More of the same…

The Rudd government announced another advertising campaign to ‘confront illicit drug use’ last night. Their media release states that:

Too many young Australians don’t understand the very real and dangerous impacts of taking or using illegal drugs

Their ‘new’ campaign will tackle this perceived lack of knowledge by using graphic images that emphasise the damaging effects drugs have. Young people need to ‘face facts’ about the risks involved in drug use.

I have numerous problems with this announcement.

  1. This is not a new campaign. Howard’s Tough on Drugs campaign has been on the go for many years with the same concepts and ideas.
  2. Social marketing campaigns like this are not informed by credible evidence. The National Drug Research Institute’s Prevention Monograph, a report commissioned by the Department of Health and Ageing themselves, found limited evidence to support the effectiveness of social marketing campaigns in reducing or preventing drug use and associated harms. Some studies even find such campaigns may lead to increased drug use through curiosity or reactance. Their most likely outcome is to have little influence on drug use decisions.
  3. These campaigns seem to be designed more for showing the general voting public that the government is ‘doing something’ about drug use. It seems no accident that this announcement and action comes in an election year.
  4. Assuming that young Australians don’t understand the dangers of drug use is unfair. This assumption should be tested. Research suggests that young people do understand and acknowledge the risks they are taking, yet they still choose to use drugs. Until the government can accept that choosing to use drugs can be a logical, informed decision, they will miss their mark in trying to engage young drug users.
  5. The Department of Health and Ageing needs to learn how to interpret statistics accurately!

Two prevalence estimates are compared across time by the Department to support their action in ‘tackling illicit drug use’. They appear to be drawn from the National Drug Strategy Household Survey series. The first read:

The proportion of recent regular ecstasy users who use weekly or more often has risen from 0.8 per cent in 1998 to 17.3 per cent in 2007.

I traced these figures back to their sources in the NDSHS reports and found that these figures refer to teenagers aged 14 to 19, and that the 1998 estimate was based on such small numbers that the estimate should be used with caution. The second reads:

There is also a disturbing trend in the increased ecstasy use by young females aged between 14-19 which is up from 4.7 per cent in 2004 to 6 per cent in 2007.

The table this comparison is taken from in the NDSHS 2007 report shows the increase is not statistically significant. That is, there is no disturbing trend. It is, in fact, hard to find ‘disturbing trends’ in the NDSHS series. Most drug use estimates are decreasing or steady. Whoever was charged with finding these disturbing trends to fit this media release has capitalised on the fact that most people who read it won’t know its source and how to access and interpret the original data.

I recall the Rudd government talking about its plans to use evidence-based policies on drugs and health issues more generally. This campaign is just more of the same. I guess drug policy misses out again when it comes to evidence-based policy.

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The debate about informed drug use

Drug safety card

The NSW government produced a booklet aimed at young drug users called Drug safety: Guide to a better night. The SMH reports that the state opposition and youth workers want the booklet destroyed, because it sends the ‘wrong’ message. Guiding drug users about how to have a ‘better night’ could be seen as endorsing drugs in the party setting.

It was great to see an alternative position in favour of the harm-reduction information booklet, written by Julie Bowen of Moreland Hall. The harm reduction philosophy is realistic about continued drug use and aims to make that drug use less harmful. After exploring common harms from drug use and ways to look after yourself and your friends, the booklet’s end message is:

Remember the best way to avoid problems with drugs is not to use them at all.

This is also the take-home message of the harm reduction approach. While using drugs, try to do all you can to reduce the harms to yourself and others who may be affect by your activities. Yet, always remember that abstinence is the only way to completely avoid harms.

Officially, since 1985, Australia’s drug policy has been described as harm minimisation, in which three approaches (supply reduction, demand reduction and harm reduction) are all aimed at reducing drug-related harms for the individual, their families, communities and society. This pragmatic approach is complex. For example, supply reduction activities may increase the harm experienced by drug users. Harm reduction activities may increase demand for a drug. Demand and supply reduction activities focused on one drug may increase harm by creating a trend towards a new, lesser-known drug. It is difficult to evaluate the effects of individual policies, especially when considering the whole system of health harms that harm minimisation policies target.

The argument against harm-reduction drug information, whether in booklets or websites, needs to be challenged. As Julie Bowen writes:

People need reliable information to make informed decisions and take care of themselves and each other. Information contained in the brochure could be the catalyst for a simple, life-saving action such as a person being rolled onto their side when unconscious. Drugs continue to play a role in the world in which we live in, therefore the only humane approach is to equip people to be aware of and manage the risks that they or their friends may face.

However, the anti-information argument also needs to be examined for aspects of truth, even by those who feel offended at the apparent lack of concern for the safety of drug users that comes through in the views of those supporting ‘zero tolerance’. It may be true that for some people, knowing how to use a drug ‘more safely’ may encourage them to try that drug or to use it more often. It is likely that the dangers or harms of some drugs put people off using them, and if these are reduced by detailed information about safer use, these people may ultimately use more drugs! However, if they do so and come to less harm overall, is this really a problem?

Taking the view that ‘informed drug use’ is desirable for those who choose to use drugs leads to activities that get appropriate information out to those that want it. For example, we could create a harm reduction app for the iPhone that would make it easy to access accurate information, such as that found in the NSW drug safety booklet, any time and place it was needed. Getting information to people when they are actually making decisions about drug use is a critical next step, in my view.

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Drugs and nice people

The UK drugs and rights organisation Release sparked controversy in London recently, after their campaign aimed at de-stigmatising drug use was withdrawn from London buses by advertising regulators. The advertisement, featuring the deceptively simple statement ‘Nice people take drugs’, was chosen to draw attention to the way drug takers are typically demonised in the media and through drug policies.

The Guardian reports that the chief executive of Release, Sebastian Saville, stated that the withdrawal of the advert from buses was an “overreaction to a legitimate message”. He believes that “the time has come where potential leaders of our country have much to gain from real honesty about drug use in the UK, including their own drug use”. Release has also produced an animated youtube clip featuring people of all walks of life describing to their use of every manner of psychoactive drug, in an effort to humanise people who use drugs.

The truth is that a large proportion of the population (in the UK, Australia, USA, etc.) has at least tried an illegal drug, and research indicates that most people who use drugs also work, study, have families and are valued parts of our community. These facts are kept secret due to a legitimate fear of open discussion of drug use by these people, who do not want to risk their jobs and reputations over potential criminal punishment.

This situation allows politicians and the public to continue believing that ‘drugs are bad’ and anyone who uses drugs is, well, also bad, or at least, misguided and in need of treatment. It is this belief that allows continuation of the War on Drugs. If drugs are evil, there is no room to question punitive drug policies even when there is little evidence that they actually work.

I do wonder whether Nice people take drugs really captures this argument, though. There are many definitions of ‘nice’ and many definitions of ‘drugs’, and to lump all types of drug use and all types of drugs together muddies the picture. Yet, if the goal of the advertisement was to spark debate, it has certainly succeeded in spreading its message (just google ‘nice people take drugs’ and have a look for yourself!).

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