So let’s move on now to the next person who will keep you up at night with their thoughts -
Alison Ritter.
Alison is an NHMRC Senior Fellow Professor a leading global authority on drug treatment policy
and the social and economic cost of illicit drug use.
She will be talking to you about improving drug and alcohol policies to save lives.
Please welcome Alison Ritter.
Thank you very much for coming.
What keeps me up at night is getting governments to make better decisions about what to do
about illicit drugs.
Heroin, methamphetamine, cocaine, ecstasy.
About 8 million Australians have used an illicit drug at some time in their life.
2.9 million Australians used an illicit drug in the last year.
2.9 million Australians.
The vast majority didn't run into any trouble, but some number did.
In fact, we estimate that 98,000 people injected an illicit drug last year in Australia.
Half the number of people who wanted and needed treatment could not get it.
What other health disorder has such a terrible unmet treatment rate?
And globally we know that drug related deaths are rising.
So what can governments do about this?
Firstly, we can offer prevention programs, we can prevent people from commencing drug use.
Secondly, we can offer treatment services to those people experiencing drug use disorders.
Thirdly, we can provide harm reduction services for people who are using drugs to reduce harms.
And fourthly, we can provide policing and law enforcement to deter drug use
and to reduce drug supply.
It's this last one that is the predominant response.
In our research, we have shown that 64% of Australian government investment in responding to illicit drugs
is in policing and law enforcement.
This imbalance is not unique to Australia. Countries like the US, Germany and Sweden
also spend more than 60% of their drug budgets on policing and law enforcement.
There are also examples of appalling drug policies, the rate of imprisonment in the
United States for drug use especially amongst blacks and minorities.
In our near neighbour countries the forced labour camps, for example in Vietnam and Thailand.
And of course the terrible extrajudicial killings that are occurring as we speak in the Philippines.
These are terrible things being done in the name of drug policy.
If instead governments did what the evidence suggests, lives would be saved, the enormous
social and economic costs would be reduced and it would be much more effective and humane.
So how's Australia doing?
Australia's got a number of very good evidence based policies.
But there are a number of examples of evidence based policies
that are not being imlemented in Australia.
I am going to give you 3 examples.
The first example that's evidence based that we don't provide in Australia
is heroin assisted treatment.
Currently there are only 2 medications for the treatment of heroin dependence -
methodone and buprenorphine.
Randomised controlled trials have shown that heroin assisted treatment is an effective intervention.
Yes for a small number of people but it improves health and it reduces crime.
The second example is needle syringe programs in prisons.
As many of you will know today is World Aids day.
Needle syringe programs reduce the risk of infection.
Prisons are hot beds of infection.
We know people get infected with HIV and Hepatitis C in prisons.
Needle syringe programs work.
They have been shown to be effective, efficacious and cost effective.
Are they available in Australian prisons?
No.
The third example of an evidence based policy
is the decriminalisation of the personal use of drugs.
Last year there were 102,000 arrests for drug use in Australia.
This is not drug supply.
This is not drug dealing.
This is drug use.
This is an enormous cost both economically and socially.
Is there evidence that the decriminalisation of the personal use of drugs work?
Yes there is.
Portugal decriminalised drug use some years ago.
One of my colleagues, Dr Caitlin Hughes, conducted a comprehensive research evaluation of the
Portuguese decriminalisation.
Three key findings.
Firstly, significant reductions in the cost to society associated with the decriminalisation
particularly to the criminal justice system.
Secondly, significant social savings to individuals and particularly their future.
Thirdly, they found that it did not significantly increase drug use
which is the thing that everyone worries about.
So there are three examples of policies that have a very strong evidence base
that are not implemented in Australia.
Are there things that we do in Australia that are not evidence based?
Sadly the answer is yes.
The example that I am going to give you is the police use of drug detection dogs.
The sniffer dogs.
So the original rationale for the introduction of sniffer dogs in New South Wales
was to deal with drug supply, to deal with drug dealing.
This is exactly what we want policing and law enforcement to do.
We want them to focus on the high levels of the market.
We want them to draw all of their attention towards drug supply.
What's happened with the sniffer dogs in New South Wales is failed implementation.
As many of you know they are deployed in entertainment districts and around music festivals.
They detect young people who are using drugs recreationally.
They are not detecting drug supply.
Is there evidence that sniffer dogs are effective or there's evidence that they are ineffective?
On average, the dogs are correct 26% of the time.
That's a terrible hit rate for a policy.
Secondly, the New South Wales ombudsman conducted a systematic review of the use of drug detection dogs in New South Wales
and the conclusion from the ombudsman's report and I quote:
"these have been proven to be an ineffective tool".
So we have things that don't work being implemented
and we have things that we know work not being implemented.
What can we conclude? Drug policy is rarely evidence based.
So what does drive drug policy?
Anecdote, singular events, tragedies, a death at a music festival.
Drug policy is fuelled by a media - The Daily Telegraph.
And based on perceptions of what the public want:
"John Howard's tough on drugs."
And yet we keep insisting on evidence based policy.
We perpetuate the idea that policy is some kind of technical rational exercise.
Policy as a technical rational process is a convenient myth.
It is convenient to politicians because they don't want to be seen to be reacting to shock jocks
and creating policy on the run.
It's convenient to the public, the public don't want to think that social policy and
drugs policy is some kind of irrational process that's driven by a singular anecdote.
And it's really convenient for researchers like me because of course my job is about building
an evidence base to feed into this technical rational process.
This is what keeps me up at night.
This disjuncture between the reality of the policy making
and the myth that is it rational evidence based policy.
So what do we need to do?
Well there are three things I think that we need to do.
The first thing that we need to do is we need more and better evidence.
This is a really important role that UNSW can play
and other research institutions can play.
There's no question we need to continue with the evidence generation.
Secondly we need to study policy.
We need to understand about power and ideology and public opinion and the role of the media.
And how these things come together to generate the situation that we find ourselves.
Thirdly and most importantly I think we need to get much smarter about the policy process.
What I propose is that we hijack the current policy processes and make them work for us.
If we can capitalise on how policy gets made in reality, that is co-opt that process
we stand a chance I think of having more effective and humane drugs policy.
This means we need to leave behind the myth of technical rational policy processes
and engage with the messiness that is policy.
This doesn't mean we ditch the evidence, but we do need to stop assuming that we as researchers
have a monopoly on knowledge and authority.
We need to recognise that there are multiple types of knowledge that need to be brought
to the table and that we need to engage multiple voices including people who use drugs.
Making good drug policy involves bringing together different kinds of knowledge.
Social science and empirical data, alongside and equal to
public opinion, anecdote and personal experience.
We also need to stop working with the usual suspects.
We need to talk to the people and engage the people who don't agree with us.
We need to bring business leaders and people of influence.
We need to get them to care about drugs and care about people who use drugs.
We need a contest of ideas across multiple knowledges and types of evidence.
In August 2012 the O'Farrell government responded to a tragedy
with the introduction of lockout laws in Kings Cross amongst other measures.
Since that time, you will all be aware there has been vocal public debate, both vocal support
and vocal opposition to the introduction to the lockout laws.
This contest of ideas that we have had, has included all sorts of evidence
and types of knowledge.
Information from the music industry. The experiences of the LGBTI community.
The perceptions of local residents and police data on assaults.
Emergency department presentations.
This contest of ideas happened after the policy was introduced.
What would happen if this dialogue occurred before?
This is what my work is about.
It's about creating opportunities for that kind of contest of ideas that brings together
the media, the public, business leaders, politicians, people who use drugs.
Yes, it's going to be really messy.
But it's messy already and it's messy without reference to evidence and without the voices
that we need to hear that are so important.
I reckon the chances of more effective and more humane drug policy are much greater through
these kinds of processes than what we have been doing so far.
Thank you very much.