The First International Conference On Heroin Maintenance: Legal/Policy Strategies, Gabriele Bammer

I come from a city called Sydney where there has been a large outcry against this stupid notion of heroin prescription. While it's been fairly broadly supported in other jurisdictions in Australia, in my particular city which has the worst heroin problem, we've had strong opposition to it by two of the most powerful radio journalists in Australia, and one of the most powerful newspapers. And they've made it very clear to me that if this trial goes ahead, they will campaign actively against it, and they will campaign actively against me. And therefore despite the fact that every other media outlet in Australia's been neutral or quite supportive of it, these very important media outlets, these very powerful ones nationally, have not been. And they're going to make it very difficult for my government if I go ahead with it.

It's also really important to understand that Australia is a country that relies on trade with other nations, and we rely quite heavily on our trade with the Asian community. We're also a country that's not particularly a leader in terms of world opinion. And for us to prescribe heroin, we would have two supporters on the international scene. We'd presumably get support from Switzerland, and we'd also get support from the Netherlands.

Neither of those countries are important to us in terms of trade. The countries that are important to us would at best be neutral, and at worst be hostile. Those countries include the United States, and most of our Asian neighbors, which are very important to us. We have an important poppy industry in one of our weakest economies in the state of Tasmania. They're very worried that the markets will be affected. They have an important market in Europe, and that market is heavily under competition from both Turkey and India. And they're worried that preference will be given to these developing countries over our own market, despite the fact that we can prove that we have less diversion from our poppy growing industry than anywhere else. At present we have 20 percent of the United States market. We're hoping to increase our market share in the United States. But we believe that if a heroin trial goes ahead, that may well not happen.

I also come from a long tradition of anti-intellectuals.

Australians do not think particularly highly of academics in their ivory towers. I'm a practical person, I'm a family man, I've been approached by families who have lost their children. These people have been very powerful in influencing my opinion that family values will be compromised by going ahead with the trial of heroin prescription.

And so I hope that you can see that it was a very sensible decision for me to make not to go ahead with this particular program. And I hope that you will encourage your leaders to do the same.

DAVID MARSH: Now, I wonder if I could call upon on Gabriele Bammer to respond to Mr. Howard's remarks.

GABRIELE BAMMER: Now, I won't take that seriously. I think if you're honest about it and put yourself in the Prime Minister's shoes, there are very good reasons for not having gone ahead with the trial. It would have been an incredibly brave decision for him to make to do it, and it would not have made any sense for him to do it. And it takes a huge amount of political courage to push through support for a trial. And I think understanding that makes the trial in Switzerland and the trial which is to go ahead in the Netherlands much more remarkable, from my point of view. And I think their political leadership has to be applauded.

Question from the audience:
Wasn't anybody worried about the illicit [drug] trade?

GABRIELE BAMMER: I was trying to put myself in the Prime Minister's shoes to try to understand why he made the decision that he made. Because he's not a stupid man, and I think there are good reasons for the decision that he made. One of the things that has come about as a consequence is that more money has been put into supply reduction activities, and money has been given back to the Customs Service to try to stop drugs from coming into the country.

As you can see, we're an island, we've got many points of potential entry for a drug. It's very easy to get heroin into Australia. And I think it's one of those areas where you're between a rock and a hard place, if you like. Heroin prescription is not going to eliminate the illicit drug market. It might have an impact on it, but it's not going to eliminate it. Part of the problem is that politicians don't like not knowing what the answer is going to be. And the whole point of conducting trials is that you don’t know what the outcome will be and you have to be open to the trials showing that heroin prescription may not be effective. But politicians don’t like this and only if they can be convinced that it's going to work, then they'll buy it. And it was really interesting that the Swiss results came out a month before our trials were being considered in the political arena, and that wasn't enough to convince them that further trials should be conducted, partly because of a concerted campaign of misinformation about the Swiss results.

This campaign argued that what the Swiss results show is that heroin prescribing does not work because at the end of 18 months, 80-some percent of people were still dependent on heroin. And it doesn't matter that they weren't using illicit heroin, it doesn't matter that they weren't using cocaine, it doesn't matter that their health was improved. The fact of the matter is that they were still using heroin. And it doesn't even matter that the crime went down.

So there's a group in Switzerland which hasbeen very influential in Australia in promoting misinformation about the Swiss trials and that is being picked up the Salvation Army. This is a very important non-government organization that is an abstinence-based foundation. They have used their opposition to trials of heroin prescription, to very much strengthen their own political base. And, you know, the truth is always the casualty in these arguments, and it's really important that that doesn't happen. I need to make it clear that the Salvation Army opposition isn’t malicious. I respect their opposition and because they are not scientists or adept at interpreting scientific information, it is easy to understand that they can be mislead by groups that have misinterpreted the Swiss statistics.

THOMAS ZELTNER: I should comment on what you have been saying. You know, you need a plan on how to lead the political debate, and to lead different options. And I can't give you any advice on that, how to do that in the United States. The only information I can give you is that we have been showing these programs in Switzerland to the American Ambassador in Switzerland, and she was very impressed. And that has actually led that McCaffrey (the U.S. drug czar) will come to Switzerland and to Holland late this Summer I guess, to have at least a look at it.

And that's the last point I want to make, in contrast to what has been said to Australia. We in Switzerland had never ever had any pressure from the United States so far regarding our prescription programs. The United States always has been very neutral in all international forums where we were discussing and presenting these data so far. So I think to some extent eventually the US foreign affairs might even be interested that this question is answered in a serious way.

GABRIELE BAMMER: Can I just answer the question?

DAVID MARSH: Oh, yes, sure.

GABRIELE BAMMER: One of the things that happened in Australia that was really important was that people who use illicit drugs were humanized. And that happened because families started to stand up, middle class families, church-going families, started to stand up and say, "this has happened in my family, and my child has died." And many of those people became supporters of the trial of heroin prescription. There were some families who had children who died who were opponents, and they had the Prime Minister's ear, more than the families who were supportive.

In addition, there are a small number of users who are opposed to a trial of heroin prescription. And they were the ones who got air play on the media that were opposed to a trial. And you can have hundreds of people who use heroin supporting a trial, and one person who opposes it, and it's the one person who is newsworthy, because it's not what you would expect.

We have very active user groups in Australia, and they were very important in helping develop our proposal. But they didn't believe that it was worth their while to tackle the negative media. They didn't feel that they would get a fair hearing. My view is that that's not correct. I think that they have to work along with everybody else, and you just have to work on these people and try to get them to listen to all the arguments.

I didn't mean to try to say it was bad politics. I'm trying to portray political reality. And the other reality is that all governments, and the Australian government in particular, are trying to cut costs, and the health dollar is one of the costs that governments are trying to cut. If you were taking money away from premature babies, from diabetics, from asthmatics, to give heroin to dependent heroin users, you've got a big political problem. It's just not a palatable thing. The vast majority of the Australian population was supportive of the trial as long as it wasn't in their own city. Except in the city in which it was being proposed where the majority of the population was prepared to have it go ahead. But if you read the letters to the editor opposing a trial, they were generally about "these people have brought it on themselves, they've made a rational decision to use heroin. Why should we use our taxpayers' dollar to bail them out?" And I think that the whole economic argument is also quite important.

I think that while the trial hasn't gone ahead, it's not dead in Australia. It might get back on to the agenda. And we're not at the front of innovation in this area anymore. We weren't right at the front, because the Swiss conducted the first trials, but that was still too far out in front for an Australian government to be. So it's great that the Swiss are trialling heroin, the Dutch are going to be trialing it, the British are thinking about conducting trials to evaluate their long-standing prescribing practice. As soon as an English speaking country does it that will be very important for Australia. For Australian politicians it doesn't actually matter about all you non-English speaking people, you don't really count in their scheme of things. But if England was to do it and if Canada was to do it, that would be much more influential in the Australian context, particularly if England was to do it, because it's part of our heritage.