2010, p49). Their families suffer with them from these consequences.

<span style="font-family: Calibri,sans-serif;">Formulated in 1985 Australia’s National Drug Strategy is built around 3 pillars: <span style="font-family: Calibri,sans-serif;">The strategy employs elements of an abstinence approach in achieving the first aim; harm minimisation approach for the third and elements of both for the second. Despite the gains made in Australia’s harm minimisation program two decades ago, since the landmark decision by the Howard government to embark on it’s ‘tough on drugs’ policy, this approach has more recently relied heavily on prohibition (Mazerolle, Soole & Rombouts, 2007). The current situation on illicit drugs is damaging Australian society and resulting in an unacceptable and avoidable death toll.
 * <span style="font-family: Calibri,sans-serif;">The first pillar is broadly aimed at reducing the availability of drugs through legislation and law enforcement.
 * <span style="font-family: Calibri,sans-serif;">The second pillar is concerned with reducing the demand for drugs through prevention and treatment.
 * <span style="font-family: Calibri,sans-serif;">And the final pillar of the strategy aims to reduce the harm of drugs among the people who continue to use them.

<span style="font-family: Calibri,sans-serif;">The effectiveness of harm minimisation strategies in controlling the spread of blood borne disease has been established in the literature review on this wiki. Further to this, harm minimisation strategies have demonstrated results in reducing the general health, social and economic impact of continued illicit drug use. Despite this evidence there remains significant opposition to the expansions of Australia’s harm minimisation policies.

<span style="font-family: Calibri,sans-serif;">The moral panic surrounding drug use is fuelled by the littering of streets and parks with used syringes and other drug paraphernalia, crime and public disorder from users. These create a sense of otherness between users and non-users and adds to the atmosphere of insecurity and violence.

<span style="font-family: Calibri,sans-serif;">According to the views of Brook and Stringer (2005, p321) prohibitionists capitalise on this by reinforcing a binary opposition between their view and competing views: if one is not committed to the idea that illicit drug use should be outlawed, one must be preaching the contrary position—that is, promoting drug use as a harmless recreational activity to be enjoyed by young and old. Prohibitionists use panic as a basis for policy.

<span style="font-family: Calibri,sans-serif;">Furthermore with harmful drug use most concentrated among lower socioeconomic groups, and the power to affect legislation and policy most concentrated among higher socioeconomic groups, Marxist social theory can clearly be applied for another perspective on this social class conflict and the failure of higher socioeconomic groups to enact legislation and policy that are appropriate and effective.

<span style="font-family: Calibri,sans-serif;">As Stuart illustrates in his comic, drugs can consume and ruin lives, but can also provide fun, positive experiences. Despite this, only the harmful aspect is acknowledged in public discourse, stifling the the range of acceptable public attitudes towards drugs.

<span style="font-family: Calibri,sans-serif;">Artefact Analysis and Reflection
<span style="font-family: Calibri,sans-serif; font-size: 13px; line-height: 1.5;">It is astounding that as a society we have forgotten the lessons from the past, from the prohibition of alcohol in the USA from 1920 to 1933. This policy forced drinkers to turn to a black market run by violent criminals who made concentrated hard liquor of dubious quality. The social and health implications were apparent. Crime, homelessness, mental illness and the burden on the criminal justice system were serious issues during prohibition of alcohol and have been rising steadily under the prohibition of drugs. Like the failure of the prohibition of alcohol, the current prohibition of illegal drugs is creating more harms than benefits and needs to be reconsidered by the Australian community. While recognising the harms that psychoactive drugs are causing, the policy of prohibition, with it’s current emphasis on criminalisation of use and possession is exacerbating those harms.
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<span style="font-family: Calibri,sans-serif;">Alcohol and tobacco have in the past been a significant burden on health and society however as a result of progressive social and regulatory controls, the use and harms arising from tobacco and alcohol have diminished profoundly in Australia. The defining difference has been the issue is managed primarily as a social and health issue rather than as a law enforcement issue. It make sense then that drug dependence and drug use should be managed primarily within the health and education system, not the criminal justice system.

<span style="font-family: Calibri,sans-serif;">Peer Reviews
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<span style="font-family: Calibri,sans-serif;">References
<span style="font-family: Calibri,sans-serif;">Australian Institute of Health and Welfare. (2010) //Drugs in Australia 2010: Tobacco, alcohol and other drugs.// Retrieved from Australian Institute of Health and Welfare website http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737420455

<span style="font-family: Calibri,sans-serif;">Des Jarlais, D. C., Marmor, M., Paone, D., Titus, S., Shi, Q., Perlis, T.,. . . Friedman, S. R. (1996). HIV incidence among injecting drug users in New York City syringe-exchange programmes. //Lancet, 348//(9033), 987-991. doi:10.1016/S0140-6736(96)02536-6

<span style="font-family: Calibri,sans-serif;">Dolan, K., Wodak, A. (1999). HIV transmission in a prison system in an Australian State. //Med. J. Australia// 171(1):14–7.

<span style="font-family: Calibri,sans-serif;">Dolan, K., 2000, //Surveillance and prevention of Hepatitis C infection in Australian Prisons. A Discussion Paper//. Retrieved from http://ndarc.med.unsw.edu.au/

<span style="font-family: Calibri,sans-serif;">Falster, K., Kaldor, J. M., Maher, L., on behalf of the collaboration of Australian Needle and Syringe Programs, & collaboration of Australian Needle and Syringe Programs. (2009). Hepatitis C virus acquisition among injecting drug users: A cohort analysis of a national repeated cross-sectional survey of needle and syringe program attendees in Australia, 1995-2004. //Journal of Urban Health : Bulletin of the New York Academy of Medicine, 86//(1), 106-118. doi:10.1007/s11524-008-9330-7

<span style="font-family: Calibri,sans-serif;">Gupta, G., Parkhurst, J., Ogden, J., Aggleton, P., & Mahal, A., (2008). HIV prevention 4: Structural approaches to HIV prevention. //The Lancet, 372//(9640), 764.

<span style="font-family: Calibri,sans-serif;">Hughes, C., & Stevens, A., (2010). What can we learn from the portuguese decriminalization of illicit drugs? //British Journal of Criminology//, 50(6), 999-1022. doi:10.1093/bjc/azq038

<span style="font-family: Calibri,sans-serif;">Levy, M. H., Treloar, C., McDonald, R. M., & Booker, N. (2007). Prisons, hepatitis C and harm minimisation. //The Medical Journal of Australia, 186//(12), 647. Retrieved from http://qut.summon.serialssolutions.com

<span style="font-family: Calibri,sans-serif;">Mathers, B. M., Toufik, A., Mattick, R. P., Degenhardt, L., Phillips, B., Wiessing, L.,. . . 2007 Reference Group to the UN on HIV and Injecting Drug Use. (2008). Global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review. //Lancet, 372//(9651), 1733-1745. doi:10.1016/S0140-6736(08)61311-2

<span style="font-family: Calibri,sans-serif;">MacDonald, M (1997). HIV prevalence and risk behaviour in needle exchange attenders: a national study. The Collaboration of Australian Needle Exchanges. //Medical journal of Australia, 166//(5), p.237.

<span style="font-family: Calibri,sans-serif;">Mazerolle, L., Soole, D. & Rombouts, S. (2007). Drug Law Enforcement: a review of the evaluation literature. //Police Quarterly, 10//(2), 115-153. doi:10.1177/1098611106287776

<span style="font-family: Calibri,sans-serif;">Reuter, P. and Stevens, A. (2007), //An Analysis of UK Drug Policy//. London: UK Drug Policy Commission. Retrieved from http://www.ukdpc.org.uk/publication/an-analysis-uk-drug-policy/

<span style="font-family: Calibri,sans-serif;">Stoové, M. A., Dietze, P. M., Aitken, C. K., & Jolley, D. (2008). Mortality among injecting drug users in melbourne: A 16-year follow-up of the Victorian injecting cohort study (VICS). //Drug and Alcohol Dependence, 96//(3), 281-285. doi:10.1016/j.drugalcdep.2008.03.006

<span style="font-family: Calibri,sans-serif;">Wodak, A. (1999). Developing more effective responses to illicit drugs in Australia. In K. van den Boogert & N. Davidoff (Eds.), //Heroin crisis// (pp. 197–210). Melbourne: Bookman Press.

<span style="font-family: Calibri,sans-serif;">Wodak, A., & Cooney, A. (2005). Effectiveness of sterile needle and syringe programmes. //International Journal of Drug Policy, 16//(supp 1), 31-44. doi:10.1016/j.drugpo.2005.02.004