Medicinal Cannabis

[thedarkestone]

Here is a link to what Sandra Kanck has to say about the medicinal use of cannabis.

 

Sandra Kanck - Speeches and Questions: Medical Marijuana (Controlled Substances (Palliative Use of Cannabis) Amd Bill

 

I though this might be an interesting read for some.

 

Being a medicinal user myself - the law gives me the shits to no end. If it wasn't for this plant I don't think I'd still be here. I'm glad some pollies aren't total retards.

[grace]

Sandra Kanck - Speeches and Questions: Medical Marijuana (Controlled Substances (Palliative Use of Cannabis) Amd Bill

on Thursday, July 24, 2008 - 03:23 PM

South Australian Democrats Website

1 August 2008

<http://www.sa.democrats.org.au/html/modules.php?op=modload&name=News&file=article&sid=1545&mode=thread&order=0&thold=0>

 

23-07-08 This bill proposes that fines be waived for the personal cultivation and use of marijuana for people suffering designated medical conditions.

....like the vote for women, it is an idea whose time has come and, eventually, such legislation will pass.

 

This would be on the proviso that a medical practitioner has signed a palliative cannabis certificate to indicate that the person is suffering from a specified illness or disease, the symptoms of which might be palliated by the smoking or consumption of cannabis or cannabis resin. The certificate would:

(a) certify that the person has a specified illness or disease;

( describe the symptoms;

© declare that in the doctor's opinion the use of cannabis would palliate those symptoms;

(d) state that the doctor has discussed with the patient the risks associated with the use of cannabis; and,

(e) prescribe the amount and method of administration and the period of time for which the use is recommended. Such a certificate would be valid for a maximum of one year, but it could be revoked earlier by the doctor. The doctor would be required to provide the minister with a copy of the certificate within seven working days of issuing it, and similarly provide advice if it has been revoked.

 

Given that in South Australia cannabis is a controlled substance and is illegal under normal circumstances, under this legislation the medical practitioner is given protection so that they would not be subject to legal disciplinary proceedings by virtue of issuing a certificate if they did it in the form prescribed in the bill. Failure to provide the appropriate advice to the minister would attract a fine, and any false or misleading statements made by a doctor in relation to any of the above could see them imprisoned for two years or fined up to $10,000. The bill also provides for the sale of approved equipment for the consumption of cannabis to a person who holds a palliative cannabis certificate.

Cannabis is a drug that has been referred to in literature in all cultures. It was being used in China as a herbal remedy 5,000 years ago; in the US the 1896 edition of the Pharmacopeia had 20 pages devoted to its uses; and until 1934 cannabis was widely used in pharmaceutical preparations in the US. Queen Victoria is said to have used it to relieve period pain.

 

The Howard government produced a booklet that was issued with the 'Tough on Drugs' stamp on it. It came from the commonwealth Department of Education, Science and Training. The booklet is called Cannabis and consequences: Parent brochure/information booklet, and it gives a little (dare I say it) 'potted' history of cannabis, as follows:

Cannabis is relatively new to modern Europe, possibly introduced by Napoleon’s army returning from Egypt around 1800. Cannabis was known to early civilisations in China, India, Mesopotamia and Egypt from 4,000–2,000 BC. Used as an analgesic and sedative, cannabis was one of the earliest known medicines. After its intoxicating properties were discovered it appears to have been used in rituals. The plant was first used as a fibre for making cloth, rope and paper. Known as Indian hemp, the cannabis plant was a commercial crop in the United States until the 1930s.

Cannabis use was progressively restricted in the Western world between 1890 and 1940. The 1931 League of Nations convention, which sought to limit the production of opium, also banned other drugs including cannabis and cocaine.

 

I suppose the question that needs to be answered is that, given it was used so widely in the past and then made illegal in so much of the world, why is there a demand for it now? I think it is because we all respond differently to medications. I use aspirin for headaches but if you give me paracetamol it does nothing for me; when I have been in hospital and have been administered pethidine the first thing I experience, within a matter of minutes, is nausea and vomiting. However, simply because I have those reactions does not mean it should not be prescribed for anyone else.

 

It is because of the different responses to drugs that cannabis should be part of our palliative armoury. There are some people with conditions that cannot be alleviated with the normal range of chemically-synthesised drugs. Some of these conditions include multiple sclerosis, and up to 30 per cent of people in Europe who suffer with multiple sclerosis use cannabis to alleviate their symptoms. A British study showed that the use of cannabis by MS sufferers resulted in improvements in their walking speed, reduction in muscle spasms, pain relief, and better sleep.

 

People who have nausea and vomiting associated with chemotherapy, as well as people with body wasting because of AIDS, find that the effect of cannabis is to suppress the nausea and vomiting. It can only be good for people trying to recover from cancer if they are able to hold down their food and get some nutrition into their body, and the effect of cannabis for people who have AIDS is to restore the appetite which, again, gives their body that capacity to fight off the impact of the HIV. Other conditions that can be assisted are glaucoma, depression, bursitis, control of seizures, and neuropathic pain associated with spinal cord injuries. There are other conditions associated with spasms, but not particular illnesses, that people tell me can also be alleviated.

 

Again I turn to the booklet produced by the Howard government. Under the heading, 'Are there any medical uses for cannabis?'—and, remember, this is the government that said it was tough on drugs—it reads:

Some cannabis users report that cannabis helps them relieve the symptoms of medical problems. In 2000, a NSW government report concluded that cannabis could be useful for certain medical conditions, and recommended more research should be conducted. The report suggested that cannabis may be most useful for the following conditions:

• pain relief (analgesia), for example in people with cancer;

• nausea and vomiting, particularly in people having chemotherapy for cancer;

• wasting, or severe weight loss, in people with cancer or AIDS; cannabis may help increase the person’s appetite and relieve their nausea; and

• neurological disorders; cannabis may be useful in relieving the symptoms of multiple sclerosis, spinal cord injury and other movement disorders, because it helps relieve muscle spasms.

One of the short-term effects of THC in cannabis is to expand the airways in the lungs, helping people who have asthma; however, cannabis users may develop tolerance to this effect.

 

Like all drugs, there is a potential for side-effects, and the use of cannabis for medical conditions, just as with other drugs, needs to be tightly controlled.

 

One of the websites I visited that advocates the use of medical marijuana has this disclaimer in relation to medical marijuana:

 

OZ Stoners

 

"There is no pharmacological free lunch in cannabis or in any drug. Negative reactions can result. A small percentage of people have negative or allergic reactions to marijuana. Heart patients could have problems even though cannabis generally relieves stress, dilates the arteries and in general lowers diastolic pressure. A small percentage of people get especially high rates and anxieties with cannabis. These people should not use it. Some bronchial asthma sufferers benefit from cannabis; however, for others it may serve as an additional irritant."

 

It is important to remind ourselves that each year in Australia there are approximately 19,000 deaths from the use of tobacco, 2,000 from alcohol and 1,000 for all other illicit drugs combined. Paracetamol kills 400 people per year, and even aspirin causes more deaths than cannabis. In fact, ABS figures do not show up cannabis as causing any deaths. In the UK, recent figures show that 114,000 people died from tobacco usage in one year, 22,000 from alcohol usage and 16 from cannabis usage.

 

We need to recognise potential dangers, but we need to get things into perspective. In terms of this question of how safe cannabis is, I address the question of a link to psychosis. There is not anywhere in any of the literature a causal link between cannabis and psychosis. Certainly, there is evidence that shows that some people who are psychotic have a tendency to self-medicate with cannabis and, of course, that is interesting in itself because there is an ingredient in cannabis called CBD that inhibits psychotic symptoms among schizophrenics. It may be, in fact, that they have cottoned on to that and are using it to effectively alleviate some of their symptoms.

 

Dr Syril D'Souza who is from Yale University co-authored an article with Dr Asif Malik also at Yale University published on the website psychiatrictimes.com, and I will read part of that, as follows:

 

If cannabis causes psychosis in and of itself then one would expect that any increase in the rates of cannabis use would be associated with increased rates of psychosis. However, in some areas where cannabis use has clearly increased, e.g., Australia, there has not been a commensurate increase in the rate of psychotic disorders. Further, one might also expect that, if the age of initiation of cannabis use decreases, there should also be a decrease in the age of onset of psychotic disorders. We are unaware of such evidence.

 

I indicate for members that the AMA, to whom I provided a copy of the draft bill, has rejected the bill because of safety concerns, but what I find interesting about that is that there do not appear to be the same concerns in relation to prescribing drugs that come from chemical companies. So, I want to look at some of the drugs that our medical practitioners already legally prescribe. For instance, there is Strattera for ADHD. Side-effects of that include suicidal thoughts, weight loss, chest pain and swollen testicles, but doctors still prescribe it.

In relation to Viagra, I got this off the VicHealth website, and it states in relation to side effects:

 

You may not get any of them but tell your doctor or pharmacist if you notice any of the following and they worry you:

• headache,

• dizziness,

• flushing,

• indigestion,

• nasal congestion,

• diarrhoea,

• rash.

That is not so bad. Then it goes on:

Tell your doctor as soon as possible if you notice any of the following:

• unusual heartbeat

• urinary tract infection, stinging or burning urine, more frequent need to pass urine, blood in the urine

• changes in vision such as blurring, a blue colour to your vision or a greater awareness of light

• persistent headache or fainting

• bleeding from the nose.

Then it gets better:

If any of the following happen, tell your doctor immediately or go to Accident and Emergency at your nearest hospital:

• signs of allergy, such as shortness of breath, wheezing or difficult breathing, swelling of the face, lips, tongue or other parts,

• chest pain,

• sudden decrease or loss of hearing,

• seizures, fits or convulsions.

• Very rarely your erection may persist for longer than usual. If your erection continues for four hours, or sooner, if there is pain, you should seek medical attention urgently.

• Rarely, men have lost eyesight some time after taking drugs to treat erectile dysfunction...it is not known at this time if

 

Viagra causes this. if you lose eyesight in one or more eyes, seek medical attention urgently.

This is not a complete list of all possible side-effects; others may occur in some people and there may be side-effects not yet known.

 

So, these are some of the side-effects of Viagra and doctors continue to prescribe it. Benzodiazepines are drugs that are often used for sleeping tablets and to calm people. From the website benzo.org.uk, according to Professor Malcolm Lader:

Five per cent of those using benzodiazepines may be affected by so-called 'paradoxical' reactions in response to the drugs rather than the desired tranquilliser defects. Such reactions include increased aggressiveness (in some individuals even violent behaviour), depression (with or without suicidal thoughts or intentions) and sometimes personality changes. In some instances, reactions such as hallucinations, depersonalisation, derealisation and other psychiatric symptoms occur.

Five per cent of people are put on these drugs and doctors still prescribe them, despite the side-effects. There has been a lot of research into the effect of benzodiazepines and the relationship with hip fracture in the elderly. Research on that by Eileen E. Ming at Harvard University states:

 

In long-term care sessions where 45 to 70 per cent of residents fall each year, 1,600 falls occurred per 1000 person years.

By the way, that is compared to the rest of the population, which is 224. It continues:

One to two per cent of falls result in hip fracture, and the risk of hip fracture increases almost 100-fold from age 60 to 64 to 80 to 84. In the year following a fracture, there is a 23 per cent mortality rate, compared to an expected 8 per cent; 50 per cent of the ambulatory lose the capacity to walk independently; one-third of the community-dwelling require long-term nursing care; and many are incapacitated by the fear of falling again...BZDs—

benzodiazepines—

have been found to impair basic psychomotor function and postural sway in normal volunteers, a side effect which lasts at least through four weeks of continuous use; impairment increases with dose...Sedatives slow reaction time and reduce coordination and alertness...protective responses at the time of a fall may be too late to prevent a hip fracture.

 

So, here we have another drug that amongst the elderly in particular has some quite catastrophic side effects in terms of losing balance and falling and hip fractures. The range of increased risk is between 1.5 and 5.8 times compared to those not using psychoactive substances.

Thalidomide is another very dangerous drug. I am sure most people will recall that in the 1960s it was prescribed to prevent morning sickness in pregnant women, and many of those women subsequently gave birth to children with deformities. It has now been rehabilitated, so to speak. It still causes those effects, which are pretty disastrous, but it is being prescribed by doctors now for blood cancer and leprosy. Among the drugs that doctors prescribe—I believe justifiably—is morphine, because it has a very important role to play for the relief of extreme pain. But everybody knows what morphine in its illegal forms can do. In relation to this whole question of harm, the US Institute of Medicine concluded:

 

Except for the harms associated with smoking, the adverse effects of marijuana are within the range of effects tolerated for other medicines.

Let us look at what is happening in other countries. There are places in the world where there are no laws at all about cannabis, such as Bangladesh and, in Belgium, it has been decriminalised. Obviously, no legislation is needed to allow the medical use of cannabis in those countries.

 

At the present time in the United States, 12 states—Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington—have removed criminal sanctions for possession of marijuana if it is used to relieve medical conditions. Michigan will vote on a medical marijuana initiative later this year, and a bill was introduced in the Ohio legislature last month.

In terms of the application of the law in those 12 states, some give out ID cards to the users. Most state laws are silent about the procurement of marijuana; whether users can grow it themselves or buy it from somebody and, if so, from whom. In New Mexico the governor himself introduced legislation which envisaged a state licensed and protected system of cannabis production, and that was passed last year. Regulations to allow this are now being prepared, and at least 150 people have already formally applied to be able to use the drug. In addition to the states' involvement, both patients and carers will be able to grow their own cannabis.

Polling back in 1995 showed that two-thirds of Americans believe that medical marijuana was justified. Proposition 215 in California, which brought about the decriminalisation of marijuana for medical use, got a strong 56 per cent of the vote. In California, hundreds of medical marijuana dispensaries are now offering assorted varieties for sale and providing advice about which varieties are best for differing medical conditions. Cannabis dispensaries were never authorised: they just sprang up.

 

The Bush administration has been trying to stop regulation for the legitimisation, and threats have been made to arrest state legislators if they proceed down this path. Doctors do not prescribe under California law; rather: they write a statement saying that they think it is okay for a particular patient to use cannabis, which is similar to the proposal in my bill.

Despite all the foregoing, US federal law still prohibits the growing, possession, supply or use of cannabis for medical purposes. The DEA can, and does, conduct raids in states where medical marijuana has been decriminalised. However, this year the bill has been introduced by former presidential candidate, Ron Paul, to make it legal at the federal level.

In Israel, cannabis is being used on a limited basis to treat PTSD in former soldiers. Additionally, trials are taking place in many other parts of the world. The Israeli Health Ministry grows marijuana which it gives away to more than 150 registered patients with cancer, AIDS or chronic inflammation of the intestine. The facility is being expanded, and consideration is being given to distributing through government-approved hospitals and perhaps private pharmacies where it could be sold.

 

In Canada, federal government regulations, under the Controlled Drugs and Substances Act, allow people with certain illnesses to apply for permits to possess and/or grow marijuana for personal medical purposes, or to designate another person to grow it for the person who has the permit. All usages must be prescribed by physicians. The symptoms covered are: severe nausea, cachexia, anorexia, weight loss, persistent muscle spasms, and seizures or severe pain associated with any of the following medical conditions: cancer, AIDS, HIV infection, multiple sclerosis, spinal cord injury or disease, epilepsy and severe forms of arthritis.

 

In the Netherlands, there is a medicinal program that allows pharmacies to sell standardised quality-controlled marijuana from authorised growers to sufferers of chronic or terminal diseases, such as multiple sclerosis, HIV/AIDS, neuralgia, cancer and Tourette's syndrome. It is a program that is not working very well because cannabis coffee shops are able to sell cannabis at a cheaper rate than pharmacies. The Netherlands is having second thoughts about the program because they are simply not able to compete.

 

There is a lot of support, and growing support, for the use of medical marijuana here in Australia with organisations like the Country Women's Association (who see particularly that it could be used for people who are experiencing the effects of chemotherapy when having cancer treatment); the New South Wales Cancer Council; the AIDS Council of Victoria; and, here in South Australia, the South Australian Voluntary Euthanasia Society.

 

I mentioned that the South Australian branch of the AMA told me that it does not support my bill. However, in the letter it sent to me, it provided a copy of the AMA's national policy which does not say that it is against the use of medical marijuana; rather, it says that there needs to be more research. I want to read that particular part of the AMA position statement (as it calls it) into the record. The AMA position is as follows:

1. The Australian Medical Association does not condone the use of cannabis for non-medical purposes—it is a harmful drug.

2. The Australian Medical Association believes that cannabis use, as with all licit and illicit drug use, needs to be viewed in terms of social determinants and the social gradient, whereby people living further down the gradient are at greater risk of drug harms.

3. The Australian Medical Association considers cannabis use to be both a health and social issue.

4. The Australian Medical Association considers cannabis to be a drug that causes a range of health and social harms at the individual and community level.

5. The Australian Medical Association supports a harm reduction approach to cannabis use.

 

This is a fairly long policy and, in fact, there are nine pages of it, so I will not read it all out. However, under the heading Medical Use of Cannabis, it states:

26. The Australian Medical Association considers cannabis may be of medical benefit in: HIV-related wasting and cancer-related wasting; and

Nausea and vomiting in people with cancer, undergoing chemotherapy, which does not respond to conventional treatments.

27. The Australian Medical Association believes that more research needs to be undertaken to determine the medical benefit of cannabis in:

Neurological disorders including (but not limited to) multiple sclerosis and motor neurone disease; and

Pain unrelieved by conventional treatments.

28. The Australian Medical Association supports research to examine whether cannabinoids provide any greater benefit than the newer antiemetics.

 

If anybody wants to see a complete copy of that, I will be happy to provide it to them. In the United States, support has come for medical marijuana from the United Methodist Church, the Episcopal Church, the United Church of Christ, the Union for Reform Judaism, the Progressive National Baptist Convention, the Presbyterian Church and the Unitarian Universalist Association.

In introducing this bill, I ask members to exercise common sense and compassion when determining their position. In relation to common sense, I quote US presidential candidate Barak Obama who, when recently asked if he became president would he halt the Drug Enforcement Administration's raids on medical marijuana growers in Oregon, replied:

 

I would, because I think our federal agents have better things to do, like catching criminals and preventing terrorism. The way I want to approach the issue of medical marijuana is to base it on science and, if there is sound science that supports the use of medical marijuana, and if it is controlled and prescribed in a way that other medicine is prescribed, then it is something we should consider.

 

A man whose friend died from cancer wrote to me. He stated:

During her illness she asked me for some cannabis, which I took to her...this personal experience showed me that cannabis really does provide relief from cancer. It is my deepest regret that I could not take her more and of better quality.

In her last weeks she was bedridden and hardly able to move and her body withered away and her stomach bloated. These are the effects of morphine. Diagnosis came too late for her but, with cannabis, she could have lived a little longer with a higher quality of life, but prohibition deemed that she live in suffering and die an early death in a morphine-induced narcosis, as a state-sponsored morphine addict. To allow someone to die by withholding their medicine is no different to holding someone under water and preventing them from having air.

The war against marijuana is ideological; it is a matter of what substance fits with what set of values. In the West there is a view that nature is bad and synthesising is better. It is time for us to consider the use of medical marijuana as part of being a humane and compassionate society. If we know that a substance works by improving the health of people and we continue to deny access to it, particularly when so many people use it illegally without any bad effect, then there is something else driving the argument—and it is certainly not science.

 

In a civilised society, debate on drugs should not be about criminality or belief systems but about health. Bit by bit the demand for medical marijuana is growing and, bit by bit around the world, the medical efficacy of this drug is being recognised. This is the second time that legislation for medical marijuana has been introduced to the South Australian parliament, and I am sure it will not be the last, given the phoney 'tough on drug' stance of most members of this parliament—most of whom drink alcohol and less of whom smoke tobacco. However, like the vote for women, it is an idea whose time has come and, eventually, such legislation will pass. Debate adjourned

[freddie]

Sandra Knack for PM!!!!

 

Pity she's a SA Democrat. One very dead party at the moment.

 

Some great points about the dangers of prescription drugs compared to MJ. In fact WOW, what a speech.

[Mothball]

bloodyhell viagra has some seiously nasty side effets....

[bufo marinus]

That is one of the best speeches I've ever read regarding cannabis so much of what she wrote we discuss here on a daily basis. Sandra Knack has my utmost respect for detailing such a sound, logical argument. She makes so many excellent points.

That is what politicians are supposed to do, represent the people that elected them and act accordingly, not run for cover and hide.

I can't say enough good things about this article or the politician

[Guest niall]

It's finally begun!

[WantDaChronic]

what a legend, i so hope it gets passed

[brick]

Sandra Knack for PM!!!!

 

Pity she's a SA Democrat. One very dead party at the moment.

 

Some great points about the dangers of prescription drugs compared to MJ. In fact WOW, what a speech.

 

Give them time freddie. My son is a young democrat and they are working very hard all over Australia to resurrect the party.

[iamnotacop]

It's finally begun!

 

I woudn't get your hopes up. Common sence has nothing to do with politics.

 

Example....

 

 

Legislative Council

4 November 1998

A NEW APPROACH TO TACKLING THE DRUG PROBLEM

 

The Hon. M.J. ELLIOTT: I move:

That the Legislative Council notes the drug policies of the Netherlands and Switzerland and their impacts, and therefore—

I. Supports the separation of the cannabis market from the market of other illegal drugs; and

II. Calls on the Federal Government to allow the proposed heroin prescription trial to proceed in Australia.

On Thursday 8 October this year—in fact, the day before I left to travel overseas—the State Police Commissioner, Mal Hyde, announced that 34 heroin users had died in South Australia so far this year. It seems reasonable to assume that, by the end of the year, the death rate will have reached somewhere approaching 50, which is around about the ballpark of what it has been for the past couple of years—I believe that it has been 50, 60 and slightly over. As I said, that was the day before I departed for two countries that I believe have made encouraging progress in the drugs area, namely, the Netherlands and Switzerland.

Some people might wonder why I should spend my time on heroin addicts. I believe that there has to be an appreci-ation that drug users are people: they are someone's son, daughter, sister, brother, father or mother. They come from all sectors of our society; they are ordinary people; but they have an extraordinary problem—and we must acknowledge that. They have a health problem that needs to be confronted.

In Australia we introduced drug laws to protect people. We did that with the best of intentions. We believed that, by introducing laws that came down hard not just on those who sold but on those who might consider using, we would stop their use. We now have a long enough history to know that what has happened instead is that the very laws we introduced to protect people are killing people. The laws we introduced to protect people mean that they are now leading lives of crime and prostitution, over which they have no choice, because of what the addiction is doing. They have enough of a sentence from the addiction itself without our considering some other penal reaction to it.

South Australian laws are costing not just the individuals and their families dearly but ultimately they are also costing our community dearly. We are all sharing the cost of the crime that is generated by the habit and the need for the drug and the need for the money to get the drug.

After spending two weeks in those two countries studying their drug policies and their implementation—of course, I have looked at them from a distance for some time but it is not quite the same as being there and meeting with the various players—I have come back convinced that there is not a single solution to the drug problem. In fact, there is no solution as such. However, there is a suite, or a range, of approaches which together offer some hope and clearly offer an improvement on the situation in which we currently find ourselves. Yes, we need law enforcement, but law enforce-ment should not be targeting the users: it has to be targeted at the pushers—the people who are inducing people to use drugs and who are making the mega profits out of the misery that is being created. Let the police focus their efforts there: do not have them chasing around after the people who have a problem and, in fact, exacerbate their problems. We need a health and a social approach adopted towards the users.

I witnessed the programs in the Netherlands and Switzer-land. I spoke with health professionals, politicians, police and drug users. I went into the clinics and user rooms, etc., and saw what was happening. I even experienced first-hand drug-related theft, in that in the second week when I was in a tourist office obtaining directions to find my way to a suburb of Bern a bag was taken from my feet. It was found about 50 minutes later in a park that drug users frequent. They had been through it and taken the money from it but, luckily, had not taken my passport, tickets and notes. I was most worried about the notes that I had taken, because at that stage I was about three-quarters of the way through the tour. So, I suppose I had contact from almost every aspect of the drug situation in those countries.

I believe it would be most productive if I took the two countries separately because, while there is some clear overlap between what they are doing, there are also some clear differences. I will talk about the Dutch experience first: what they are doing and those things that appear to be working and, in some cases, just comment about it. I will do the same with the Swiss, and I may spend more time focusing on the heroin prescription situation in Switzerland, because that is where they have been doing it the longest, and I will focus on other matters in Holland, where they have had greater experience.

The Netherlands reported 65 drug deaths from a popula-tion of 15.4 million in 1995. Compare that with South Australia, which has had 34 drug deaths so far this year from a population of 1.3 million, and your maths will tell you pretty quickly that our rate of death from use of hard drugs is about eight times as great as that in the Netherlands. In fact, I commend to members (and I will quote from it later) a publication The Annual Report on the State of the Drug Problems in the European Union, which is put out by the European Monitoring Centre for Drugs and Drug Addiction and which contains a table of deaths over the period 1986 to 1995. In the Netherlands, the number of drug deaths was 55 in 1986. It went down to 40 in 1987, varied through the 50s, 60s, 70s and up to 82 and 84 in 1993 and 1994, and went back down to 65 in 1995. There is a bit of variation there, but it is relatively flat.

In the United Kingdom the number of deaths was 1 212 in 1988 (when it started compiling figures) and that country has had a rising line with very little relief in it. By 1995, it had reached its highest figure of 1 778 deaths, in a population of 58 million. France—another near neighbour of the Netherlands—with a population of 58 million, had 465 deaths in 1995—a significantly higher death rate than that of the Netherlands. And Germany (a country that is very tough on drugs) had 1 565 drug deaths in 1995, in a population of 81 million. I believe that is about 20 times as great as the figure in the Netherlands, its neighbour, which it also criticises for its drug policies. In some ways it is rather amusing, I suppose, that countries that are failing in their approach to the drug problem, such as the United States, Australia and Germany, condemn countries that are making not only a very real effort but also some achievement in that area as well.

The Dutch drug policy is pragmatic that is, its ideological or normative aspects are less important. Its primary objective is health protection, and the key concept is harm reduction. The outcome that the Dutch are seeking is assistance to drug users, aiming primarily at minimising health risks, with drug abstinence as a secondary aim. That does not mean that they do not want drug abstinence: they are setting themselves what are achievable goals and are achieving them. However, the aim of the Dutch drug policy is broader: it is to minimise the risks of drug use for individual drug users, their immediate environment and society at large.

Besides minimisation of health risks, other important issues in the Dutch drug policy are to limit nuisance and criminality caused by addicts and to combat illicit drug trafficking. Therefore, the Dutch drug policy follows a two track approach which consists of repressive measures based on legislation, drug law (that is, criminal law) and law-based regulations—and I will give the Council some statistics later on just how much they are achieving in the repression area. They are not soft on drugs; indeed, they are very successful in the repression area. The other track is the social and health care measures. There are three distinguishing features: first, in general, a pragmatic orientation; secondly, in the field of social and health policy, drug problems are defined primarily as health problems; and, thirdly, in the field of criminal law, there is a less repressive approach towards users.

With a pragmatic orientation, as well as harm reduction there is also what they call normalisation, which is a key concept of the Dutch drug policy, entailing the following connotations: getting the drug issue to normal proportions is just one health issue besides others; integrating drug treat-ment services as far as possible into general health services; and getting the drug problem under control. This concept of normalisation is an example of the pragmatic orientation, `pragmatic' meaning effect or result oriented and not principle oriented.

In relation to social and health policy, the drugs problem is defined in the first place as a health problem. The Ministry of Health, Welfare and Sport is responsible for coordinating drug policy. The basic aim of the Dutch drug policy is harm reduction to help drug users to live a life as healthy as possible and to survive with a subsequent aim of drug-free treatment. Therefore, low threshold programs are a priority, that is, easily accessible services where drug users do not have to fulfil certain requirements to be accepted as clients. These activities entail: the provision of methadone, sterile needles, food, medical care and accommodation. Most of that is not really different from what we are doing in Australia.

The choice of harm reduction is a pragmatic one. The principal and moral imperative that drug users should give up drug use resulting in an approach offering treatment as the only solution has proved to be not realistic, and realism is what is necessary in all of this. Harm reduction, as stated before, is important for individual drug users to prevent damage to their health. It is important for their immediate environment, preventing infection risks, reducing social problems and keeping children alive and relatively healthy, as well as for society at large.

We want to decrease the cost of health measures, law enforcement and criminality generally. Besides low threshold facilities, a variety of facilities offer treatment. There are brief detoxification periods of up to three weeks, short-term admittances of up to three months, longer-term admittances with a maximum of one year, part-time treatment and outpatient treatment.

The third point involves legislation and regulations. In drug law itself there is only one distinguishing feature, and that is the distinction between soft and hard drugs. They make a distinction between cannabis and the other illicit drugs. The outcomes are that penal provisions for soft drug offences are milder than those for hard drug offences. The possession of up to 30 grams of cannabis is seen no more as a crime but as a misdemeanour. That is not dissimilar from the South Australian approach.

The main rationales are a separation between the market for soft drugs and the market for hard drugs, preventing cannabis users from ending up in an illegal environment where they are difficult to reach for the purpose of prevention and intervention. A minor distinguishing feature is lower maximum penalties, and another major distinguishing feature—perhaps the most important one—is the expediency principle which is included within the Dutch penal code. The expediency principle empowers the public prosecutor to refrain from prosecution of criminal offences if this is in the public interest.

Guidelines for detecting and prosecuting offences under the Opium Act contain recommendations regarding the penalties to be imposed and priorities to be observed in investigating and prosecuting offences. Priorities according to these guidelines, which were amended on 1 October 1996, are: punishable offences involving hard drugs other than for individual use take the highest priority; punishable offences involving soft drugs other than for individual use; and investigation and prosecution for possession of hard drugs for individual consumption, generally .5 of a gram, and soft drugs to a maximum of five grams. To my mind, the most significant action that the Dutch have taken with their pragmatic approach and the move to separate markets is the separation of cannabis from drugs such as heroin, cocaine and amphetamines.

There are many people who prescribe to the stepping stone hypothesis: an assumption that cannabis consumers run a higher risk of switching to hard drugs, especially heroin. This idea was first put forward in the 1940s in the USA and has since greatly influenced public opinion, as well as American and international drug policies. Opinions differ as to whether or not the hypothesis is correct. Regarding a possible switch from cannabis to hard drugs, it is clear that the pharmacologi-cal properties of cannabis are irrelevant in this respect. There is no physically determined tendency towards switching from soft to harder substances.

Social factors, however, do appear to play a role. The more users become integrated into an environment (a subculture) where, apart from cannabis, hard drugs can also be obtained, the greater the chance that they may switch to hard drugs. Separation of the drug markets is therefore essential and forms the basis of the cannabis policies of the Netherlands.

As part of that policy, the police and public prosecutors have allowed the establishment of coffee shops. The law does not. It is the fact that the expediency principle is in operation within their legal system that allows them to have coffee shops. These coffee shops are established and sell cannabis and have been doing so for over a decade. They will not suffer the wrath of the law unless they go over a set of published criteria.

The first criterion is that coffee shops will not advertise: no commercials, no promotion. They will have no hard drugs for sale, nor will they allow hard drugs to be used within them. They will allow no public nuisance and no selling of soft drugs to persons under the age of 18 and in no great quantities, which means more than five grams per transaction. The maximum trade stock allowed is 500 grams, so they cannot have more than half a kilogram in a coffee shop at any one time, although councils can set a lower maximum. Depending on specific local problems, some local councils have added several stipulations in the form of a covenant: for instance, there may be no parking in the front of the entrance and a closing time may be set.

According to police estimates, the number of coffee shops in the Netherlands was 1 200 to 1 500 in 1991. A research bureau estimated their number at 1 460 in 1995 and 1 293 in 1996. So, over the past couple of years the number has decreased. It is also fair to say that there are estimates which place higher and lower figures on them.

Coffee shops are mainly small cafÈ-like enterprises. I issue a warning for people who go to Amsterdam or Rotterdam: if you are looking for coffee, go to a cafÈ; if you are looking for cannabis, go to a coffee shop. The cafÈ-like enterprises cater for a diverse public from various social backgrounds. Most offer a wide range of hashish and marijuana products from various countries and of varying quality. Coffee shops have various functions. Some act solely as shops. In others, people may use drugs if they buy something, whilst others serve mainly as meeting places where little is bought and people stay longer.

I visited a couple of cannabis coffee shops and spoke with their owners and some of the customers. Anyone who has been to a hotel and then goes to one of these coffee shops would see a remarkable difference in the behaviour of people. In a hotel you may see aggressive drunks. In coffee shops I saw a number of people sitting around engaging in social discourse. I personally do not smoke, but they were having a smoke, and they certainly were not creating a public nui-sance. Most importantly, from a drug perspective, this environment that they were in was not providing links with other drugs such as heroin, cocaine and LSD, etc.

It is worth noting that the consumption of cannabis in the Netherlands is about on a par with neighbouring European nations. Again, quoting from the Annual Report on the State of Drug Problems in the European Union, in relation to cannabis consumption among teenagers—and this is a question not as to who are regular consumers but as to who have ever consumed—in the Netherlands it stands in the age range 16 to 19 at about 30 per cent. Compare that with the United Kingdom, which has much harsher laws, where in the same age group it is 36 per cent. If you compare it with the French, ages 18 to 24, it is 30 per cent. The Germans claim that from 18 to 20 (which is just a two year age range) it is 22.6 per cent.

So, the allowance of coffee shops has not led in the Netherlands to this rapid escalation in consumption relative to the surrounding countries which have entirely different laws. Although I do not have the Australian figures with me, I have no doubt in terms of those who will have consumed at some time that the figure would have been higher in Australia and is definitely much higher in the United States. The laws have not led to increased usage. It is important that one understands that the Dutch not for one moment, having allowed the coffee shops, were saying, `Look, cannabis is a good thing.' I brought back a large amount of material from the Netherlands in relation to the education programs being run in the Netherlands, in their schools and outside. I quote from Fact Sheet No. 5 `Education and prevention policy alcohol and drug' put out by the Netherlands Alcohol and Drug Report, as follows:

The Government is striving to prevent a situation in which judicial measures do more damage to the drug users than the drug use itself. The sale of small quantities of soft drugs in coffee shops is not prosecuted provided that the owner complies with a numberof rules. One important aim of this policy is the separation of the markets for soft drugs and hard drugs. . .

Effective prevention requires a combination of voluntary restraint on the part of people themselves and restrictions imposed by the authorities in form of legislation and regulation. In addition, great importance is attached to strong, well-organised social controls. The government also takes a positive view of self-regulating initiatives developed by the industry and its umbrella organisations, such as the trade organisations for beer and liquor. . .

Although a great deal of attention is devoted to the Dutch government's relatively lenient attitude to drugs compared with other countries, the supply of drugs is in fact much more stringently restricted, both legally and in practice. Supplying drugs is completely banned. . . while supplying alcohol is primarily regulated. . . The distinction between soft drugs and hard drugs is also considered of great preventive value. This is why a distinction is being made between drugs that carry an unacceptable risk (heroin, cocaine, LSD, amphetamines, hash oil, XTC), listed on Schedule 1 of the Opium Act, and hemp products (hashish and marijuana), listed on Sched-ule 2 of the Opium Act. By making the distinction between drug users and dealers, the government is attempting as much as possible to prevent drug users from entering an illegal environment, where they are difficult to approach for prevention and intervention.

Finally, the cohesion within the policy as a whole is also important, with accessible and outreaching care also being realised along with prevention. And what is more, the care is not only provided by highly specialised facilities, but also by primary care facilities—close to the population—which also provide help and prevention.

In relation to the education programs, the fact sheet states:

The Alcohol Education Plan (AVP) aims at providing people with more information on the effects of alcohol, making them more aware of the negative consequences of excessive drinking and motivating them to moderate their consumption (therefore, less often and less per occasion). The AVP uses four instruments: the conducting of national education campaigns, the initiation of projects, individual information supplied to the public, social organisations and the media and the conducting of research. Since 1986, there have been five general mass-media campaigns and five campaigns targeted at specific groups, particularly young people and young adults. Commercials on radio and television were comple-mented by commercials in cinemas, on billboards in railway stations, on the metro and in schools, together with leaflets and other written information. Such materials can also be developed specifically for intermediaries. . .

The interactive computer game `Zefalo' is a recent development. It is available in shops but can also be accessed on the Internet. A free-phone Alcohol Information phone-line is being set up to increase the range of existing information line.

In addition to the national campaigns, small-scale information and education actions are being organised at local level, for instance in schools and youth centres. There are 20 regional AVP Support Centres that cooperate with other local prevention organisations. The AVP budget for 1995 was $3 million guilders [which is about $A3 million].

In June 1996 the AVP became part of the National Institute for the Promotion of Health and Prevention of Illness.

What is worth noting—I have not gone through the detail of the programs themselves—is that between 1986 and 1994 alcohol consumption fell from 8.6 litres of pure alcohol per capita to 7.9 litres. This reduction is partly the result of increasing numbers of non drinkers. In 1995 young people between the age of 15 and 25 who used alcohol drank 6 per cent less than in 1994. That is a quite interesting result. Within one year they had decreased consumption of alcohol by 6 per cent. The percentage of non drinkers rose from 19 per cent to 31 per cent.

I have also been supplied with a one page summary sheet of data in a brochure called the Healthy School and Drugs Project. This is about an education program which is in schools and which compares control groups who did not receive the education programs with those that do. It looks at the age group 12, 13 and 14 in relation to three drugs: tobacco, alcohol and cannabis.

From time to time I have heard people suggest that, if you supply an education program, you need to get the age right or you might have the opposite effect. I am not sure whether that might partly explain why in relation to tobacco the project group showed marginally more consumption of tobacco than the control group. It was 9 per cent for the project group and 8 per cent for the control group for the consumption of tobacco. Interestingly, by the age of 13 it had flipped around the other way—14 per cent in the control group, 12 per cent in the project group—and by the age of 14 the difference had grown further to 29 per cent of the control group and 25 per cent of the project group. That is a 5 per cent difference in those who were consuming tobacco. Clearly, that education program was biting.

If we look at alcohol, at age 12 the control group was a little over 35 per cent, while the project group were at about 30 per cent. By the age of 14 and those who had consumed (that does not mean regular consumers), the project group was still significantly lower at about 59 per cent compared to the control group who were at 67 per cent. I would be concerned that that many people had actually tried it in either group but, importantly, the education had had some effect—and a measurable and distinct effect.

In fact, the most profound effect was achieved with cannabis where, at the age of 13 (they did not supply figures for age 12), 3.5 per cent of the project group had tried cannabis, whereas with the control group it was about 2.5 per cent. But by age 14 a marked difference was showing: in just over one year the control group had gone up to 13.5 per cent, compared to the project group, 9 per cent. I have seen material that the Dutch have produced for their schools and I know that they are rewriting it and further refining it even as we speak. So, the Dutch have not given up on drugs. Clearly, they are following a different approach.

When I went away I was clearly intending to look at the cannabis rules and policies of the Netherlands and to look at the heroin prescription trials in Switzerland, but I was also going to look at any other matters that came up. The one matter which got in my face really as an issue and one for which I was not prepared was the issue of consumer rooms, of user rooms. I must say that I went away with some vague awareness of them and not feeling happy about them at all and, having visited several of them and having seen them in operation, in terms of my own discomfort I felt probably even worse. In fact, after being in the second consuming room and the third time having seen people actually injecting while I was there, I was really feeling very ill. But having said all that—and I will talk more about specific experiences later—I am absolutely convinced in my own mind that they are part of an overall program and, when I get to the end of my speech, I hope I will have stitched it all together. All these things are components.

The first consumer room that I visited was a room in Rotterdam. I went to a church, Paulus Kerk, near the Rotter-dam Central Station. The pastor there some 18 years before had said, `I welcome into my church all those who are homeless and who are in need of care of whatever sort.' Every night since then large numbers have slept in the church and he has had social workers based in the church offering assistance. In among those people were drug users.

Near the Rotterdam station, to which, as I said, the church was quite close, there was a major public drug scene, if you like, including the consumption of heroin etc. around the station and a huge amount of public nuisance of all the sorts you can imagine. The police wanted to close this down, but to some extent when you squeeze in one place it comes up somewhere else. In this case, the police squeezed and it came back up inside the church. The church allowed people to consume heroin and cocaine within the church itself, it appears with the police blessing, although to some extent, having had no experience with it before, they did not know quite what to do, particularly as it was in a church.

The program is about a number of things. First, it is about compassion. These people are coming into the church and they have available to them all the assistance of various sorts that they might want. Obviously, it offers the sort of assist-ance you would expect any church to offer, but it also has more. It has social workers, health workers and an enormous team of volunteers are working there. Coming into this place are people who are at the most desperate end of the heroin scene. They are people who have not gone into methadone programs; people who have probably tried them and failed; people who have probably tried abstinence a couple of times and failed. They are in desperate trouble.

There is a human relationship, I guess, established between those people working in the church and the people coming into the injecting room. Through that human relationship they work to get those people into a fixed place of abode or into a residence. They work to try to get them jobs. The church has no requirement of them in terms of abstinence. In fact, as I said, it allows consumption to happen. But, importantly—and I think this is true with drug users—you cannot help them until they are ready to be helped. The church tries to get as much of their life into order as it possibly can when they have that dreadful habit. When the people are ready to go further, it will take them further.

In fact, there are two consumer rooms in the church. Many of the Dutch do not inject; it is one of the few countries of which I am aware where heroin is actually inhaled. It is heated on aluminium foil and inhaled through a straw—they call it `chasing the dragon'. In one consumers' room people were consuming heroin in that way and in another consum-ers' room people were injecting. A limited number of people are in the room at one time; I think it was eight in the injecting room—one person out, one person in. Health workers are available and if somebody needs health assist-ance it is there. So many of the drug deaths which happen are drug overdoses, and they happen where people are in an isolated spot where medical assistance is not available.

To put it quite simply, for a person to die in a consuming room would be a rarity. The first thing about a consuming room is to ensure that people do not die from an overdose. The second thing about a consuming room is that health professionals are available to address some of the other problems. I remember seeing one lady in a consumer room in Bern and her face was covered in sores. I was told that that was likely to happen because she was injecting cocaine. I do not understand these things, but I was told quite matter of factly that that is what it was. There was a doctor treating her at the time. So, those very immediate health issues are being attacked.

The two consumer rooms that I visited—and I understand it is a regular practice—also sell a cheap and healthy meal, because malnutrition can be a major problem among drug addicts. Then, importantly, other help is there for people when they need it. Some people would say that they should be forced to take the help but, if you try to force them to take the help, they disappear from the system. If they are put into gaol, they come out worse than when they went in. I spoke to a person who telephoned me only today to speak to me about this. She said that her sister went into gaol and came out a worse addict than when she went in.

The heroin problem is a very difficult one, and all the experts tell me that, unfortunately, people will not get over it until they are ready to get over it. They will follow many different paths. Some people will follow abstinence; for some people religion is their solution; for some people it is methadone programs; naltrexone seems to be offering some hope; and, of course, there are the heroin consumer trials.

I had great difficulty finding the first consumer room—which, I guess, must be promising in one sense. People expect consumer rooms to create a great deal of public nuisance. At the first site I visited, frankly, from the outside you would be struggling to know that a consumer room was there, and in Bern I left a consumer room and within 80 to 100 metres of that consumer room I sat down to have a meal in a restaurant which was full of people who were quite oblivious to what was so close to them. I commented before that after my last visit to a consumer room I was not feeling particularly well, and I must say that it was a meal that I did not enjoy.

I, like everyone else in this place, cannot fathom why anyone would ever want to do it, why anyone would want to stick a needle in their arm. It has me beaten and, when I looked at them, I could not see where the joy of it was. But, it does not matter whether I can see it. They are there and they are doing it, and they are doing it for reasons that are beyond, I suppose, the comprehension of a person who has not experienced it. All I can do is look at the practical impacts of the various programs that are being tried.

Some people with all the best will in the world have said that we have to be hard on these people. I can tell you that being hard on them will kill them; it will mean that they will stay in crime and the women will stay in prostitution against their will. Even if it means that they continue to use drugs for some time, offering programs of compassion and care means that they stay alive and may re-establish human relations with other people, that those who care for them still have them and that they may commit less crime. That is the sort of thinking which drove the heroin trials in Switzerland. Before I leave the Netherlands I should note that the Netherlands itself has now commenced a heroin trial, which is very much modelled on the Swiss one, but it might be better to reflect on the Dutch experience once I have talked about the Swiss, who now have experience over a period of some four or five years.

I will make a couple of final observations about the Dutch. The Dutch are certainly tough on traffickers. In 1995, 351 kilograms of heroin were confiscated. The Netherlands is not a major transit country for heroin, and most consignments that are confiscated come through other European countries. In 1995, 4 851 kilograms of cocaine were confiscated; that was 23 per cent of the total amount confiscated in the European Union in that year. In 1994, 215 kilograms of amphetamines were confiscated, in addition to 143 000 pills containing other synthetic drugs, mainly MDMA, MDA and MDEA. Seventeen illegal laboratories for the production of synthetic drugs were dismantled in 1995, while a total of 50 were dismantled in the EU in the same year. In 1995, too, 549 337 hemp plants and 332 tonnes of cannabis were confiscated. That is 44 per cent of the total amount confis-cated in the EU in that year. In 1994, 323 illegal hemp nurseries were dismantled. So, if anybody thinks that the Netherlands is soft on drugs and allowing trafficking to go on, they are wrong: the Dutch are not soft on these things at all.

I will quote from the April 1997 document: Drugs Policy in the Netherlands put out by the Ministry of Health, Welfare and Sport. In a short section here entitled `Results of public health policy,' it states:

There were 2.4 drug related deaths per million inhabitants in the Netherlands in 1995. In France, this figure was 9.5; in Germany, 20; in Sweden [which is a country notoriously tough on drugs], 23.5; and, in Spain, 27.1 [a very conservative nation]. According to the 1995 report of the European Monitoring Centre for Drugs and Drug Addiction in Lisbon, the Dutch figures are the lowest in Europe.

There is no doubt that what the Dutch are doing is having a very real impact and result on people.

Having spent a week in the Netherlands (and for those who want to know precisely to whom I spoke, that will be all in the report which I will table in the Parliamentary Library in due course), I move on now to the Swiss. According to current estimates, about 30 000 of the 7 million inhabitants of Switzerland are dependent on illegal narcotics, with the primary use by this group being heroin and cocaine—and, I must stress, predominantly heroin. In addition, a number of people use drugs regularly or from time to time without actually being addicted. It is nearly impossible to determine the size of that group of drug users. Cannabis is the most frequently used drug, followed by heroin and cocaine. The use of synthetic drugs, especially of Ecstasy/MDMA, seems to be increasing. Seen as a whole, however, drug use in Switzerland has remained stable in past years, and the number of deaths related to drug use has decreased. In 1992, 419 drug related deaths were recorded, while in 1997 there were just 241. In a period of five years the Swiss had almost halved the number of drug related deaths. With the closing of the open drug scenes in the spring of 1995, drug addition has become less visible. As a result of the economic recession and the spread of AIDS, many drug addicts remain socially marginal-ised.

Switzerland is an interesting country to look at, because its structure is very similar to ours. It is a federation where the primary responsibility for drug law resides with the cantons, which are equivalent to our States. Although the cantons are reliant upon the Federal Government to provide a lead and coordination, it is the cantons and the cities which ultimately have most of the responsibility. In view of the apparent increasing drug problems, the federal government decided in 1991 to intensify its commitment considerably in this area. In order to fight the harmful effects of drug abuse, the federal government is pursuing a policy comprising four strategic elements. It has what it calls a `four-fold approach' to drugs, of prevention, treatment or therapy, harm reduction and repression or law enforcement.

In relation to prevention—the most important strategic element—it is a matter of convincing young people not to use drugs and to adopt a healthy lifestyle (primary prevention) as well as keeping occasional users from developing an addiction, while maintaining their social integration in the family, at school and at work, which is secondary prevention. Therefore, the federal government supports and encourages cantonal and private projects for prevention and early intervention. It coordinates cantonal and private projects, provides technical assistance and guidelines and takes part in planning and funding of pilot projects. Certain target groups, such as socially deprived youth and migrant populations or certain environments such as schools, youth homes and youth events as well as sporting events, receive special attention.

I turn now to therapy. Those who have become drug dependent should be encouraged to enter therapy. In addition, specific means and individual support have to be made available in order to overcome addiction. The federal government supports various state and private programs for treatment and reintegration. It offers coordination and supports quality assurance and evaluation. At present about 100 institutions in Switzerland are specifically designed to provide drug therapy. In-patient therapy is available for a total of 1 750 persons. The declared goal of these therapies is abstinence and social reintegration. That is 1 750 out of the total addict population of 30 000. In 1996 more than 2 100 individuals began therapy. The federal government also offers recommendations by experts concerning oral metha-done treatments and supports evaluation of this method of treat-ment. About 14 000 methadone users live in Switzerland, so almost half of the heroin addicts in Switzerland are within the methadone program.

At the end of 1995 the Swiss Federal Commission on Narcotic Drugs published a report on the practical and technical aspects of methadone treatment. The report is available in German, French and English at the Swiss Federal Printing and Material Centre. The federal government also offers support for patients who suffer from psychological problems as well as from drug abuse—a double diagnosis. That appears to happen in about 30 per cent of cases, from my recollection, where you will get a double diagnosis of both psychological problems and drug abuse, and it is very difficult to prove which came first. There is no doubt that drug abuse has the capacity to cause psychological problems, but it is also true that people with psychological problems find the drug culture fairly easy to fit into.

Since 1994 the federal government has been supporting scientific studies of medically prescribed narcotics for severely addicted individuals. These studies aim at clarifying whether marginalised drug addicts who have already tried treatment several times can be integrated into yet another therapy that leads to health improvements, social rehabilita-tion and finally to abstinence. That is the heroin prescription trial to which I will come back shortly. It has been running in Switzerland for some four years. The third plank is harm reduction. Drug addiction represents for the majority of people concerned a limited period of several years in their life. It needs to be recognised that most heroin addicts do eventually get out the other end. Unfortunately, a number do not get out for a considerable period but, for a great majority of people, it is something that lasts for several years in their life and then they do eventually emerge out the other end. I would never say they emerge unscathed, not by any measure.

The third plank relates to measures intended to limit harm that aim at protecting the health of addicts during the addition period as much as possible. Drug addicts are at great risk of being infected with HIV and hepatitis. Depending on the group, the rate of HIV infection among drug addicts is between 5 and 20 per cent. I note that hepatitis C is looming as a far bigger threat than HIV among drug users: its level is up around 75 or 80 per cent, I understand. Hepatitis C is far more contagious than HIV. At this stage HIV appears to be responding to a range of medical treatments, not that that is any comfort because they are still invasive sorts of treatments and it is a dreadful disease. Hepatitis C leads eventually to cirrhosis of the liver, cancer and the like, and people are still unsure at this stage precisely what that will mean for us in health terms in years to come.

We desperately need programs to curb the spread of hepatitis C amongst the using population because the experience is that, like HIV, it moves from the using population into the general population and continues to spread. We now find with HIV that the major people catching it are outside the early danger groups. Hepatitis C could be the same. It is in everyone's interest that harm reduction takes place. The federal government therefore supports a variety of measures, for example, needle exchange programs, housing and employment programs to improve health and the lifestyle of drug addicts and to prevent the spread of HIV and other infectious diseases. Compared with the late 1980s, HIV prevalence among drug addicts has decreased.

Switzerland has also followed the Dutch example and is setting up consuming rooms. I referred to having visited one in Bern. At this stage they have set up relatively few facilities compared with the Dutch but I think the Swiss have come to the same conclusion that, by the establishment of consumer rooms, it brings in those people previously outside the system. If you go outside the methadone and abstinence programs—and now the heroin prescription programs—you are still reaching only between 50 per cent and 60 per cent of addicts and another 40 per cent are out there injecting in parks, lanes, flats and units, spreading HIV, catching hepatitis C, dying from overdose, totally and socially dislocated in almost every sense, committing crimes and working as prostitutes, etc. The consumer rooms are reaching out to these people, bringing them in and trying to improve their health status, trying to keep them alive and trying, bit by bit, to restore their human dignity, with the long term goal of getting them off the habit.

The fourth plank is law enforcement. Swiss drug policy relies on strict regulation and prohibition of certain addiction causing substances and products. This asks for criminal prosecution of illicit production, of illicit trafficking and illicit consumption of substances regulated by law as well as the strict control of authorised use of narcotics in order to prevent abuse. That is one difference from the Dutch approach. The Dutch do not have consumption as an illegal act, whereas the Swiss do.

As to the heroin prescription trial, I had the opportunity to meet with the person in charge of the program in Geneva, Dr Mino, and I also met with one of the principal architects of the whole heroin prescription program in Switzerland, Dr Robert Haemmig, from Bern. I like to believe I gained a good insight into the heroin prescription trial. Basically, people cannot go into the heroin prescription trial unless they have been addicted for at least two years, although the reality is that most people who entered that program had been addicted for five years and longer. I spoke with one addict who had been addicted for 20 years and another for 15 years. They were people who had to have failed other treatments on several occasions. They had to have failed abstinence and methadone programs, etc.

There has to be an indication of adverse effects of drug use on health in those individuals and their social relations. One could not just roll up and say, `I want to be in the heroin prescription trial.' People had to prove that they had made genuine efforts in other forms of rehabilitation previously and failed at them. People also had to be a Swiss resident. The clinics work in such a way that they open three times a day, seven days a week for 52 weeks a year. They are open for about two hours, once in the morning, in the middle of the day and early in the evening. Participants in the program report and are under observation for about 10 minutes so that the nurse or social worker is confident that they are not under the influence of some other drug, because they do not want to add a drug to a drug and risk an overdose. Only eight people can enter the room at any one time and it is very much like the consumer room in that regard.

Participants come up to a counter and ask for a quantity of heroin. Each person will be prescribed perhaps a different amount; there will be a maximum dose for the day and a maximum dose at any one time. I am told that users usually come about twice a day and not three times a day and ask for heroin. They say how much they want and the nurse checks with the computer that they are not asking for more than what is prescribed. Of course, the hope is that they are reducing their dose, but there is no forcing of reduction.

The patient is then provided with a needle, which has the heroin put into it and injects there and passes the needle back where it is put into a receptacle. There is no chance that the heroin can be taken out of the room and resold. Some of these people are really bad cases and need assistance from nurses on some occasions. Their veins have collapsed and they are doing intramuscular injections. What we are not seeing in these programs, and what we are seeing in the consumer rooms and what is clearly rife in the consuming populations outside these programs, is the skin infections and the like. Because people are no longer hunting for money to get their fix they are well nourished and their physical status has improved markedly. In fact, the only deaths from the program have been due to pre-existing illnesses such as HIV and the like which they got before they entered the program. The program is aimed to stop the spread of disease and to improve significantly the health of people in attend-ance.

I will quote now from the Final Report of the Research Representatives of the Program for Medical Prescription of Narcotics, which is a summary of the synthesis report published on 10 July 1977. This was the two-yearly report: the trial had been running for two years and this is what it found at that point. First, in relation to substance related results, it stated:

Recruitment of patients, retention rate (the duration of continuing participation) and compliance. . . were better with the prescription of injectable heroin than with that of injectable morphine and methadone.

It started off making comparisons between the two but found that morphine and methadone were not retaining people within the program. It continues:

Of the injectable narcotics used, morphine and methadone proved to be of limited use; heroin was also more suitable in therapeutic terms because of its fewer side effects. There are as yet no apparent absolute contra-indications to the prescription of heroin; particular caution is necessary in cases of pre-existing epilepsy.

In other words, it is saying that using heroin itself is not causing further health problems. When people are receiving clean needles and known amounts, they are not suffering other health problems, the only caution being, as I said, possible pre-existing epilepsy. Also trialled were heroin cigarettes, and the report states about that:

Heroin cigarettes are relatively ineffective (up to 90 per cent of the heroin is destroyed) and may be replaced by other non-injectable forms.

I move from substance related results to patient related results, and the report states:

This summarises the extent to which the designated target group of heroin dependents could effectively be reached, what changes occurred in their state of health during the treatment, how illicit drug use and social integration among patients in the program developed, and what changes were observed in criminal behaviour. The program was able, to a greater extent than other treatments, to reach its designated target group: those with chronic heroin dependency, a history of failed attempts with other forms of treatment and marked deficiencies in terms of health and social integration. Those patients admitted to the project who had previously been following metha-done substitution treatment had continued to use illicit heroin to a large extent during their methadone treatment.

I turn now to the development of the state of health, as follows:

The improvements in physical health which occurred during treatment with heroin also proved to be stable over the course of one and a half years and in some cases continued to increase (in physical terms, this relates especially to general and nutritional status and injection-related skin diseases). In the psychiatric area, depressive states in particular continued to regress, as well as anxiety states and delusional disorders. Pre-existing HIV infections were referred for suitable medical treatment in the majority of cases; the same applied to other clinically apparent infectious diseases. Three new HIV infections, four hepatitis B infections, and five hepatitis C infections occurred during the study (in a total of 11 people).

We must note that close to 1 000 people were involved in this trial. The report continues:

This was very probably related to cocaine injected outside the program.

The pregnancies and births which occurred during treatment were adequately supervised and progressed normally (with the exception of one spontaneous miscarriage during heroin withdrawal); there were no indications of developmental defects in the neonates.

Regarding dependent behaviour, the report states:

Illicit heroin and cocaine use rapidly and markedly regressed, whereas benzodiazepine use decreased only slowly and alcohol and cannabis consumption hardly declined at all.

In a minority of patients, the continued regular use of cocaine (5 per cent) and benzodiazepine (9 per cent) even after 18 months of treatment constituted a difficult therapeutic problem to manage.

So, there is no doubt that the multiple users of drugs were the most difficult within this heroin prescription trial. Concerning social integration, the report continues:

The participants' housing situation rapidly improved and stabilised (in particular, there were no longer any homeless).

Nobody within the program was homeless. The report continues:

Fitness for work improved considerably; those with permanent employment more than doubled (from 14 per cent to 32 per cent), and the number of unemployed fell by more than a half (from 44 per cent to 20 per cent); the remainder lived on benefits or irregular employment or were engaged in housework.

Debts during the treatment period were constantly and substan-tially reduced. A third of patients who, on admission, were dependent on welfare required no further support; on the other hand, others turned to welfare support (as a result of the loss of illicit income).

Contact with drug dependents and the drug scene declined massively, but was not adequately replaced by new social contacts during the observation period.

If we look at social integration matters, we see that the Swiss put a great deal of effort into the provision of social workers to try to maximise social integration but that development of new social contacts proved to be the most difficult of all of those, although again the people to whom I spoke at least had improved the contacts with their immediate families. That is a terribly important first step. In relation to criminal activity the report continues:

Income from illegal and semi-legal activities decreased dramati-cally: 10 per cent as opposed to 69 per cent originally. Both the number of offenders and the number of criminal offences decreased by about 60 per cent during the first six months of treatment (according to information obtained directly from the patients' and from police records). Court convictions also decreased significantly (according to the central criminal register).

With regard to the retention rate, the report states:

In some cases, the improvement in the participants' health and social situation referred to above occurred soon after the beginning of treatment, but in others not until after several months of treatment. The extent to which early discontinuation of treatment can be avoided therefore plays a major role. The retention rate in the study, 89 per cent over a period of six months and 69 per cent over a period of 18 months, proved to be above average compared with other treatment programs for heroin dependents.

This is a tough program. If you want it, you are required to turn up twice a day, seven days a week, 365 days a year. You also have to hand in your driver's licence. So the retention rate is quite staggering. Concerning drop-outs, the report shows that:

By the end of 1996 a total of 83 people had decided to give up heroin and switch to abstinence therapy. The probability of this switch to abstinence therapy grows as the duration of individual treatment increases.

So, the longer this treatment continues the more people will go to abstinence, and I will give more recent data in relation to that in a moment. The report continues:

The longer a patient remains in treatment, the more the rate of drop-outs and exclusions from treatment decreases. Severe physical illness, particularly in conjunction with AIDS, is over-represented among drop-outs as it leads to hospitalisation.

Improvements in the social situation which occurred in the course of treatment persisted for at least six months, whether or not follow-up treatment was administered.

The use of illicit drugs increased somewhat after withdrawal but remained clearly below the initial level; the same applied to contacts with the drug scene and illicit income.

So, even those who dropped out have gone, in some cases, to places where you would want them to go—to abstinence or methadone programs. I have figures on that to which I will refer later. Generally, even those other drop-outs, for the most part, have improved their quality of life. The report continues:

Of the 1 146 patients in the study, 36 had died by the end of 1996.

It is important to note that none of those died due to overdoses within the program. It continues:

Seventeen deaths were attributable to AIDS and other infectious diseases; other causes of death include overdosage of non-prescribed narcotics, suicide and accidents. . . .Despite a high toll on health, the annual mortality rate of 1 per cent in the total cohort remains at the lower limit of what is known from other studies on treated heroin dependents (0.7 per cent to 2.6 per cent per year). The mortality of untreated patients is markedly higher.

I have a lot of other information about project related results in terms of what was done to ensure that there were not disturbances in the local community, security problems, and so on. If members are interested I would be happy to let them see that documentation.

I now move to the conclusions of this study. On the basis of these results, the report came to the following conclusions and recommendations:

 

* Heroin-assisted treatment is useful for the designated target group and can be carried out with sufficient safety.

* As a result of above average retention rates, significant improve-ments can be obtained in terms of health and lifestyle, and these persist even after the end of treatment; of special interest is the striking decline of criminal activities.

* Such improvements are of great public interest, too (prevention of dangerous infections, diseases, struggle against drug-related delinquency etc.).

* In view of the considerably impaired state of health of patients on admission to the program, the mortality rate of 1 per cent per year is relatively low.

* The economic benefit of heroin-assisted treatment is consider-able, particularly due to the reduction in the costs of criminal procedures and imprisonment in terms of disease treatment.

* These improvements were achieved subject to the prescrip-tion of heroin as part of a comprehensive program of patient education and therapy.

* The same can be said with regard to the general conditions governing the organisation and operation of the program; the safety of participants and others can only be guaranteed by establishing appropriate supervisory measures.

 

The continuation of heroin-assisted treatment can be recommend-ed for the indications described in this research and as long as the general organisational and operational conditions set out in the research protocol are established.

If the program is continued, the unresolved questions and problems mentioned in the report should be further examined and elucidated through scientific research. The treatment itself should be appropriately monitored, documented and evaluated.

The final recommendation was as follows:

It is apparent from these conclusions that a continuation of heroin-assisted treatment can be recommended for the group targeted by this program, provided that it is administered in suitably equipped and supervised outpatient clinics which meet the general conditions and criteria as described above.

I also have another paper that has been prepared by Dr Mino and others specifically about the heroin prescription program in Geneva, as well as a swag of other documents that I will not quote from extensively here today.

The key messages are that a heroin maintenance program may be a useful treatment option for patients who do not succeed in conventional drug treatment programs—and I stress that they do not succeed in those other programs. Patients randomly allocated to the Geneva heroin mainte-nance program fared better than patients in conventional drug treatments in terms of street drug use, mental health, social functioning and illegal activities. The results of the trial apply only to a subgroup of severely addicted people who failed repeatedly in conventional drug treatments.

As one would expect, there was controversy about the heroin trial in Switzerland—such controversy that a citizens initiated referendum was run last year. The required number of signatures was obtained—I believe that about 131 000 signatures, or something like that, were gathered—and that referendum was aimed to stop the heroin prescription program. When the vote was taken (in a community that most people would recognise as quite conservative) it was defeated 79 per cent to 21 per cent. Very few referenda will get votes of that sort. So, the Swiss themselves are absolutely convinced that the heroin prescription process is one that works.

The Hon. T. Crothers: Other solutions that had been tried hadn't worked.

The Hon. M.J. ELLIOTT: Absolutely.

The Hon. T. Crothers: That is more what their concerns were.

The Hon. M.J. ELLIOTT: Yes, that's true enough.

The Hon. T. Crothers: As indeed are mine.

The Hon. M.J. ELLIOTT: But, as I have said, it is only one of many solutions, and we must always keep our mind open for others. But, having witnessed at that stage the heroin prescription process for three years, the people of Switzerland—79 per cent to 21 per cent—said that it should continue. The Swiss Government will now expand that program. As I understand it, that program will take in up to 3 000 persons, at which time it will peak. The experts tell me that it is their belief that only about 10 per cent of heroin addicts are suitable for this program. So, when they go to 3 000 that will be the maximum—and I suppose once again that underlines the fact that there is nothing magical about the heroin prescription trial. It is one of a range of treatments, and it is something that will work and has worked for some people: other treatments will be necessary for other people.

It is worth noting that the Dutch also have started their own heroin prescription program. It currently involves 50 users, based in Amsterdam and Rotterdam. I had the oppor-tunity to visit the clinic in Amsterdam (although at a time when it was not operating) and to speak with some of the professionals there. As I understand it, that trial, also scientifically constructed and also expected to be reassessed over time, will expand to 1 000 users in the new year. So, the Dutch have clearly watched very closely what happened in Switzerland. And, might I add, both Switzerland and the Netherlands watched very closely what happened in Aust-ralia. A number of people there commented on and gave praise to the scientific integrity of the trial that has been proposed for Australia and then said, `What happened? Why did it stop? Why did the Prime Minister do that?' I shrugged my shoulders and said, `I honestly do not know.' I do not know whether it was because of his innate conservatism; whether Johnson and Johnson (I believe it is), which is a major producer of methadone and uses a lot of the opium that we grow legally in Tasmania, had made a threat in relation to that, as some people have hypothesised; or whether the American Ambassador came knocking on the door—as he has a habit of doing, as do other American Ambassadors around the world, sticking their nose into other people's business—all by himself.

But, as I said, the Dutch are now following the Swiss in such a program, and when I spoke with people in Switzerland and the Netherlands they told me that they believed it would not be long before Germany followed the same path—and, indeed, France not long after that. For a number of reasons, I believe that everywhere around the world people are coming to the same realisation. They are looking to places such as the Netherlands and Switzerland and seeing what is happening. There has been a change of Government in both those countries, and those Governments appear to be more open minded and prepared to look at alternatives.

In relation to the costing of the heroin programs, the Swiss have done their own work, and they believe that they are making significant savings to the public purse. They say that these heroin programs save close to 45 francs per patient per day. When they compared the cost of running the program with all the health professionals and the provision of the heroin against how much they would have spent in other programs and with policing and courts, etc., they estimated that they would save, in Australian terms, close to $A50 per patient per day.

So, it does not matter whether you look at it from the perspective of the individual and our human and humane approach to them and their families, from the perspective of Government expenditure or from the perspective of a society with less crime (indeed, any way you look at it), this heroin prescription process is an improvement on the previous situation. No-one can feel happy that people are still consum-ing heroin and that they are still struggling to get their lives together, and I am certainly not happy about that. However, I do appreciate the very real improvement that has been made within that program.

For those people who have been addicted for 20 years, one can only say, `If only such a program had been available 10 or 15 years ago,' because there is no doubt that the longer the addiction the more difficult it is to overcome it. How does a 38 year old, a person who has been addicted for 20 years and who has no work experience, enter the work force? How do they achieve normalisation? That person's mistake was made 20 years ago and, 20 years later, our society has worked out how it should respond to that mistake. Hopefully, in future people will have been addicted for much shorter periods before we offer appropriate treatment to give them a real chance at normalisa-tion.

There is one set of figures to which I said I would refer. The most recent data in relation to the just over 1 000 people who began the heroin trial in Switzerland states that 80 had gone into abstinence at the end of 1996, increasing to 120 in 1998; and 120 had gone on to methadone at the end of 1996, increasing to 200. So, close to one-third of the people on that program after four years are in abstinence or have moved on to a methadone program. As I said, it was the toughest of the tough who were involved in those programs—those who had failed everything else despite their best efforts—so those figures must be seen as encouraging. It would be so nice if we could wave a magic wand and say, `I cure you of your dependency, please don't do it again', but that magic wand simply does not exist.

We must be mindful to design laws that really work. We must ask ourselves what we are trying to achieve and whether we are achieving it. Our current laws are not achieving what we had hoped. We have major drug problems that are worse than those experienced in other countries which are adopting different approaches. We have done many useful things. Let us not neglect the good things that we have done such as the methadone and needle exchange programs, which have been a success. We have done a number of things, but there are still far too many people dying or becoming involved in crime and prostitution against their will. As human beings, we must offer them real hope. As I said, there is no one answer—there is a suite.

I ask members to consider this motion in the light of what has happened in the Netherlands. That country has quite consciously and deliberately set about separating the cannabis market from the market for hard drugs. This data shows us that cannabis consumption has not taken off in the Nether-lands relative to other countries. It seems to indicate that the recruitment of problematic drug users to heroin, etc. has been in decline and that the drug death rate in the Netherlands is much lower than in other European nations.

The one thing that stands out as different is the very long period during which the Netherlands have been operating with this approach of separating cannabis from heroin and other drugs. As I have said, they are not soft on cannabis use either. They are running education programs—and those programs appear to be biting. Sensibly, those education programs do not tackle only cannabis but also other drugs such as alcohol and tobacco. Let not anyone who enjoys a tipple of alcohol become too pontifical about people who might consume cannabis. Alcohol itself is a problematic drug. The Dutch have recognised that and are running very good programs that are directed at all drugs.

The second part of my motion looks at what the Swiss have done, I believe so successfully, and that is to run a heroin prescription trial. It calls for the Legislative Council to support the heroin trial proceeding in Australia. It should be noted that all the Health Ministers of Australia met with the Police Commissioners and the Federal Health Commis-sioner and agreed for the heroin prescription trial to proceed.

There was consensus until the Prime Minister stepped in and said that this would not happen. I strongly believe that he has made a mistake. He may have done this with the best of intentions from a conservative viewpoint that says that people shall not take drugs, we will not allow them to do it, we will tell them not to do it, and they should know better. I can only ask the Prime Minister in all humanity to look at the conse-quences of that decision. I believe strongly that a decision not to allow heroin prescription amounts to a sentence of death for some and a sentence to a life of crime and prostitution for others, a life of suffering, not just for those who are addicted but for their families. I have talked with members of those families. In fact, they have been telephoning again today and offering support.

We must realise the impact on the broader community of home invasions, the robberies that are occurring as people seek to sustain their habit. The heroin prescription trial seeks to address all these matters. It must be stressed that this would be a staged trial that would start initially with a small number of people in the ACT. It will not proceed beyond that stage unless people are satisfied with certain conditions that will be laid down. It will continue to be a trial as, hopefully, it spreads to two other major cities. Again, it will not continue unless the people have examined it and are satisfied with it.

The Swiss went through a trial process. They were convinced that it was a good thing. Why would we not be prepared to allow such a trial to go ahead? For those who are not prepared for a trial to go ahead, I would like to know what is there alternative. I will tell you what their alternative is: it is that these people will continue to inject in parks, alleyways and isolated locations, and they will continue to die, suffer and commit crime, etc. Those who reject the heroin prescrip-tion trial support all those things happening. They must be aware of that. They should not hide behind any personal feeling about what is right or wrong about this. What is right or wrong is what we do to people. What is right or wrong is whether we actually show humanity to other human beings.

The Hon. T. Crothers: What is right or wrong is whether it works or not.

The Hon. M.J. ELLIOTT: Yes, whether it works or not. That is the question that only the trial can answer. If at the end of two or four years it is shown that I am wrong and they are right, then they can gloat. I do not believe they will be in that position. The worst that can happen is that those people will be told to go back to the streets and the alleyways, to their isolated rooms and parks, and to go back to injecting in the way they were. Because that is all there was before, and that is all there will be afterwards.

I urge members to support this motion. I have a great deal more information that I have not presented, but I believe that I have covered the major points. If members respond in the negative and start to raise their own questions, I could at that time go through this material that I have and respond to any questions and doubts that they may have.

 

The Hon. T. CROTHERS secured the adjournment of the debate.

 

 

 

The State Government formally opposes the motion: 3 March 1999

Edited August 4, 2008 by iamnotacop

[grace]

I woudn't get your hopes up. Common sence has nothing to do with politics.

 

Example....

 

Qld 'plans heroin shooting galleries'

Sun Aug 3 2008

ninemsn website

http://news.ninemsn.com.au/article.aspx?id=608373

 

The Queensland Opposition says it fears the government has a secret agenda to introduce Kings Cross-style heroin injecting rooms for drug addicts.

 

Liberal National Party (LNP) spokesman Tim Nicholls said Labor's state convention last year adopted a policy which called for a review of shooting galleries to determine if Queensland should have one.

 

The state government has also recently appointed Mick Reid as Queensland Health's director-general.

 

Mr Reid, who took over his new role on June 23, approved the controversial injecting room in Sydney's Kings Cross when he was head of the NSW health department.

 

Mr Nicholls called on Premier Anna Bligh to reveal if Queensland was also considering a similar move.

 

"We think the premier needs to be honest and open with the people of Queensland as to where she is heading with Mr Reid's appointment and with this Labor Party policy to review shooting galleries in Queensland," Mr Nicholls told AAP.

 

"There is a concern we will have them here and it will slip through under the radar.

 

"Previously, the government has said they won't be having shooting galleries but the party has adopted this policy that is being kept pretty well under wraps and they've appointed the man who introduced them in New South Wales as the head of Queensland Health.

 

"There is a very real concern we will see shooting galleries here in Queensland."

 

Queensland Health Minister Stephen Robertson has said he has no plan to introduce heroin injecting rooms in Queensland, nor had Mr Reid approached him about it.