advertising and the news media.
This construction of drug use has a number of implications, which are examined later.
The construction of drug use as something which is outside the control of individuals then flows through all of the major report into drug use in Australia in the 1970s and 1980s. It is worth noting that in supporting documents, the Sackville report of 1979 recognized that the 'pleasure' of using drugs may be an important factor in people's decision to use drugs [3]. This recognition was not included in the final report.
Typologies of drug users
The Marriott report of 1971 produced a series of availability, of distinctions which are still vital to Australia's responses to perceived drug problems. The Committee clearly constructed a hierarchy between the drug trafficker, the drug pusher, the drug peddler, and drug users (peddlers may also be users, while pushers are less likely to be so involved). The existence of experimenters was also recognized [2]. For the authors of the report, the relationship between these types of people is vital.
The abuser becomes enslaved by his habit to the extent of requiring constant and increasing dosages to obtain an equal effect to his original dose. This then provides the trafficker with a regular market. [2]
This typology helps identify the targets of criminal sanctions, and the targets of medical intervention.
The typology of the Marriott report has survived to this day, with various embellishments. The Sackville report increased the complexity of these classifications by differentiating between experimental, social or recreational, circumstantial, intensified, and compulsive drug use. The Rankin Committee applied this more elaborate taxonomy to heroin users as a specific group of drug users, and came up with a classification system which included: drug dabblers, joy poppers (recreational users), hustlers, conformists, addicts, drug dependents, maturing-out users, and burnt-out users [4].
The three prongs of government action
The principal recommendations of the Marriott Committee called for more education and treatment, better co-ordination of law enforcement efforts, more research into drug use which included the creation of better statistics, and legislation which emphasizes a humanitarian approach to users, while providing for penalties which will be ,sufficiently severe to deter the drug trafficker and drug pusher' [2]. This report sets the structure of the recommendations of following reports. In general, the recommendations of reports into drug use in Australia concern three policy options: law enforcement, treatment and education. These three elements are always the core of the inquiries' policy responses to harmful drug use.
While the recommendations of later reports do differ from those of the Marriott report, and from each other, the basic organization of substantive recommendations remains the same. However, more than the other lines of argument which make up the reports, the repetition of these recommendations throws up logical problems for the reports. For instance, the Williams Commission noted that its recommendations do not differ 'from the main thrust of the conclusions' of the Senate Select Committee report in 1971 [5]. Given that nearly a decade had passed since the earlier report, it was felt that some explanation had to be offered.
If the Commission is proposing a policy that is not novel the question that inevitably must be answered is why it has not worked before. The answer is that it has not really been tried. [5]
Other ways in which the reports justify recommending options which appear to have failed in the past are examined below.
Heroin policy
The Marriott and Baume reports did not produce recommendations which specifically addressed heroin use. Heroin dependence was the subject of specific recommendations for the first time in the Sackville report. In that report, maintenance of heroin-dependent individuals was discussed, and while heroin and morphine were considered, methadone was preferred because its effects are longer lasting. The report argued that the short action of heroin and morphine creates difficulties [6]. This does not mean that heroin and morphine could not be used for maintenance. It merely means that the Commission considered that methadone was generally a more appropriate opioid. Later in the report, under its consideration of legal controls, the Commission discussed the legalization of heroin.
Theoretically the illicit market might be eliminated if heroin were provided lawfully to everyone who desired it, but such a policy would be unthinkable, even if it were feasible in the light of Australia's international treaty obligations, simply because such a policy would actively encourage wider use of the drug and rapidly lead to an increased incidence of addiction. [6]
However, the Commission did argue that the total prohibition on heroin should be reconsidered if it can be shown that heroin is a better analgesic than competing drugs. If heroin does have advantages as an analagesic, it should be reclassified, so that it can be used as such. If this were done, then the Commission envisaged some limited use of heroin in the 'treatment of addiction' [6]. So, while methadone was found to be a generally more appropriate drug for maintenance, and while legalization was 'unthinkable', the Commission did find that heroin could be used as an analgesic (subject to proof of its effectiveness) and that it could possibly be used for some limited 'treatment'.
Heroin maintenance was again considered by the Williams Royal Commission as was the use of heroin for analgesic purposes [5]. Like Sackville, Williams considered it possible that heroin could be used for the treatment or maintenance of heroin-dependent individuals. Again the report preferred methadone, for similar reasons to the Sackville report. Unlike the Sackville report, the use of heroin for treatment or maintenance was explicitly recommended against. However, the Williams report did consider that heroin might prove to have some other medical uses [5].
On this line of argument, the Rankin report from NSW is particularly important. Primarily, this Committee was to examine whether providing heroin to dependent users would decrease the involvement of organized crime in drug trafficking, and decrease the likelihood of dependent users becoming involved in criminal activities to support their habits [4].
The Rankin Committee considered a number of approaches to providing heroin in a controlled manner:
- long-term heroin maintenance for residual addicts;
- short-term heroin maintenance for all addicts;
- long-term heroin maintenance for all addicts;
- heroin made legally available to all who ask for it [4].
Each option had its advantages and disadvantages for the Committee. The first three proposals would not eliminate the black market in heroin, and so they did not meet all of the criteria which were before the Committee. In relation to the fourth option (free availability), this would eliminate the black market.
However, the social cost would be enormous Heroin is one of the strongest reinforcers of repetitive behaviour known, and the addict becomes lost to the drug to the extent where he is unable to evaluate or control his own actions, unable to judge or choose or live any sort of rationally determined life. And though proponents of the addict's right to choose his own destiny consider that drug-taking is a victimless crime, heroin-addiction has many victims--the addicts themselves, their spouses, children, families, friends and society at large. As a consequence, the unlimited availability of licit heroin would seem wholly unacceptable to the Australian community and to the international community. All of our witnesses were agreed that availability creates demand--indeed, that it is the chief factor in demand. [4]
Interestingly, a later Committee repeated, exactly, the words of the Rankin report used to dismiss the notion that heroin should be freely available (see Committee of Review into Drug and Alcohol Services in New South Wales, Report of the Committee of Review into Drug and Alcohol Services in New South Wales 1985, New South Wales Department of Health, 1985: 128 [5]). This was done without citation. It should also be noted that a dissenting recommendation on this later review by Margaret Sargent advocated a national movement towards the 'decriminalization of heroin'.
Thus, proposals which limit the involvement of professional criminals in heroin trafficking would be unacceptable because of their social costs. The Committee felt that methadone is a more appropriate drug for opioid maintenance for most clients. However, the Committee did consider that heroin maintenance may be appropriate for:
. . .the comparatively small group of hard-core dependents who, after repeated attempts at seeking improvement through methadone maintenance and other forms of treatment, remain firmly addicted to heroin. . . [4]
The clients of such a programme would be the 'burnt-out' users who are at one extreme end of the Rankin report's taxonomy of heroin users.
Harm minimization
The Baume Committee defined the goals of drug strategies in terms of harm minimization.
Total elimination of drug abuse is unlikely, but government action can contain the problems and limit their adverse effects. [7]
The Sackville report also endorsed the objective of harm reduction, as opposed to the elimination of drug use.
It follows above all from what we have said that it is neither desirable nor feasible for the Government of South Australia to pursue a policy of eliminating the non-medical use of drugs. The broad policy objective, underlying official controls in this State, should be concerned with the harmful aspects of drug use and drug-related behaviour. In our view, then, the objective of social policy should be to minimize the harmful consequences of the non-medical use of drugs. [6]
The report noted that harm may arise from drug use either by the effect of drug use on the community, or on the individual. This line of argument on harm minimization did not appear in the Williams report, or the Rankin and Kerr reports, as such, but it did reappear in the National Campaign Against Drug Abuse (NCADA) and in the Cleeland report of 1989.
The implications of failure
As we have argued, the later committees and commissions often noticed the continuity of their recommendations with those of their predecessors. This produced problems for the reports, in that they had to explain the previous failure of approaches they were recommending. In general the reports deal with this problem by recommending more co-ordination, more research and more debate. A vital part of the call for more research is the creation of better, and more comprehensive, statistics. The need for more co-ordination clearly involves a national approach to drug use, and led eventually to the formation of NCADA.
Politics and the Australian drug report industry
We are interested in the connections between these different lines of argument, and the hierarchy between the lines of argument. In general, all the reports asked similar questions, and came up with similar answers. This similarity revolves around their construction of drug use as the result of a myriad of factors which are not within the control of individuals. In other words, drug use is something that is caused by social, pharmacological, and psychological factors. It is not the result of free choice. The reports also worked with taxonomies of drug users and drug dealers of varying degrees of elaboration. These classifications clearly relate to the constructions of drug use as something that is not within the control of individuals, because they identify individuals with varying levels of control over their lives. In their recommendations, all of the reports relied on a three-pronged approach, namely education, treatment and law enforcement. Clearly these options relate to the notion that drug use is not within the control of individuals. If individuals are manipulated by external factors, or factors beyond their control, so that drug use is attractive to them, then clearly they can be manipulated in the opposite way. Because they were formulated in relation to the notion that drug use is a determined phenomenon, the aim of policies became the minimization of drug use. Thus, radical interpretations of harm minimization were excluded. Harm minimization was interpreted as the reduction of drug use, rather than the reduction of harm associated with drug use. The three prongs combine with the taxonomies to identify the targets of law enforcement, treatment and education. Basically, the reports argued that law enforcements is for traffickers, treatment for 'addicts' and education for non-users and recreational users. Given all of this, it is not surprising that the use of heroin for treatment (including maintenance) was recommended against. Finally, the calls for debate, co-ordination and research, connected to the substantive recommendations of the reports, in the face of failure, implicitly construes the failure of law enforcement, education and treatment as the result of inessential features of these approaches. The approaches failed because there was not enough co-ordination, debate, and research, not because they are flawed.
The coherence to these arguments, the way in which these different lines of argument constitute a consensus, is vital to understanding whether or not it is possible to argue for change in heroin availability. The Cleeland report is an important break here. We argue that the Cleeland report starts to unravel the connections between these lines of argument, but that it does so in an ambivalent way.
The Cleeland report of 1989
The Cleeland report clearly stated that prohibition has been a failure, and attempted to gauge the costs of the prohibitionist approach. These include: direct costs to governments of policing, the courts and gaols; the raising of drug prices which attracts organized crime; drug-related crime; the criminal milieu which is created; corruption; health costs; adulteration of supplies; stigmatization of users; civil liberties violations; hypocrisy (the drugs of older people are legal, while the drugs of the young are illegal); and benefits foregone [8].
To some extent this change in perspective is attributable to the (comparatively) recent rise of economistic ways of examining social issues. The Committee was clearly motivated, in part, by direct considerations of the economic costs of present policies, and by the notion that social policies can be assessed in terms of economic costs and benefits (which is a more indirect influence on the arguments of the Cleeland report). This aspect of the Cleeland committee's report ties to other recent assessments of Australia's 'drug problem' [9, 10]. Along with the advent of awareness of the risks of HIV infection, this change in the political scene led to a reconsideration of present drug policies. Interestingly, it should also be noted that the risks associated with HIV can be construed in economic terms [8, 9, 11].
The Cleeland Committee considered a diversity of alternatives to Australia's present policies, which ranged from increasing penalties to arrangements which would increase the availability of drugs, such as de-facto decriminalization, de-jure decriminalization, the prescription of drugs like heroin, licensing of users, and a regulated market for presently illegal drugs that would resemble the markets for alcohol [8]. Not surprisingly the Committee found arguments for and against each option. Harm minimization is of central importance to the arguments of the Cleeland Committee. Indeed, in discussing NCADA, the Cleeland Committee formulated a radical interpretation of harm minimization.
It is clear from the thrust of the campaign that at the official level harm minimization means reducing the use of drugs, both by demand reduction (through education, treatment and rehabilitation) and by supply reduction (through law enforcement). An alternative interpretation, based on an acceptance of certain levels of drug use in Australian society, would emphasize the need to minimize the harm which users may do to themselves as a result of their drug use. Such an interpretation implies rather different policies to those being pursued at present. It would suggest, for example, that the policy should put primary emphasis on safe use, rather than on deterring use, and that the supply of the illegal drugs should be regulated by the government in some way rather than being left outside the law in the hands of criminals. It would certainly imply that use and possession should not be criminal offences as they are at present. [8]
Interestingly, the radicalism of this reinterpretation of harm reduction is only indirectly reflected in the recommendations of the Cleeland report. Apart from recommending that more information be gathered (again), and that advertising of alcohol and tobacco be banned, the Committee recommended that movement away from prohibition be debated.
Recommendation: The Committee recommends that the Federal and State Governments and the community at large give earnest consideration to the options by which governments might impose more controls on the sale and marketing of the presently illegal drugs. [8]
While that recommendation does not mention problems with prohibitionist approaches as such, it should be read in conjunction with the supporting text of the report.
Should these latest initiatives fail to make any significant inroads on the market then it would be appropriate to consider some relaxation of the present prohibitions as an alternative policy. [8]
In other words, the 'controls' referred to are not necessarily stronger prohibition and law enforcement. Rather, 'control' is a concept that encompasses the option of legal, controlled availability of currently illicit drugs.
It is important to know why the Cleeland report's radical interpretation of harm minimization is only indirectly reflected in its recommendations. Obviously, a number of factors might be mentioned here, including the need to formulate a (relatively) unanimous report in a multi-party Parliamentary Committee. What is central to the report is its judgement about heroin use, and what a good society looks like. In assessing the costs and benefits of different options for the 'control' of heroin, the report has this to say:
Each option involves trade-offs between costs and benefits. The present policy raises prices and restricts access, thus making it more risky and difficult for both new and existing users to obtain drugs. It deters new users and may push existing users into treatment and rehabilitation programmes. At the same time it imposes an enormous cost on the users themselves-through damage to their health and now the threat of the spread of AIDS through sharing needles--and on society at large through drug-related street crime, corruption and the direct costs of law enforcement. At the other end of the spectrum making the presently illegal drugs available subject to government regulation would eliminate many of the social costs although not necessarily diminishing the health problems of addicts or improving their employment prospects. At the same time, however, it could lead to a dramatic increase in the use of the drugs and almost certainly to an increase in addiction. [8]
The judgement at the end of this quotation--making illegal drugs (especially heroin) available under government control could lead to an increase in 'addiction'--seems to be what stops the Committee from recommending a change in the law. This judgement is a nearly exact repetition of the judgements of previous reports. It is also a construction of what a good society looks like. Explicitly, the report compares a society in which a group of people use drugs at great cost to themselves, and significant cost to society, to a society in which (possibly) more people use drugs at less cost to themselves, and less cost to society. Ironically, the first society is the one which is deemed desirable.
Conclusion
Over time perceptions of drugs, the 'drug problem' and even strategies for dealing with drug problems have been changing. This is reflected by the break from other reports evidenced by the Cleeland report. This change is uneven. It is not all in one direction, or attributable to one cause. But it is present. What appears to be happening is that the hierarchy between the lines of argument on drugs is changing. Two features of the current political scene are particularly important here. First, the risk associated with HIV is leading to consideration of how safe drug use can be ensured. This implies a move away from attempting just to prohibit or eliminate drug use. Secondly, the importance of economics, and economistic conceptions of social problems, is leading to a consideration of the economic costs of attempting to prohibit drug use. Both of these features of the Australian political scene can lead directly to proposals to make heroin more available (and they can of course be combined into one argument). But perhaps more importantly they contribute to a political context where harm minimization is the dominant argument on drug use. This creates space for those who would want to examine the feasibility of changing the availability of heroin.
Acknowledgements
A number of people have read, and commented on, drafts from which this paper was derived. The comments of Prof. Barry Hindess and Dr Margaret Sargent were particularly helpful.
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