Details

Published: 07 November 2024

Hits: 48

In what might go down as the most expensive experiment in missing the point, Australia’s decades-long dance with harm reduction policies has produced results that would be laughable if they weren’t so tragic. New data reveals a sobering reality: whenever harm reduction takes centre stage, drug-related deaths perform their own tragic encore.

Historical Context: Australia’s Drug Policy Journey

The trajectory of Australia’s drug policy reads like a cautionary tale in unintended consequences. Between 1985 and 1999, as Australia embraced harm reduction approaches, it achieved an unfortunate distinction: the highest drug use rates among OECD countries. The numbers tell a stark story – opiate deaths rose from 347 in 1988 to 1,116 in 1999, a trajectory that should have set off alarm bells throughout the public health community.

However, a brief period of hope emerged between 1998 and 2006, when Australia implemented the Federal Prevention approach. During this period, deaths from all drug types decreased significantly. This success was short-lived. From 2007 onward, with the return to harm reduction priorities, death rates began climbing again across all drug categories.

The harm reduction movement’s reliance on questionable scientific methodology deserves scrutiny. Consider the 2011 Lancet study on Vancouver’s injecting room, which claimed a 9% reduction in overdose deaths. Official British Columbia coroner’s figures tell a different story:

• 2001: 90 overdose deaths
• 2002: 49 deaths
• 2003: 51 deaths
• 2004: 67 deaths (37% increase after facility opened)
• 2005: 55 deaths (still 12% higher than pre-facility)

The study’s methodology artificially created positive results by comparing different time periods in a way that obscured the actual impact of the facility.

Current Harm Reduction Proposals: A Critical Examination

Pill Testing: The Dangerous Illusion of Safety

Proponents of pill testing present it as a scientific solution to drug-related deaths. However, a comprehensive analysis of 392 Ecstasy-related deaths in Australia between 2000 and 2018 reveals the fundamental limitations of this approach:

• 14% of deaths resulted from allergic-type reactions that no pill testing regime could predict
• Nearly half (48%) of deaths involved polysubstance use, particularly combinations with alcohol and cocaine
• 29% of deaths occurred due to accidents while intoxicated

These statistics highlight a crucial flaw in the pill testing paradigm: it creates a false sense of security while being unable to prevent the primary causes of Ecstasy-related deaths. The very presence of pill testing facilities may inadvertently legitimise drug use, suggesting to potential users that there exists a “safe” way to consume illegal substances.

Injecting Rooms: The Statistics That Don’t Add Up

Perhaps nowhere is the failure of harm reduction more evident than in the statistics surrounding injecting facilities. The Sydney injecting room reported overdose rates 63 times higher than the pre-registration rates of its clients – a number that defies logical explanation. Melbourne’s Medically Supervised Injecting Room (MSIR) reported even more troubling numbers, with overdose rates 102 times higher than street rates.

These statistics raise serious questions:

1. How do these facilities actually prevent harm when they appear to be associated with increased risk-taking behaviour?
2. Are these facilities inadvertently creating “safe spaces” for dangerous behaviour rather than reducing it?
3. Does the presence of medical supervision encourage users to take greater risks?

The 2020 government-funded evaluation of Melbourne’s MSIR revealed another troubling trend: deaths actually increased in the facility’s area, mirroring increases across Melbourne. This suggests that rather than preventing deaths, these facilities may be prolonging dangerous drug use patterns, ultimately leading to greater loss of life.

The International Experience: Cautionary Tales

Portugal’s Decriminalisation: A Closer Look at the Data

Portugal’s 2001 drug decriminalisation policy is often cited as a model for drug policy reform. However, a detailed examination of the outcomes reveals concerning trends:

• Overall drug use has increased by 59% since implementation
• Minor drug use has seen increases of up to 80%
• Overdose deaths have risen by 85% since 2002
• Portugal now ranks among the top three EU countries for illegal drug use in wastewater testing

These statistics stand in stark contrast to the narrative of success often presented by harm reduction advocates. The Portuguese experience suggests that removing criminal penalties, while maintaining technical illegality, creates a confusing middle ground that may actually increase drug use and associated harms.

The Colorado Cannabis Experiment: Unintended Consequences

Colorado’s journey with cannabis liberalisation provides another warning about the potential consequences of harm reduction approaches. Following medical cannabis law loosening in 2009 and full legalisation in 2013, the state experienced:

• A 410% increase in cannabis-related suicides by 2016
• A 360% increase in cannabis-related hospitalisations
• A 230% increase in cannabis-related traffic deaths
• A doubling of adult cannabis use

These numbers suggest that policies intended to reduce harm may instead normalise drug use and increase overall societal costs.

Evidence-Based Success Stories: What Actually Works

While the failure of harm reduction approaches is clear, several jurisdictions have demonstrated remarkable success with prevention-focused policies:

• Sweden achieved an 80% reduction in secondary student illicit drug use between 1971 and 1990 through a consistent focus on prevention and clear anti-drug messaging.
• Iceland’s prevention-focused approach resulted in a 60-90% reduction in secondary student illicit drug use from 1998 to present.
• Australia achieved a 40% reduction in both student and adult drug use during the “Tough on Drugs” period (1998-2007).
• The US much-maligned but effective “Just Say No” campaign achieved a 70% reduction in secondary student use between 1981 and 1991, demonstrating the power of clear, consistent messaging.

Time for Change: The Path Forward

As Australia approaches another Drug Summit, policymakers face a critical choice. The evidence clearly shows that harm reduction policies, despite their compassionate intentions, have failed to deliver on their promises. Instead, they have often contributed to increased drug use, higher death rates, and greater societal costs.

The success stories from Sweden, Iceland, and Australia’s own “Tough on Drugs” era provide a clear roadmap for effective drug policy:

1. Prioritise prevention over harm reduction
2. Implement clear, consistent anti-drug messaging
3. Maintain strong legal deterrents while providing appropriate treatment options
4. Focus on reducing overall drug use rather than merely managing its consequences

The time has come to acknowledge that enabling drug use while calling it “harm reduction” has failed. The data shows that Prevention, Demand Reduction, and Recovery aren’t just buzzwords – they’re proven lifesavers. The cost of maintaining failed harm reduction policies is measured not just in dollars, but in lives lost and potential squandered. It’s time for a return to these evidence-based strategies that have demonstrated real success in reducing drug use and its associated harms. (WRD News November 6th 2024^thWRD News November 6th 2024)

Also see

• How Harm Reduction Works in Australia
• And Podcast “Drug Policy: ‘Injecting’ Healing, Hope or Harm?”

Details

Published: 07 November 2024

Hits: 94

The fentanyl crisis has emerged as one of America’s most pressing public health emergencies, with devastating consequences that touch every corner of society. Only ‘layering’ up on the worst opioid addiction disaster (arguably) in US history. In a shocking revelation of the crisis’s scope, fatal drug poisonings reached a record 111,451 in the 12 months ending in August 2023, with fentanyl driving the majority of these deaths. Yet as the body count rises, America’s response remains fragmented, ineffective, and mired in political theatre.

A Perfect Storm

What makes fentanyl particularly dangerous is its unique nature as a synthetic drug. Unlike traditional narcotics such as heroin or cocaine that require crop cultivation, fentanyl is purely chemical-based. As DEA officials note, the only limitation on fentanyl production is access to precursor chemicals, making it potentially limitless in supply. This fundamental difference from traditional drugs has created an unprecedented challenge that our current drug control infrastructure seems woefully unprepared to address.

The crisis is further complicated by the cartels’ deceptive tactics. Drug traffickers are pressing fentanyl into counterfeit pills designed to look identical to legitimate medications like oxycodone, Percocet, or Adderall. This practice has led to countless deaths among users who had no intention of taking fentanyl, creating an unprecedented public health challenge that demands far more urgent attention than it’s receiving.

The Politics of Failure

As the crisis deepens, American politicians have reduced this complex challenge to simplistic campaign fodder. Republicans, led by former President Trump, hammer Democrats over border policies, while Vice President Kamala Harris responds by touting her prosecution record and promising more border agents. Lost in this rhetorical crossfire is any meaningful discussion of what primary prevention and demand reduction; or drug use exiting treatment and recovery – the very elements experts say are crucial to addressing the crisis.

It has been said by many a pundit… “we cannot arrest our way out of this mess”, but be rest assured, we cannot ‘treat our way out’ either, especially with treatment is but a ‘mop’ and the faucet of demand continues to flow unchecked, only driving supply.

A Global Criminal Enterprise

The fentanyl supply chain represents a complex international network that makes a mockery of traditional drug enforcement approaches. The DEA has identified two primary cartels responsible for most of the fentanyl entering the United States: the Sinaloa cartel and the Jalisco cartel. These organisations operate as sophisticated multinational corporations, with operations spanning more than 45 countries.

The supply chain typically begins in China, where precursor chemicals are purchased, before moving through Mexico, where the final product is synthesised. Last year alone, the DEA seized enough fentanyl to kill every American – approximately 410 million deadly doses. Yet, significant quantities continue to enter the country through various means: by air, land, and sea, often through the Southwest border. This stark reality raises serious questions about the effectiveness of our current enforcement-first approach.

The Social Media Scandal

Perhaps most damning is the role of social media companies in this crisis. These platforms have become what DEA officials call “the last mile” in the deadly supply chain, providing cartels with direct access to potential victims. Despite their own terms of service prohibiting drug sales, social media companies have provided what law enforcement describes as minimal cooperation in addressing the crisis. The result is a digital marketplace for death, operating in plain sight.

Institutional Inertia

The international response has been equally inadequate. China, the primary source of precursor chemicals, has effectively ceased cooperation with U.S. law enforcement over the past year. Mexico’s president has gone so far as to deny that fentanyl is even synthesised in his country, despite overwhelming evidence to the contrary. Meanwhile, U.S. authorities are left to combat what amounts to a multinational criminal enterprise with fragmented resources and inconsistent international support.

Again, the demand coming from not only a now ‘addicted’ cohort, but a demographic that wants to either party or medicate away everything from perceived ‘boredom’ and trauma’ to genuine cultural and psycho-social despair you have the incentive that addiction for profit actors love. When a society tacitly enables pleasure seeking as a ‘right’ and refuses to identify contributing factors to self-harming behaviours or celebrated unaccountability that needs to be called out and addressed, then those ‘supplying’ have a continuingly enabled ‘demand’ for the preferred ‘agent of symptom annihilation’.

Ground-Level Reality

The human cost of this institutional failure is stark. At DEA headquarters, a memorial wall now displays over 4,000 photographs of fentanyl victims, with hundreds more being added regularly. These images – showing victims as young as 12 or 13 – stand in silent rebuke to the political grandstanding and institutional paralysis that characterises the current response.

The stories of survivors paint an equally damning picture. Crystal Long, who survived multiple overdoses before finding recovery, describes fentanyl’s overwhelming pull: “All of your problems go away… it’s like this tingling feeling from head to toe that just you’re calm, nothing else matters.” Her survival, thanks to a drug court program, represents the exception rather than the rule in a system that prioritises enforcement over treatment.

We see here again a perception in, arguably, the world’s most affluent and ‘free’ nation that every form of positive emotional disruption is viewed as trauma, and the faux right to comfort as all costs drives self-soothing behaviours in some many of the population who are not genuinely traumatised or suffering privation.

A Glimmer of Hope?

Recent CDC data showing a 13 percent decline in overdose deaths between May 2023 and May 2024 offers some encouragement. This improvement is attributed to expanded treatment access, over-the-counter naloxone availability, and increased border seizures. However, with deaths still hovering near 100,000 annually, celebrating such marginal improvement seems premature at best.

The Path Forward

The solution to the fentanyl crisis requires more than campaign promises and border security theatre. It demands a three-pronged approach that has thus far been largely absent from the national conversation: demand reduction, supply reduction, and recovery support.

Demand Reduction: The most glaring oversight in current policy is the lack of comprehensive demand reduction strategies. While politicians focus on border security, they largely ignore the factors driving Americans to seek out opioids in the first place. Effective demand reduction requires:

• Expanded access to mental health services, particularly in underserved communities where fentanyl use often takes root
• Prevention programs that address the root causes of addiction, including trauma, poverty, and lack of economic opportunity
• Educational initiatives that go beyond by include the “just say no” messaging, as this powerful protective factor now seems to have been erased (if not eroded) in our first world entitled culture. Not uptake, No problem! No, is powerful and needs to be empowered and equipped, not undermined by throw away and evidence-deprived ideology that saying no doesn’t work.
• Early intervention programs in schools and communities, with particular focus on the vulnerable 12-25 age group that’s increasingly falling victim to fentanyl. This must include sound anthropologically anchored resilience building factors in the individual, family and the community.

Supply Reduction: While current supply reduction efforts focus almost exclusively on border interdiction, a truly effective strategy must be more comprehensive:

• International cooperation agreements with real enforcement mechanisms, particularly with China and Mexico
• Regulatory reform to better track and control precursor chemicals
• Enhanced prosecution of social media platforms that fail to adequately police drug sales
• Targeted disruption of cartel financial networks through enhanced cooperation between law enforcement and financial institutions
• Investment in advanced detection technologies at all points of entry, not just the Southwest border

Recovery Support: Of course, for those caught in the tyranny of this addiction, we need a fundamental shift in how we approach recovery, particularly in light of recent scientific evidence. A 2024 study in the Journal of Addiction Medicine has conclusively demonstrated that Medications for Opioid Use Disorder (MOUD) remain highly effective even against highly potent synthetic opioids like fentanyl. Whilst this can be a good start, it can also be an ongoing addiction trap, as much lived experience and earned resiliency has made clear. The healthcare system should not place bureaucratic barriers in the way of these proven treatments but should also harness them to other proven drug use exiting protocols that empower the substance use to live substance free. That is what recovery has always meant.

The evidence is clear:

• Both buprenorphine and methadone have proven effective in preventing death and opioid overdose – This, again, is a great start, but the Gold standard for treatment isn’t ‘death prevention’, it is the exiting of practices that facilitate the near death experiences.
• Higher daily buprenorphine doses (>16mg per day) show increased effectiveness
• Low-dose buprenorphine initiation protocols have demonstrated feasibility even with ongoing opioid use
• These Medically Assisted Treatments (MAT) must be part of a more holistic approach for recovery to not only be lifesaving, but also life affirming, developing and recalibrating – thus ensuring the very thing causing all this grief is no longer in play.

Despite this compelling evidence, we continue to underutilise these life-saving treatments. A comprehensive recovery support system must include:

• Creation of robust aftercare programs to prevent relapse and support long-term recovery
• Investment in job training and educational programs for recovering addicts to break the cycle of addiction and poverty.
• Immediate expansion of medication-assisted treatment programs, with particular attention to optimal dosing strategies that research shows are most effective
• Removal of bureaucratic barriers that prevent addiction specialists from prescribing treatment medications, especially given the proven effectiveness of MOUD against synthetic opioids
• Insurance reform to ensure that recovery programs are covered at the same level as other medical conditions, including coverage for higher-dose treatment protocols that research shows are more effective

The tools and knowledge to implement these solutions exist. What’s lacking is the political will to move beyond simplistic enforcement narratives and invest in comprehensive solutions. The success stories – like Crystal Long’s journey through drug court to recovery – demonstrate what’s possible when we implement evidence-based solutions. But these success stories remain the exception rather than the rule.

Each day we delay implementing this comprehensive approach, more faces appear on the DEA’s memorial wall. The choice is clear: we can continue with the current failed approach of political posturing and enforcement-only solutions, or we can implement the comprehensive strategy that evidence shows will work. The fentanyl crisis is not unsolvable – it’s simply unsolved because we’ve lacked the courage and commitment to implement real solutions.

Until we embrace this three-pronged approach and marshal the resources and political will to implement it effectively, Americans (and all other cultures wrestling with this nightmare) will continue to die needlessly. The question isn’t what needs to be done – we know what works. The question is whether we’re finally ready to do it.

Dalgarno Institute

Endnotes

• Everyone’s tough on drugs again
• DEA’S Faces of Fentanyl documents extent of drug crisis
• Full DEA head: ‘We don’t know the exact amount’ of fentanyl that gets through to the U.S.
• Recovering fentanyl addict speaks out about dangers of the drug
• Dramatic turnaround for fentanyl addict
• Medications for Opioid Use Disorder Remain Effective as Highly Potent Synthetic Opioids Permeate North American Illicit Drug Supplies

Details

Published: 30 October 2024

Hits: 55

While the carefree days of childhood are supposed to be a time of joy and wonder, the harsh reality is that too many young lives are marred by abuse, neglect, and exposure to toxic substances. A sobering new study from the University of Sydney has shed light on the long-lasting mental health consequences of such childhood trauma.

The research, published in JAMA Psychiatry, found that a staggering 40% of common mental health conditions can be directly attributed to the impact of maltreatment during formative years. This includes:

• 21% of depressive disorder cases
• 24% of anxiety disorder cases
• 32% of drug use disorder cases
• 39% of self-harm cases and 41% of suicide attempts
• 27% of alcohol use disorder cases

In other words, the wounds inflicted on these vulnerable young minds don’t just heal with time – they fester, leading to a lifetime of emotional turmoil and anguish.

The culprits behind this mental health crisis are all too familiar: physical, sexual, and emotional abuse, as well as emotional and physical neglect. And let’s not forget the insidious impact of exposure to drugs and alcohol, which can further compound the trauma. It’s a veritable perfect storm of factors that rob children of their innocence and saddle them with invisible scars.

But what’s most alarming is that these issues aren’t just limited to the individual. The researchers estimate that eradicating childhood maltreatment could prevent over 1.8 million cases of mental illness in Australia alone. That’s a staggering societal cost, both in terms of human suffering and the strain on our healthcare system.

Yet, despite these sobering statistics, the conversation around childhood trauma and its mental health implications often remains hushed and stigmatised. It’s time to shed light on this silent epidemic and demand better support systems for vulnerable children and their families.

After all, the mind is a precious thing, and no child should have to navigate its darkest corners alone. It’s high time we prioritise prevention, intervention, and holistic healing – because the alternative is a generation haunted by the demons of their past, condemned to a lifetime of mental health struggles.

Source (WRD News)

Also see

• Child Abuse – Girls a Particular Target. (The AOD Factor?)
• Childhood maltreatment linked to greater cognitive difficulties than previously thought
• AOD Use and the Kincare Crisis

Details

Published: 17 October 2024

Hits: 65

Research spanning over three decades has consistently highlighted how the frequency, severity, and impact of violence escalate in the presence of alcohol and drugs.

Unified Care for Safer Lives

It’s all too common for domestic violence and substance use to be treated as separate issues, which often leads to patchy solutions. We really need to start looking at these problems together, creating strategies that keep victims and children safe. By focusing on comprehensive policies, we can tackle these complex challenges head-on.

When we truly grasp how substance use and domestic violence are linked, we can advocate more effectively for solutions that protect families and foster a healthier society. It’s crucial to break the silence that many victims endure. By having open conversations and building supportive networks, we can provide those in need with the resources to rebuild their lives and make our communities safer. 

For complete story