Moving Away from the War on Drugs: An Interview with Dr Alex Wodak

The war on drugs in not over yet. But there seems to be some glimmering light at the end of the tunnel, with the major drug law reforms that have been taking place globally over recent years.

The US once led the world on drug prohibition. But today, one in five American citizens now lives in a jurisdiction where recreational marijuana is legal. This month marks five years since Colorado and Washington became the first two US states to legalise the possession and sale of recreational pot.

However, these developments are yet to be felt worldwide. In India, where the traditional use of cannabis goes back centuries, the plant for the most part remains illegal. And this is due to the Indian government buckling to pressure from the US Reagan administration to ban it back in 1985.

Decriminalisation models

Portugal is heralded as the shining example of the benefits forward-thinking drug law reform can bring about. In 2001, the Portuguese government decriminalised the use and possession of small quantities of all illicit substances.

Prior to this move, one percent of the nation’s population was dependent on heroin, and the nation had the highest number of drug-related AIDS deaths in the EU. Today, its drug-induced death rate is five times lower than the European average, and drug-related HIV infections have plummeted.

Currently, Ghana is set to become the first African nation to decriminalise the personal possession and use of all illegal drugs. A bill that seeks to address drug use as a public health issue, and end the use of punitive sentencing, is expected to be passed later this year.

Shifting policies

Over recent months, the Victorian government has come under criticism for escalating its law enforcement approach to illicit substances.

The use of drug detection dogs has been expanded to nightclub precincts, the police want increased powers to search people at festivals without a reasonable suspicion to do so, and a bill was passed that placed a blanket ban on synthetic drugs.

However, the attitudes of some Victorian politicians are starting to change. Last week, premier Daniel Andrews approved a safe injecting centre trial for North Richmond.

And this decision followed the ACT government’s recent announcement that it will allow a pill testing trial to take place at a music festival.

Evidence-based approaches

Both safe injecting facilities and pill testing services are measures designed to reduce the harms associated with the use of illegal drugs. Many of these harms are caused or made more severe due to the conditions brought about by the criminalisation of these substances.

Dr Alex Wodak is one of Australia’s leading drug law reformists. The doctor has been instrumental in getting harm reduction initiatives, such as the nationwide needle and syringe program and the King’s Cross medically supervised injecting centre (MSIC), across the line.

Sydney Criminal Lawyers® spoke with Dr Alex Wodak, president of the Australian Drug Law Reform Foundation, about the recent harm reduction measure approvals, the government’s proposal to drug test welfare recipients, and Australia’s harm minimisation track record.

Firstly, Dr Wodak, last week, the Victorian state government finally approved a medically supervised injecting centre for North Richmond.

However, authorities have stated that heroin will be the only illicit substance allowed into the premises.

What do you think the approval of the facility? And what sort of an impact will the heroin-only rule have?

First, the decision by the Victorian government to conduct a trial of a medically supervised injecting centre in Richmond is a huge step forward. No such centre has been approved in Australia by a government for 18 years.

Second, premier Andrews acknowledged that the evidence for MSICs is now overwhelming. These are both very important developments.

I am sure that there will be a lot of discussion and thought given in the next little while regarding the details of how the centre should and will operate. Governments are usually very nervous about any drug policy that is not punitive and draconian. Even though, these have a very high failure rate.

On the other hand, I am sure that the Victorian government will be advised that if the rules that the centre has to follow are too far away from the reality of the street, there is a risk of setting the MSIC up to fail.

I am convinced that the Victorian government badly wants this MSIC to work well. In the end, it will be a balance between the reality of the street and what the government feels is the political reality, what the community will accept.

The approval of a trial in NSW in 1999 and the approval of a trial in Victoria in 2017 followed a similar pattern.

In NSW, a Royal Commission recommended that the NSW parliament consider establishing an MSIC and the parliament then conducted an inquiry, including an international tour. In Victoria, a coronial inquiry was also followed by a parliamentary inquiry, including an international tour.

I think this is the last time Australia will use such an expensive and protracted decision-making process for an MSIC.

In September, the ACT government announced it was allowing the nation’s first pill testing service to be trialled at a music festival. But, the promoters of the festival pulled out stating that last minute paperwork had not been submitted.

Again, let’s not lose sight of the fact that for the first time in Australia, a state/territory government approved a pill testing trial.

It is now clear that the ACT Opposition threw a spanner in the works to thwart the will of the government. Perhaps, the Opposition even believed what they said were their concerns.

The ACT community reaction to the Opposition’s sabotage was pretty negative. The federal Coalition government assisted the ACT Opposition to try to prevent the trial proceeding, but, significantly, said little about this issue in public.

Governments do not like being thwarted. I expect that the ACT government will find some way to overcome the obstacles and proceed with their original plans at a future youth festival.

This was not the first time, and will not be the last time, that a new harm reduction measure has had a tricky birth.

So, you believe there was more to the trial being called off than just some official documents that hadn’t been submitted in time?

Of course, there was more to the attempt to stop the trial from proceeding than just incomplete paperwork.

This was first and foremost about the contest between a war on drugs approach versus a pragmatic, compassionate and evidence-based approach.

The ACT Opposition did not come out well from this contest.

The NSW Liberal party went to the 1988 elections committed to closing down the then new needle syringe program. But to their eternal credit, the new government ditched that commitment once in office.

Governments are often much more responsible than Oppositions and this episode is just another example of that tendency.

You were one of the most vocal proponents behind the renewed push for pill testing services in Australia, when it commenced early last year. The ACT government’s sanctioning of the trial was quite a milestone.

New harm reduction measures are usually much harder to advocate for than to oppose. So, it is extremely common to have a vigorous and polarised debate when any new harm reduction measure has been proposed.

But, over time, harm reduction gradually gains the ascendency over the critics who claim not only will the new measure not work, but it will actually cause the sky to collapse.

We have seen this pattern with car seat belts, condom promotion, needle syringe programs, methadone treatment, a heroin trial, drug consumption rooms, pill testing and many other harm reduction innovations.

Now, we have essentially the same sort of debate over e-cigarettes.

I agree: the ACT government’s decision was a milestone. Harm reduction and drug law reform is gradually winning more debates.

The federal government has been surprised at the vigorous negative reaction to its Welfare Reform Bill, which now faces defeat in the Senate soon.

Do you think that pill testing becoming a reality in this country is still close? Or was the last minute cancellation of the Spilt Milk trial a major setback?

Pill testing will become a national reality. My hunch is that the ACT government will soon find some way to carry out its trial.

The results will be favourable. Then one by one other state and territory governments will follow the lead of the ACT government.

That was what happened in 1986 with the needle syringe program when first the NSW government accepted the compelling arguments to proceed.

Within two years, every jurisdiction had approved a needle syringe program. That saved many thousands of lives and many billions of dollars. And I really mean billions, not millions.

So, this is not a setback. Just a temporary irritant.

The government’s proposal to drug test welfare recipients has drawn widespread criticism from health professionals and politicians.

However, a recent poll found that three out of four voters believed the scheme was a good idea.

When authorities use a similar technique to drug test drivers on the roadside, they give road safety as a reason for doing so.

We don’t have to be political scientists to know that the federal government is in deep trouble. It lost the last 22 Newspolls. They are deeply divided. Energy costs are still rising. And the dual citizenship issue added insult to injury.

So, populist distractions are needed. Answer: find a scapegoat and give them a good kick.

Virtually every expert in this area who has commented, and every relevant professional organisation, has trashed the proposed drug testing trial of income support applicants and the related proposals regarding exclusions and exemptions.

If it goes ahead, the drug testing trial will just be temporary, but the changes to legislation regarding income support will be much harder to get rid of.

These are easy proposals to sell to an unwitting public. But their impact will be very cruel. It amounts to more punishment of people who use drugs, rather than offering them what they need, which is more support.

Brexit was also sold to an unwitting UK public. When the community really started realising what Brexit means, they soon started changing their opinion about leaving the EU.

Governments can mould public opinion for quite a while. But public opinion on the drugs issue is changing.

Roadside drug testing involves three drugs – which make at best a modest contribution to the road toll – while ignoring other drugs, which make a much larger contribution.

It involves testing the presence or absence of these drugs, when we don’t really know what the relationship is between the level of drug in our body and an increased risk of a road crash.

Innocent drivers are being punished, while some guilty drivers go unpunished. There has been no evaluation of the impact on road safety of roadside drug testing. It is also very expensive.

It is a disgrace and should be carefully evaluated and reviewed.

What justifications does the government have for its proposed drug testing of welfare recipients? And what would you say the actual purpose of the program is?

The objectives of the Welfare Reform Bill are very hard to identify. Several similar trials have been conducted in other countries and have been abandoned.

The argument seems to be that illicit drug use is very common among the unemployed and this drug use prevents these individuals getting a job. But, these are deeply flawed arguments.

It seems self-evident to me that the real purpose of the bill is to try and revive the government’s terrible political situation.

Random breath testing (RBT) for alcohol is an evidence-based approach to road safety that tests for driver impairment. It is a practice that is well-respected within the community.

However, mobile drug testing (MDT) doesn’t test for driver impairment. As you mentioned, it merely tests for traces of three selected drugs in a person’s system.

Roadside drug testing is sold to the public as though it is akin to random breath testing for alcohol. But, RBT really is based thoroughly on rock hard science. It has saved many lives, prevented many serious injuries and saved a fortune.

We know a lot about alcohol. It is a small molecule and its water soluble. We know much less about the other drugs. Cannabis is fat soluble and contains more than a hundred psychoactive ingredients.

The law is supposed to prefer ten guilty people going free, than one innocent person being found guilty and punished. This principle is clearly being transgressed by this legislation. We need a parliamentary inquiry to consider this legislation.

What sort of impact do current MDT practices have when they are said to be encouraging road safety, but they actually do nothing to improve it?

The MDT scheme has not been evaluated, even though all states and territories have MDT legislation. In 2004, Victoria became the first state in the world to introduce such legislation.

The Turnbull government passed legislation in February last year to establish a framework for the legal cultivation and manufacture of cannabis medicines. However, there is still no legal domestic product available.

Due to this, the government announced a new fast track importation scheme for medicinal cannabis products in February this year. But, the majority of patients cannot access them.

The majority of the community supports medicinal cannabis. So too, do many leading politicians. But the leadership of the medical profession and the bureaucracy is very much against it.

In the whole of Australia only 150 lucky patients have been able to obtain legal medicinal cannabis so far. In Canada, 140,000 patients have been able to obtain legal medicinal cannabis so far.

Medicinal cannabis is theoretically lawfully available in Australia. But in practice, it is still not available. Reversing this will be very difficult and very slow.

What do you think is behind the government’s moves to legalise cannabis medicines, while at the same time placing so many restrictions around them that those in need cannot get their hands on them?

I think many of the politicians involved were sincere in wanting to make medicinal cannabis available to people who could benefit from it.

But, many government officials were alarmed by medicinal cannabis itself, and also that it could become a precedent for an avalanche of complementary medicines.

Putting TGA in charge was a mistake, as many people (including me) predicted.

It is going to be very hard to sort this mess out. Patients will have to get organised. The inevitable regulation of recreational cannabis in Australia will help a great deal, but that is still years away.

But, Canada will become the first G7 country to regulate recreational cannabis next July and California, the world’s 6th biggest economy, will start sometime in 2018. NZ will hold a referendum on this issue before 2020.

All of this will shift the debate on medicinal cannabis in Australia, because many of the obstacles are residues of the war on drugs.

Dr Wodak, you played an integral role in the establishment of the needle and syringe program in this country in the mid-1980s.

At that time, it placed Australia at the forefront of harm reduction globally. Harm minimisation formed the basis of the national drug strategy in 1985, and it continues to do so.

I was part of a group that started the first needle syringe program in Australia as a civil disobedience exercise in 1986.

But, as you pointed out, harm minimisation became Australia’s official national drug strategy at a meeting in April 1985. So that happened before we started the needle syringe program.

And harm minimisation is still Australia’s official national drug strategy. Every Commonwealth, state and territory government since 1985 has respected that, although the Howard government was both a vigorous exponent and also a vigorous opponent of harm minimisation.

Well then, how would you rate Australia’s current position in the field of harm reduction on the world stage? And are leaders in this country paying attention to the evidence out there that supports these approaches?

Australia, once an international leader in pragmatic drug policy, has now become a laggard.

Countries seem to go in cycles. Labor governments are often more timid in office, than Coalition governments.

Harm reduction and drug law reform have won their debates in Australia. Police commissioners, retired and serving, line up before the microphone to remind us that Australia cannot arrest and imprison our way out of our drug problems.

In 2014, then PM Tony Abbott acknowledged that the war on drugs could not be won, but could be lost.

The critics of harm reduction and drug law reform are old and shrinking in number and influence. In contrast, supporters of harm reduction and drug law reform are young, and growing in number and influence.

But every battle is still tough. Ridiculous amounts of time and energy still have to be expended for modest gains.

But the ratchet now seems to be only going in the direction of reform. All social policy reform is slow. Drug law reform will be no exception.