Australia Has a Long History of Fighting Harm Minimisation Drug Policies
Getting Pill Testing Into Music Festivals Is a Struggle, but So Was Legalising Needle Exchange Programs in the 1980s
In the closing weeks of 2015 two Australians died at music festivals on drugs, bringing the total number of similar deaths to six since November 2014. This unsettling statistic has since prompted a group of community members to present an open letter to NSW premier Mike Baird, calling for legalised pill testing at public events. So far politicians in NSW, and across Australia, have been reluctant to introduce such measures, arguing pill-testing will only encourage pill-taking.
This has long been the Australian way. In 1985 'harm minimisation' formed the basis for the National Drug Strategy, which led to recommendations that clean syringes should be freely distributed to the public. Many argued then—as they do now—that handing out syringes condoned heroin use, but in fact the Australian needle and syringe program (NSP) prevented a major HIV outbreak, stabilised hepatitis C rates, and saved countless lives. The introduction of the NSP wasn't a simple case of sense triumphing over stigma. It was a real shit fight, which is worth remembering as the community pushes for pill testing today.
On November 12 1986, Dr Alex Wodak, then director of the Alcohol and Drug Service at Sydney's St Vincent hospital, and a group of his colleagues, set up an illegal pilot needle and syringe exchange in the inner city suburb of Darlinghurst. This self-funded program was an act of civil disobedience, established in response to the pending threat of HIV. "We didn't know how serious that threat was, but we knew it was very serious," said Wodak, currently the president of the Australian Drug Law Reform Foundation. According to him studies from overseas were "showing how rampant HIV was spreading among and from people who inject drugs to the general community."
The NSW Department of Health responded by calling Wodak to a meeting and told him to close his operation or face legal action. But on a subsequent meeting called by NSW detectives, in light of evidence presented by Wodak, a senior detective said they wouldn't press charges. "Soon as he said that, I knew the battle was going to be won," Wodak recalled.
The 2014 Australian NSP survey found the current rate of HIV amongst injecting drug users in Australia is 1.7 percent. This compares with 9 percent in the United States.
Soon after the NSW government legalised NSPs. They were initially run through pharmacies, but community clinics were established by early 1987. From there they were rolled out across the nation.
Today, there are around 800 NSPs nationwide, supplying 30 million needle and syringes annually to an estimated population of 89,000 to 205,000 people who inject drugs. The 2014 Australian NSP survey found the current rate of HIV amongst injecting drug users in Australia is 1.7 percent. This compares with 9 percent in the United States, 36.4 percent in Indonesia, and 87 percent in the Libyan capital of Tripoli.
An Australian government Department of Health cost-effectiveness report found that for every dollar spent on the NSP there's a 4 dollar healthcare cost saving and a saving of 27 dollars overall.
Tony Mac has been an intravenous drug user for 35 years. He's witnessed the benefits of NSPs firsthand and was one of the first to access the Darlinghurst Road clinic. As he explained to VICE, "Before there were needle exchanges, people were sharing syringes. We didn't even know about HIV or hep C. We lost thousands. But we actually stopped the spread of HIV amongst IV drug users, because we started needle exchanges early."
"People were sharpening syringes on matchboxes because of the lack of supply."
NSPs also work as an important peer-based health information exchange—'peer-based' as being run by and for people who use drugs. In the early 80s, a group of injecting drug users from Darlinghurst mobilised in response to HIV. They formed the AIDS Drugs Information Collective (ADIC) and began consulting with Dr Wodak and his team about the initial NSP. Since these early days, the drug user community has always played an active role in the running of NSPs.
ADIC became the NSW Users and AIDS Association (NUAA) in 1989. Julie Bates was the first manager of this government-funded drug user organisation. She recalls "people were sharpening syringes on matchboxes because of the lack of supply" prior to the opening of the NSP. "The harm that people were then doing to themselves by the reuse of injecting equipment was considerable," she said.
But Bates stresses NSPs wouldn't have worked alone, it was their implementation alongside peer-based responses that curbed an Australian HIV epidemic. Now she's concerned that some of these gains could be lost. Recently, it's been announced that at of the end of June, due to restructuring, funding will be cut to the Australian Injecting and Illicit Drug Users League (AIVL).
Executive officer of AIVL, Annie Madden, said peer-organisations like theirs are essential to the success of programs like the NSP. "You can give out as many needles and syringes as you like, but if people aren't properly educated, then the whole picture doesn't come together," she explained. "Every HIV infection prevented is a conscious decision by a person who injects drugs." An online campaign to save AIVL has been started to ensure that one of society's most marginalised groups continues to be represented at the federal level.
In 1986, when Dr Wodak presented his case for establishing the pilot NSP to his staff, Gino Vumbaca, who was working as a drug counsellor, volunteered. He remembers that as the number of injecting drug users utilising the service grew, a group of people the health workers had never seen before started showing up. "This was a way of actually gaining access to a whole hidden group of people and then providing information," Vumbaca said. "If they did ask, 'I want to do something about my drug use.' Then we could do something about that."
Vumbaca is now president of the newly formed Harm Reduction Australia, an independent organisation bringing together some of the nation's most prominent drug experts. They're calling for a return to Australia's harm minimisation strategies of the past, which recent governments have lost sight of.
Now Dr Wodak is advocating for the introduction of pill testing at festivals, as well as a move away from heavy policing. However last week, NSW deputy premier Tony Grant said the program would not be introduced. Wodak reiterated that testing detects dangerous substances in an unregulated market and therefore saves lives.
Follow Paul on Twitter